Children's Health Asperger's syndrome

Subject: Children's Health Asperger's syndrome Sun Jan 02, 2011 8:33 pm

Asperger's syndrome is a
developmental disorder that affects a person's ability to socialize and
communicate effectively with others. Children with Asperger's syndrome
typically exhibit social awkwardness and an all-absorbing interest in
specific topics.

Doctors group Asperger's syndrome with other conditions that are called
autistic spectrum disorders or pervasive developmental disorders. These
disorders all involve problems with social skills and communication.
Asperger's syndrome is generally thought to be at the milder end of this
spectrum.

While there's no cure for Asperger's syndrome, if your child has the
condition treatment can help him or her learn how to interact more
successfully in social situations.

Symptoms

Asperger's syndrome symptoms include:

* Engaging in one-sided, long-winded conversations, without noticing
if the listener is listening or trying to change the subject
* Displaying unusual nonverbal communication, such as lack of eye
contact, few facial expressions, or awkward body postures and gestures
* Showing an intense obsession with one or two specific, narrow
subjects, such as baseball statistics, train schedules, weather or
snakes
* Appearing not to understand, empathize with or be sensitive to others' feelings
* Having a hard time "reading" other people or understanding humor
* Speaking in a voice that is monotonous, rigid or unusually fast
* Moving clumsily, with poor coordination

Unlike children with more-severe forms of autism spectrum disorders,
those with Asperger's syndrome usually don't have delays in the
development of language skills. That means your child will use single
words by the age of 2 and phrases by the time he or she is 3 years old.
But, children with Asperger's syndrome may have difficulties holding
normal conversations. Conversations may feel awkward and lack the usual
give and take of normal social interactions.

Toddlers and school-age children with Asperger's syndrome may not show
an interest in friendships. Youngsters with Asperger's often have
developmental delays in their motor skills, such as walking, catching a
ball or playing on playground equipment.

In early childhood, kids with Asperger's may be quite active. By young
adulthood, people with Asperger's syndrome may experience depression or
anxiety.

When to see a doctor
All kids have their quirks, and many toddlers show a sign or symptom of
Asperger's syndrome at some point. It's natural for small children to be
egocentric, and many children show a strong interest in a particular
topic, such as dinosaurs or a favorite fictional character. These
generally aren't reasons to be alarmed.

However, if your elementary schoolchild has frequent problems in school
or seems unable to make friends, it's time to talk with your child's
doctor. These difficulties have many possible causes, but developmental
disorders such as Asperger's syndrome need to be considered. Children
who have behaviors that interfere with learning and social development
should have a comprehensive evaluation.

Causes

It's not clear what causes Asperger's syndrome, although changes in
certain genes may be involved. The disorder also seems to be linked to
changes in the structure of the brain.

One factor that isn't associated with the development of Asperger's
syndrome or other autism spectrum disorders is childhood immunizations.

Risk factors

Boys are far more likely to develop Asperger's syndrome than are girls.

Preparing for your appointment

You'll probably first see your child's pediatrician or family doctor,
who will likely refer your child to a mental health expert, such as a
child psychologist or psychiatrist.

Being well prepared can help you make the most of your appointment.
Here's some information to help you get ready for your appointment, and
what to expect from your doctor.

What you can do

* Write down any symptoms you've noticed in your child, including
any that may seem unrelated to the reason for which you scheduled the
appointment.
* Write down key personal information, including any major stresses or recent life changes.
* Make a list of any medications, as well as any vitamins or supplements, that your child is taking.
* Ask a family member or friend to join you and your child for the
appointment, if possible. Sometimes it can be difficult to soak up all
the information provided during an appointment. Someone who accompanies
you may remember something that you missed or forgot.
* Write down questions to ask your doctor.

Preparing a list of questions ahead of time will help save time for the
things you want to discuss most. List your questions from most important
to least important in case time runs out. For Asperger's syndrome, some
basic questions to ask your doctor include:

* What is likely causing my child's behavior?
* Are there other possible causes?
* What kinds of tests does my child need?
* Will he or she outgrow this condition?
* What treatments can help?
* Can these treatments cure Asperger's syndrome?
* Are there any specialized programs available to help educate my child regarding social skills?
* What should I tell his or her school?
* What are the alternatives to the primary approach that you're suggesting?
* Would changes in diet help?
* What's the prognosis for my child? Can he or she live a relatively normal life?
* Should I see a specialist?
* Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask additional questions during your appointment.

What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:

* What specific behaviors prompted your visit today?
* When did you first notice these symptoms in your child?
* Have these behaviors been continuous, or occasional?
* Does anything seem to improve your child's symptoms?
* What, if anything, appears to worsen your child's symptoms?
* When did your child first crawl? Walk? Say his or her first word?
* Does your child have close friends?
* What are some of your child's favorite activities? Is there one that he or she favors?
* Have you noticed a change in his or her level of frustration in social settings?

Tests and diagnosis

Because Asperger's syndrome varies widely in severity and signs, making a
diagnosis can be difficult. If your child shows some signs of
Asperger's syndrome, your doctor may suggest a comprehensive assessment
by a team of professionals.

This evaluation will likely include observing your child and talking to
you about your child's development. You may be asked about your child's
social interaction, communication skills and friendships. Your child may
also have a number of tests to determine his or her level of intellect
and academic abilities. Tests may examine your child's abilities in the
areas of speech, language and visual-motor problem solving. Tests can
also identify other emotional, behavioral and psychological issues.

To be diagnosed with Asperger's syndrome, your child's signs and
symptoms must match the criteria spelled out in the Diagnostic and
Statistical Manual of Mental Disorders (DSM), a manual published by the
American Psychiatric Association and used by mental health providers to
diagnose mental conditions.

Some of the DSM criteria for Asperger's syndrome are:

* No significant language delays
* A lack of eye to eye contact
* Unusual body posture or social expressions
* Difficulty making friends
* A preoccupation with one subject
* No interest in interactive play
* An inflexible attitude toward change

Unfortunately, some children with Asperger's syndrome may initially be
misdiagnosed with another problem, such as
attention-deficit/hyperactivity disorder (ADHD) or obsessive-compulsive
disorder, possibly because the symptoms of some conditions are similar
to those of Asperger's. Additionally, these other conditions may coexist
with Asperger's, which can delay the diagnosis.

Treatments and drugs

The core signs of Asperger's syndrome can't be cured. However, many
children with Asperger's syndrome grow into happy and well-adjusted
adults.

Most children benefit from early specialized interventions that focus on
behavior management and social skills training. Your doctor can help
identify resources in your area that may work for your child.

Asperger's syndrome treatment options may include:

Communication and social skills training
Children with Asperger's syndrome may be able to learn the unwritten
rules of socialization and communication when taught in an explicit and
rote fashion, much like the way students learn foreign languages.
Children with Asperger's syndrome may also learn how to speak in a more
natural rhythm, as well as how to interpret communication techniques,
such as gestures, eye contact, tone of voice, humor and sarcasm.

Cognitive behavioral therapy
This general term encompasses many techniques aimed at curbing problem
behaviors, such as interrupting, obsessions, meltdowns or angry
outbursts, as well as developing skills such as recognizing feelings and
coping with anxiety. Cognitive behavioral therapy usually focuses on
training a child to recognize a troublesome situation — such as a new
place or an event with lots of social demands — and then select a
specific learned strategy to cope with the situation.

Medication
There are no medications that specifically treat Asperger's syndrome.
But some medications may improve specific symptoms — such as anxiety,
depression or hyperactivity — that can occur in many children with
Asperger's syndrome. Examples include:

* Aripiprazole (Abilify). This drug may be effective for treating
irritability related to Asperger's syndrome. Side effects may include
weight gain and an increase in blood sugar levels.
* Guanfacine (Intuniv). This medication may be helpful for the
problems of hyperactivity and inattention in children with Asperger's
syndrome. Side effects may include drowsiness, irritability, headache,
constipation and bedwetting.
* Selective serotonin reuptake inhibitors (SSRIs). Drugs such as
fluvoxamine (Luvox) may be used to treat depression or to help control
repetitive behaviors. Possible side effects include restlessness and
agitation.
* Risperidone (Risperdal). This medication may be prescribed for
agitation and irritability. It may cause trouble sleeping, a runny nose
and an increased appetite. This drug has also been associated with an
increase in cholesterol and blood sugar levels.
* Olanzapine (Zyprexa). Olanzapine is sometimes prescribed to reduce
repetitive behaviors. Possible side effects include increased appetite,
drowsiness, weight gain, and increased blood sugar and cholesterol
levels.
* Naltrexone (Revia). This medication, which is sometimes used to
help alcoholics stop drinking, may help reduce some of the repetitive
behaviors associated with Asperger's syndrome. However, the use of
low-dose naltrexone — in doses as low as two to four mg a day — has been
gaining favor recently. But, there's no good evidence that such low
doses have any effect on Asperger's syndrome.

Alternative medicine

Because there are no definitive treatments for Asperger's syndrome, some
parents may turn to complementary or alternative therapies. However,
most of these treatments haven't been adequately studied. It's possible
that by focusing on alternative treatments, you may miss out on behavior
therapies that have more evidence to support their use.

Of greater concern, however, is that some treatments may not be safe.
The Food and Drug Administration has warned about over-the-counter
chelation medications. These drugs have been marketed as a therapy for
autism spectrum disorders and other conditions. Chelation is a therapy
that removes heavy metals from the body, but there are no
over-the-counter chelation therapies that are approved by the Food and
Drug Administration (FDA). This type of therapy should only be done
under the close supervision of medical professionals. According to the
FDA, the risks of chelation include dehydration, kidney failure and even
death.

Other examples of alternative therapies that have been used for Asperger's syndrome include:

Melatonin
Sleep problems are common in children with Asperger's syndrome, and
melatonin supplements may help regulate your child's sleep-wake cycle.
The recommended dose is 3 mg, 30 minutes before bedtime. Possible side
effects include excessive sleepiness, dizziness and headache.

Other dietary supplements
Numerous dietary supplements have been tried in people with autism
spectrum disorders, including Asperger's syndrome. Those that may have
some evidence to support their use include:

* Vitamin B-6 and magnesium
* Vitamin C (usually in combination with other vitamins)
* Carnosine
* Omega-3 fatty acids

Avoidance diets
Some parents have turned to gluten-free or casein-free diets to treat
autism spectrum disorders. There's no clear evidence that these diets
work, and anyone attempting such a diet for their child needs guidance
from a registered dietitian to ensure the child's nutritional
requirements are met.

Secretin
This gastrointestinal hormone has been tried as a potential treatment.
Numerous studies have been conducted on secretin, and none found any
evidence that it helps.

Other therapies that have been tried, but lack objective evidence to
support their use include hyperbaric oxygen therapy, immune therapies,
antibiotics, antifungal drugs, chiropractic manipulations, massage and
craniosacral massage, and transcranial magnetic stimulation.

Coping and support

Asperger's syndrome can be a difficult, lonely disorder — both for
affected children and their parents. The disorder brings difficulties
socializing and communicating with your child. It may also mean fewer
play dates and birthday invitations and more stares at the grocery store
from people who don't understand that a child's meltdown is part of a
disability, not the result of "bad parenting."

Luckily, as this disorder gains widespread recognition and attention,
there are more and more sources of help. Here are a few suggestions:

* Maintain a consistent schedule whenever possible. If you have to introduce change, try to do so gradually.
* Learn about the disorder. There are numerous books and websites
dedicated to the disorder. Do some research so that you better
understand your child's challenges and the range of services in your
school district and state that may help.
* Learn about your child. The signs and symptoms of Asperger's
syndrome vary for each child, and young children have a hard time
explaining their behaviors and challenges. But, with time and patience,
you'll learn which situations and environments may cause problems for
your child and which coping strategies work. Keeping a diary and looking
for patterns may help.
* Find a team of trusted professionals. You'll need to make
important decisions about your child's education and treatment. Find a
team of teachers and therapists who can help evaluate the options in
your area and explain the federal regulations regarding children with
disabilities.
* Help others help your child. Most children with Asperger's
syndrome have no visible sign of disability, so you may need to alert
coaches, relatives and other adults to your child's special needs.
Otherwise, a well-meaning coach may spend time lecturing your child on
"looking at me while I'm talking" — something that can be very difficult
for a child with Asperger's syndrome.
* Help your child turn his or her obsession into a passion. The
tendency to fixate on a particular narrow topic is one of the hallmarks
of Asperger's syndrome, and it can be annoying to those who must listen
to incessant talk about the topic every day. But a consuming interest
can also connect a child with Asperger's syndrome to schoolwork and
social activities. In some cases, kids with Asperger's syndrome can even
turn their childhood fascination into a career or profession.
* Find support. Lean on family and friends when you can. Ask someone
who understands your child's needs to babysit sometimes so that you can
get an occasional break. You may also find a support group for parents
of children with Asperger's syndrome helpful. Ask your child's doctor if
he or she knows of any groups in your area. Or, visit the Online
Asperger Syndrome Information and Support website.

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