Unfortunately, there is no cure for Aspergers; however, there are a wide variety of helpful treatments that help those with Aspergers to learn better social skills and communication cues, and to help them be able to interact socially more naturally. By focusing on learning ways to cope with the symptoms and pick up on social cues, most people with Aspergers lead fairly typical lives, with close friends and loved ones.
The mainstay of management for Aspergers is behavioral therapy, focusing on specific deficits to address poor communication skills, obsessive or repetitive routines, and physical clumsiness. Most kids improve as they mature to adulthood, but social and communication difficulties may persist. Some researchers and individuals with Aspergers have advocated a shift in attitudes toward the view that it is a “difference” rather than a “disability” that must be treated or cured.
Treatment for Aspergers attempts to manage distressing symptoms and to teach age-appropriate social, communication and vocational skills that are not naturally acquired during development, with intervention tailored to the needs of the child based on multidisciplinary assessment. Although progress has been made, data supporting the efficacy of particular interventions are limited.
Therapies for Aspergers—
Therapy for Aspergers concentrates on three-core symptoms: physical clumsiness, obsessive or repetitive routines, and poor communication skills. There is no single treatment for children suffering from all three of these core symptoms, but professionals do agree that the disorder can be treated when the intervention is carried out at the earliest possible time.
The ideal treatment for Aspergers coordinates therapies that address core symptoms of the disorder, including poor communication skills and obsessive or repetitive routines. While most professionals agree that the earlier the intervention, the better, there is no single best treatment package. Treatment for Aspergers resembles that of other high-functioning ASDs, except that it takes into account the linguistic capabilities, verbal strengths, and nonverbal vulnerabilities of children with Aspergers.
A typical program generally includes:
• Cognitive behavioral therapy to improve stress management relating to anxiety or explosive emotions and to cut back on obsessive interests and repetitive routines
• Medication for coexisting conditions such as major depressive disorder and anxiety disorder
• Occupational or physical therapy to assist with poor sensory integration and motor coordination
• Social communication intervention, which is specialized speech therapy, to help with the pragmatics of the give and take of normal conversation
• Training and support of moms and dads, particularly in behavioral techniques to use in the home
• Training of social skills for more effective interpersonal interactions
Of the many studies on behavior-based early intervention programs, most are case studies of up to five participants, and typically examine a few problem behaviors such as self-injury, aggression, noncompliance, stereotypies, or spontaneous language.
Despite the popularity of social skills training, its effectiveness is not firmly established. A randomized controlled study of a model for training moms and dads in problem behaviors in their kids with Aspergers showed that moms and dads attending a one-day workshop or six individual lessons reported fewer behavioral problems, while moms and dads receiving the individual lessons reported less intense behavioral problems in their Aspergers kids.
Vocational training is important to teach job interview etiquette and workplace behavior to older kids and grown-ups with Aspergers, and organization software and personal data assistants can improve the work and life management of individuals with Aspergers.
Medications for Aspergers—
No medications directly treat the core symptoms of Aspergers. Although research into the efficacy of pharmaceutical intervention for Aspergers is limited, it is essential to diagnose and treat comorbid conditions. Deficits in self-identifying emotions or in observing effects of one's behavior on others can make it difficult for children with Aspergers to see why medication may be appropriate.
Medication can be effective in combination with behavioral interventions and environmental accommodations in treating comorbid symptoms such as anxiety disorder, major depressive disorder, inattention and aggression. The atypical antipsychotic medications risperidone and olanzapine have been shown to reduce the associated symptoms of Aspergers. Risperidone can reduce repetitive and self-injurious behaviors, aggressive outbursts and impulsivity, and improve stereotypical patterns of behavior and social relatedness. The selective serotonin reuptake inhibitors (SSRIs) fluoxetine, fluvoxamine and sertraline have been effective in treating restricted and repetitive interests and behaviors.
Side Effects of Medications for Aspergers—
Care must be taken with medications, as side effects may be more common and harder to evaluate in children with Aspergers, and tests of drugs' effectiveness against comorbid conditions routinely exclude children from the autism spectrum.
• Weight gain and fatigue are commonly reported side effects of risperidone, which may also lead to increased risk for extrapyramidal symptoms such as restlessness and dystonia and increased serum prolactin levels.
• SSRIs can lead to manifestations of behavioral activation such as increased impulsivity, aggression and sleep disturbance.
• Sedation and weight gain are more common with olanzapine, which has also been linked with diabetes. Sedative side-effects in school-age kids have ramifications for classroom learning.
• Abnormalities in metabolism, cardiac conduction times, and an increased risk of type 2 diabetes have been raised as concerns with these medications, along with serious long-term neurological side effects.
Children with Aspergers may be unable to identify and communicate their internal moods and emotions or to tolerate side effects that, for most individuals, would not be problematic.
Studies are on the way to discover the best treatment for Aspergers, which includes the use of functional magnetic resonance imaging (MRI) to identify the abnormalities in the brain that causes malfunction. Clinical trials are being conducted to identify the effectiveness of anti-depressants in people with Aspergers. Even the analysis of the DNA of the Aspergers sufferer and his/her family may cause a breakthrough in the treatment of the Aspergers.
With effective treatment, children with Aspergers can learn to cope with their disabilities, but they may still find social situations and personal relationships challenging. Many adults with Aspergers are able to work successfully in mainstream jobs, although they may continue to need encouragement and moral support to maintain an independent life.
The Aspergers Comprehensive Handbook