Asperger's syndrome: The other way of seeing the world

When Lars talks about his favourite hobby «flags» at school, he knows no bounds. The twelve-year-old then talks incessantly about the colours, shapes, patterns and special features of flags - even when the other children are already yawning, rolling their eyes or demonstratively looking away.

Lars has Asperger's syndrome. It affects around 0.5 per cent of all Swiss people. This is a congenital developmental disorder from the autism spectrum. In addition to Asperger's syndrome, it also includes early childhood autism and atypical autism. The various forms of autism are all characterised by an altered perception and processing of external stimuli in the brain, albeit to very different degrees. The boundaries are fluid.

Children with Asperger's syndrome have difficulty empathising with others and do not recognise how the other person is feeling or what they want.

Bettina Jenny, Psychologist

Conspicuous behaviour when playing with other children

The causes of Asperger's syndrome are still not fully understood. «The only thing that is certain is that genetics play a certain role,» explains Bettina Jenny, head psychologist at the Department of Child and Adolescent Psychiatry and Psychotherapy at the Psychiatric University Hospital Zurich. «Children with Asperger's syndrome have good to above-average intelligence, and their language development is also largely unremarkable at the beginning.»

Parents and close carers usually notice certain peculiarities early on, says child psychologist Jenny: «However, these are usually accepted and not investigated further.» The abnormalities only become clearer from the age of around three, especially when playing with other children.

«Children with Asperger's syndrome have difficulty empathising with others and don't recognise how the other person is feeling or what they want,» says Jenny. «They often fail to recognise or misinterpret non-verbal codes in the form of facial expressions, gestures and posture.» It later becomes apparent that irony, intentions expressed between the lines or figurative expressions are often misunderstood or taken literally. For example, a child with Asperger's may run to the fridge when asked to «add their two cents».

Reliable structures are important for Asperger's

Without constant feedback from outside, the world is difficult to predict and extremely uncertain for people with Asperger's. Asperger autistic people therefore love fixed and reliable processes and structures that are familiar to them and are constantly repeated. They reject new things, changes, spontaneity and surprises because they frighten them.

«This manifests itself differently in every child,» says Asperger's expert Jenny. «Some always want to go on the same excursions or spend their holidays in the same place, others eat the same food every day or always wear similar clothes.»

It is also typical of children with Asperger's syndrome that they often develop special interests that are not typical for their age and therefore appear somewhat strange. They pay attention to many details and memorise an unusually large number of facts. In the case of boys, their preferences usually stem from the fields of science and technology, with topics such as the distance between planets, melting points of metals, train timetables and volcanism.

Asperger girls also have more common themes such as dragonfly species or horse breeds. In addition, both genders are often very intensively involved with computer games such as Minecraft, in which worlds are created.

When the senses work differently

Another characteristic of the altered perception in Asperger's syndrome is the hypersensitivity or hyposensitivity of the sensory system. People with Asperger's often experience normal sensory impressions much more strongly or noticeably less strongly than other people.

«They can find even the gentle touch of a breeze on their skin, as well as washing their hair or showering, extremely unpleasant or even painful,» says Jenny. «Noises are quickly too loud for them, and odours from deodorants or aftershaves can cause an unpleasant stinging sensation in their nose. Cold stimuli and pain, on the other hand, are often less noticeable to Asperger's sufferers.»

Most children with Asperger's want to make friends. They just often don't know how to go about it.

Bettina Jenny, Psychologist

Conversely, certain sensory impressions, triggered for example by stroking cool, smooth or soft, fluffy surfaces, have a calming effect on the nervous system. «Children with Asperger's syndrome often repeat such actions over and over again in order to regulate themselves,» says Jenny. Their frequent lack of eye contact is also noticeable. «Studies show that direct eye contact activates the anxiety centre in the brain of Asperger's sufferers,» says Jenny. «This explains why those affected often avoid eye contact with others.»

«Many of the behaviours that Asperger's children display also make sense in terms of the way they perceive the world,» says expert Jenny. «However, their actions often seem inappropriate, self-centred or simply strange to others.» It is not uncommon for children with Asperger's to offend others or even become victims of marginalisation or bullying.

«But that doesn't have to be the case,» emphasises Jenny. «If the environment is right, Asperger's autistic children can have friends and be integrated into the class community.» Most children with Asperger's want to make friends and socialise with others. «They simply often don't know how to do this or how to maintain the contact they have made.»

Toxic strategy for girls with Asperger's

Girls with Asperger's in particular therefore sometimes develop a toxic strategy to keep up with their peers: They observe their facial expressions and gestures very closely and then copy them. «This often still works in primary school,» says Jenny, «but by the start of puberty at the latest, when the social skills of others become much more pronounced, they have less success with it.» As a result, the girls affected suffer immensely because, despite their best efforts, they are unable to make up for their lack of social development.

Borderline is one of the most common misdiagnoses of Asperger girls.

Leah Gerstenkorn, remedial teacher

«By constantly acting and over-adapting, they deny themselves and still feel that they are not enough,» says Leah Gerstenkorn, herself an Asperger's autistic, remedial teacher and further education expert on Asperger's autism. «This often leads to massive self-deprecation with secondary illnesses such as depression, anxiety disorders, compulsions, eating disorders, self-harming behaviour and suicidal thoughts. Borderline is therefore one of the most frequently misdiagnosed disorders in Asperger girls.»

Asperger's affects more girls than assumed

Mimicry also means that Asperger's syndrome in girls is usually not recognised or only recognised very late. While boys with Asperger's often react aggressively when overwhelmed and are disruptive in class or at home, affected girls are generally less noticeable.

«Typical abnormalities such as a lack of eye contact and withdrawn behaviour in girls are also more socially accepted and are simply interpreted as shyness,» says Gerstenkorn. For this reason, and because diagnostic criteria are primarily based on male symptoms, scientists have long assumed that Asperger's syndrome primarily affects boys.

«Until a good 20 years ago, the gender ratio between boys and girls was described as 6:1 or even 8:1, depending on the study,» says Gerstenkorn. Today we know that these figures are outdated. «I personally assume an actual distribution of 4:1 or even 2:1,» says the curative educator. «This is also suggested by the current study situation,» says psychologist Jenny.

Other symptoms in girls

«Signs that can indicate Asperger's syndrome in girls - in addition to the symptoms already mentioned - are sleep problems, constant overstimulation, tantrums at home while everything works at school, as well as emotional withdrawal and emotional outbursts and breakdowns,» says Gerstenkorn.

The abnormalities often occur in connection with external changes such as moving house, a change of school, parental divorce or the birth of a sibling. «For example, a change of school from primary school to upper school can lead to a previously well-integrated girl completely refusing to go to school within weeks,» says the curative teacher. «This is because a child with Asperger's is often no longer able to compensate for the new situation, including unfamiliar surroundings and increased demands, which then leads to total overwhelm.»

However, if Asperger's syndrome has not yet been recognised, parents, teachers and peers are often unable to understand the child's violent reaction. «Appeasement and gentle persuasion won't help,» says Gerstenkorn. «At this point, it makes sense to seek professional help.»

To ensure that affected children receive the best possible support, but also to help parents, teachers and class members better understand the child's behaviour, it is important that Asperger's syndrome is diagnosed as early as possible. «In Switzerland, there are specialised centres for this in every canton,» says child psychologist Jenny. «A diagnosis can be made there with the help of clinical observations, detailed parental interviews and information from third parties, for example from school, as well as special tests.»

Not all children need therapy

Formally, Asperger's is an illness. «However, we understand it primarily as a different way of perceiving the world, which brings with it not only weaknesses but also strengths,» emphasises Jenny. «Asperger's is not curable and does not need to be cured.» However, there are certainly ways to positively support children with Asperger's in their development and help them to integrate better into communities.

«For example, individual therapies to regulate tension, groups for social skills training as well as remedial education and occupational therapy can help,» says Jenny. «Comprehensive parent and family counselling is also important.»

Because the severity of Asperger's syndrome varies widely, treatment is not actually necessary in every case. «There are certainly children who manage well overall because they only have slight deficits and many resources or - sometimes even beyond that - grow up under particularly favourable conditions,» emphasises Jenny.

«This includes, for example, a low-stimulus environment, sufficient breaks and opportunities to retreat, smaller classes, possibly a school companion as well as respect, patience and consideration for the children concerned.»

Free workshops for school classes

In order for children with Asperger's to benefit from a good environment, the school, teachers and class must also be informed about the topic. «There are free awareness-raising workshops especially for schools in collaboration with the self-help organisation Procap, where people with Asperger's, like me, go into the classroom and talk about their impairment,» says Gerstenkorn.

«Specialist centres can also arrange further training for teachers on request.» Both sides benefit from such measures, as Asperger's autistic people not only have weaknesses, but also plenty of strengths: For example, they are less prone to prejudice and are considered honest, helpful, loyal and reliable. In addition, they usually act without ulterior motives and often provide unusual solutions to various problems.