Editing Asperger syndrome (section)

== Characteristics ==
[[File:Autism-stacking-cans 2nd edit.jpg|thumb|upright|People with Asperger syndrome often display restricted or specialized interests, such as this boy's interest in stacking cans.|alt=A young boy is seen stacking several colorful cans on top of each other.]]

As a [[pervasive developmental disorder]], Asperger syndrome is distinguished by a pattern of symptoms rather than a single symptom. It is characterized by qualitative impairment in social interaction, by stereotyped and restricted patterns of behavior, activities, and interests, and by no clinically significant delay in cognitive development or general delay in language.<ref name="DSM-IV-TR 299.80">{{cite book|title=Diagnostic and Statistical Manual of Mental Disorders|edition=4th, text revision ([[DSM-IV-TR]])|author=American Psychiatric Association|year=2000|isbn=978-0-89042-025-6|chapter=Diagnostic criteria for 299.80 Asperger's Disorder (AD) |publisher=American Psychiatric Association|location=Arlington, VA}}</ref> Intense preoccupation with a narrow subject, one-sided [[verbosity]], restricted [[Prosody (linguistics)|prosody]], and physical clumsiness are typical of the condition, but are not required for diagnosis.<ref name=Klin />

Suicidal thoughts and behaviors are a serious concern within the autistic population. One study found that adults with Asperger syndrome exhibited suicidal thoughts at 9 times the rate of the general population. Of autistic study participants, 66% had experienced [[suicidal ideation]], while 35% had planned or attempted suicide.<ref>{{cite journal | pmid = 26360578 | date = 2014 | last1 = Cassidy | first1 = S. | last2 = Bradley | first2 = P. | last3 = Robinson | first3 = J. | last4 = Allison | first4 = C. | last5 = McHugh | first5 = M. | last6 = Baron-Cohen | first6 = S. | title = Suicidal ideation and suicide plans or attempts in adults with Asperger's syndrome attending a specialist diagnostic clinic: A clinical cohort study | journal = The Lancet. Psychiatry | volume = 1 | issue = 2 | pages = 142–147 | doi = 10.1016/S2215-0366(14)70248-2 }}</ref><ref>{{cite journal | vauthors = Newell V, Phillips L, Jones C, Townsend E, Richards C, Cassidy S | title = A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability | journal = Molecular Autism | volume = 14 | issue = 1 | pages = 12 | date = March 2023 | pmid = 36922899 | pmc = 10018918 | doi = 10.1186/s13229-023-00544-7 | doi-access = free }}</ref>

=== Social interaction ===
{{Further|Asperger syndrome and interpersonal relationships}}

A lack of demonstrated [[empathy]] affects aspects of social relatability for persons with Asperger syndrome.<ref name="Baskin">{{cite journal |vauthors=Baskin JH, Sperber M, Price BH |year=2006 |title=Asperger syndrome revisited |journal=Reviews in Neurological Diseases |volume=3 |issue=1 |pages=1–7 |pmid=16596080}}</ref> Individuals with Asperger syndrome experience difficulties in basic elements of social interaction, which may include a failure to develop friendships or to seek shared enjoyments or achievements with others (e.g., showing others objects of interest); a lack of social or emotional [[Reciprocity (social psychology)|reciprocity]]; and impaired [[Nonverbal communication|nonverbal behaviors]] in areas such as [[eye contact]], [[facial expression]], posture, and gesture.<ref name=McPart2006 />

People with Asperger syndrome may not be as withdrawn around others, compared with those with other forms of autism; they approach others, even if awkwardly. For example, a person with Asperger syndrome may engage in a one-sided, long-winded speech about a favorite topic, while misunderstanding or not recognizing the listener's feelings or reactions, such as a wish to change the topic of talk or end the interaction.<ref name=Klin /> This social awkwardness has been called "active but odd".<ref name=McPart2006 /> Such failures to react appropriately to social interaction may appear as disregard for other people's feelings and may come across as rude or insensitive.<ref name=Klin /> However, not all individuals with Asperger syndrome will approach others. Some may even display [[selective mutism]], not speaking at all to most people and excessively to specific others.<ref>{{cite web|url=http://emedicine.medscape.com/article/912296-overview|work=Medscape eMedicine|title=Asperger's Syndrome| vauthors = Brasic JR|date=7 July 2010|access-date=25 November 2010|url-status=live|archive-url= https://web.archive.org/web/20101223170232/http://emedicine.medscape.com/article/912296-overview |archive-date=23 December 2010}}</ref>

The cognitive ability of children with Asperger syndrome often allows them to articulate [[social norms]] in a laboratory context,<ref name=McPart2006 /> where they may be able to show a theoretical understanding of other people's emotions; however, they typically have difficulty acting on this knowledge in fluid, real-life situations.<ref name=Klin /> People with Asperger syndrome may analyze and distill their observations of social interaction into rigid behavioral guidelines and apply these rules in awkward ways, such as forced eye contact, resulting in a demeanor that appears rigid or socially naïve. A history of failed attempts to establish reciprocal social relationships can cause autistic individuals to isolate themselves and cease attempts to engage; however, autistic people overwhelmingly report a desire for social contact and friendship.<ref name=McPart2006 />

==== Violent or criminal behavior ====
The [[hypothesis]] that individuals with Asperger syndrome are predisposed to violent or criminal behavior has been investigated but is unsupported by data.<ref>{{cite journal | vauthors = Allen D, Evans C, Hider A, Hawkins S, Peckett H, Morgan H | title = Offending behaviour in adults with Asperger syndrome | journal = Journal of Autism and Developmental Disorders | volume = 38 | issue = 4 | pages = 748–58 | date = April 2008 | pmid = 17805955 | doi = 10.1007/s10803-007-0442-9 | s2cid = 12999370 }}</ref><ref>{{cite journal |title=Violent behavior in autism spectrum disorders: Who's at risk? |journal=Aggression and Violent Behavior |year=2018 | vauthors = Del Pozzo J, Roché M, Silverstein S |volume=39 |pages=53–60 |doi=10.1016/j.avb.2018.01.007 }}</ref> More evidence suggests that children diagnosed with Asperger syndrome are more likely to be victims, rather than offenders.<ref name=Tsatsanis>{{cite journal | vauthors = Tsatsanis KD | title = Outcome research in Asperger syndrome and autism | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 12 | issue = 1 | pages = 47–63, vi | date = January 2003 | pmid = 12512398 | doi = 10.1016/S1056-4993(02)00056-1 }}</ref>

A 2008 review found that about 80% of reported violent criminals with Asperger syndrome also had other coexisting psychotic [[psychiatric disorders]] such as [[schizoaffective disorder]]. The sample size of this review was small (''n'' = 37).<ref>{{cite journal | vauthors = Newman SS, Ghaziuddin M | s2cid = 207158193 | title = Violent crime in Asperger syndrome: the role of psychiatric comorbidity | journal = Journal of Autism and Developmental Disorders | volume = 38 | issue = 10 | pages = 1848–52 | date = November 2008 | pmid = 18449633 | doi = 10.1007/s10803-008-0580-8}}</ref>

=== Empathy ===
People with an Asperger profile might not be recognized for their empathetic qualities, due to variation in the ways [[empathy]] is felt and expressed. Some people feel deep empathy, but do not outwardly communicate these sentiments through facial expressions or language. Some people come to empathy through intellectual processes, using logic and reasoning to arrive at the feelings. People with Asperger profiles may be bullied or excluded by peers, and might as a result be guarded around people, which could appear as lack of empathy. People with Asperger profiles can still be caring individuals; indeed, it is particularly common for those with the profile to feel and exhibit deep concern for individual rights, human welfare, animal rights, environmental protection, and other global and humanitarian causes.<ref>{{Cite news | vauthors = Rourke A |date=2019-09-02 |title=Greta Thunberg responds to Asperger's critics: 'It's a superpower' |language=en-GB |work=The Guardian |url=https://www.theguardian.com/environment/2019/sep/02/greta-thunberg-responds-to-aspergers-critics-its-a-superpower |access-date=2023-02-02 |issn=0261-3077}}</ref>

Evidence suggests that in the "[[double empathy problem]] model, autistic people have a unique interaction style which is significantly more readable by other autistic people, compared to non-autistic people."<ref>{{Cite web |date=2016-03-29 |title=We May Have Been Wrong About Autism And Empathy |url=https://www.huffpost.com/entry/autism-empathy-brain-research_n_56f92575e4b014d3fe237413 |access-date=2022-04-08 |website=HuffPost UK |language=en}}</ref><ref>{{Cite web |date=2016-07-29 |title=Asperger Profiles: Emotions and Empathy |url=https://www.aane.org/emotions-and-empathy/ |access-date=2022-04-08 |website=The Asperger / Autism Network (AANE) |language=en-US}}</ref><ref>{{cite journal | vauthors = Patil I, Melsbach J, Hennig-Fast K, Silani G | title = Divergent roles of autistic and alexithymic traits in utilitarian moral judgments in adults with autism | journal = Scientific Reports | volume = 6 | issue = 1 | pages = 23637 | date = March 2016 | pmid = 27020307 | pmc = 4810325 | doi = 10.1038/srep23637 | bibcode = 2016NatSR...623637P }}</ref><ref>{{cite journal | vauthors = Mitchell P, Sheppard E, Cassidy S | title = Autism and the double empathy problem: Implications for development and mental health | journal = The British Journal of Developmental Psychology | volume = 39 | issue = 1 | pages = 1–18 | date = March 2021 | pmid = 33393101 | doi = 10.1111/bjdp.12350 | s2cid = 230489027 | doi-access = free }}</ref>

=== Restricted and repetitive interests and behavior ===

People with Asperger syndrome can display behavior, interests, and activities that are restricted and repetitive and are sometimes abnormally intense or focused. They may stick to inflexible routines, move in [[Stereotypy|stereotyped]] and repetitive ways, preoccupy themselves with parts of objects, or engage in compulsive behaviors like lining objects up to form patterns.<ref name="DSM-IV-TR 299.80" />

The pursuit of specific and narrow areas of interest is one of the most striking among possible features of AS.<ref name=McPart2006 /> Individuals with AS may collect volumes of detailed information on a relatively narrow topic such as weather data or star names without necessarily having a genuine understanding of the broader topic.<ref name=McPart2006 /><ref name=Klin /> For example, a child might memorize camera model numbers while caring little about photography.<ref name=McPart2006 /> This behavior is usually apparent by age five or six.<ref name=McPart2006 /> Although these [[Special interest (autism)|special interests]] may change from time to time, they typically become more unusual and narrowly focused and often dominate social interaction so much that the entire family may become immersed. Because narrow topics often capture the interest of children, this symptom may go unrecognized.<ref name=Klin />

Stereotyped and repetitive motor behaviors, called [[stimming]], are a core part of the diagnosis of AS and other ASDs.<ref>{{cite journal | vauthors = South M, Ozonoff S, McMahon WM | s2cid = 36078197 | title = Repetitive behavior profiles in Asperger syndrome and high-functioning autism | journal = Journal of Autism and Developmental Disorders | volume = 35 | issue = 2 | pages = 145–58 | date = April 2005 | pmid = 15909401 | doi = 10.1007/s10803-004-1992-8}}</ref> Stims are believed to be used for self-soothing and regulate [[Sensory processing disorder|sensory input]].<ref>{{Cite book |last=Foley |first=Valerie |url=https://books.google.com/books?id=FGO8S2RmckEC |title=The Autism Experience: International Perspectives on Autism Parenting |date=October 2011 |publisher=ReadHowYouWant.com |isbn=978-1-4587-9728-5 |language=en}}</ref> They include hand movements such as flapping or twisting, and complex whole-body movements.<ref name="DSM-IV-TR 299.80" /> These are typically repeated in longer bursts and look more voluntary or ritualistic than [[tic]]s, which are usually faster, less rhythmical, and less often symmetrical.<ref name=RapinTS>{{cite journal | vauthors = Rapin I | title = Autism spectrum disorders: relevance to Tourette syndrome | journal = Advances in Neurology | volume = 85 | pages = 89–101 | year = 2001 | pmid = 11530449}}</ref> Stimming may have a connection with tics, and studies have reported a consistent comorbidity between AS and [[Tourette syndrome]] in the range of 8–20%,<ref name=RapinTS/><ref>{{cite journal|vauthors=Steyaert JG, De la Marche W|year=2008|title=What's new in autism?|url=https://www.academia.edu/24262348|journal=Eur J Pediatr|volume=167|issue=10|pages=1091–101|doi=10.1007/s00431-008-0764-4|pmid=18597114|s2cid=11831418}}</ref><ref name="Mazzone">{{cite journal | vauthors = Mazzone L, Ruta L, Reale L | title = Psychiatric comorbidities in asperger syndrome and high functioning autism: diagnostic challenges | journal = Annals of General Psychiatry | volume = 11 | issue = 1 | pages = 16 | date = June 2012 | pmid = 22731684 | pmc = 3416662 | doi = 10.1186/1744-859X-11-16 | doi-access = free }}</ref><ref name="Gillberg&Billstedt2000"/> with one figure as high as 80% for tics of some kind or another,<ref name="Gillberg&Billstedt2000" /> for which several explanations have been put forward, including common genetic factors and [[dopamine]], [[glutamate]], or [[serotonin]] abnormalities.<ref>{{cite journal | vauthors = Zafeiriou DI, Ververi A, Vargiami E | title = Childhood autism and associated comorbidities | journal = Brain & Development | volume = 29 | issue = 5 | pages = 257–72 | date = June 2007 | pmid = 17084999 | doi = 10.1016/j.braindev.2006.09.003 | s2cid = 16386209}}</ref>

According to the Adult Asperger Assessment (AAA) diagnostic test, a lack of interest in fiction and a positive preference towards non-fiction is common among adults with AS.<ref name=ASAdulthood />

=== Speech and language ===
Although individuals with Asperger syndrome acquire language skills without significant general delay and their speech typically lacks significant abnormalities, [[language acquisition]] and use is often atypical.<ref name=Klin /> Abnormalities include verbosity; abrupt transitions; literal interpretations and miscomprehension of nuance; use of metaphor meaningful only to the speaker; [[Auditory processing disorder|auditory perception deficits]]; unusually [[Pedantic speech|pedantic]], [[Register (sociolinguistics)|formal]], or [[Idiosyncrasy#Psychiatry and psychology|idiosyncratic]] speech; and oddities in loudness, [[Tone (linguistics)|pitch]], [[Intonation (linguistics)|intonation]], [[Prosody (linguistics)|prosody]], and rhythm.<ref name=McPart2006 /> [[Echolalia]] has also been observed in individuals with AS.<ref>{{cite journal | vauthors = Frith U | s2cid = 978233 | title = Social communication and its disorder in autism and Asperger syndrome | journal = Journal of Psychopharmacology | volume = 10 | issue = 1 | pages = 48–53 | date = January 1996 | pmid = 22302727 | doi = 10.1177/026988119601000108}}</ref>

Three aspects of communication patterns are of clinical interest: poor prosody, [[Tangential speech|tangential]] and [[circumstantial speech]], and marked verbosity. Although [[inflection]] and intonation may be less rigid or monotonic than in classic autism, people with AS often have a limited range of intonation: speech may be unusually fast, jerky, or loud. Speech may convey a sense of [[Coherence (linguistics)|incoherence]]; the conversational style often includes monologues about topics that bore the listener, fails to provide [[Context (language use)|context]] for comments, or fails to suppress internal thoughts. Individuals with AS may fail to detect whether the listener is interested or engaged in the conversation. The speaker's conclusion or point may never be made, and attempts by the listener to elaborate on the speech's content or logic, or to shift to related topics, are often unsuccessful.<ref name=Klin />

Children with AS may have a sophisticated vocabulary at a young age and such children have often been colloquially called "little professors"<ref>{{cite web|url=https://archive.nytimes.com/www.nytimes.com/library/magazine/home/20000618mag-asperger.html|title=The Little Professor Syndrome | vauthors = Osborne L |work=The New York Times|date=18 June 2000}}</ref> but have difficulty understanding [[figurative language]] and tend to use language literally.<ref name=McPart2006 /> Children with AS appear to have particular weaknesses in areas of nonliteral language that include [[humor]], [[irony]], [[teasing]], and [[sarcasm]]. Although individuals with AS usually understand the cognitive basis of humor, they seem to lack understanding of the intent of humor to share the enjoyment with others.<ref name=Kasari /> Despite strong evidence of impaired humor appreciation, anecdotal reports of humor in individuals with AS seem to challenge some psychological theories of AS and autism.<ref>{{cite journal | vauthors = Lyons V, Fitzgerald M | s2cid = 22187553 | title = Humor in autism and Asperger syndrome | journal = Journal of Autism and Developmental Disorders | volume = 34 | issue = 5 | pages = 521–31 | date = October 2004 | pmid = 15628606 | doi = 10.1007/s10803-004-2547-8}}</ref>

=== Motor and sensory perception ===
Individuals with Asperger syndrome may have signs or symptoms that are independent of the diagnosis but can affect the individual or the family.<ref>{{cite journal | vauthors = Filipek PA, Accardo PJ, Baranek GT, Cook EH, Dawson G, Gordon B, Gravel JS, Johnson CP, Kallen RJ, Levy SE, Minshew NJ, Ozonoff S, Prizant BM, Rapin I, Rogers SJ, Stone WL, Teplin S, Tuchman RF, Volkmar FR | s2cid = 145113684 | title = The screening and diagnosis of autistic spectrum disorders | journal = Journal of Autism and Developmental Disorders | volume = 29 | issue = 6 | pages = 439–84 | date = December 1999 | pmid = 10638459 | doi = 10.1023/A:1021943802493}}</ref> These include differences in perception and problems with motor skills, sleep, and emotions.

Individuals with AS often have excellent [[Hearing (sense)|auditory]] and [[visual perception]].<ref>{{cite journal | vauthors = Frith U | title = Emanuel Miller lecture: confusions and controversies about Asperger syndrome | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 45 | issue = 4 | pages = 672–86 | date = May 2004 | pmid = 15056300 | doi = 10.1111/j.1469-7610.2004.00262.x| doi-access = free }}</ref> Children with ASD often demonstrate enhanced perception of small changes in patterns such as arrangements of objects or well-known images; typically this is domain-specific and involves processing of fine-grained features.<ref>{{cite book|chapter=Psychological factors in autism |vauthors=Prior M, Ozonoff S|pages=69–128|title=Autism and Pervasive Developmental Disorders|edition=2nd| veditors = Volkmar FR |publisher=Cambridge University Press|year=2007|isbn=978-0-521-54957-8}}</ref> Conversely, compared with individuals with high-functioning autism, individuals with AS have deficits in some tasks involving visual-spatial perception, auditory perception, or [[visual memory]].<ref name=McPart2006 /> Many accounts of individuals with AS and ASD report other unusual [[sensory processing|sensory]] and perceptual skills and experiences. They may be unusually sensitive or insensitive to sound, light, and other stimuli;<ref>{{cite book|vauthors=Bogdashina O|title=Sensory Perceptional Issues in Autism and Asperger Syndrome: Different Sensory Experiences, Different Perceptual Worlds|publisher=Jessica Kingsley|year=2003|isbn=978-1-84310-166-6}}</ref> these sensory responses are found in other developmental disorders and are not specific to AS or to ASD. There is little support for increased [[fight-or-flight response]] or failure of [[habituation]] in autism; there is more evidence of decreased responsiveness to sensory stimuli, although several studies show no differences.<ref>{{cite journal | vauthors = Rogers SJ, Ozonoff S | title = Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 46 | issue = 12 | pages = 1255–68 | date = December 2005 | pmid = 16313426 | doi = 10.1111/j.1469-7610.2005.01431.x}}</ref>

Hans Asperger's initial accounts<ref name="McPart2006" /> and other diagnostic schemes<ref name="EhlGill">{{cite journal | vauthors = Ehlers S, Gillberg C | title = The epidemiology of Asperger syndrome. A total population study | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 34 | issue = 8 | pages = 1327–50 | date = November 1993 | pmid = 8294522 | doi = 10.1111/j.1469-7610.1993.tb02094.x}}</ref> include descriptions of physical clumsiness. Children with AS may be delayed in acquiring skills requiring [[dexterity]], such as riding a bicycle or opening a jar, and may seem to move awkwardly or feel "uncomfortable in their own skin". They may be poorly coordinated or have an odd or bouncy gait or posture, poor handwriting, or problems with [[motor coordination]].<ref name="McPart2006" /><ref name="Klin" /> They may show problems with [[proprioception]] (sensation of body position) on measures of [[developmental coordination disorder]] ([[motor planning]] disorder), balance, [[tandem gait]], and finger-[[thumb apposition]]. There is no evidence that these motor skills problems differentiate AS from other high-functioning ASDs.<ref name="McPart2006" />

Children with AS are more likely to have sleep problems, including difficulty in falling asleep, frequent [[Middle-of-the-night insomnia|nocturnal awakenings]], and early morning awakenings.<ref>{{cite journal | vauthors = Polimeni MA, Richdale AL, Francis AJ | title = A survey of sleep problems in autism, Asperger's disorder and typically developing children | journal = Journal of Intellectual Disability Research | volume = 49 | issue = Pt 4 | pages = 260–68 | date = April 2005 | pmid = 15816813 | doi = 10.1111/j.1365-2788.2005.00642.x}}</ref><ref name=Tani /> AS is also associated with high levels of [[alexithymia]], which is difficulty in identifying and describing one's emotions.<ref>Alexithymia and AS:
* {{cite journal | vauthors = Fitzgerald M, Bellgrove MA | title = The overlap between alexithymia and Asperger's syndrome | journal = Journal of Autism and Developmental Disorders | volume = 36 | issue = 4 | pages = 573–76 | date = May 2006 | pmid = 16755385 | pmc = 2092499 | doi = 10.1007/s10803-006-0096-z}}
* {{cite journal | vauthors = Hill EL, Berthoz S | s2cid = 28686022 | title = Response to "Letter to the Editor: The overlap between alexithymia and Asperger's syndrome", Fitzgerald and Bellgrove, Journal of Autism and Developmental Disorders, 36(4) | journal = Journal of Autism and Developmental Disorders | volume = 36 | issue = 8 | pages = 1143–45 | date = November 2006 | pmid = 17080269 | doi = 10.1007/s10803-006-0287-7}}
* {{cite journal | vauthors = Lombardo MV, Barnes JL, Wheelwright SJ, Baron-Cohen S | title = Self-referential cognition and empathy in autism | journal = PLOS ONE | volume = 2 | issue = 9 | pages = e883 | date = September 2007 | pmid = 17849012 | pmc = 1964804 | doi = 10.1371/journal.pone.0000883 | veditors = Zak P | bibcode = 2007PLoSO...2..883L| doi-access = free }}</ref> Although AS, lower sleep quality, and alexithymia are associated with each other, their causal relationship is unclear.<ref name=Tani>{{cite journal | vauthors = Tani P, Lindberg N, Joukamaa M, Nieminen-von Wendt T, von Wendt L, Appelberg B, Rimón R, Porkka-Heiskanen T | s2cid = 45311366 | title = Asperger syndrome, alexithymia and perception of sleep | journal = Neuropsychobiology | volume = 49 | issue = 2 | pages = 64–70 | year = 2004 | pmid = 14981336 | doi = 10.1159/000076412}}</ref>