The Clinical Guide To Asperger’s Syndrome. Final Part.

This continues the list of symptoms started in part 2. Please be aware accurate identification of Asperger’s Syndrome is complex and requires ongoing analysis.

(7) Bottled up anger and outbursts. The team of clinicians who assisted Asperger were trained to manage possibly violent outbursts amongst autistic children. In fact, Asperger himself was often shocked by such behaviour, which results from an accumulation of frustration and bottled-up anger. Children at the clinic – as stated before – suffered from severe deficiencies in the area of social, instinctive communication and this creates internalised nervous tension. The result may be explosive outbursts or emotional overload. Asperger fully understood his patients reacted in this way to the demands of the outside world, which they were unable to satisfy.
(8) Facial Agnosia. Autistic children (and adults) are often unable to recognise faces of known individuals, outside of familiar context and surroundings. This symptom wasn’t referred to directly by Asperger but psychiatrist Dr. G. Suhareva briefly mentioned it in her essays. G. Suhareva studied the case histories of similar patients to those outlined by Asperger. Facial Agnosia would be very difficult to recognise in children. Suhareva wrote with regard to one child:
“Память хорошая, но неравномерная; хорошо запоминает числа и слова, путает лица.”
“Memory is good but uneven. Recalls numbers and words well but gets confused over faces.”
This symptom actually goes beyond memory for faces and is now identified as an inability to recognise the human face. Psychologists found problems only surface outside the familiarity of the usual social context. The reason I consider this symptom so important is because it points to the breakdown in connection that typifies this pathology. It indicates that external people don’t “register” or create sufficient stimulus to enable normal sensory perception.
(9) Stereotypical movements and rigidness. The Asperger children were seen to engage in repetitive movements such as obsessively playing with a string or rocking back and forth. It’s been noted too there is a pathological tendency to stick to routine and maintain consistency. Everything is done the same way and kept in the same order. There is also a tendency to form strong attachments to some object, toy or doll.
(10) Sensory abnormalities. Asperger noted he had observed extreme sensitivity to touch and noise. Children affected had a strong dislike of coarse fabrics and would avoid certain shirts or trousers that felt too rough. External noise was intrusive and unwelcome. Even less evident noise such as rustlng, a dripping tap or knocking could act as an irritant.
(11) Somatotype. German geneticist and psychologist E. Kretschmer demonstrated that autistic pathologies are more commonly associated with the ectomorphic body type. Such is reflected by a narrow rib-cage, long limbs, poor muscle tone, fast metabolism and pale skin. The research that supports this theory was extensive and conducted by many European geneticists. There are, of course, exceptions to the rule.
(12) Consistency and Stability. Asperger very much stressed the point that those who he observed in his Vienna university clinic displayed a consistent and unchanging pathological condition. There were no abrupt changes or onset of psychotic episodes. Asperger noted the close resemblance to Schizophrenia but argued this latter disorder manifests abrupt periods of change, remissions and relapses. Asperger insisted his syndrome exhibited consistency and that the symptoms remained steadfast. So, in diagnosing the symptoms outlined above, the psychologist must ask whether there is a progressive deterioration in status, or not.

The Clinical Guide To Asperger’s Syndrome (part 2)

We will now proceed to the symptoms, bearing in mind that taken out of context they aren’t conclusive:
(1) Inability to respond to systematic, organized teaching, especially where group participation is required. Asperger’s patients were made up of children who had proven to be unteachable in any mainstream school. Either they didn’t pay attention in the classroom, or they were disruptive. These children often gave the impression of being unusually perceptive and yet they lagged behind others. Asperger attributed this to a breakdown in the ability to process information via any means, or mechanism, of social interaction. These patients have little emotional connection to other human beings. In the same way, emotional incentives such as praise, approval, scolding or group- empathy were seen by Asperger to produce negative effects. These children were neither stupid nor purposefully disruptive. Asperger discovered they tended to respond better if information was communicated impersonally and monotonously.
(2) Autism. The autism Asperger described starts in early age. This is a crucial factor because, in general terms, autism doesn’t always commence in childhood. Autistic withdrawel in Schizophrenia, for example, usually occurs at age 20, or around. Given Asperger autism begins in early childhood it is, therefore, more likely to hinder and disrupt overall development. The ability to study in groups, find employment, marry or socialise will be affected. Whereas, in cases where autism begins much later in life, the individual concerned would already have acquired some basic skills in socialisation, education and employment. For this reason, Asperger autism can be a serious condition and very frequently leads to social alienation.
(3) Obsessive interests. The Asperger children tended to show giftedness in narrow areas of interest. Asperger highlighted interest in music or art, chemistry or aspects of history. These obsessive interests tend to detach the child (or adult) from the surrounding environment. Psychiatrists over the years (including Lorna Wing) have taken great pains to argue the accumulated knowledge of the child, in these cases, is rote-learned and lacks a thorough understanding of the subject matter. However, this misunderstands what Asperger had observed. In many cases, people with this syndrome have a very abstract, associative and theoretical approach to the subject matter. My research in this area led me to conclude that the so-called rote-learning phenomenon applies in some cases but not always. Psychiatrists of the academy of S. Muhnin, in the Soviet Union, divided autistic children into categories. It was concluded that in the case of Asperger Syndrome, obsessive interests tended to reflect giftedness and may lead to genuine achievements in the area concerned. Yet, in the cases of autistic children whose conditon was caused by pre-natal, or post-natal viral illness, obsessive interests do tend to be mechanical and superficial (memorising baseball statistics e.t.c.). Conclusion? The obsessive interests symptomatic of Asperger Syndrome tend to be intellectual and more productive. Incidentally, this point is essential to bear in mind for the following reason: Some progressive psychologists have inadvertently put pressure on families affected by autism by over-emphasising the area of “giftedness”. Many autistic children never go beyond mechanical rote-learning of facts and figures. Many – far from being future Einsteins – remain severly limited or maladjusted.
(4) Motor clumsiness. Children with Asperger Syndrome show poor co-ordination and may well struggle to catch a ball. Sometimes the physical clumsiness is less obvious but it may be more evident when dexterity is required in assembly work, for example. In hand-writing it may become quite apparent. The Asperger children struggled to write straight lines and letters were scrawled across the paper. It has also been noted that, with Asperger Syndrome, there may be som- e disorientation over left and right, clockwise or anticlockwise.
(5) Emotional flatness and disconnection. Asperger described in some detail that his patients suffered a pathological condition that entailed an inability to connect to other human beings. In fact, other people are “objectified” in the perceptions of patients. Awareness of others is the product of an abstraction of perception, after emotional resonance and association have been filtered out. For this reason, people who have Asperger Syndrome may fail to understand the need to reciprocate, acknowledge or show subtle awareness of the fee!ings of others. They may seem rude, blunt and uncaring. This leads to an inability to form relationships, especially within a social context. People with Asperger Syndrome are perceived by family as being selfish but the reality is they are, in fact, inward and tend to view the world accordingly.
(6) Mimicry. Any psychologist who attempts to diagnose Asperger Syndrome must, by necessity, understand how facial mimicry is a factor. Normal human beings “resonate” thoughts in unison with expression. Smiles, frowns, raised eyebrows, eye expression and general “animation” of mood. People with Asperger Syndrome do not have this responsiveness. Facial expression is weak and hardly changes. Eyes may not be directed towards others, during communication. The gaze may be directed into space, with no actual connection specified. Sometimes, where some facial mimicry exists, it is out of phase with the appropriateness of the subject matter discussed. Thus, the topic of some unfortunate event may provoke a smile, or grin, which doesn’t express the real feelings of the individual. Some psychologists attribute this latter symptom to Schizophrenia, whereas mask-like expression they attribute to autism. Still others make no distinction. However the case may be, people with Asperger Syndrome show clear deficits in facial expression. They also have a flat, monotone voice that lacks emotional expression. Communication is recited matter-of-factly and pancake flat in tone.

The Clinical Guide To Asperger’s Syndrome

In this essay, we will attempt to outline the core symptoms of Asperger Syndrome, the aim being to provide a basic guide to the syndrome. Every attempt will be made to utilize clear explanations that may be better understood by non-psychologists.
In discussing the symptoms that equate to Asperger Syndrome, we need to understand that Dr. Asperger himself referred to the condition as “autism”, with the crucial distinction that the children affected showed signs of higher than average intelligence. Diagnosis was complicated by the fact that high intelligence, in these cases, was difficult to measure by any orthodox I.Q. test and, furthermore, Asperger Syndrome paradoxically combines high intelligence with inability to receive knowledge from others. As we shall see, the inability to process information via normal processes is caused by deficits in the sphere of social communication, and in the instinctive functioning of the brain. We should be careful also how we apply the term “high intelligence” to Asperger Syndrome. In such cases, the processing of information is typically unorthodox, associative, abstract, original and not subject to standardised measurement. As Asperger stressed, the essence of the intelligence – he attempted to measure – was tied up in the exclusion of social, environmental bias, which led to extreme originality. To give an example, people who show very high orthodox intelligence tend to perform very well in terms of speed and efficiency of information processing. However, such intelligence is strongly influenced by the environment, social hierarchy, socialisation and standardisation. Asperger felt the advancement of science and knowledge sometimes requires uniqueness, a component of anti-social impairment and the ability to approach subject matter from a new perspective. At this stage, it becomes essential to acknowledge two points:
(1) Hans Asperger’s approach to certain autistic conditions had nothing in common with the widespread conception in psychiatry that abnormality = inferiority (in the sense of a black and white formula). As a scientist, not only was Asperger fascinated by neurological diversity and its implications but he also gave less importance to diagnostic categories and contrived, clinical classifications. Likewise, Asperger concluded the role of genetics was a big factor in his research.
(2) Symptoms by their own merit don’t enable us to “diagnose” Asperger Syndrome. We should bear in mind that of the four children presented by Asperger in his essays, one of them (Helmut) had suffered encephalitis. By this example, Asperger demonstrated that cause is more fundamental here than symptoms. Autism as a term describes a child who fails to develop at a normal level, relative to other people. We are dealing with a developmental condition. However, the cause may be connected to below average intellect or the consequences of encephalitis, birth or organic factors. It may also be the case too that children with higher intelligence carry genes that influence the processes of social adaptation. Therefore, although Asperger’s patients Fritz and Helmut displayed almost identical symptoms in the clinical sense, the two cases were not at all the same. Fritz became an outstanding mathematician and had a hereditary background that fitted the “mad-genius” category. Helmut, however, was suffering behavioural abnormalities as a result of encephalitis.
To correctly diagnose Asperger Syndrome, we need to look beyond the symptoms (which are described below). We need to ask if the child concerned displays unusual curiosity or inward concentration. In the case of this syndrome, children appear to be highly perceptive but simultaneously appear unteachable. Genetics, as stated, helps too since the Asperger children tended to have gifted but psychologically unstable blood relatives, grandparents and aunts or uncles.
We will now proceed to the symptoms, bearing in mind that taken out of context they aren’t conclusive:

Challenging The Autism Spectrum And A.S.D.

This post is divided into two parts on the same page. Davidbanner99 at yahoo dot com

Introduction

(Since this was published I have continued my research and will return to this issue. This present essay I still uphold but it was a little too polarised. Later I will add to this essay.)

At this stage in my essays, I believe it would make sense to address the almost universally accepted idea that autism must be diagnosed as “a spectrum”. It may well be the case I am practically the only researcher who, not only questions this approach, but am able to provide evidence that suggests the spectrum theory was discredited by leading European researchers decades ago. Here, as the case may be, I am restricting myself to clinical psychology and diagnosis. Within the confines of non-clinical psychology, the spectrum concept was not as problematic.

There are many reasons why leading psychiatrists (of the early 20th century), urged caution over assessment of clinical pathologies as a spectrum. Hans Asperger himself appears to have ruled out this approach. Even more to the point, professor G. Suhareva stressed the need for “definition”, as opposed to the lack of consistency reflected by the spectrum criteria.

“Defining characteristics of the schizoid personality, as outlined by Kretschmer in Körperbau und Charakter”, are too widely applied. The definition of “schizoid” is too vague and undefined.” (G. Suhareva)

How did the DSM come to adopt ASD instead of Asperger Syndrome? (Part 1)
Back in the 1980s, research into high-functioning autism in Britain, The United States and Australia lagged some other European countries. On the other hand, The Soviet Union, at that time, had been keeping up to date with autism research. Soviet psychiatrists such as S. Munhin and V. Kagan were already familiar with Hans Asperger’s “Die Autistischen Psychopathen Im Kindesalter” and, therefore, the same pathology was familiar to specialists there.
At this point it will help to clarify that the historical terms used to describe the higher functioning autism Hans Asperger described were as follows:
(1) Autistic Psychopathy = the term used by Dr.Hans Asperger himself.
(2) Autistic, Schizoid Avoidant Psychopathy = this is the same as the above, but a fuller definition.
(3) Schizoid Disorder = used widely in the USSR but essentially the same diagnosis.
(4) Verschroben = The oldest term used to diagnose Asperger Syndrome.
Asperger Syndrome, for the most part, is exactly the same clinical condition as all of the above. At least in the more general sense. From the onset, Asperger Syndrome (in its former definition), was associated with Schizophrenia. “Schizoid” means “borderline Schizophrenia”.

In my view, British psychiatrists Wing and Goulde somehow missed this fundamental connection. They attempted to create a new, spectrum disorder, at the same time missing the historical evolution of its original conception. Lorna Wing wrote:

“Furthermore, the word ‘schizoid’ was originally chosen to underline the relationship of the abnormal personality to Schizophrenia……There is not firm evidence of a special link between this syndrome and Schizophrenia.” (Lorna Wing)

Note: Asperger himself seems to have dismissed this link, since he stated he had found no evidence that points in that direction. That probably influenced Wing’s position. However, data gathered by geneticists (Hoffman, Rudin, Kahn, Medow, A. Schneider) reveals how the autism Asperger described is most often found in families where Schizophrenia has had some impact.
All my research to date indicates the pathology Hans Asperger described in the 1940s has a clinical connection to Schizophrenia and this is supported by the following:

“The Schizoid Psychopathic Group has a certain relationship to Schizophrenia. This is supported by the following: Firstly, hereditary-biological data that indicates a large number of schizoid psychopaths within schizophrenic families. Secondly, similarities between the pre-psychotic personality of schizophrenics and schizoid psychopaths.” (Prof G Suhareva)

The problems that confronted the elite psychologists and geneticists of pre WW2 Germany were as follows:
(1) How to provide evidence of a definite relationship and similarity between Schizoid Disorder (i.e. Asperger Syndrome) and Schizophrenia. This involved the research of family medical history and accumulation of anamneses.
(2) How to differentiate between Schizoid Personality as a concrete clinical disorder against a background of contrasting, vague, undetermined interpretations of “Schizoid” as it initially existed. Here, I must emphasise all this initial confusion and vagueness returned to modern psychology through the DSM and A.S.D diagnostic criteria.
I have tried to bring as much clarity to this essay as possible. It is important to bear in mind the terms used by psychiatrists tend to change as history progresses.

The Discovery Of German Clinical Psychology Research In 1980s Britain.
Due to the lack of information, regarding autism, in the English-speaking world, psychiatrist Lorna Wing made the decision to undertake extensive research into this area of clinical psychology. Wing’s daughter herself suffered from autism, yet there was very little support or research available at that time. This motivated a determination to seek whatever research had been developed in other countries. Based in a London clinic, Wing and Goulde observed autistic patients and read translated German research texts. After reading essays by Austrian psychiatrist Leo Kanner, Wing became especially interested in the work of Dr. Hans Asperger. After much painstaking research along these lines, both psychiatrists concluded autism functioned as a spectrum (although, as we have seen this was not in any way a new concept). It was decided to name the new diagnosis after Hans Asperger – “Asperger Syndrome”.

The question should be raised as to whether Wing’s introduction of the autism spectrum concept came to be misunderstood over time. We will consider this point later in the essay.

“There is no question that Asperger Syndrome can be regarded as a form of Schizoid Personality. The question is whether this grouping is of any value.” (Lorna Wing)

In my view, the shortcoming in Wing and Goulde’s research was to omit the fact initial problems surrounding a clinical definition of Schizoid Personality Disorder, had mostly been resolved in 1925 in G. Suhareva’s essays, as already stated. Note the following statement by E. Kretschmer:

“Schizoid type is a pathological personality which reflects the basic symptoms of Schizophrenia to a lesser degree.” (Kretschmer).

To bring this essay to a close, we can now confirm the concept of autism as a spectrum was a very dated, and discredited theory which only has some use in the sphere of non-clinical psychology.

The Original Theory Of Autism Spectrum (part 2)

The initial conception of a spectrum of symptoms that pertain to neurological deviation was pioneered by E. Kretschmer in his book “Körperbaû und Character”. It was developed by Kahn and Hoffman in the 1920s. For example, Hoffman suggested the Schizoid Personality type functions as a spectrum that reflects opposite extremes. So, in the examples below, the autistic personality may range from flat, emotional unresponsiveness to excessive emotion and feeling.
Hoffman listed a wide range of polar opposites that are merely aspects of one pathological disorder, i.e. Autistic, Psychopathic Personality, Schizoid Disorder.

This reflects the “wide range of clinical pictures” referred to above:
Gemütsruhig = quiet, meek and withdrawn.
Gemütskalt = cold, selfish, avoiding other people.
Gemütstumpf = morally insensitive – Stumpf überempfündlich = excessive emotion.

If we read Hoffman and Khan carefully, it becomes quite obvious they are discussing Schizoid Autism as a spectrum. This is what caused Wing and Goulde to dismiss Schizoid Disorder as irrelevant, thereby losing the demonstrable connection to Schizophrenia.

“Although Wolff & Chick have listed five features operationally defined, that they regard as core characteristics of Schizoid Personality, this term, as generally used, is so vague and ill-defined a concept that it covers a wide range of clinical pictures in addition to Asperger’s Syndrome.” (Lorna Wing)

Hans Asperger had clearly read a great deal on the subject of autism as a spectrum, given his native language was German. The views of leading German-speaking psychiatrists were, therefore, familiar to Asperger. If we read Asperger’s particular approach to the diagnosis of his patients, we ought to be able to interpret his views in modern terminology. For instance, Asperger writes:

“Kurt Schneider divides psychopathic (schizoid) types into hypersensitive, depressive, insecure, fanatical, ambitious, as well as those with mood-swings, explosive, nonchalant, weak-willed and neurotic. Without any doubt, he describes different personality types, while relying upon the resources of applied psychology.” (Hans Asperger)

So, here it is quite clear. Psychologists today would interpret “fanatical” or “nonchalant” as “being on opposite ends of the spectrum”, whereas Asperger goes on to explain why such an approach is unreliable. Moreover, he wasn’t alone in this view.

“Substantial objections to this approach were raised initially by Paul Schroder and his school. They considered the classification of personality types on the basis of one characteristic symptom (schizoid) to be an unacceptable simplification. This meant that all other traits which made an impact on the personality were left aside.” (Hans Asperger)

Personally, I am inclined to be very skeptical as to how people who today struggle with Asperger Syndrome could be identified and supported on the basis of A.S.D. As my articles will go on to demonstrate, Asperger Syndrome can be diagnosed today as a recognised pathological condition. Attempts to interpret the said pathology as A.S.D. risk more confusion than Wing and Goulde’s original efforts to assist people with this condition imagined. Furthermore, on reading Wing’s essays (as mentioned before), it seemed to me to be the case her views on the spectrum issue were inspired by the various, suggested forms of Schizoid Personality. Wing probably never intended her new diagnosis to lose its meaning and clinical integrity:

“There is no question that Asperger Syndrome can be regarded as a form of Schizoid Personality. The question is whether this grouping is of any value.” (Lorna Wing)

As G. Suhareva concluded:
“What’s required is a more precise distinction of the Schizoid Group, in order to distinguish it from, (1) other types of psychopathic disorders and (2) the reactive type of Schizoid Disorder, often encountered as a physiological phenomenon, within the limits of normal variation. For the latter group it is appropriate to seek a term not linked to clinical psychology.” (Grunya Suhareva)

On ending this essay, I should add I have no idea if people affected by Asperger Syndrome are satisfied with the A.S.D. diagnosis. My belief is Hans Asperger himself would have felt his 10 years of research has been ignored and under-estimated. My other article will explain how to diagnose this pathology.