A profound developmental disorder with individual therapy needs

A reduced interest in social contact as well as a reduced understanding of social situations are the core symptoms of an autism spectrum disorder. This complex and multifaceted neurodevelopmental disorder manifests before the age of three and persists throughout the lifespan. However, it can be treated very well and not every ASD patient is in need of treatment for a long time.

Autism is considered a developmental disorder of the central nervous system that is primarily genetic and associated with structural and functional changes in the brain. This has a fundamental impact on a person’s ability to make contact and on their behavior. Autism spectrum disorder is one of the autistic spectrum disorders. This is a profound developmental disorder with onset in early childhood and a chronic course. The term “profound developmental disorders” means that the qualitative deviations from the age-appropriate course of development can be expressed in all areas of life and that these abnormalities vary in their degree of expression and phenomena in the course of development, but show themselves as a consistent pattern since earliest childhood and persist in their central neuronal causes throughout life. Worldwide, a mean prevalence of 0.62%-0.70% is currently estimated.

A typical symptom is a diminished ability to intuit nonverbal cues in others. Therefore, social interaction opportunities are limited. This can result in a lowered interest in fellow human beings. Interaction disorders refer to the initiation, maintenance and shaping of interpersonal relationships in the context of family, friendship, partnership as well as peers in kindergarten, school and work. However, unlike early childhood autism, there are no other developmental disorders or delays, such as in language or cognition. Children with ASD, on the other hand, tend to stand out because of the special interests they pursue intensively. Repetitive behavior patterns also occur. In addition, those affected are conspicuous for their fixation on rigid daily routines and an environment that is as constant as possible. Even though these behaviors first appear before the age of three and persist throughout life, the clinical presentation still changes over the lifespan. Often, strategies are also learned that make everyday life easier.

Symptom severity over the life course

In infancy, patients will seek little to no eye contact. Attention and pleasure are less often shared with others, and those affected do not use facial expressions or gestures to establish or regulate social contact. Accordingly, they find it difficult to judge the state of mind of others on the basis of such characteristics. Misunderstandings are therefore inevitable. The full-blown disease develops in preschool age, while the severity then often subsides in school age. In adolescence and early adulthood, about half of those affected achieve significant behavioral improvement. However, the severity of symptoms and the variety of symptoms vary from individual to individual.

Diagnostics in childhood

An Asperger syndrome implies autism-specific abnormalities of social interaction and in the area of stereotypic and repetitive behavior including special interests. Linguistic and cognitive development are inconspicuous. The exact classification of a developmental disorder with autistic features can often only be made after long observation. By means of an extensive physical, psychiatric, neurological and laboratory examination, other clinical pictures such as epilepsy, ADHD, anxiety, obsessive-compulsive and tic disorders are delineated. Possible hearing and vision disorders must also be ruled out.

Differential diagnostic differentiation can be difficult, especially from schizoid and schizotypal personality disorders. This is because sufferers of these two diseases also withdraw and are usually loners. The schizoid type has emotional indifference, affective detachment, and a diminished capacity for pleasure. Schizotypal personality disorder is characterized by behavior perceived as bizarre with often magical thinking content and a distrustful to paranoid relational experience. Both disorders lack the narrowed special interests typical of ASD as well as the tendency to stereotypic behavior.

Individual therapy management

Not every Asperger’s syndrome has disease value and therefore needs to be treated. However, if the symptoms are pronounced enough, a multimodal therapy concept with symptomatically oriented pharmacological and psychotherapeutic elements seems to be indicated. There is as yet no possibility of curing ASD. Established therapy methods are based on behavioral therapy and exercise approaches, combined with psychoeducation of the affected person and the environment. Above all, patients with autism spectrum disorders need a manageable, predictable environment to feel safe. For cognitively average ASD patients, autism-specific social skills training in a group setting is particularly effective in improving social interaction, one’s action planning, and one’s management of anger and rage. Comorbid conditions should be treated appropriately. In this context, drug interventions may also become necessary.