Discussing Autism

Isn’t High Functioning Autism Aspergers or is Aspergers High-Functining Autism? Or, are they not related? I’m confused.

But, there is also a syndrome called Hyperplexia that I have uncovered.

Here is a very interesting article comparing the three.

Hyperlexia Definition:
Hyperlexia appears to be different from what is known as hypergraphia, the urge or compulsion to write, although as with many mental conditions or quirks it is possible that this is more a matter of opinion than strict science. Often, hyperlexic children will have a precocious ability to read but will learn to speak only by rote and heavy repetition, and may also have difficulty learning the rules of language from examples or from trial and error, which may result in social problems.

Children with hyperlexia may recite the alphabet as early as 18 months, and have the ability to read words by age two and sentences by age three. Many are overly fascinated with books, letters, and numbers. Often their ability is looked at in a positive light, so many parents delay their children receiving help because they believe that their child may be a struggling genius.

Hyperlexia often coexists with high functioning autism or Asperger syndrome.

Despite hyperlexic children’s precocious reading ability, they may struggle to communicate. Their language may develop in an autistic fashion using echolalia, often repeating words and sentences. Often, the child has a large vocabulary and can identify many objects and pictures, but cannot put their language skills to good use. Spontaneous language is lacking and their pragmatic speech is delayed. Hyperlexic children often struggle with Who? What? Where? Why? and How? questions. Between the ages of 4 and 5 many children make great strides in communicating and much previous stereotypical autistic behavior subsides.

Often, hyperlexic children have a good sense of humor and may laugh if a portion of a word is covered to reveal a new word. Many prefer toys with letter or number buttons.

They may have olfactory, tactile, and auditory sensory problems. Their diets may be picky, and often toilet training can be difficult.

Social skills lag tremendously. Social stories are extremely helpful in developing effective age-relative social skills, and setting a good example is crucial.

High Functioning Autism
High-functioning autism (HFA) is an informal term applied to individuals with autism, an IQ of 80 or above, and the ability to speak, read, and write.[1] HFA may simply refer to autistic people who have normal overall intelligence, i.e. are not cognitively challenged.

Care should be exercised when attempting to determine whether a person with autism is “high functioning” or “low functioning” based on an IQ score since it is sometimes difficult to measure IQ in autistic persons accurately using standard measurement instruments. The amount of language processing necessary on the tests and the large quantity of verbal instructions involved in the testing process even on the “non-verbal” portion of standard intelligence measures can produce a misleadingly low score. There can be a significant difference between an autistic person’s measured IQ scores when comparing standard testing methods and a truly non-verbal method such as the Leiter-R. [1]

A diagnosis of high-functioning autism exists in neither the DSM-IV-TR nor the ICD-10, which have diagnoses of autistic disorder and childhood autism respectively. Analogous to high-functioning when applied to schizophrenia and other psychiatric disorders, the term high-functioning autism started out as a shorthand to describe diagnosed autistic individuals who could nevertheless speak and carry on with many day-to-day activities like eating and dressing independently.[citation needed] Low-functioning autism was the conceptual opposite.[citation needed] Researchers then began using high-functioning autism as a quasi-diagnostic label itself, along with low-functioning autism and sometimes also Asperger’s Syndrome, to distinguish relative levels of adaptation and development.[citation needed]

Many people on the autistic spectrum contest that a simple categorical division into low- and high-functioning creates an illusive division. They prefer to see the spectrum as multidimensional, with several autistic traits varying in intensity and sometimes varying day by day.[citation needed] For instance, the definition of Asperger’s syndrome as essentially autism without speech or other cognitive delays creates an arbitrary barrier in a common condition, they believe.[citation needed]

There is some evidence that the label has wrongly become a catch-all diagnosis for badly-behaved children. In 2000 in the UK, the lead clinician and autism specialist at Northgate and Prudhoe NHS Trust in Morpeth, Dr Tom Berney, published a paper commenting on this. He wrote in the prestigious British Journal of Psychiatry:- “There is a risk of the diagnosis of autism being extended to include anyone whose odd and troublesome personality does not readily fit some other category. Such over-inclusion is likely to devalue the diagnosis to a meaningless label.”[citation needed]

Some intellectually gifted students are also being diagnosed with an autistic spectrum disorder.[citation needed]

[edit] Social aspects

Autistic people are prone to commit social faux pas because of an inability to predict others’ reactions. They may also neglect social niceties like knocking or returning a greeting. Similarly, they may be overly trusting or paranoid of strangers. It may be best summed up as a lack of common sense with respect to social matters.

They may appear somewhat removed or dissociated or dreamy at times, especially when in sensory overload or from a perception of extreme social pressure. They may make little eye contact, leading others to conclude that they are shy.

Unlike with low-functioning autism, people with high-functioning autism are not mentally retarded. The research community recognizes that high-functioning autism does not happen in people with an IQ of below roughly 70. They also have adequate speech.

As with people elsewhere on the autistic spectrum, people with high-functioning autism generally prefer routine and order, and this usually begins in early childhood. They may, for example, write an alphabetized index of their comic book collection, or they may stick to a limited wardrobe.

[edit] Difficulties for people with HFA

Generally, there are difficulties with social interaction. This might not adversely impact their ability to interact with others on a day-to-day basis at a basic working level, although they may be seen as being overly serious or earnest, and as being without any “small talk” in conversation. In many instances though, these individuals have such severe social delays and difficulties that interaction within a “normal” social setting can be severely hampered.

They may have difficulty initiating love and friendship relationships, often being rejected because potential partners perceive them as being either too “nerdy” or too intelligent. This can lead to low self esteem or loneliness, which further impairs their ability to find meaningful companionship.

People may label HFA people as “oddballs” or worse, and HFA people can easily become the target of bullying. This can be especially true from primary school through the late teens. Young, intelligent HFA people usually do best by seeking out the company of their intellectual peers or by joining hobby groups, while avoiding their age-group peers. Exposure to an age equivalent peer group within the autism spectrum on a regular basis can be especially beneficial.

Given the proven crucial role of body language in job interviews, lack of eye contact in such a situation may be perceived by potential employers as indicating that the candidate is “not telling the truth” or “uninterested in the job”, and thus lead to a cumulative difficulty in finding employment. Attending social and business events to network is also proven to play a crucial role in job hunting, but events such as these are the type that HFA people usually avoid due to their unease with the complex social interactions required. Difficulties with such pre-employment factors may contribute to comparative poverty, although intelligent HFA adults can usually find a good job if they can specialise in their area of interest. Once in a good job, however, their talents may lead to promotion and they may find themselves in a new job description that does not fit their personality.

Some may have minor to moderate difficulty with motor skills and co-ordination. This may manifest itself as mere clumsiness or awkwardness but in some instances can be found at a level where the child is a danger to themselves (this is especially true when younger). “Sensory motor dysfunction” is a comorbid diagnosis that is increasingly being associated with individuals with HFA. Many of these motor skills and functional issues can be helped through the use of regular physical therapy.

Some may also nurture a complex habitual movement (termed “stimming”) at which they become adept, e.g. pen spinning, while otherwise being prone to clumsiness.

They do not lack empathy (although they may have difficulty expressing it), and can thus enjoy films and stories with emotional content. Some may gain the bulk of their insight into why people behave the way they do through watching movies that provide a forceful and musically-cued “capsule lesson” in human emotions (e.g. melodramas).

Some people with HFA can be extreme procrastinators. A small minority may also be unusually sensitive to sudden or annoying noise (hyperacusis).

[edit] Benefits of HFA

Alongside deficiencies they may simultaneously benefit from some of the more positive aspects of autism. For example, they may have the ability to focus intensely and for long periods on a difficult problem. There is often an enhanced learning ability, although this often is not applied to subjects they are uninterested in. They often present no problems in a supportive, well-resourced educational institution and often do well academically if they can be stimulated by good teachers.

People with HFA often have intense and deep knowledge of an obscure or difficult subject and a passion for pursuing it in an organized and scholarly manner.

They are usually intelligent, gifted, honest, hard workers when interested in a task and excellent problem solvers. People with HFA are thought to become excellent scientists and engineers or enter other professions where painstaking, methodical analysis is required. Some believe this particular assertion is a stereotype, as some HFA adults tend to struggle with the traditional work setting and the surrounding societally accepted ways of behaving.

Speech and diction can be unusually precise in some individuals with HFA but this may be delayed or awkward in many other individuals.

[edit] Gender differences

There is a general consensus that HFA seems to affect far more males than females.[citation needed] British psychopathologist Simon Baron-Cohen referred to HFA as a form of “extreme maleness”.

[edit] Frequency in the population

In the 1990s the prevalence was assumed to be about 1 person per 2,000 in England. However, a study published in The Lancet medical journal in July 2006 reported that a team at a hospital in London England had applied autism tests to a large number of children aged 9 to 10. They found 39 of 10,000 children had autism, and 77 of 10,000 had some form of “autism spectrum disorders” (i.e.: a ratio of about 1 in 130 people). The apparent rise may be due to better diagnosis, and to better awareness of autism related disorders in people without learning disabilities.

Asperger Syndrome

Asperger syndrome (also referred to as Asperger’s syndrome, Asperger’s disorder, ‘Aspergers, or AS) is a condition on the autistic spectrum. It manifests in individual ways and can have both positive[1][2][3][4][5] and negative effects on a person’s life. Like other autistic spectrum disorders, Asperger’s includes repetitive behavior patterns and impairment in social interaction. However, Asperger’s differs from ‘classic’ autism in that non-social aspects of intellectual development generally proceed at a normal or accelerated rate.[6]

The disorder affects people in various ways, but individuals with Asperger’s commonly share characteristics such as an ability to focus intensely on areas of interest, hyposensitivity/hypersensitivity to certain stimuli and sensory integration problems, self-stimulating (’stimming’) behaviors such as rocking back and forth or verbal utterances, and difficulty interpreting facial expressions and other social cues.[6] Some positive characteristics include things such as enhanced mental focus, excellent memory abilities, superior spatial skills, and an intuitive understanding of logical systems. These characteristics can often lead to fulfilling careers in mathematics, engineering, the sciences,[1][2][3], music, art, or language.[7]

There is significant controversy over the difference between AS and the broader category of high-functioning autism (HFA). While neither AS nor HFA have universally accepted definitions,[8] most diagnostic manuals distinguish the two according to speech development. Delayed speech indicates HFA; normal onset of speech indicates Asperger’s.[6] However, at least one diagnostic guide takes the opposite position; that delayed onset of speech favors a diagnosis of AS.[9]

Some clinicians deny that AS is differentiated from other autistic spectrum disorders at all. Instead they refer to Asperger’s as HFA, or treat the diagnoses interchangeably, arguing that language delay is a difference in degree and not kind.[10][4] Even among those who feel that the differences between AS and HFA are significant, it is common for diagnoses to be influenced by non-technical issues, such as availability of government benefits for one condition but not the other.[11][12] Due to the mixed nature of its effects, and continued debate over its definition, Asperger’s remains controversial among researchers, clinicians, and people with the diagnosis.

History
Dr. Hans Asperger, after whom the syndrome is named.
Dr. Hans Asperger, after whom the syndrome is named.
Dr. Asperger described his young patients as “little professors.”
Dr. Asperger described his young patients as “little professors.”

Asperger syndrome was named in honour of Hans Asperger by the English psychiatrist Lorna Wing, who first used the term in a 1981 paper.[13] In 1994, AS was recognized in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as Asperger’s Disorder.[14]

In 1944, Hans Asperger (1906–1980), an Austrian psychiatrist and pediatrician, observed four children in his practice who had difficulty integrating socially. Although their intelligence appeared normal, the children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Their way of speaking was either disjointed or overly formal, and their all-absorbing interest in a single topic dominated their conversations. Dr. Asperger called the condition “autistic psychopathy” and described it as a condition primarily marked by social isolation.[15] He also stated that “exceptional human beings must be given exceptional educational treatment, treatment which takes into account their special difficulties. Further, we can show that despite abnormality, human beings can fulfill their social role within the community, especially if they find understanding, love and guidance.”[16]

The Austrian-American child psychiatrist Leo Kanner identified a very similar syndrome in 1943, although the population characterized by Kanner was perhaps less “socially functional” than Asperger’s.[17] Kannerian autism is therefore characterized by significant cognitive and communicative deficiencies, including delays in language development or complete lack of language.[18] (In contrast, AS is characterized by normal language acquisition.)

Asperger’s observations, published in German, were not widely known until 1981, when Lorna Wing published a series of case studies showing similar symptoms, which she called “Asperger’s Syndrome.”[13] Wing’s writings were widely published and popularized. In 1992, the tenth published edition of the World Health Organization’s diagnostic manual and the International Classification of Diseases (ICD-10) included AS, making it a distinct diagnosis.[19] Later, in 1994, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the American Psychiatric Association’s diagnostic reference book also added AS.[14][20]

Uta Frith (an early researcher of Kannerian autism) wrote that people with AS seem to have more than a touch of autism to them.[21] Others, such as Lorna Wing and Tony Attwood, share Frith’s assessment. Dr. Sally Ozonoff, of the University of California at Davis’s MIND Institute, argues that there should be no dividing line between “high-functioning” autism and AS,[22] and that the fact that some people do not start to produce speech until a later age is no reason to divide the two groups because they are identical in the way they need to be treated.

In January 2006, Professor Simon Baron-Cohen of the University of Cambridge, regarded as one of the leading current researchers in this field, proposed the theory that people with AS tend to hyper-systematize; that they tend to seek to approach all spheres of life, including the social sphere, by developing systems or sets of rules to operate to.[23]

[edit] Classification and diagnosis

Asperger’s Disorder (Asperger Syndrome) is defined in section 299.80 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) by six main criteria:

1. Qualitative impairment in social interaction;
2. The presence of restricted, repetitive and stereotyped behaviors and interests;
3. Significant impairment in important areas of functioning;
4. No significant delay in language;
5. During the first three years of life, there can be no clinically significant delay in cognitive development such as curiosity about the existing environment or the acquisition of age appropriate learning skills, self-help skills, or adaptive behaviors (other than social interaction); and,
6. The symptoms must not be better accounted for by another specific pervasive developmental disorder or schizophrenia.[14]

AS is an autism spectrum disorder (ASD), one of five neurological conditions characterized by difference in language and communication skills, as well as repetitive or restrictive patterns of thought and behavior. The four related disorders or conditions are autism, Rett syndrome, childhood disintegrative disorder, and PDD-NOS (pervasive developmental disorder not otherwise specified).[19]

The diagnosis of AS is complicated by the use of several different screening instruments.[19] The diagnostic criteria of the Diagnostic and Statistical Manual are criticized for being vague and subjective.[24][25] Other sets of diagnostic criteria for AS are the ICD 10 World Health Organization Diagnostic Criteria, Szatmari Diagnostic Criteria,[26] Gillberg Diagnostic Criteria,[27] and Attwood & Gray Discovery Criteria.[28] The ICD-10 definition has similar criteria to the DSM-IV version.[28] Asperger’s syndrome had at different times been called Autistic psychopathy and Schizoid disorder of childhood,[29] although those terms are now understood as archaic and inaccurate, and are therefore no longer accepted in common use.

Some doctors believe that AS is not a separate and distinct disorder, referring to it as high functioning autism (HFA).[19] The diagnoses of AS or HFA are used interchangeably, complicating prevalence estimates: the same child can receive different diagnoses, depending on the screening tool the doctor uses, and some children will be diagnosed with HFA instead of AS, and vice versa.[19] Many experienced clinicians apply the early onset of High Functioning Autism or the regressive pattern of development as the distinguishing factor in differentiating between AS and HFA. The current classification of the pervasive developmental disorders (PDDs) is unsatisfying to many parents, clinicians, and researchers, and may not reflect the true nature of the conditions.[30] Peter Szatmari, a Canadian researcher of PDD, feels that greater precision is needed to better differentiate between the various PDD diagnoses. The DSM-IV and ICD-10 focus on the idea that discrete biological entities exist within PDD, which leads to a preoccupation with searching for cross-sectional differences between PDD subtypes rather than recognition of the conditions as distinct points on a spectrum, a strategy which has not been very useful in classification or in clinical practice.[30]

A self-diagnosis tool now commonly used, including within Aspie communities, is the AQ (Asperger Quotient) questionnaire developed by Professor Simon Baron-Cohen.

[edit] Clinical features

AS is characterized by:[14][19]

* Narrow interests or preoccupation with a subject to the exclusion of other activities
* Repetitive behaviors or rituals
* Peculiarities in speech and language
* Extensive logical/technical patterns of thought
* Socially and emotionally inappropriate behavior and interpersonal interaction
* Problems with nonverbal communication
* Clumsy and uncoordinated motor movements

The most common and important characteristics of AS can be divided into several broad categories: social impairments, narrow but intense interests, and peculiarities of speech and language. Other features are commonly associated with this syndrome, but are not always regarded as necessary for diagnosis. This section mainly reflects the views of Attwood, Gillberg, and Wing on the most important characteristics of AS; the DSM-IV criteria represent a slightly different view. Unlike most forms of PDDs, AS is often camouflaged, and many people with the disorder blend in with those who do not have it. The effects of AS depend on how an affected individual responds to the syndrome itself.[28]

[edit] Social differences

Main article: Asperger syndrome and interpersonal relationships

Although there is no single feature that all people with AS share, difficulties with social behavior are nearly universal and are one of the most important defining criteria. People with AS may lack the ability to communicate their own emotional state (alexithymia) and the natural ability to see the subtexts of social interaction, resulting in well-meaning remarks that may offend, or finding it hard to know what is “acceptable.” The unwritten rules of social behavior that mystify so many with AS have been termed the “hidden curriculum.”[31] People with AS must learn these social skills intellectually through seemingly contrived, dry, math-like logic rather than intuitively through normal emotional interaction.[32]

Non-autistics are able to gather information about other people’s cognitive and emotional states based on clues gleaned from the environment and other people’s facial expression and body language, but, in this respect, some Aspergers are impaired; this is sometimes called mind-blindness.[33][34] Mind-blindness is also known as a lack of “theory of mind.”[35] Without theory of mind, AS individuals lack the ability to recognize and understand the thoughts and feelings of others. Some are deprived of this insightful information and are unable to interpret or understand the desires or intentions of others and thereby are unable to predict what to expect of others or what others may expect of them. This sometimes leads to social awkwardness and inappropriate behavior. In Asperger’s Syndrome: Intervening in Clinics, Schools and Communities, Tony Attwood categorizes the many ways that lack of theory of mind can negatively impact the social interactions of people with Asperger’s:[35]

1. Difficulty reading the social and emotional messages in the eyes: those with AS don’t look at eyes often, and when they do, they can’t read them.
2. Making literal interpretation: Some AS individuals have trouble interpreting colloquialisms, sarcasm, and metaphors.
3. Being considered disrespectful and rude: prone to egocentric behavior, individuals with Asperger’s miss cues and warning signs that this behavior is inappropriate.
4. Honesty and deception: children with Asperger’s are often considered “too honest,” and may even proclaim themselves to be “honest” or “frank” as a way of explaining their behavior. They have difficulty being deceptive, even at the expense of hurting someone’s feelings.
5. Inadequate nonverbal communication: their facial expressions, hand gestures, and other forms of body language, are sometimes limited.
6. Becoming aware of making social errors: as children with Asperger’s mature, and become aware of their inability to connect, their fear of making a social mistake, and their self-criticism when they do so, can lead to social phobia.
7. Differences in speech: they display less speech intonation than neurotypical persons. Their speech may be perceived as “flat.” However, those with AS also possess superficial fluency in day-to-day conversation.
8. A sense of paranoia: because of their inability to connect, persons with Asperger’s have trouble distinguishing the difference between the deliberate or accidental actions of others, which can in turn lead to a feeling of paranoia.
9. Managing conflict: being unable to understand other points of view can lead to inflexibility and an inability to negotiate conflict resolution. Once the conflict is resolved, remorse may not be evident.
10. Sense of humor: although jokes can be grasped at an intellectual level, the emotional worth of humor, in some Asperger individuals, is not appreciated. Smiles and laughter may appear unnatural with some Aspergers.
11. Awareness of hurting the feelings of others: some Aspergers exhibit a lack of empathy, which often leads to unintentionally offensive or insensitive behaviors.
12. Repairing someone’s feelings: lacking intuition about the feelings of others, people with AS have little understanding of how to console someone or how to make them feel better.
13. Recognizing signs of boredom: inability to understand other people’s interests can lead AS persons to be inattentive to others. Conversely, people with AS often fail to notice when others are uninterested.
14. Introspection and self-consciousness: individuals with AS have difficulty understanding their own feelings or their impact on the feelings of other people.
15. Clothing and personal hygiene: people with AS tend to be less affected by peer pressure than others. As a result, they often do what is comfortable and are unconcerned about their impact on others.
16. Reciprocal love and grief: since people with AS have difficulty emotionally, their expressions of affection and grief are often short and weak.
17. Lack of participation in chitchat: they are not generally interested in, and do not participate in idle chat and gossip.
18. Preference of routine: they prefer routine work, and are not able to cope well to changes, even small ones. Such disruptions from routine can cause stress and anxiety.
19. Coping with criticism: people with AS are compelled to correct mistakes, even when they are made by someone in a position of authority, such as a teacher. For this reason, they can be unwittingly offensive.
20. Formal mannerisms and etiquette: their etiquette is formal, even within the family. Their speech may be interlaced with “thank you” or “please” or “good evening” more than necessary. Some persons with AS may even insist that other members of their family follow this ritual.
21. Speed and quality of social processing: because they respond through reasoning and not intuition, AS individuals tend to process social information more slowly than the norm, leading to uncomfortable pauses or delays in response. This means that although the AS individual will tend to make a more reasoned and balanced understanding and/or decision, it can lead to the AS individual being told to use their ‘common sense’ to solve problems, a concept they cannot understand or use in the way a neurotypical person can.
22. Faithfulness towards family: people with AS are staunchly faithful to their spouses and/or immediate members of their family.
23. Exhaustion: as people with AS begin to understand theory of mind, they must make a deliberate effort to process social information. This often leads to mental exhaustion.
24. Financial imprudence: although some people with AS can manage their own finances, in many cases linear thinking impedes their ability to make larger financial decisions, where they require the assistance of others.

A person with AS may have trouble understanding the emotions of other people: the messages that are conveyed by facial expression, eye contact and body language are often missed. They also might have trouble showing empathy with other people. Thus, people with AS might be seen as egotistical, selfish or uncaring. In most cases, these are unfair labels because affected people are neurologically unable to understand other people’s emotional states. They are usually shocked, upset and remorseful when told that their actions are hurtful or inappropriate. It is clear that people with AS do not lack emotions. The concrete nature of emotional attachments they might have (i.e., to objects rather than to people), however, often seems curious or can even be a cause of concern to people who do not share their perspective.[36] This deficit in the ability to read one’s own and other’s emotions goes by the name alexithymia, a Greek term coined in 1972 by P.E. Sifneos meaning literally “lack of words for emotions.”[37] Recent studies have confirmed that 85% of people with ASD’s have alexithymia,[38] a finding which raises important questions for future research regarding how to explain the high co-morbidity. According to Tony Attwood, alexithymia may also account for difficulties AS individuals have with anger management where the inability to express feelings using words predisposes the individual to use physical acts to articulate the mood and release the emotional energy.[39]

The problem may be exacerbated by the responses of those neurotypical people who interact with AS-affected persons. An Asperger patient’s apparent emotional detachment may confuse and upset a neurotypical person, who may in turn react illogically and emotionally — reactions that many Asperger patients find especially irritating. This can often become a vicious cycle and can sometimes cause families with Asperger-affected members to become especially dysfunctional.

Failing to show affection — or failing to do so in conventional ways — does not necessarily mean that people with AS do not feel affection. Understanding this can lead partners or care-givers to feel less rejected and to be more understanding. Increased understanding can also come from learning about AS and any comorbid disorders.[36]:57–66 Sometimes, the opposite problem occurs: the person with AS is unusually affectionate to significant others; and misses or misinterprets signals from the other partner, causing the partner stress.[36]:165–169

Another important aspect of the social differences often found in people with Asperger’s is a lack of central coherence.[40] People who have poor central coherence may be so focused on details that they miss “the big picture.” A person with a central coherence deficit might remember a story or an incident in great detail but be unable to make a statement about what the details mean. Another might understand a set of rules in detail but be unclear how or where they apply. Frith and Happe explore the possibility that attention to details may be a bias rather than a deficit. There certainly appear to be many advantages to being detail-oriented, particularly in activities and professions that require a high level of meticulousness. One also can see that this would cause problems if most non-autistic (but certainly not all) people are able to move fluidly between detail and big-picture orientations.

[edit] Speech and language differences

People with AS typically have a highly pedantic way of speaking, using a far more formal language register than appropriate for a context. A five-year-old child with this condition may regularly speak in language that could easily have come from a university textbook, especially concerning his or her special area of interest.[41]

Literal interpretation is another common, but not universal, hallmark of this condition. Attwood gives the example of a girl with AS who answered the telephone one day and was asked, “Is Paul there?” Although the Paul in question was in the house, he was not in the room with her, so after looking around to ascertain this, she simply said “no” and hung up. The person on the other end had to call back and explain to her that he meant for her to find him and get him to pick up the telephone.[42]

Individuals with AS may use words idiosyncratically, including new coinages and unusual juxtapositions. This can develop into a rare gift for humor (especially puns, word play, doggerel and satire). A potential source of humor is the eventual realization that their literal interpretations can be used to amuse others. Some are so proficient at written language as to qualify as hyperlexic. Tony Attwood refers to a particular child’s skill at inventing expressions, e.g., “tidying down” (the opposite of tidying up) or “broken” (when referring to a baby brother who cannot walk or talk).[43]

Children with AS may show advanced abilities for their age in language, reading, mathematics, spatial skills, or music, sometimes into the ‘gifted’ range, but these talents may be counterbalanced by appreciable delays in the development of other cognitive functions.[44] Some other typical behaviors are echolalia, the repetition or echoing of verbal utterances made by another person, and palilalia, the repetition of one’s own words.[45]

A 2003 study investigated the written language of children and youth with AS. They were compared with neurotypical peers in a standardized test of written language skills and legibility of handwriting. In written language skills, no significant differences were found between standardized scores of both groups; however, in hand-writing skills, the AS participants produced significantly fewer legible letters and words than the neurotypical group. Another analysis of written samples of text, found that people with AS produce a similar quantity of text to their neurotypical peers, but have difficulty in producing writing of quality.[46]

Tony Attwood states that a teacher may spend considerable time interpreting and correcting an AS child’s indecipherable scrawl. The child is also aware of the poor quality of his or her handwriting and may be reluctant to engage in activities that involve extensive writing. Unfortunately for some children and adults, high school teachers and prospective employers may consider the neatness of handwriting as a measure of intelligence and personality. The child may require assessment by an occupational therapist and remedial exercises, but modern technology can help minimize this problem. A parent or teacher aide could also act as the child’s scribe or proofreader to ensure the legibility of the child’s written answers or homework.[47]

[edit] Narrow, intense interests

AS in children can involve an intense and obsessive level of focus on things of interest, many of which are those of ordinary children. The difference in children with AS is the unusual intensity of the interest.[48] Some have suggested that these “obsessions” are essentially arbitrary and lacking in any real meaning or context; however, researchers note that these “obsessions” typically focus on the mechanical (how things work) as opposed to the psychological (how people work).[49] Those with an artistic proclivity may be more interested in music or art, rather than in fiction, especially ones whose content is intended to arouse emotions, such as romance novels etc.

Sometimes these interests are lifelong; in other cases, they change at unpredictable intervals. In either case, there are normally only one or two interests at any given time. The interests are often linked in some way that is logical only to the AS individual. In pursuit of these interests, people with AS often manifest extremely sophisticated reasoning, an almost obsessive focus, and a remarkably good memory for trivial facts (occasionally even eidetic memory).[13][50] Hans Asperger called his young patients “little professors” because he thought his patients had as comprehensive and nuanced an understanding of their field of interest as university professors.[15]

Some clinicians do not entirely agree with this description. For example, Wing and Gillberg both argue that, in children with AS, these areas of intense interest typically involve more rote memorization than real understanding,[13] despite occasional appearances to the contrary. Such a limitation is an artifact of the diagnostic criteria, even under Gillberg’s criteria, however.[27]

People with AS may have little patience for things outside these narrow interests. In school, they may be perceived as highly intelligent underachievers or overachievers, clearly capable of outperforming their peers in their field of interest, yet persistently unmotivated to do regular homework assignments (sometimes even in their areas of interest). Others may be hypermotivated to outperform peers in school. Symptoms may be seen by obsessional absorption with inanimate objects, such as watches and clocks; or a predominant interest in systematic things like numbers, indices, telephone directories, encyclopedias, dictionaries, and measuring scales. The combination of social problems and intense interests can lead to unusual behavior, such as greeting a stranger by launching into a lengthy monologue about a special interest rather than introducing oneself in the socially accepted way. However, in many cases adults can outgrow this impatience and lack of motivation and develop more tolerance to new activities and meeting new people.[44]

[edit] Other differences

Those affected by AS may show a range of other sensory, developmental, and physiological anomalies. Children with AS may evidence a slight delay in the development of fine motor skills. In some cases, people with AS may have an odd way of walking, and may display compulsive finger, hand, arm or leg movements,[51] including tics and stims.[52][53]

In general, orderly things appeal to people with AS. Some researchers mention the imposition of rigid routines (on self and/or others) as a criterion for diagnosing this condition. It appears that changes to their routines cause inordinate levels of anxiety for some people with this condition.[54]

Some people with AS experience varying degrees of sensory overload and are extremely sensitive to touch, smells, sounds, tastes, and sights. They may prefer soft clothing, familiar scents, or certain foods. Some may even be pathologically sensitive to loud noises (as some people with AS have hyperacusis), strong smells, or dislike being touched; for example, certain children with AS exhibit a strong dislike of having their head touched or their hair disturbed while others like to be touched but dislike loud noises. Sensory overload may exacerbate problems faced by such children at school or indeed adults at work, where levels of noise in the classroom/workplace can become intolerable for them.[51] Some are unable to block out certain repetitive or background stimuli, such as the constant ticking of a clock, or a television in another room of the house. Whereas most children stop registering this sound after a short time and can hear it only if they consciously attend to it, a child with AS can become distracted, agitated, or even (in cases where the child has problems with regulating emotions such as anger) aggressive if the sound persists.[55]

Strip-lighting, and computer monitors at low refresh rates (either of which may often be encountered in schools) can be very disturbing visual stimuli for AS people, contributing to otherwise inexplicable headaches, bad moods and agitation.[56]

Also related to sensory overload, is that AS children can have or appear to have irrational fears, for example, closed doors, flushing toilets.

A study of parent measures of child temperament found that children with autism were rated as presenting with more extreme scores than typically-developing children.[57]

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