Spring, 2014

Asperger’s Syndrome was officially recognized by the American Psychiatric Association in its DSM-IV (Diagnostic Statistical Manual-IV) in 1994 as a separate disorder from Autism. Essentially, it is still a form of autism on the high end of the spectrum along with other classifications such as Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) and Autism Spectrum Disorder (ASD). The difference between Asperger’s and Autism is that the former typically does not have cognitive or speech delays, and exhibits ability for self-care and environmental curiousity. Last year, the APA reabsorbed the high end classifications back into the Autism Spectrum. The reasons given were:

  • The numerous spectrum differences between individuals as well as within one individual’s lifetime
  • That the very definition of Asperger’s qualifies it as a disorder within the spectrum
  • The difficulty for medical professionals to properly place individuals into very specific subcategories on the Autism Spectrum given the variety of manifestations of the disorder
  • The importance of allowing for a more individualized, specific approach to management on a case by case basis.

The APA believes by its regrouping and broader definition of spectrum characteristics that it satisifies these issues.

The prevalence for Asperger’s is 8:1 males and gender strongly dictates the symptoms. However, at this time, the most underdiagnosed group is middle-aged females. The primary reason for this is that autism of any sort is typically diagnosed in early childhood. During the 1950s to 1970s, autism was only thought to occur in males and Asperger’s had not been sufficiently defined as to be considered a disorder on the spectrum. Asperger’s main complication lies within personal and social development so many people have lived their lives thinking they were just “difficult to get along with” or “emotionally distant.”

So back to the Asperger patient in for a scan. As I said, the syndrome presents in many different ways but there are some fairly universal symptoms that may have relevance to your patient/healthcare provider interaction. These include:

  • Sensitivity to sounds, sights, and smells: the sound of the pulse wave Doppler, fluorescent lights, the feel of the towels, the pressure of your probe, the touch of your gloved hand
  • Inappropriate vocal volume: Speaking too loudly or too softly
  • Difficulty with making eye contact: the patient may not seem to be paying any attention to your instructions or may be actively looking around the room instead of focusing on you
  • Clumsiness, repetitive movements, unusually large gestures, difficulty with coordination: they may have trouble following your commands regarding patient positioning or they may flop over dramatically into that RLD position
  • Talkative, word repetition, precise usage of grammar: the patient may even repeat what you say, repeat the same thing over and over, or use words not common in typical conversation such as usurp or cajole (those are a couple of my favorites)
  • Flat or blank facial expression and monotone speech
  • Extreme honesty and oversharing: the patient may rattle off an entire litany of symptoms and complaints because they are not able to fully distinguish between the relevant and irrelevant information
  • Depression or paranoia: Many patients, particularly those unaware of their disorder, have experienced a lifetime of negative interactions and are used to living in a state of anxiety when dealing with other people
  • Sometimes there are comorbid disorders such as Obsessive Compulsive Disorder (OCD), Social Anxiety Disorder, and Attention Deficit Hyperactivity Disorder (ADHD)

Now you have a working knowledge of what to watch for and if you want to learn more, please visit some of the references in my work cited section.

What does the mean for you? There are ways to make these patient scans smoother. There are definitely ways to make it worse. Given the unusual affect of an Asperger’s patient, it can be easy to make assumptions about their mood or willingness to be a good patient. Many times though, the patient is feeling perfectly pleasant and likes you quite a bit but that monotone speech, flat facial expression, and lack of eye contact sends the wrong message. Asperger patients are easy enough to read if you forget subtext. Pay no attention to the volume of their voice or where they are looking and forget about adding subtext into their words. What they are saying is just the sum of their words; no more, no less. And avoid any sarcasm on your part because they probably will not perceive it. They also just listen to the words. Subtext is hard for Asperger people.

These are intelligent people typically so they may ask a lot of questions about the technology or the images. Try to find ways to engage them that doesn’t put you in a position of revealing medical information. Be aware that they may have done extensive research on their symptoms and diagnoses. The sensitivity to fluorescent lights may not be an issue since so many sonographers live in the dark. Let them know what you are doing before you do it. Some are sensitive to touch. They may prefer to wipe off the gel themselves again because of touch or maybe the sensation of the towel is irritating. While highly logical, an Asperger patient (particularly a male) can have an emotional outburst if they are extremely agitated so check in with them and make sure they are as comfortable and relaxed as possible.

Asperger’s sounds like a lot of work to deal with and, depending on the symptom grouping in an individual, it can be but there are many positive traits to appreciate. These include:

  • Highly intelligent, logic thinkers
  • An enormous ability to focus which means they are internally motivated and don’t require much supervision or direct incentive
  • Honesty and simplicity in their communication
  • Unique and highly visual in their thinking
  • A great attention to detail
  • The inability to distinguish sarcasm means that they can usually get along with difficult people

The list of symptoms is helpful but how are you going to know if you have a typical difficult patient or an Asperger patient? The truth is you may never know. Asperger’s walk among us and many do not stand out like the more severely affected Autistic people do. Given the traits that make a good sonographer, you may even work with one or two. Including Asperger’s Syndrome in your excuses for those difficult patients may make all the difference in the world to that patient and, for that matter, to you!

**AUTHOR DISCLOSURE: The author discloses that she too has Asperger’s Syndrome and it is largely the reason why she is so awesome, good at sonography, and gets along with difficult people.

Works Cited

  • Happe, F. (2011). Why Fold Asperger Syndrome into Autism Spectrum Disorder in the DSM-5? Simons Foundation Autism Research Initiative. Retrieved from: http://sfari.org/news-and-opinion/viewpoint/2011/why-fold-asperger-syndrome-into-autism-spectrum-disorder-in-the-dsm-5
  • 22 Main Aspergers Symptoms. Asperger-Symptoms.net
  • Katz-Wise, S. (2006). Asperger’s Syndrome. Fort Drum Patient Education Handouts. Retrieved from: http://www.drum.amedd.army.mil/pt_info/handouts/Asperger's_Syndrome.pdf
  • Roy, M. Dillo, W., et al. Asperger’s Syndrome in Adulthood. OhlmeierDeutschesÄrzteblattInternational⏐DtschArzteblInt 2009; 106(5): 59–64
  • Asperger Syndrome: Pervasive Developmental Disorder-Asperger Syndrome; Autistic Spectrum Disorder-Asperger. (2013). PubMed Health. A Service of the National Library of Medicine, National Institutes of Health A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA). Retrieved from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002516
  • Simone, R. Help 4 Aspergers. http://help4aspergers.com