Assessment and Treatment of Asperger’s Syndrome in Adults
Comprehensive Assessment of Adult Asperger’s
Treatment Recommendations and Therapy
What Hans Asperger Said About Asperger’s Syndrome-Part I
The term, Asperger’s syndrome, is widely recognized these days but few people know what the man who discovered this condition actually said about it. In the years since this Viennese pediatrician published his findings in 1944, many of Hans Asperger’s concepts have been modified, overlooked, neglected or discarded, often to our detriment. What we know about Asperger’s today is not always in line with what he first proposed. Returning to Asperger’s original thinking adds a fresh understanding of this often-misunderstood condition.
The Fundamental Problem of Asperger’s
It is a basic drive in humans to have contact with the world around them. From the first moments of their existence, children instinctively engage in life, responding to the sights, sounds, and actions they experience, interacting with and creating an interplay between themselves and the outside world. Hans Asperger’s place in history derives from his realization that for some children this fundamental drive is absent. Instead, they suffer from an underlying disturbance of contact with the world.
Asperger noticed that instead of engaging with what exists outside of them, the children he observed preferred to focus their attention inward, towards themselves. He described them as having, “a disturbance of the lively relationship with the whole environment.” They were not interested in directing their attention to what occurred around them, instead they paid attention mainly to their internal life, shutting off contact between themselves and the outside world.
It is not hard to imagine that when someone is fundamentally uninterested in the world around them, especially people, it becomes hard to conceive of how others think and feel and why they act as they do. A basic disturbance in understanding somebody else’s point of view, their attitudes and beliefs, is central to the problem of Asperger’s.
The Sally-Anne Test
A simple experiment shows the nature of this problem. Called the Sally-Anne test, two young children enact a play scene in which one of them, Sally, takes a marble and hides it in a basket. She then leaves the room. While she is away, Anne takes the marble out of Sally’s basket and puts it in her own basket. Sally returns to the scene. A third child observing this setting is asked, where will Sally look for her marble?
Children with Asperger’s expect Sally to know that the marble has been transferred to Anne’s basket even though she was absent when it took place. They cannot conceive of Sally looking anywhere but where the marble was placed when she was gone. They lack an understanding of the fact that their own beliefs are not shared by others. They assume Sally knows the marble is in Anne’s basket, as they do, because they don’t understand that Sally has a separate mind, with separate knowledge and beliefs.
Misunderstanding of Emotions
The Sally-Anne test dramatizes the unreliability of understanding somebody else’s point of view for people with Asperger’s due to their inward focus. Imagining other people having their own inner world of thought is difficult for them to comprehend. Predictably, their understanding of emotions in others is also quite limited.
Normally, people acquire social habits without being consciously aware of them and of the process of acquiring them. They learn to engage with others instinctively. It is this instinctive relation to the social world that is disturbed in Asperger’s. Instead, social adaptation has to proceed through the intellect. They have to acquire knowledge of how others think, feel and act in specific situations by watching them, figuring out how they operate, then practicing that in order to learn how to behave themselves. Social understanding is not a natural operation, it has to be constructed formally.
The Constancy of Asperger’s
Through many observations, Hans Asperger realized that everyone with the disorder he was studying lacked psychological and emotional contact with others from the beginning of their life, unlike similar disorders, such as schizophrenia, in which there is a gradual, progressive loss of contact with the world. He realized this problem of contact with the world persists over time. He understood it to be an essential part of one’s self. It is one’s personality, constant through the whole life-span.
Of course, personality unfolds, certain features of the person develop and others retreat, and progress occurs, so that aspects of who a person is change over time, in some cases considerably. Nevertheless, the essential features of the problem remain unchanged. It is this constancy, in addition to the essential inward focus, that makes Asperger’s such a distinctive condition.
These are several of the important things Hans Asperger had to say about his namesake condition. In subsequent articles, I will address his understanding of the expressive characteristics, intellectual features, social behaviors and other components of the condition he brought to our attention.
Dr. Kenneth Roberson is an Asperger’s psychologist in San Francisco with over 30 years of experience. To ask a question or schedule an appointment, please call 415-922-1122.