In the wake of the tragic shooting at Sandy Hook Elementary School in Newtown, Connecticut, it has recently been reported by several media outlets that the perpetrator, Adam Lanza, was diagnosed with Asperger’s syndrome along with other medical and psychological problems.  I would like to help clarify what Asperger’s Syndrome is, and some common characteristics of people who have this diagnosis.

The entity now called Asperger’s syndrome (AS) was first described by Hans Asperger in 1944 in an article in which he described 4 children with normal intelligence but significant difficulty with social skills and nonverbal communication.  The term “Asperger’s syndrome” was first used in 1981, and it was recognized as a distinct medical diagnosis for the first time in 1994 in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DMS-IV).  Interestingly, it was recently decided by the editors of the DSM-V, which has a planned release of 2013, that the specific diagnosis of “Asperger’s syndrome” will be absorbed into the broader term “autism spectrum disorder.”  However, since the term has entered common usage outside the medical field, it is still important to understand.

AS is generally considered to be a “milder” form of autism.  Whereas the diagnosis of autism requires impairment in social interaction and verbal communication, along with restrictive or repetitive behaviors or interests, the diagnosis of AS does not require difficulty with verbal communication.  Additionally, the onset of autism is generally seen before the age of 3 years, in contrast to AS which tends to be later (on average, 7-8 years).  People with AS typically have normal or even above-average intelligence, and tend to do well in subjects that require a lot of memorization.  However, they have significant difficulty with abstract thinking, and this can lead to problems when they reach middle or high school. 

A common characteristic in people with AS is focus on a limited number of very specific, narrow interests.  These interests can be in anything, although topics that lend themselves to memorization of large numbers of facts or statistics are most common – for instance, sports or history.  They are often encyclopedic in their knowledge about their particular area and may have difficulty understanding why others do not find it as fascinating as they do; they want to share their knowledge with others, but this can frustrate them when other people become bored or disengaged.

The most significant problem encountered by people with AS is social interaction.  Although they generally have normal language skills, non-verbal communication is very difficult for them.  While people with AS can understand obvious social cues such as crying or yelling, more subtle facial expressions are often missed.  They tend to interpret words and phrases literally and have a lot of difficulty with symbolic or non-literal language, such as irony or sarcasm, or certain types of humor.  It is this characteristic that makes it difficult for people with AS to make friends or develop other long-term relationships. 

It is very important to emphasize that a tendency to violent behavior has NEVER been associated with Asperger’s syndrome.  People with AS are no more prone to aggression than other people.  Fear and misunderstanding of people with AS is unfortunately common – as children they are often lonely, or bullied, because classmates and peers can see they are different.  Helping each other to understand AS is a positive step we can take as a community to reduce that fear.

Catherine Nicholas, M.D.,  joined Frank McGehee’s practice at the Sixth Avenue clinic after graduating from residency in 2012. She is a fellow of the American Academy of Pediatrics, as well as the Fort Worth Pediatric Society and the Tarrant County Medical Society. She is thrilled to be part of the Cook Children’s network, and has many interests within pediatrics, including nutrition, behavior and development, and children with special health care needs.

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