Autism Spectrum Disorder (ASD) | Asperger's Syndrome

What is ASD?

ASD is a neurological condition people are born with and it often runs in families. It seems likely that 1% of the population has ASD, which means in the UK there are some 700,000 people living with it. If you have it, you were born with it, which means your symptoms will have been there from a very young age.

It is not caused by bad parenting or eating too much sugar or junk food or playing videogames all the time. This is a picture of a functional MRI scan (a scan that shows brain activity) and it shows that the brain of the person with ASD looks quite different from the one who is not autistic. This points to the actual biological basis of autism.

 

It often runs in families (often with ADHD and other conditions) so it is hereditary and it is genetic. Extensive genetic studies have revealed hundreds of genes linked to autism and we are not clear what exactly the impact of any genetic background is. Nor can we predict if someone with ASD will pass it on to any children.

What are the symtoms?

These vary immensely from one individual to another and no autistic person is the same as another. The symptoms can be categorised in certain ‘domains’, or areas of daily functioning, such as:

  • Communication
  • Social interaction
  • Behaviours and routines
  • Obsessional interests
  • Sensitivities in certain senses, eg hearing, seeing, feeling and so on

Some symptoms will be recognisable throughout life, but others may vary: many people with ASD learn how to ‘mask’ certain symptoms or deficits. For instance: someone may learn by observing others how to show empathy or sympathy. There are unfortunate caricatures of autism being banded about and certain films have led people sometimes to think that if you don’t look like ‘Rainman’, you can’t be autistic. This is nonsense: autistic people vary as much as non-autistic people.
Quite a few autistic people will for instance report that they feel other people’s problems intensely, sometimes to the point of experiencing physical pain. And some of those may try to protect themselves from this distress by trying to be less empathetic.

People say the symptoms are different if you are male or female: whilst there might be a difference in what it looks like on cursory glance, in fact there is often no clear difference.

How is it diagnosed?

There is no blood test for ASD and scans are not precise enough and are not of any use when diagnosing someone (although that may change in the future). We diagnose by asking about a range of symptoms, how severe they are and how long you have had them. For instance, if all your symptoms started when you were 20 and you never had them before, then whatever it is, it is not autism.

We use certain structured interviews and questionnaires, such as the Ritvo Autism Asperger Diagnostic Scale (the RAADS), which captures symptoms and signs in a range of areas of daily functioning. The scale is thoroughly validated in extensive research studies and in statistical terms it approaches a similar level of diagnostic certainty as one might expect from a blood test for other conditions, as long as it is interpreted by a specialist who is able to appraise the clinically relevant characteristics of the person being assessed.

How is it treated?

There is no treatment for autism and in a sense that is understandable: it is not an illness. Rather it is a complex situation where someone may have different strengths and weaknesses than on average those without autism have and this is the result of their brain being ‘wired’ differently. The neurological background to autism is extremely complex: there is not one mechanism or abnormality that is the sole cause: this picture shows how many areas of the brain are thought to be involved:

 
And this picture shows how the brain of some autistic people seems to be able to process what is seen 10 times more powerful than the brain of a neurotypical person, but at the same time the non-autistic person seems better able to process what is heard (this is just one example and not a constant finding in all autistic people):
 

Why diagnose if there is no treatment?

Some people see a formal diagnosis as an unhelpful label, but for many, getting a thorough assessment and diagnosis may be helpful because:

  • It helps people with Asperger syndrome (and their families, partners, employers, colleagues, teachers and friends) to understand why they may experience certain difficulties and what they can do about them.
  • It allows people to access services and support.