What is Asperger’s syndrome? Diagnosis, treatment and everyday life

The definition of Asperger’s syndrome applies to patients in whom a different way of functioning of the nervous system is observed – on the one hand, it is associated with challenges in social interactions and a strong need for routine, whilst on the other hand it can foster the development of passions, meticulousness and an exceptional memory.

The outlook depends on whether the person receives a diagnosis and appropriate support. People with Asperger’s syndrome need support, but once they receive it, they can lead fulfilling lives, build relationships and pursue a career.

What symptoms should raise concerns? When should you see a specialist? What are the diagnosis and treatment options for Asperger’s syndrome? 

What is Asperger’s syndrome?

Asperger’s syndrome is a neurodevelopmental disorder. In the latest ICD-11 classification, it no longer appears as a separate condition, but forms part of the autism spectrum. The term is still sometimes used to refer to people who were diagnosed before the changes were introduced.

Asperger’s syndrome is characterised by difficulties in social interactions and an atypical way of communicating, whilst intellectual and language development remains normal. People with an autism spectrum disorder often find it difficult to interpret subtle emotional cues in other people (such as innuendo, irony or metaphors). They are not always able to interpret tone of voice, facial expressions or gestures correctly – elements which, for most people, naturally complement what is said. They respond mainly to messages conveyed directly and in clear language. At the same time, their own emotions can be difficult for those around them to read – they may struggle to put a name to what they are feeling, or to express their emotions in a way that others can understand. 

• This does not, however, mean that they are not empathetic people. They often experience emotions deeply, but lack the ‘tools’ to express them appropriately. 

An additional challenge is limited non-verbal communication – people with autism spectrum disorders are less likely to use gestures, changes in tone of voice, facial expressions or eye contact. Consequently, to outsiders, their communication is sometimes perceived as cold or distant, even though in reality it is not.

The history of the Asperger’s group

Asperger’s syndrome is named after the Austrian doctor Hans Asperger, who in 1944 described a group of boys with specific developmental characteristics. The children studied had well-developed language skills, but spoke in a pedantic and unnatural manner. They displayed limited empathy, had difficulty making friends and exhibited unusual interests. The psychiatrist Hans Asperger described their behaviour as ‘autistic psychosis’, not yet realising that, many years later, the characteristics he had described would form the basis of a separate diagnosis.

It was not until the 1980s that the term ‘Asperger’s syndrome’ was popularised by the British researcher Lorna Wing, and in 1994 it was included in the DSM-IV as a pervasive developmental disorder. In the ICD-10, Asperger’s syndrome was listed as a separate condition.

This distinction was based on the fact that people with Asperger’s syndrome were characterised by normal intellectual and linguistic development, but exhibited difficulties in social interactions and typical patterns of behaviour.

In 2013, with the publication of the DSM-5, a change was introduced – the previously separate diagnoses (PDD-NOS, Heller’s syndrome, autism and Asperger’s syndrome) were combined into a single concept – autism spectrum disorder (ASD). In 2022, the ICD-11 was updated in the same way.

What are the causes of Asperger’s syndrome?

The causes of Asperger’s syndrome are not fully understood, but scientists are gaining a better understanding of the factors that may be associated with it.

Most attention is focused on genetics – although no single gene has been identified that could, on its own, contribute to the development of Asperger’s syndrome, certain links have been found that may point to the significance of combinations of multiple genetic variants. The risk is increased, for example, by changes in the number of gene copies (where certain sections of DNA are repeated or deleted), point mutations (changes to a single ‘letter’ in the genetic code) or chromosomal abnormalities that affect brain development.

Another area being studied in relation to Asperger’s syndrome is the nervous system – it has been observed that in some people it functions slightly differently. Research focuses on the networks of connections between neurons – the structures involved in communication and the processing of emotions. Often, at the level of nerve impulses, a different way of processing stimuli – such as sounds, smells, touch or light – is also observed.

The most important thing to remember is that Asperger’s syndrome is not caused by parenting mistakes or isolated childhood experiences.

When considering potential causes, we are referring to the interplay of many independent factors which, together, shape the way a child develops.

How does a person with Asperger’s syndrome behave?

Asperger’s syndrome is a disorder whose clinical presentation (i.e. the symptoms exhibited by the patient) changes with age. We will observe different symptoms of Asperger’s syndrome in young children, different ones in teenagers, and yet others in adults.

A common feature of Asperger’s syndrome in both children and adults is a different way of functioning in relationships and a specific pattern of behaviour. Regardless of age, patients find it difficult to understand unwritten social rules, whilst at the same time they can be extremely candid and literal in their communication – the only difference lies in the areas in which these behaviours can be observed.

The symptoms do not disappear, but they may change as a result of cognitive development, academic demands, social experiences or coping strategies developed in society.

What are the early signs of Asperger’s syndrome in young children?

The first symptoms of autism spectrum disorders may appear as early as infancy, although parents most often notice them at the age when the child begins to interact with their peers.

Why is the pre-school years so often discussed? It is precisely at this stage that developmental differences become more apparent. The child joins a group where they naturally have to grapple with the rules of playing together, forming their first relationships and the need to adapt to new situations. This is the point at which a lack of flexibility, an unusual communication style or difficulties with social interactions become more noticeable to carers.

Typical symptoms in children include:

• limited eye contact,
• failing to smile in response to a parent’s smile,
• a lack of spontaneity in gestures,
• difficulties with imitation (most commonly observed during play),
• a strong focus on a single activity,
• a very strong aversion to change (manifesting itself in crying, screaming or aggression when faced with it),
• a lack of spontaneous expression of emotions,
• difficulty in understanding the rules of playing together.

What are the symptoms of Asperger’s syndrome in teenagers?

In theory, the symptoms in teenagers could be described as almost identical to those of Asperger’s in children. Only in theory, however, because in practice it is worth paying attention to their consequences. Adolescence is a period in which the peer group becomes an important point of reference, and social norms begin to exert a strong influence and shape a teenager’s day-to-day functioning. It is at this stage that the symptoms become more apparent, as their consequences have a greater impact on the young person’s relationships and self-esteem.

The most common symptoms observed in teenagers with Asperger’s syndrome usually include:

• difficulty in understanding jokes, irony and metaphors (taking all messages literally),
• strong reactions to changes in the daily routine (stress, anger, sadness, aggression),
• withdrawal from social interactions (lack of a close circle of friends),
• highly focused and very specific interests,
• an unusual style of communication (unnaturally formal, stiff or characterised by technical vocabulary),
• emotional difficulties (low self-esteem, a sense of being different, social anxiety),
• limited flexibility in behaviour (a very strong attachment to routine and one’s own habits).

Symptoms characteristic of Asperger’s syndrome in adults

The symptoms in adults diagnosed with Asperger’s syndrome are, at their root, a continuation of those observed in childhood and adolescence. The difference is that in adulthood, new challenges arise – work, relationships, responsibilities – which can accentuate the effects of developmental differences.

Many people learn to mask their difficulties, observe those around them and try to imitate the behaviour of others. If a patient undertakes appropriate therapy and receives support, the main symptoms may become less noticeable – but they do not disappear.

Adults with Asperger’s syndrome are characterised by:

• a need for routine and a strong attachment to established patterns,
• difficulties in maintaining close relationships,
• a literal interpretation of language,
• sensitivity to stimuli,
• expert-level knowledge in selected fields,
• a distinctive manner of speaking – rigid syntax, a monotonous tone of voice, an excessive focus on details.

How does someone with Asperger’s show their feelings?

People with Asperger’s syndrome are often perceived as emotionally distant or as failing to express their feelings in a way that is considered typical. However, this stereotype stems from differences in expression, rather than a lack of inner feelings.

In many cases, emotions in adults and children are just as intense (or even more so) as in neurotypical people – the difference lies in the difficulty they have in expressing them.

Feelings – love, friendship, affection – are expressed in different ways. They may take the form of recurring gestures (e.g. daily phone calls, giving gifts related to one’s partner’s interests, or persistently initiating conversations on important topics).

In the case of children, this expression of emotion may take the form of persistently returning to conversations about a favourite person, sharing knowledge, or involving that person in their interests. Adults with Asperger’s syndrome, on the other hand, often show their feelings through loyalty, consistency in relationships and maintaining shared routines.

These symptoms are also associated with difficulties in recognising subtle emotional cues in other people – such as tone of voice, changes in facial expressions or gestures. For this reason, a patient with an autism spectrum disorder does not always notice when the person they are talking to is feeling sad, irritable or disappointed. However, when these feelings are pointed out to them directly, they usually respond empathetically and try to offer support.

Diagnosis of Asperger’s syndrome – how does it work and where can you seek help?

At present, Asperger’s syndrome is diagnosed on the basis of an analysis of the patient’s behaviour (using interviews, observation and standardised assessment tools). A team of specialists is usually involved in the process, as each member looks at the child’s or adult’s development from a different perspective.

A psychologist examines behaviour in social interactions, assesses communication patterns and analyses strengths – our specialists use detailed questionnaires and tools (including the ADOS-2, ADI-R and ASRS) as part of the diagnostic process. A speech and language therapist assesses speech, which in people with Asperger’s syndrome develops normally, but the style can sometimes be atypical. A psychiatrist collates all the observations, analyses the developmental history and makes the diagnostic decision.

At the Dialog Centre for Children and Families, we offer comprehensive support for children, their parents and adult patients. Our centre is staffed by experienced specialists who possess the necessary skills and qualifications to guide people with Asperger’s syndrome through all the stages leading to a diagnosis.

Diagnostic criteria for autism spectrum disorders

Just a dozen or so years ago, diagnostic records contained various terms – childhood autism, pervasive developmental disorder, Asperger’s syndrome. To parents, these sounded like different conditions, which, according to current guidelines, described the same set of difficulties, manifesting themselves in different ways.

Nowadays, the term ‘autism spectrum’ is used rather than separate subtypes. Specialists do not focus on the classification of Asperger’s syndrome itself, but rather on describing the symptoms and their severity. This makes it easier to understand how a particular patient functions and exactly what they need.

Asperger’s syndrome and autism – what exactly is the autism spectrum?

The spectrum refers to a continuum – a range of behaviours that share a common underlying cause but differ in severity and form. When we talk about the autism spectrum, we mean a wide range of characteristics. These range from very severe difficulties, which are apparent from the earliest years of life, to milder forms, in which a child learns to speak and achieves good intellectual outcomes, but still experiences social difficulties.

From this perspective, it is easier to understand why Asperger’s syndrome is no longer described as a separate clinical condition, but rather as part of a broader spectrum of disorders with a common underlying cause. The diagnosis identifies which difficulties have developed in a particular patient and to what extent they affect their day-to-day functioning.

What rules out Asperger’s syndrome?

Before a specialist makes a diagnosis, they must check whether the clinical presentation is not due to another condition. At this stage of the process, specialists focus on ruling out other possibilities. It is worth being aware of the importance of differential diagnosis – every test with a negative result is not ‘a waste of time’, but a step closer to an accurate diagnosis.

Which characteristics definitely rule out a diagnosis of Asperger’s syndrome?

• Delayed speech development and below-average intelligence – if a child has not developed language by the appropriate age or their intellectual development is clearly impaired, the doctor is likely to consider other neurodevelopmental disorders or other forms of ASD.
• Isolated language difficulties – difficulties confined solely to speech, without the typical social difficulties – are more indicative of developmental aphasia than of Asperger’s syndrome.
• A predominance of impulsivity and concentration difficulties without pronounced features of Asperger’s syndrome – symptoms typical of attention-deficit/hyperactivity disorder.

The symptoms of Asperger’s syndrome can vary in severity. The cases mentioned above are merely examples intended to illustrate the importance of specialist knowledge. An experienced team is able to distinguish between seemingly identical symptoms in different individuals.

What does treatment for Asperger’s syndrome involve?

Asperger’s syndrome is a neurodevelopmental disorder that persists throughout a person’s life. Autism spectrum disorders should not be viewed as illnesses. The challenges faced by those with these conditions should always be viewed through the lens of neurodiversity – people with this diagnosis develop and function differently from the majority of society. Whilst this can sometimes present various challenges, it can just as often be associated with a very high potential for developing unique skills and interests. 

People with autism spectrum disorders often stand out for their above-average memory and ability to think logically, focus on details or become deeply immersed in their passions. 

When viewed alongside the start of therapy and the use of various forms of support, this reality can be seen as an opportunity rather than a limitation. Measures tailored to the needs of the child or adult will make a real contribution to reducing the severity of the symptoms of autism spectrum disorders.

The symptoms of Asperger’s syndrome can appear at various ages and change as the individual develops – which is why therapy must be flexible and tailored to the patient’s current challenges. At the Dialog Centre for Children and Families, we ensure that those seeking support receive it in a form tailored to their neurodiversity.

Therapeutic approach – individual therapy, family therapy and support groups

How should one tailor the approach to the symptoms of Asperger’s syndrome, which vary in severity? Different strategies are employed in the treatment of children and adults. Each may focus on developing different qualities in the patient. At the Dialog Centre for Children and Families, we run a wide range of activity blocks, and our patients can choose those that are most suitable for them at any given stage.

In the case of Asperger’s syndrome, patients may attend:

• Social Skills Training,
• Aggression Redirection Training,
• developmental activities (Gordonki, Sensoplastics, Smyk Sensory Activities, English),
• Sensory Integration,
• speech and language therapy.

Asperger’s syndrome – pharmacology

People with Asperger’s syndrome do not usually take medication on a long-term basis. Pharmacotherapy is only considered when there are accompanying conditions – such as severe anxiety, depression, sleep problems or ADHD.

In this case, there is no single, strictly defined approach. The decision to prescribe specific medicines is made by a psychiatrist – it must be made clear here that their use in therapy is not intended to ‘treat Asperger’s syndrome’, but to alleviate other difficulties that reduce quality of life.

Untreated Asperger’s syndrome – why should we help someone with Asperger’s syndrome?

Without a diagnosis and with no prospect of receiving support, autism spectrum disorders have an increasingly significant impact on everyday life over time.

In nursery, a child who does not understand the rules of playing together may be excluded by their peers. During adolescence, a sense of being different, without the right support, leads to withdrawal from the community. An adult who is unaware of the cause of their difficulties experiences problems at work and in family relationships, as well as stress and anxiety.

A diagnosis and the treatment that follows open up a different perspective. They offer the chance to develop social skills, greater flexibility in relationships and a better understanding of one’s own emotions.

The support of loved ones is just as important – it ensures that a person on the spectrum is not left to face their difficulties alone, but learns to make the most of their strengths. Appropriately tailored support enables them to build a life based on their abilities, rather than their limitations.

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