Asperger’s is often thought of as the other end of the autism spectrum or the ‘‘lighter’’ version, emphasizing social and communication difficulties as opposed to the pervasive language deficits. By definition, Asperger’s disorder means impaired social interaction, restricted interests and activities without the significant delay in language, and average and/or above average intelligence.
A thorough psychological evaluation of those individuals who meet the DSM criteria for the diagnosis of Asperger’s tends to result in the finding of a more fragile emotional persona along the schizophrenia continuum. Whether the diagnosis is that of schizoid personality features, schizotypal personality, schizoaffective disorder or frank schizophrenia tends to depend upon the developmental age of the person and the degree of environmental stressors present in their life. The idea being that this fragile emotional status leaves the individual so vulnerable to their external environment that they require the protection of retreating inward emotionally and removing themselves socially as a defense mechanism to protect against the excess internal sensitivity. These are the individuals diagnosed in adolescence. They may come across as odd, eccentric, quirky individuals attempting to cope with the overflow of emotions and the difficulty existing in the real world on a day to day basis.
But what about the child diagnosed with Asperger’s? They may say the wrong thing at the wrong time that is often inappropriate and/or not germane to the conversation. They may become overly focused upon one particular topic, discussing this in detail without regard to whether the person is listening or not. In this regard while being overly sensitive they are highly insensitive in recognizing the non-verbal reactions of others, showing little empathy. Difficulty reading the non-verbal emotions and understanding the role they have in relationships results in the overlap with non-verbal learning disabilities.
The question is which came first, a brain problem or an emotional problem? We know that emotional problems can be sufficiently severe to create thinking problems. Taken from a brain perspective these children may have executive reasoning deficits that result in the inability to place themselves in someone else’s shoes or to integrate all of the factors into the big social picture. Outwardly they may appear aloof, socially awkward and clearly different from their peers.
Asperger’s syndrome (referenced as Asperger’s disorder) did not appear as a separate entity until 1980 and the debate remains as to whether Asperger’s and autism are actually separate entities or represent a continuum.
The primary distinction of Asperger’s is the lack of cognitive impairment or significant fluctuations in their neuropsychological functioning, the exact opposite of the definition of autism. However what if you had a bright person with injury to the brain particularly in the executive reasoning areas; might they not appear with qualities of Asperger’s?
Therefore it becomes important to separate out factors of injury to the brain as well as sleep disorders that may result in similar behaviors and social difficulties and to determine which came first. Did the emotional problem create a thinking problem, or is the thinking problem a symptom of a disorder affecting the brain?