Asperger syndrome is often considered a high functioning form of autism. People with this syndrome have difficulty interacting socially, repeat behaviors, and often are clumsy. Motor milestones may be delayed.

Although there are many possible symptoms of Asperger?s syndrome, the main symptom is significant trouble with social situations. Your child may have mild to severe symptoms or have a few or many of these symptoms. Because of the wide variety of symptoms, no two children with Asperger's are alike.

Symptoms during childhood

1. Not pick up on social cues and may lack inborn social skills, such as being able to read others' body language, start or maintain a conversation, and take turns talking

2. Dislike any changes in routines

3. Appear to lack empathy

4. Be unable to recognize subtle differences in speech tone, pitch, and accent that alter the meaning of others? speech. So your child may not understand a joke or may take a sarcastic comment literally. And his or her speech may be flat and hard to understand because it lacks tone, pitch, and accent.

5. Have a formal style of speaking that is advanced for his or her age. For example, the child may use the word "beckon" instead of "call" or the word "return" instead of "come back."

6. Avoid eye contact or stare at others.

7. Have unusual facial expressions or postures.

8. Be preoccupied with only one or few interests, which he or she may be very knowledgeable about. Many children with Asperger's syndrome are overly interested in parts of a whole or in unusual activities, such as designing houses, drawing highly detailed scenes, or studying astronomy. They may show an unusual interest in certain topics such as snakes, names of stars, or dinosaurs.

9. Talk a lot, usually about a favorite subject. One-sided conversations are common. Internal thoughts are often verbalized.

10. Have delayed motor development. Your child may be late in learning to use a fork or spoon, ride a bike, or catch a ball. He or she may have an awkward walk. Handwriting is often poor.

11. Have heightened sensitivity and become overstimulated by loud noises, lights, or strong tastes or textures. For more information about these symptoms, see sensory integration dysfunction.

A child with one or two of these symptoms does not necessarily have Asperger?s syndrome. To be diagnosed with Asperger?s syndrome, a child must have a combination of these symptoms and significant trouble with social situations

Although the condition is in some ways similar to autism, a child with Asperger's syndrome typically has normal language and intellectual development. Also, those with Asperger's syndrome typically make more of an effort than those with autism to make friends and engage in activities with others.

Symptoms during adolescent and teen years

Most symptoms persist through the teen years. And although teens with Asperger's can begin to learn those social skills they lack, communication often remains difficult. They will probably continue to have difficulty "reading" others' behavior.

Causes, incidence, and risk factors

Hans Asperger labeled this disorder "autistic psychopathy" in 1944. The exact cause is unknown. More than likely, an abnormality in the brain is the cause of Asperger syndrome. There is a possible link to autism, and genetic factors may play a role. The disorder tends to run in families. A specific gene has not been identified. The condition appears to be more common in boys than in girls. Although people with Asperger syndrome often have difficulty socially, many have above-average intelligence. They may excel in fields such as computer programming and science. There is no delay in their cognitive development, ability to take care of themselves, or curiosity about their environment.

General Symptoms

People with Asperger syndrome become over-focused or obsessed on a single object or topic, ignoring all others. They want to know everything about this topic, and often talk about little else.

• Children with Asperger syndrome will present many facts about their subject of interest, but there will seem to be no point or conclusion.
• They often do not recognize that the other person has lost interest in the topic.
• Areas of interest may be quite narrow, such as an obsession with train schedules, phone books, a vacuum cleaner, or collections of objects.

People with Asperger do not withdraw from the world in the way that people with autism withdraw. They will often approach other people. However, their problems with speech and language in a social setting often lead to isolation.

• Their body language may be off.
• They may speak in a monotone, and may not respond to other people's comments or emotions
• They may not understand sarcasm or humor, or they may take a figure of speech literally
• They do not recognize the need to change the volume of their voice in different settings.
• They have problems with eye contact, facial expressions, body postures, or gestures (nonverbal communication).
• They may be singled out by other children as "weird" or "strange."

People with Asperger syndrome have trouble forming relationships with children their own age or other adults, because they:

• Are unable to respond emotionally in normal social interactions
• Are not flexible about routines or rituals
• Have difficulty showing, bringing, or pointing out objects of interest to other people
• Do not express pleasure at other people's happiness

Children with Asperger syndrome may show delays in motor development, and unusual physical behaviors, such as:

• Delays in being able to ride a bicycle, catch a ball, or climb play equipment
• Clumsiness when walking or doing other activities
• Repetitive behaviors, in which they sometimes injure themselves
• Repetitive finger flapping, twisting, or whole body movements

Many children with Asperger syndrome are very active, and may also be diagnosed with attention deficit hyperactivity disorder (ADHD). Anxiety or depression may develop during adolescence and young adulthood. Symptoms of obsessive-compulsive disorder and a tic disorder such as Tourette syndrome may be seen.

Signs and tests

There is not a standardized (used and accepted by almost everyone) test used to diagnose Asperger syndrome.
Most doctors look for a core group of behaviors to help them diagnose Asperger syndrome. These behaviors include:

• Abnormal eye contact
• Aloofness
• Failure to turn when called by name
• Failure to use gestures to point or show
• Lack of interactive play
• Lack of interest in peers

Symptoms may be noticeable in the first few months of life. Problems should be obvious by age 3 years. Physical, emotional, and mental tests are done to rule out other causes and look more closely for signs of this syndrome. The team that will see your child includes a psychologist, neurologist, psychiatrist, speech therapist, and other professionals who are experts in diagnosing children with Asperger syndrome.

Signs and symptoms of learning disabilities and disorders

If you?re worried, don?t wait

If you suspect that your child's learning difficulties may require special assistance, please do not delay in finding support. The sooner you move forward, the better your child's chances for reaching his or her full potential.
Learning disabilities look very different from one child to another. One child may struggle with reading and spelling, while another loves books but can?t understand math. Still another child may have difficulty understanding what others are saying or communicating out loud. The problems are very different, but they are all learning disorders.
It?s not always easy to identify learning disabilities. Because of the wide variations, there is no single symptom or profile that you can look to as proof of a problem. However, some warning signs are more common than others at different ages. If you?re aware of what they are, you?ll be able to catch a learning disorder early and quickly take steps to get your child help
The following checklist lists some common red flags for learning disorders. Remember that children who don?t have learning disabilities may still experience some of these difficulties at various times. The time for concern is when there is a consistent unevenness in your child?s ability to master certain skills.

Preschool signs and symptoms of learning disabilities

• Problems pronouncing words
• Trouble finding the right word
• Difficulty rhyming
• Trouble learning the alphabet, numbers, colors, shapes, days of the week
• Difficulty following directions or learning routines
• Difficulty controlling crayons, pencils, and scissors or coloring within the lines
• Trouble with buttons, zippers, snaps, learning to tie shoes

Grades K-4 signs and symptoms of learning disabilities

• Trouble learning the connection between letters and sounds
• Unable to blend sounds to make words
• Confuses basic words when reading
• Consistently misspells words and makes frequent reading errors
• Trouble learning basic math concepts
• Difficulty telling time and remembering sequences
• Slow to learn new skills

As children with Down syndrome grow and become aware of their limitations, they may also feel frustration and anger.

Grades 5-8 signs and symptoms of learning disabilities

Difficulty with reading comprehension or math skills
Trouble with open-ended test questions and word problems
Dislikes reading and writing; avoids reading aloud
Spells the same word differently in a single document
Poor organizational skills (bedroom, homework, desk is messy and disorganized)
Trouble following classroom discussions and expressing thoughts aloud
Poor handwriting

Signs and tests

A doctor can often make an initial diagnosis of Down syndrome at birth based on how the baby looks. The doctor may hear a heart murmur when listening to the baby's chest with a stethoscope.
A blood test can be done to check for the extra chromosome and confirm the diagnosis. See: Chromosome studies Other tests that may be done include:

• Echocardiogram to check for heart defects (usually done soon after birth)
• ECG
• X-rays of the chest and gastrointestinal tract

Persons with Down syndrome need to be closely screened for certain medical conditions. They should have:

• Eye exam every year during infancy
• Hearing tests every 6 - 12 months, depending on age
• Dental exams every 6 months
• X-rays of the upper or cervical spine between ages 3 - 5 years
• Pap smears and pelvic exams beginning during puberty or by age 21
• Thyroid testing every 12 months

Treatment

There is no specific treatment for Down syndrome. A child born with a gastrointestinal blockage may need major surgery immediately after birth. Certain heart defects may also require surgery.

When breast-feeding, the baby should be well supported and fully awake. The baby may have some leakage because of poor tongue control. However, many infants with Down syndrome can successfully breast-feed.

Obesity can become a problem for older children and adults. Getting plenty of activity and avoiding high-calorie foods are important. Before beginning sports activities, the child's neck and hips should be examined.

Behavioral training can help people with Down syndrome and their families deal with the frustration, anger, and compulsive behavior that often occur. Parents and caregivers should learn to help a person with Down syndrome deal with frustration. At the same time, it is important to encourage independence.

Adolescent females and women with Down syndrome are usually able to get pregnant. There is an increased risk of sexual abuse and other types of abuse in both males and females. It is important for those with Down syndrome to:

* Be taught about pregnancy and taking the proper precautions
* Learn to advocate for themselves in difficult situations
* Be in a safe environment

If the person has any heart defects or problems, check with the physician about the need for antibiotics to prevent heart infections called endocarditis.

Special education and training is offered in most communities for children with delays in mental development. Speech therapy may help improve language skills. Physical therapy may teach movement skills. Occupational therapy may help with feeding and performing tasks. Mental health care can help both parents and the child manage mood or behavior problems. Special educators are also often needed.

Support Groups

National Down Syndrome Society - www.ndss.org

National Down Syndrome Congress -- www.ndsccenter.org

Expectations (prognosis)

Persons with Down syndrome are living longer than ever before. Although many children have physical and mental limitations, they can live independent and productive lives well into adulthood.

About half of children with Down syndrome are born with heart problems, including atrial septal defect, ventricular septal defect, and endocardial cushion defects. Severe heart problems may lead to early death.

Persons with Down syndrome have an increased risk for certain types of leukemia, which can also cause early death.

The level of mental retardation varies from patient to patient, but is usually moderate. Adults with Down syndrome have an increased risk for dementia.

Complications

• Airway blockage during sleep
• Compression injury of the spinal cord
• Endocarditis
• Eye problems
• Frequent ear infections and increased risk of other infections
• Hearing loss
• Heart problems
• Gastrointestinal blockage
• Weakness of the back bones at the top of the neck

Calling your health care provider

A health care provider should be consulted to determine if the child needs special education and training. It is important for the child to have regular checkups with his or her doctor.

Prevention

Experts recommend genetic counseling for persons with a family history of Down syndrome who wish to have a baby. A woman's risk of having a child with Down syndrome increases as she gets older. The risk is significantly higher among women age 35 and older. Couples who already have a baby with Down syndrome have an increased risk of having another baby with the condition. Tests such as nuchal translucency ultrasound, amniocentesis, or chorionic villus sampling can be done on a fetus during the first few months of pregnancy to check for Down syndrome. The American College of Obstetricians and Gynecologists recommends offering Down syndrome screening tests to all pregnant women, regardless of age.

References

Review Date: 10/18/2010. Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.