Are there patients who do not have serious 'mental health' difficulties1, yet find it hard to fit in socially, have an unusual social style, may be unable to complete a college course, have no friends, experience anxiety and stress, or cannot find stable employment? If so, they may have Asperger syndrome.

What is Asperger syndrome?

Asperger syndrome is a developmental disorder on the autism spectrum. If your patient list is 5,000, expect there to be between 18 and 24 people with Asperger syndrome2.

People with Asperger syndrome experience difficulty in communicating effectively with others. They often have problems making 'appropriate' conversation, and sometimes seem pedantic. They can have issues with eye contact, and a poor understanding of others' non-verbal behaviour, such as intonation of voice and facial expressions.

People with Asperger syndrome find it difficult to interact with others, have problems forming close relationships with peers and often find it hard to 'read' others, act in groups, or understand others' humour. Their inability to read people's intentions can often make them vulnerable and can lead to them being taken advantage of.

Many people with Asperger syndrome desire social contact but struggle to understand the reciprocal nature of 'typical' social interaction. As a consequence, their attempts at interaction can sometimes seem rather awkward. It can make the person prone to teasing and to isolation, and can also make them them appear socially 'inappropriate'.

People with Asperger syndrome often have a need for routines, and may have narrow interests. This may not be obvious, unless asked about. They may also depend on others for the routines of daily life in a way not expected, given their apparent intelligence.

Some people with Asperger syndrome can experience over- or under-sensitivity to sounds, touch, tastes, smells, light or colours. Be aware that adults who have Asperger syndrome may have learned to 'cover up' their problems, so signs of the condition will often be quite subtle. This is why they experience difficulty in getting support. As a result of their difficulties with social interaction and communication and a lack of support, many adults with Asperger syndrome end up socially isolated and can consequently develop mental health difficulties.

Contact our Autism Helpline on 0808 800 4102 (open 10am-4pm, Mon-Fri) for further information and guidance.

Questions to ask patients

The following are suggested questions to consider when talking with adult patients who may have Asperger syndrome

Does he or she:

  • find many social situations and interactions, especially in groups, confusing (even though he or she may seem OK one-to-one with a doctor)?
  • often find it hard to guess what other people are thinking and feeling, or why they are laughing at a joke?
  • find it difficult to make and maintain close friendships?
  • have a history of problems at school/college, such as difficulties getting on with tutors or other pupils/students? Was he or she teased or bullied?
  • find it difficult to find satisfactory employment or stay in work?
  • have any hobbies or interests which take up a lot of their time (or had these when they were younger)?
  • get worried or annoyed about changes, especially unexpected ones?
  • display difficulties with communication, and appear to lack social intuition?


If the answer to most of these questions is yes, and your patient wishes to be assessed, it may be worthwhile discussing their case with your local social services/health services with responsibility for Asperger syndrome (usually mental health or learning disability services).

Five reasons why opportunity for diagnosis is important

  • Asperger syndrome is a recognised disability, and is described in both ICD-103 and DSM-IV4 international classification systems. If someone meets the criteria, he or she should have the opportunity to be diagnosed.
  • Diagnosis enables individuals to make sense of their history, which is often marked by difficult experiences and misunderstanding by others.
  • Diagnosis enables individuals to understand themselves better and to make necessary adjustments for their future.
  • Diagnosis can help families, friends, partners and carers to better understand and cope with the individual's needs and behaviour.
  • Diagnosis can help the individual locate local support and social skills groups, and get more appropriate support from employers, social and housing services, benefit agencies, colleges and other organisations.

References

1 Those adults who have Asperger syndrome and have developed serious mental health difficulties should have been referred on already.

2 Latif, A. H. W. and Williams, W. R. (2007). Diagnostic trends in autistic spectrum disorders in the South Wales valleys. Autism, 11 (6), pp.479-487; Kadesjö et al (1999). Brief report: autism and Asperger syndrome in seven-year-old children: a total population study. Journal of Autism and Developmental Disorders, 29 (4), pp 327-331; Ehlers and Gillberg (1993).
The epidemiology of Asperger syndrome. Journal of Child Psychology and Psychiatry, 34 (8), pp 1327-1350.

3 World Health Organisation (1992). International classification of diseases. 10th edition. Geneva: WHO.

4 American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders: DSM IV. Washington DC: American Psychiatric Association.