Asperger's syndrome (ASD-AS) is characterised by the core symptoms of ASD in the absence of an intellectual disability or a language delay. Clinical features are highly heterogeneous and vary depending on age and co-occurring psychiatric conditions.
Symptoms characteristic of the broader ASD spectrum can be found here.
The most typical symptoms of Asperger's syndrome are:
- No language delay
- Average or above-average intelligence
- Noticeable differences in social interaction
- Repetitive behaviours
- An intense, focused approach to certain interests or activities
People with Asperger's syndrome (ASD-AS) are considered high-functioning, which means that:
- They are more likely to go undiagnosed in childhood (due to their masking skills)
- They may need less day-to-day support
- They do not have communication or language delays*
*Although Asperger's syndrome is a subtype of ASD without a language delay, certain pragmatic language skills, such as prosody, are noticeably affected. Prosody can be described as the rhythm, stress and intonation patterns of speech. It plays a major role in conveying meaning and is key to effective communication. One example of a prosody difficulty is a sentence lexically expressing surprise being spoken in a flat, monotone voice, or a statement being spoken with the intonation of a question. It is worth noting that people with high-functioning autism often mask their autistic traits, so a flat intonation may be replaced with correct, or sometimes even exaggerated, overly precise intonation.
Symptoms of Asperger's syndrome can be divided into the following categories:
- IMAGINATION AND COGNITIVE FLEXIBILITY
People with Asperger's syndrome may have difficulty with flexible and abstract thinking, which can show up in several ways: an inability to understand other people's points of view, and taking things literally.
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DIFFICULTIES WITH SENSORY STIMULI
People with Asperger's syndrome may be more sensitive to certain sounds or sensory stimuli, such as noise, smell and light. This can lead to a feeling of "overload". This often means they live with a degree of anxiety about unexpected sensory input and may sometimes need to withdraw to a more comfortable environment.
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MOTOR DIFFICULTIES
Impaired motor skills can show up as clumsy or awkward movements. This can lead to difficulties with activities such as writing, drawing and sport. According to one theory, some people with ASD-AS have impaired procedural memory. Procedural memory is a type of unconscious memory that allows us to carry out certain tasks automatically, without thinking — such as tying shoelaces. This theory has since been scientifically disproven: people with ASD-AS do not have problems with procedural memory, and their focus and mental effort when carrying out a learned task simply reflects their different sensory processing.
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ORGANISATIONAL DIFFICULTIES
Most people with Asperger's syndrome need a highly organised environment. Unexpected situations or changes can cause them significant anxiety.
Asperger's syndrome and masking – high-functioning autism
High-functioning individuals are able to mask their autistic traits in order to fit in with those around them. One example of this is preparing "scripts" — standard phrases, behaviours and responses expected in a given social situation. Avoiding eye contact is a characteristic feature; a person with ASD-AS may feel uncomfortable looking someone directly in the eye. In this case, masking would involve forcing themselves to maintain eye contact in order to fit in. People with Asperger's syndrome often suppress stereotyped behaviours (stimming) — self-stimulatory behaviours such as repetitive movements or sounds.
Symptoms of Asperger's syndrome in children
The first signs of Asperger's syndrome can appear as early as infancy. In infants later found to have ASD-AS, weaker non-verbal communication with those around them is observed between 9 and 12 months of age. These infants communicate less through looks, facial expressions or sounds, and make less eye contact compared with their peers. Social skills training is very important, particularly during the period when the child starts interacting with peers. A child with Asperger's syndrome can function better provided that carers offer appropriate support for their neurodiversity and are taught, through psychoeducation, how to respond.
Symptoms of Asperger's syndrome in teenagers
Asperger's syndrome can be characterised by specific areas of interest, along with clumsiness and awkwardness:
The presentation of Asperger's syndrome tends to become more noticeable with age. Some children with Asperger's syndrome (ASD-AS) engage in repetitive and stereotyped play — for example, they may spend days at a time engaged in "pretend" play. They may have very specific interests that are unusual in terms of the degree of engagement involved. Children with ASD-AS often develop an interest in particular subjects, such as technical details of trains, mechanics, space, history, music or meteorology. Motor coordination difficulties, along with an unusual gait and posture (arising from atypical sensory integration), are common in people with ASD-AS. As a result, they may show little interest in sport, and some may find activities such as drawing, writing or doing up shirt buttons difficult. It is worth noting that not all of the symptoms listed here need be present in a child with Asperger's syndrome — for example, a child need not differ from their peers in terms of physical ability or motor coordination at all.
Symptoms in adults
Late diagnosis:
Asperger's syndrome is often not diagnosed until adulthood. ASD-AS is frequently associated with delayed clinical diagnosis, often until age 11 or later. This diagnostic delay is more likely because this subtype of ASD can compensate reasonably well for social difficulties. People with ASD-AS have average or above-average intelligence, which can mean they are able to mask their differences in social interaction quite effectively. However, these compensatory strategies become harder to sustain as social environments become more complex. In addition, this way of functioning ultimately breaks down because of inflexibility and difficulty coping with change in areas such as relationships or starting a job. Masking can be extremely exhausting, leading to an increased risk of anxiety and depression in people with ASD-AS.
Symptoms in this group are non-specific and mainly relate to social interaction. Particular areas where these autistic traits may become apparent in adults with ASD-AS include:
Work
Some people with ASD-AS communicate in a very formal, direct manner, often without realising that a particular comment might cause offence. This can create difficulties in the workplace, particularly in roles that require teamwork. In addition, their limited flexibility may mean they follow certain routines very strictly, and any disruption to these routines can generate anxiety. For example, they may keep their belongings in a specific place on their desk, or start and finish the working day at a strictly defined time. Even with a university degree, finding a first job can be challenging because of the difficulties they may experience during interviews. However, they may also bring many valuable qualities, such as punctuality, honesty, creativity and strong logical thinking skills.
Relationships
The autism spectrum (including Asperger's syndrome) has historically been mistakenly linked with hypo-empathy (low empathy), a trait associated with alexithymia. The latest functional neuroimaging research shows no difference in empathy between autistic and non-autistic individuals. However, people with ASD-AS may have difficulty reading facial expressions, and consequently have difficulty recognising emotions.
