A.S.D., commonly known as Asperger syndrome, is regarded as a mild form of autism spectrum disorder. Individuals with Asperger's represent a broad group of people – “when you have met one person with autism, you have met one person with autism”, to quote Dr Stephen Shore. That said, Asperger's tends to be characterised by marked difficulties with social interaction, communication and imagination.
People with Asperger syndrome may have communication deficits. Because of this, they may respond inappropriately in conversations; misread facial expressions or nonverbal interactions; and experience difficulty initiating and maintaining conversations. People with Asperger's may find it difficult to imagine alternative outcomes to situations. They may be overly dependent on routines. Individuals with Asperger's are frequently of above-average intelligence.
Impairments in social skills and communication can present everyday challenges. It is little wonder, notes Dr Valerie Gaus, that “the mental health problems seen … are often related to their attempts to fit in with society. Chronic stress comes with a dramatically uneven profile of strengths and deficits. Generally bright and often successful with academic pursuits, they struggle in the interpersonal domain of functioning” (1). Women with Asperger syndrome “often develop ‘coping mechanisms’ that can cover up the intrinsic difficulties they experience. They may mimic their peers, watch from the side-lines, use their intellect to figure out the best ways to remain undetected, and they will study, practice, and learn appropriate approaches to social situations. Sounds easy enough, but in fact these strategies take a lot of work and can more often than not lead to exhaustion, withdrawal, anxiety, selective mutism, and depression” (2).
Dichotomous thinking patterns associated with Asperger syndrome (for example, all-or-nothing/black-and-white thinking) are linked with vulnerability to depression and anxiety disorders.
People with Asperger's are especially prone to anxiety and depression. In the broader category of A.S.D., one widely-cited study found 70 percent of children also met the criteria for at least one psychiatric disorder, with anxiety disorders (especially social anxiety disorder) being the most common problem (3).
People with Asperger's are at risk for all of the mental health problems that have been successfully treated using cognitive behavioural therapy (CBT) and for which there are existing evidence-based CBT protocols. People with Asperger syndrome tend to be logical thinkers. This makes them suitable for the CBT model, with its emphasis on structure and problem-solving.
At the same time, various Asperger traits mean a modified CBT approach is recommended. CBT aims to help people modify their thoughts, but the therapist needs to be conscious that a more patient approach may be necessary, given the rigid thinking patterns sometimes associated with Asperger's. Often, this means that I may focus somewhat more on behavioural, as opposed to cognitive, mechanisms of action.
Crucially, a systematic review that examined the treatment of anxiety using modified CBT approaches noted that “positive outcomes were ubiquitous, suggesting CBT is an effective treatment for anxiety in individuals with Asperger's” (4).
1 – Gaus, V. (undated PDF). Cognitive-Behavior Therapy for Adult Asperger Syndrome (note: Dr Gaus has a book with the same title).
2 – Nichols, S., cited in Holliday Willey, L., 2011. Safety Skills for Asperger Women: How to Save a Perfectly Good Female Life.
3 – Simonoff, E. et al, 2008. Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child & Adolescent Psychiatry.
4 – Lang, R. et al, 2010. Treatment of anxiety in autism spectrum disorders using cognitive behaviour therapy: A systematic review. Developmental Neurorehabilitation.