Rely on formulation

Introduction The behavioral responses of patients with Asperger's syndrome strongly depend on formulaic and rigid social behavioral norms and social rules, and they cannot understand other people's intentions in an intuitive and spontaneous form and therefore often show a disconnected reaction.

Cause

Dependent on the cause of the formula:

The cause is not clear and may be related to environmental factors.

an examination

Related inspection

International standard intelligence test

Dependent on the formulation of the check diagnosis:

The clinical features of this syndrome are generally described as: (a) lack of understanding of the emotions of others; (b) inappropriate, unilateral social interactions, lack of ability to build friendships leading to social isolation; (c) dull (d) non-verbal communication is poor; (e) in some limitations, such as weather, TV schedules, train schedules and maps, showing strong acceptance, but only mechanical memory But can't understand, giving people an odd impression; (f) clumsy, uncoordinated movements and strange postures.

Although all cases were initially reported by Asperberg when the disease was reported, there were now cases of girls. However, boys are significantly more susceptible to the disease. Although most children have normal IQ, there are still a few with mild developmental delay. The disease is often more pronounced or at least found later than autism; therefore language and cognitive ability are preserved. This situation is usually very stable. And this higher IQ suggests a better long-term prognosis than autism.

Clinical manifestations:

1. There is qualitative damage in social interaction. AS patients are usually outliers, isolated, and often contact others with unusual or strange behavior. Although patients know the existence of others, they are usually self-centered. For example, they endlessly speak to the audience (usually adults). The content is generally about his hobbies or, more commonly, something different. A narrow topic. Most of the patients evaluated themselves as lonely. They also often expressed interest in making friends and meeting others, but these wishes are often because of their clumsy communication skills and their inability to understand other peoples feelings and wishes (such as being bored and eager to leave). , need, privacy) can not be achieved. The failure to interact with others and make friends over and over again gradually caused frustration in these children, and some people even experienced depressive symptoms and needed medication. In the emotional aspect of social communication, patients often show inappropriate responses and incorrect explanations in the process of emotional communication, and are slow to respond to other people's emotional expressions, understanding and even disregard. Despite this, they still have the ability to correctly describe other people's emotions in a cognitive and rigid way.

Patient behavioral responses are strongly dependent on formulation and stereotypes of social behavioral norms and social rules, and cannot understand other people's intentions in an intuitive and spontaneous form, and therefore often exhibit a disjointed response. This performance has led to a strong impression of AS patients with social behaviors that are childish and ridiculous. These behaviors of AS patients are at least partially present in autistic patients, the difference is that autistic patients are retreating, they seem to be not interested in the surrounding people, or are not aware of the existence of others, but AS patients are often eager Even trying to connect with others, but lacking the skills to do this.

2. There are qualitative defects in language communication. Although there is no significant dysfunction in this field in the definition of AS, at least three points in AS language communication skills are worth noting.

1 Although the patient's morphological changes and intonation are not as monotonous and rigid as autism, the rhythm of speech is poor, and there is often a lack of sway in the remarks of facts and humor.

2 Words are often digressive and accidental, giving a feeling of looseness and lack of internal connection and coherence. Although in some cases this symptom may suggest a mental disorder, it is more often the result of a lack of coherence and interactivity in this speech that is the result of a self-centered conversational model (eg, lack of affection about the name) , the long monologue of numbers, can not provide background information for comments, can not clearly define the changes in the topic, can not stop the idea of saying the heart.

3 The most typical feature of patient communication is the lengthy expression, which some authors consider to be the most obvious feature of the disease. Patients will continue to talk about topics of interest to them, completely ignoring whether the audience is interested or not listening, whether they want to interject or whether they want to change a topic. Although a lot has been said, there is usually no argument. The other party to the conversation may try to explore the content or logic of the event or relate to the relevant topic, but it is usually not successful.

Although all of these performances may be explained by major deficiencies in language utility skills or (and lack of insight or awareness of others' expectations, we still need to understand this phenomenon from a developmental perspective to benefit patients. Social adaptation skills training.

3. Limited, repetitive, fixed-mode behaviors, interests, and activities. The most common observation in the AS is the devotion to the limited interest. This performance is very much invested in some unusual and very limited topics. They have accumulated a great deal of factual knowledge about the topics of interest, and often show these facts in their first social interactions with others. Although the actual topic can change (for example, every other year or two years), it may dominate the content and daily activities of the patient's social interactions, often immersing the entire family in a long time. Although this symptom is not easy to detect during childhood (because many children have strong interests such as dinosaurs, popular cartoon characters, etc., when the subject changes are unusual and narrow, the symptoms will be highlighted. Very special because patients often learn about the extraordinary facts about some of the limitations (such as snakes, planet names, maps, TV schedules, or railway schedules).

4. Clumsy movement. In addition to the diagnostic criteria mentioned above, there is also a symptom as a relevant manifestation of the AS patient rather than a diagnostic basis, ie, delayed motor development and awkward movement. AS patients may have a personal history of poor motor skills development, such as learning to ride a bicycle, catch a ball, open a can, etc. later than their peers. Usually they are inflexible, gait rigid, eccentric posture, poor operational skills, and significant defects in visual-motor coordination. Although this performance is contrary to the motor development model of autism (usually a relatively strong motor skill in autism), in some respects it is similar to what is observed in adult autistic patients. Then, this commonality in the long run may be caused by different reasons. For example, AS patients may be caused by psycho-motor disorders, while in autism may be due to poor self-image and feeling. This requires us to describe this symptom in the context of development.

Diagnosis: Asperger's syndrome (known as "Aschberg disorder") is defined in DSM-IV (APA, 1994):

1. There are obstacles in social aspects, and at least the following two situations can be judged qualitatively.

1 There are significant defects in the ability to use some non-verbal behaviors for social interactions, such as gaze, facial expressions, body postures and gestures.

2 It is not possible to establish an appropriate partnership commensurate with their age.

3 Lack of spontaneous desire to find other people to share happiness, love or success.

4 lack of communicative and emotional reciprocal behavior.

2. A stubborn and persistent pattern of behavior, preferences, and activity that exhibits at least one of the following:

1 is always in one or more of the constant limited patterns of interest, and its intensity and concentration of interest are not normal.

2 Significantly stubbornly adhere to some special, meaningless procedures and rituals.

3 Repeat to maintain some of the special habits that you have formed.

4 Pay attention to a part of the object for a long time.

3. The above obstacles seriously impair the child's function in social interaction, occupation or other important areas.

4. There is no obvious clinically significant delay in language development (for example, a single word before the age of two, and a conversational phrase before the age of three).

5. There is no obvious clinically significant delay in the development of cognitive ability, self-care ability, adaptive behavior (except for social aspects) and childhood curiosity about the external environment.

6. Does not meet other diagnostic criteria for extensive developmental delay and schizophrenia.

Differential diagnosis

Depends on formulating confusing symptoms:

1. Childhood schizophrenia personality disorder. Some similar diagnostic concepts derived from adult psychiatry, neuropsychology, neurology, and other interdisciplinary studies have, to some extent, shared performance with AS. For example, a group of people described by Wolff and his colleagues have unusual patterns of behavior characterized by social isolation, stereotypes of thinking, and abnormal communication. The disease was named a child-like schizophrenia personality disorder. Unfortunately, there has been no further progress in the study of this subject, so it is difficult to determine how many of the cases described here show autism-like symptoms in early years. More generally, the understanding of AS as a fixed personality trait does not fully understand the new direction of research on this obstacle, and these research advances play an important role in differential diagnosis.

2. Non-language learning disabilities. In neuropsychology, a large amount of research has focused on the non-verbal learning disorder (NLD) proposed by Rourke's (1989). The main contribution of this research is to try to describe the meaning of children's social emotional development from the perspective of neuropsychology through the study of the neuropsychological aspects of human socialization and communication. The neuropsychological characteristics of NLD patients include: tactile sensation, neuromuscular coordination, visual-spatial structural defects, non-linguistic problem-solving deficiencies, and cognitive barriers to uncoordinated things and humor. NLD patients also show good mechanical language ability and verbal memory; adapt to new environment and complex environment; over-reliance on mechanical behavior to cope with new environment; mechanical computing ability is relatively poor compared to skilled single-word reading ability; Use, poor rhythm; obvious social cognition, social judgment and social skills defects. There are significant shortcomings in the understanding of some subtle, very obvious nonverbal communication that are often discriminated and rejected by others. The results show that NLD patients have a significant tendency to social withdrawal, and the risk of developing a serious emotional disorder is high.

3. Right brain syndrome. Many of the clinical features commonly seen in NLD have been described by neurological work as a state of developmental learning difficulties in the right hemisphere of the brain (Denckla, 1983; Voeller, 1986). Children with these conditions are also used as examples to illustrate "extreme interference in expression and communication and some basic interpersonal skills." It is still unclear whether these two concepts describe two completely different diseases or, more likely, different types of observational analysis methods. However, the two diseases overlap and some individuals have at least Some of the same common signs.

4. Autism. AS has many similarities with autism, especially high-function autism. Some researchers are unable to explain the findings of other researchers; clinicians can make AS diagnosis arbitrarily by their own understanding or misunderstanding of AS; parents and schools are even more confused about the name of this bypass; more worrying No one knows how to treat it, and there are few publicly available information about education and treatment available to parents and clinicians. Until the AS was officially defined in DSM-IV (APA, 1994), this confusion was improved. This definition was based on a large international experiment involving more than 1,000 children and adolescents with autism or related disorders (Volkmar, etc.). This experiment reveals some evidence that AS is a diagnostic category independent of autism, and it belongs to a wide range of developmental disorders as well as autism. More importantly, it establishes a uniform definition of AS, which should be considered as a reference basis for diagnosis. However, the problem is far from solved. In addition to some new research progress, our understanding of AS is still very limited. For example, we don't have exact figures to show how widespread it is, how much the prevalence of men and women is; and how much the disease is genetically linked to the likelihood that family members will have similar situations, and so on.

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