In particular, understanding and relating to other people, and taking part in everyday family, school, work and social life, can be harder. Other people appear to know, intuitively, how to communicate and interact with each other, yet can also struggle to build rapport with people with Asperger syndrome. Autistic people, including those with Asperger syndrome, often do not 'look' disabled.
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Some parents of autistic children say that other people simply think their child is naughty, while adults find that they are misunderstood. We are educating the public about autism through our Too Much Information campaign. Because Asperger syndrome varies widely from person to person, making a diagnosis can be difficult. It is often diagnosed later in children than autism and sometimes difficulties may not be recognised and diagnosed until adulthood.
What is Asperger syndrome?
Some people see a formal diagnosis as an unhelpful label, but for many, getting a timely and thorough assessment and diagnosis may be helpful because:. Autistic people, including those with Asperger syndrome, have difficulties with interpreting both verbal and non-verbal language like gestures or tone of voice. Many have a very literal understanding of language, and think people always mean exactly what they say. They may find it difficult to use or understand:. People with Asperger syndrome usually have good language skills, but they may still find it hard to understand the expectations of others within conversations, perhaps repeating what the other person has just said this is called echolalia or talking at length about their own interests.
This can make it very hard for them to navigate the social world. They may:. They may find it hard to form friendships. Some may want to interact with other people and make friends, but may be unsure how to go about it.
The world can seem a very unpredictable and confusing place to people with Asperger syndrome, who often prefer to have a daily routine so that they know what is going to happen every day. They may want to always travel the same way to and from school or work, or eat exactly the same food for breakfast. The use of rules can also be important. It may be difficult for someone to take a different approach to something once they have been taught the 'right' way to do it. Many people with Asperger syndrome have intense and highly-focused interests, often from a fairly young age.
These can change over time or be lifelong, and can be anything from art or music, to trains or computers. An interest may sometimes be unusual. One person loved collecting rubbish, for example. With encouragement, the person developed an interest in recycling and the environment. Many channel their interest into studying, paid work, volunteering, or other meaningful occupation. Notable differences between our study and the study by Couturier et al were the wide age ranges of participants, and the inclusion of children with medication in the latter study.
Further, the frequency of parent reported sleep-wake behaviours among our controls resembles corresponding results in a Swedish population-based study of six hundred and thirty-five 6—8 year olds [ 23 ]. The current study and that study used the same sleep questionnaire items. Notably, in a study of adults with AS, Tani et al [ 10 ] found very high prevalence of insomnia and also suggested that neuropsychiatric deficits inherent in AS may predispose both to insomnia and to anxiety and mood disorders.
The authors also speculated that the insomnia in AS frequently starts in childhood. Our findings support that speculation. Previous research has pointed to a need for more studies which examine the correlation between parent-reporting and objective sleep disruption [ 7 ]. In the present study, parent-reported insomnia coincided with actigraphic prolonged sleep latency during both school day and weekend nights; delayed sleep start on school day nights; and delayed sleep end during weekends.
This notion may possibly be of value with respect to considerations of suitable treatment options for insomnia [ 33 ]. Bedtime fading has been described as one option in the treatment of paediatric insomnia [ 34 ]. The initial phase of bedtime fading is to delay the bedtime hour of the child until he or she can readily fall asleep. The second phase of bedtime fading is to gradually advance the bedtime hour until the child gets enough sleep. Speculatively, and based on our actigraphic findings regarding the sleep start of children with insomnia, delaying their bedtime hour some 30 minutes during school day nights may ease their sleep initiation difficulties.
This could be tested in a future study. Our children with insomnia had higher scores of parent-rated autism-related symptoms, reflected in the higher ASSQ scores, than the children without insomnia.
This result resembles the findings of Schreck et al [ 35 ], that the presence of sleep disturbance and shorter sleep duration in children with PDDs was related to intensified autistic symptoms. Previous research has demonstrated that anxiety or depression are related to difficulties initiating and maintaining the state of sleep [ 10 , 23 , 36 ]. Also, Ivanenko et al [ 12 ] found that depression was related to prolonged sleep latency.
However, determination of cause and effect regarding associations between insomnia and emotional problems is widely considered to be difficult. For example, sleep deprivation in itself might produce daytime emotional distress [ 37 ]. Also, the interaction between insomnia and behavioural symptoms may be bidirectional [ 11 , 12 ], or it may be mediated by other factors such as physiological or cognitive hyperarousal [ 38 ]. With respect to studies of adult insomnia; reports indicate higher levels of physiological as well as emotional and cognitive over-arousal [ 38 ].
However, further research is needed in order to clarify the issue.
Only non-medicated children were included, since medication could have affected sleep [ 17 ] and thus could have biased our results. However, we cannot rule out the possibility that by only selecting children without medication, we might have excluded severely sleep-disturbed children from the current study. Likewise, the generalisability of the results of the current study is limited by the fact that our findings were based on a relatively small sample of children.
In addition, the rather large number of statistical tests that were performed gives a certain risk of chance findings. Moreover, it needs to be acknowledged that participating children were not subjected to any comprehensive clinical assessment or polysomnography, as the "gold standard" of sleep assessment, in conjunction with our study. There are also limitations with respect to the validity of actigraphy. These include overestimation of sleep duration and efficiency compared to polysomnography [ 40 ], underestimation of sleep latency compared to sleep diary [ 41 ], overestimation of number and duration of night awakenings and night sleep compared to sleep diary [ 42 ].
These limitations should be taken into consideration while interpreting the results of the current study. We also lacked data based on self-reports regarding children's sleep.
Autism, PDD-NOS & Asperger's fact sheets | High-functioning autism
Prevalence of autism spectrum conditions in children aged 5—11 years in Cambridgeshire, UK. Dev Med Child Neurol. J Child Adolesc Psychopharmacol. J Paediatr Child Health.
Autism and asperger's: for parents, carers and anyone working with young people
J Intellect Disabil Res. Wiggs L, Stores G: Sleep patterns and sleep disorders in children with autistic spectrum disorders: insights using parent report and actigraphy. J Sleep Res. BMC Psychiatry. Curr Ther Res. Sleep Med. J Autism Dev Disord. Brown LW: Sleep and Epilepsy. A Clinical Guide to Pediatric Sleep.
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Diagnosis and Management of Sleep Problems. Health Qual Life Outcomes. Acta Paediatr. Smedje H, Broman JE, Hetta J: Associations between disturbed sleep and behavioural difficulties in children aged six to eight years: a study based on parents' perceptions. Eur Child Adolesc Psychiatry. Ehlers S, Gillberg C, Wing L: A screening questionnaire for Asperger syndrome and other high-functioning autism spectrum disorders in school age children. J Child Psychol Psychiatry. Goodman R: Psychometric properties of the strengths and difficulties questionnaire.
Nord J Psychiatry. SPSS base 9. Givan DC: The sleepy child. Pediatr Clin North Am. Sheldon SH: Insomnia in Children.
Curr Treat Options Neurol. J Behav Ther Exp Psychiatry. Res Dev Disabil. Psychiatry Res. A diagnosis of autism can be very different from one child to another, and many children fall through the cracks with diagnoses like AS and HFA, because these children appear to fit typical norms, aside from a few social quirks.
Understanding the differences and similarities between the two diagnoses will help doctors and specialists provide the correct interventions.