Asperger syndrome: a clinical account

F. went to a normal comprehensive school. She loved history and geography, and would memorise facts in these subjects with ease, but her teacher reported that she would do no work in any subject that did not interest her, such as mathematics.

Asperger's description of the syndrome

Modifications of Asperger's account
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This is a typical example of the syndrome.

K. had no stereotyped movements, but has always been ill-co-ordinated and very poor at games. He does not swing his arms when he walks. He attended a private school and did well in subjects needing a good rote memory, such as history and Latin, but fell behind at the stage when comprehension of abstract ideas became necessary. He was in the army for a short time, but was not allowed to take part in marches and parades because of his clumsiness and inability to do the right thing at the right time. He was discharged because of these peculiarities.

He was bullied at school and remembers it as an unhappy time.

As a child he was attached to his mother, he never made any friends, and he was much teased at school. He remains a shy and socially isolated person though he would like to be able to make social contacts.

Since leaving school he has been employed as a filing clerk, and lives in a hostel.
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Asperger syndrome: a clinical account

Careful observation of speech in Asperger syndrome discloses differences from thought blocking and the 'knight's move' in thought described by Bleuler (1911). In Asperger syndrome, speech may be slow, and there may be irrelevant or tangential replies to questions, but these problems are due partly to a tendency to become stuck in well-worn conversational grooves rather than to produce new ideas. Utterances are always logical, even if they are unrelated to the question, or originated from an unusual point of view. Thus one young man, when asked a general knowledge question about organised charities, said 'They do things for unfortunate people. They provide wheelchairs, stilts and round shoes for people with no feet'. There is a marked contrast between the vague woolliness of schizophrenic thought and the concrete, pedantic approach found in Asperger syndrome.

Introduction: The National Society for Autistic Children…

During clinical examination it is necessary to be aware that comprehension of abstract or unfamiliar concepts is impaired in Asperger syndrome. Those with the more severe form of the handicap may have a habit of answering 'yes' to any question they do not understand, this being the quickest way to cut short the conversation. Some may also pick up and repeat phrases used by other people, including other patients in a hospital ward, making diagnosis even more difficult.

Kretschmer, E. (1925). Kegan Paul, Trench and Trubner: London.

B.H. is aged 10. He was delivered by forceps and had difficulty with breathing and cyanosis after birth, remaining in special care for two weeks. He was a large, placid baby, who would lie without moving for long periods. He was not eager to use gestures, to clap or to wave goodbye. His mother was worried about him from the beginning, partly because of the difficult birth and partly because of his behaviour.

Schizophrenia Symptoms and Diagnosis

His major problem is his social ineptitude. He will, for example, go on talking about his special subjects despite the most obvious signs of boredom in his audience. He makes inappropriate, often quite irrelevant, remarks in company and appears gauche and childish. He is painfully aware of his deficiencies, but is unable to acquire the skills necessary for social interaction. Nevertheless, he is kind and gentle and, if he realises someone is ill or unhappy, he will be most sympathetic and do his best to help.

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The term schizophrenia can be used more strictly. It can be confined to those who have, currently or in the past, shown the florid first-rank symptoms described by Schneider (1971). In this case, the differentiation of Asperger syndrome rests on accurate definition of the clinical phenomena. Unless they have a superimposed schizophrenic illness, people with Asperger syndrome do not experience thought echo, thought substitution or insertion, thought broadcast, voices commenting on their actions, voices talking to each other, or feelings that external forces are exerting control over their will, emotions or behaviour. The young man, L.P. (Appendix No. 2), when asked if he had such experiences, gave the matter long and careful thought and then said, 'I believe such things to be impossible'.