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Asperger's Disorder | Dr. William Winter is a child and adolescent psychiatrist.
Will Winter, MD, FAAP
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Vignette
A 50 year-old man who just had his birthday presents to the office because he feels "stuck". He works in a cubicle and has been working at the same place for over 25 years. He is good at what he does. That's not the problem. The problem is that he doesn't have close friends. He has never had what can be considered a meaningful relationship.

Friends: He has problems making them. When he is in a social situation, he becomes very anxious and uncomfortable. Because of this, he has learned to avoid situations in which he can meet new people or make new friends.

Romantic: He once was with a woman for a period of time but didn't feel any sense of connection whatsoever. To this day, no apparent impression from this relationship was left on him. On the other hand, ironically, he describes falling in love once with a woman who he walked home one week on 5 consecutive days, at the end of which she told him that she had a boyfriend. Although that was the end of this limited relationship, he considers that to be the one love of his life to date.

Thought Process: This man is intelligent. His thought process is logical and goal directed. One thing that is remarkable about his thought process is that he tends to get stuck on certain subjects. Some of these are subjects that cause him great pain that he is trying to resolve and some subjects are areas of unique fascination that others do not share. (In fact, the symptom of obsessive thoughts found in Asperger's Disorder is sometimes mistakenly diagnosed as Obsessive Compulsive Disorder (OCD).

Understandably, it can be awkward when he tries to make conversation with someone because he will talk about subjects that are of interest to him and not to the other person.

He would like to have more substantial relationships and would like to get married. But he doesn't know how to go about doing this. In fact, he is extremely uncomfortable when it comes to meeting or interacting with people.

On presentation he is polite and unremarkable in appearance.

Discussion
Asperger's Disorder is similar to Autism in some respects and different in one major aspect.

Similarities may include impairment in:
Social Interaction
Restricted repetitive and stereotyped patterns of behavior, interests and activities.

What is important to know is that, as opposed to autism, there is no impairment or delay in language and communication. There is no delay or impairment in cognitive skills or adaptability.

In this vignette, a 50 year old was presented. He could have been 60, 70 or 80. The point is that although all the symptoms of this disorder first become apparent in childhood, it often goes unrecognized and parents do not get help. That is sad because these symptoms do not resolve on their own. Symptoms can improve with treatment- regardless if that treatment starts at 5 or 50. Of course, treatment in childhood can spare the person from a lifetime of severe impairment.

Treatment for Asperger's Disorder includes talk therapy, i.e. Cognitive-Behavioral Therapy (CBT). This may include relaxation exercises and systematic desensitization. Group therapy can help. Medication may also be useful if indicated.

Therapy over time can help. If left untreated, it is likely that there will be no improvement over the course of one's lifespan.