Question
Do the symptoms of Aspergers differ according to the age of the person affected by the disorder? In other words, does a young child have a different set of issues compared to a teen or an adult?
Answer
Although there are many possible symptoms related to Aspergers (high functioning autism) across the life-span, the main symptom is usually “severe trouble with social situations” regardless of the age of the individual. An Aspie may have mild to severe symptoms or have a few or many symptoms. Because of the wide variety of symptoms, no two Aspies are alike. Parents often first notice the symptoms of Aspergers when their youngster starts preschool/school and begins to interact with other students.
Symptoms during childhood include the following:
• Appears to lack empathy
• Avoids eye contact or stare at others
• Dislikes any changes in routines
• Does not pick up on social cues and may lack inborn social skills (e.g., being able to read others' body language, start or maintain a conversation, taking turns talking, etc.)
• Handwriting is often poor
• Has a formal style of speaking that is advanced for his or her age (e.g., may use the word "beckon" instead of "call" or the word "return" instead of "come back")
• Has delayed motor development (e.g., late in learning to use a fork or spoon, ride a bike, catch a ball, etc.)
• Has heightened sensitivity and becomes over-stimulated by loud noises, lights, strong tastes, certain textures, etc.
• Has unusual facial expression or posture
• Internal thoughts are often verbalized
• Is overly interested in parts of a whole or in unusual activities (e.g., designing houses, drawing highly detailed scenes, studying astronomy, etc.)
• Is preoccupied with only one or few interests, which he or she may be very knowledgeable about
• Is unable to recognize subtle differences in speech tone, pitch, and accent that alter the meaning of others’ speech
• May have an awkward walk
• May not understand a joke or may take a sarcastic comment literally
• May show an unusual interest in certain topics (e.g., snakes, names of stars, dinosaurs, etc.)
• One-sided conversations are common
• Speech may be flat and difficult to understand because it lacks tone, pitch, and accent
• Talks a lot, usually about a favorite subject
Many kids with Aspergers also have coexisting conditions and may have symptoms of these conditions also. They include:
• Social anxiety disorder
• Obsessive-compulsive disorder
• Nonverbal learning disorder
• Depression
• Attention deficit hyperactivity disorder
• Anxiety disorder
A youngster with one or two of these symptoms does not necessarily have Aspergers. To be diagnosed, he/she must have a combination of these symptoms and severe trouble with social situations.
Preschool—
There is no single, uniform presenting picture of Aspergers in the first 3-4 years. Some children may have early language delays with rapid "catch-up" between the ages of 3and 5 years. Some of these children may have no evidence of early developmental delay (with the possible exception of motor clumsiness).
Although Aspergers children may relate quite normally with the family setting, problems are often seen when they enter a preschool setting. These may include:
• a tendency to avoid spontaneous social interactions
• a tendency to be perseverative or repetitive when conversing
• appearing to be "in one's own world"
• difficulty regulating social/emotional responses involving anger, aggression, or excessive anxiety
• difficulty with transitions
• hyperactivity
• odd verbal responses
• preference for a set routine
• problems sustaining simple conversations
• showing very weak skills in interactions
• the tendency to over-focus on particular objects or subjects
Elementary School—
• Academic progress in the early grades is an area of relative strength (e.g., rote reading is usually good; calculation skills may be strong)
• An Aspergers child will frequently enter kindergarten without having been adequately diagnosed
• Behavioral concerns (e.g., hyperactivity, inattention, aggression, outbursts, etc.) were likely observed in the preschool years
• Concern over "immature" social skills and peer interactions usually exists
• Special education may be suggested, but most Aspergers kids enter a more mainstream setting
• Teachers are often struck by the child's "obsessive" areas of interest, which often intrude in the classroom setting
• The child may already be viewed as being somewhat unusual
• They are likely to show weak friend-making and friend-keeping skills
• They may show particular interest in one or a few children around them, but usually the depth of their interactions will be relatively superficial
• Writing skills are often weak
The course for an Aspie through elementary school can vary considerably from child to child. Overall problems can range from mild/easily managed to severe/intractable depending on certain factors (e.g., the child's intelligence level, appropriateness of management at school, parenting at home, temperamental style of the child, the presence or absence of complicating factors like hyperactivity/attentional problems, anxiety, learning problems, etc.).
Symptoms during adolescence include the following:
• Most childhood symptoms persist through adolescence
• Even though Aspie teenagers can begin to learn those social skills they lacked in childhood, communication often remains difficult
• Aspergers teens will often have intense social anxiety because they are often unable to read social cues and go with the "flow" of things
• Aspie teens want friends, but often feel shy or intimidated when approaching their peers
• Difficulties associated with this disorder can cause teens with Aspergers to become withdrawn and socially isolated and to have depression or anxiety
• It is hard for teens with Aspergers to relate with other people
• Most are very honest, sometimes to the point of rudeness
• One-sided conversations are very common
• Their preference for rules and honesty may lead them to excel in the classroom and as citizens
• They are focused and goal-drive
• They are typically uninterested in following social norms, fads, or conventional thinking, allowing creative thinking and the pursuit of original interests and goals
• They have difficulty "reading" others' behavior
• They may be immature for their age
• They may be naive and too trusting, which can lead to teasing and bullying
• They may feel "different" from others
• They may find it frustrating and emotionally draining to try to fit in
• They mostly talk a lot about their favorite interests
• They often excel because of being very detail-oriented
• They often prefer routines and do not like change
• Though they may not have many friends because of extreme social anxiety, it is possible for them to have close relationships with others throughout their lives
Middle School—
• As the Aspergers youngster moves into middle school, the most difficult areas continue to be those related to socialization and behavioral adjustment
• Academic performance can continue strong, particularly in those areas of particular interest
• Aspergers children may be left out, misunderstood, teased and bullied because Middle School comes with pressures for conformity and intolerance for differences
• Attentional and organizational difficulties may be present
• Because Aspies are frequently managed in mainstream educational settings, and because their specific developmental problems may be more easily overlooked, they are often misunderstood at this age by teachers and peers
• Learning difficulties are frequent
• Pressure may build up in the Aspie with little clue until he over-reacts in a dramatically inappropriate manner
• Some degree of depression is not uncommon as a complicating feature
• Teachers often have less opportunity to get to know the child well, and as a result, problems with behavior or work/study habits may be misattributed to emotional/motivational/behavioral problems
• The child may get into escalating conflicts or power struggles with teachers and other students who may not be familiar with the Aspie’s developmental style of interacting, which can lead to more serious behavioral flare-ups
• Their behavior may become increasingly problematic in the form of outbursts of noncooperation
• There will be ongoing subtle tendencies to misinterpret information, particularly abstract or figurative/idiomatic language
• Wanting to make friends and fit in, but unable to, they may withdraw even more
High School—
• Many of these Aspergers students will have developed considerable coping skills, "social graces," and general ability to "fit in" more comfortably by this age, thus easing their way
• Peer tolerance for individual variations and eccentricity often increases to some extent
• Some Aspergers students may pass socially as "nerds," a group which they actually resemble in many ways and which may overlap with Aspergers
• The Aspie teen may form friendships with other students who share his interests (e.g., via computer or math clubs, science fairs, Star Trek clubs, etc.)
Symptoms in adulthood include:
• Aspergers syndrome is a lifelong condition, although it tends to stabilize over time, and improvements are often seen
• Aspie adults usually obtain a better understanding of their own strengths and weaknesses
• Attention to detail and focused interests increases chances of university and career success
• They have average or above-average intelligence
• They have difficulty with high-level language skills (e.g., reasoning, problem solving, being too literal, etc.)
• They have an extreme focus on a particular interest or hobby
• They sometimes have an inability to see another person's point of view
• They often lack of emotional control, particularly with anger, depression, and anxiety.
• They may lack of empathy
• Many are fascinated with technology, thus a common career choice is engineering
• Many marry and have children
• They may have problems engaging in "small talk"
• They often experience strict adherence to routines, which can lead to anxiety when something unexpected happens
• They are able to learn social skills and how to read others' social cues with help from family and friends
Children with Aspergers usually grow up to be independently functioning adults in terms of employment, marriage, and family, etc. Aspergers does not preclude the potential for a "normal" adult life.
Aspergers students are able to successfully complete college and eventually find and maintain employment. Aspie adults often gravitate to a job or profession that relates to their own areas of special interest, sometimes becoming the most proficient employee in the department. However, in most cases, they will continue to demonstrate, at least to some extent, subtle differences in social interactions.
Many Aspie adults find their way to psychiatrists and other mental health providers where the true, developmental nature of their problems may go unrecognized or misdiagnosed (30-50% of all adults with Aspergers are never evaluated or correctly diagnosed).
Many adults with Aspergers have been able to utilize their skills, often with support from loved ones, to achieve a high level of function, personally and professionally – and some represent a unique resource for society, having the single mindedness and consuming interest to advance our knowledge in various areas of science, math, etc.
Their rigidity of style and idiosyncratic perspective on the world can make interactions difficult, both in and out of the family. There is a risk for mood problems (e.g., depression, anxiety). They are often viewed by others as eccentric, and they can be challenged by the social and emotional demands of marriage (although many do marry).
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