Do any of these situations seem familiar?

You are enjoying a family gathering hosted in your home.  At about 9 PM you look around and notice your husband is no longer in the room.  You slip out and go looking for him.  He’s gone to bed.  He never said goodnight to anyone.  There was no incident.  He didn’t seem upset with anyone.  He just left when he had enough.  This is not unusual behavior for him.

Your wife is a lovely woman and you adore her.  But you are aware that except for a few long term friends, it seems difficult for the two of you to develop any new social opportunities.  You suspect that one of the reasons may be her inability to pick up on any social cues.  For example, she often holds the other person in a conversation long after they seem to have lost interest.  Even more problematic is that she can’t seem to move herself away from repeatedly  discussing a subject that is important to her, even when others clearly have no interest.

You sometimes walk on eggshells when something about your husband’s routine is interrupted.  He has a rhythm to his tasks and routines. He lays his belongings out in a certain way.  He is rigid about the way many things must be done. When there is an interruption to his schedule or routine he becomes cranky or out of sorts.

Sometimes the television can be on loud and other times your wife yells to turn it down as if you recently changed the volume when you did not.  Sometimes it seems that otherwise routine sounds seem to get on her nerves.

You tell your husband about something that is troubling you.  He appears to be looking right at you.  When you finish with what you have to say he changes to another subject  that interests him without any comment about what you just told him.  It’s almost as if  he didn’t hear heard anything you just said.

What is Asperger’s syndrome?

Technically it no longer exists in the current diagnostic handbook.  In the latest revision, which came out in 2013, the diagnosis of Asperger’s syndrome was removed and the collection of symptoms previously associated with the term were moved under the heading of high functioning autism.

While I agree with Asperger’s having similarities with autism, the old diagnosis and categorization of Asperger’s was much more clear in assessing some of the unique features of this neurological condition.  I’m afraid lumping it together with high functioning autism fails to give credence to some of the important features and, therefore, mutes our understanding and tools for assessment.  As a result, I will continue to use the term Asperger’s in my explanation.

For starters, it is important to understand that Asperger’s is the result of the way someone’s brain is wired.  It is not caused by environmental factors, poor parenting, and has been disproved (along with autism) to be the result of childhood immunizations.  Many researchers believe there is a genetic component.  I subscribe to this last theory.  Very often there is more than one person with Asperger’s or at least some aspects of Asperger’s in a household.

There are some key features of Asperger’s.  These include:

-difficulty reading social cues
-lack of empathy
-avoiding eye contact
-preference of routine, sometimes to a compulsive degree
-preference of machine over man because of its predictability
-vulnerable to over stimulation of one or more senses
-over talking about a single subject that may not include the listener’s interest
-high intelligence
-emphasis of logical thinking over emotional

Yet, despite some of these key features, there is a wide range of what Asperger’s looks like.  It is best to think of this condition on a continuum.  People with Asperger’s can be social.  They may have learned compensatory strategies to help them “get along”.  But it may be of considerable personal cost for them to try and maintain those strategies for extended periods of time.

Dr. Stephen M. Shore says, “When you meet one person with AS—you’ve met one person with AS.” That is, it is very important to remember that people with AS can differ greatly from one other.

This link from the National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/disorders/asperger/detail_asperger.htm#246953080
contains a clear and thorough view of etiology, symptoms, treatments prevalence and additional resources.

Another very helpful resource is:  http://www.aane.org/about_asperger_syndrome/

My strategy for treatment with an individual may initially be to confirm or refute the diagnosis, to educate them and to develop strategies where AS may present impairment.  Often my job is to demonstrate to them where and why a gap exists between their interpretations and the interpretations that others make of the same situations.  The next step is helping the individual to develop compensatory skills that bridge those gaps.  However, treatment also involves developing and or maintaining an appreciation for the strengths and gifts of Asperger’s Syndrome.

Work with couples is similar, but there is more focus on bridging the difference in style between both partners.  I often begin similarly to working with couples where AS is not a factor, by helping them develop a framework for having safe communication strategies.  I assume at the beginning of treatment with the AS impacted couple that both partners have strengths and weakness and are different from each other.   Neither the AS partner nor the NT (neurotypical or non AS) partner’s strategy is right but both need to be understood and that as a couple, they must learn to employ both styles at different times appropriate to the challenges they face.