Asperger's syndrome, which affects nearly 700,000 people in France, is one of the rare forms of autism that is not accompanied by any particular intellectual disability.
Characterized by difficulties in communicating, it would even participate in certain cases in the development of certain “
talents
” or particular aptitudes.
If the syndrome can be disabling on a daily basis, some have made it a strength.
Thus the billionaire Elon Musk, founder of SpaceX, Tesla and now boss of the social network Twitter, had assured in 2021 to be suffering from this syndrome.
But what exactly are the symptoms and causes?
How are diagnosis and management organised?
Le Figaro
takes stock with Professor Frédérique Brilhault, child psychiatrist and head of the Neurofunctional Psychiatry research team at the University of Tours.
What exactly is Asperger's Syndrome?
Asperger's Syndrome is part of the Autism Spectrum Disorders (ASD) family.
It manifests as deficiencies in social interaction, reasoning, and communication.
“
However, people suffering from this disorder do not have intellectual disabilities or language delays
,” insists Frédérique Brilhault.
Often, Asperger's patients can't stand exposure to bright lights or noise.
They have trouble perceiving their surroundings, such as sounds or even voices, especially in the presence of background noise or overstimulating elements.
Although there are more or less severe forms, these characteristics directly influence the ways of behaving: repetitive, stereotyped activities, interest in certain details.
This results in an impression of “
rigidity
”, “
distance
” or even “
perfectionism
”, frequent obstacles to the social integration of Asperger's patients.
"
Surprisingly, this different functioning also generates somewhat 'extraordinary' aptitudes due to the ability to perceive things that other people do not systematically see
", specifies the child psychiatrist.
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Autism, a better understood early brain development disorder
What impact on the expression or perception of emotions?
Contrary to popular belief, Asperger's patients are not lacking in empathy.
On the other hand, they may have more or less difficulty identifying and expressing their emotions or recognizing those of others.
In discussions, we usually rely on voice, gestures but also easy expressions as emotional indicators.
However, people with Asperger's can have difficulty integrating these language codes "automatically" because they do not recognize them: "
Some people with Asperger's will have a complete inability to recognize emotions.
Others will manage to identify the most obvious emotions such as joy and fear, but not the most subtle ones such as disgust or shame
,” explains Professor Brilhault.
For the most severe cases, facial motor skills are affected to the point that the face becomes friendly or inexpressive "
because they have difficulty understanding and integrating the motor facial repertoire
", continues the doctor.
” READ ALSO –
Autism: various disorders and a profile specific to each patient
How is the diagnosis made?
Asperger's Syndrome is a neurodevelopmental disorder that usually begins in childhood but can flare up in adulthood.
“
The diagnosis is rarely established before the age of 3, since before this age the symptoms are not visible.
Often this disorder is underdiagnosed until the child experiences real difficulties at school or even later at university or in his professional life
,” explains Frédérique Brilhault.
The clinical diagnosis is based, as with other forms of autism, on a set of medical examinations comprising interviews, cognitive tests to assess psychometrics, communication skills, intelligence and social intelligence.
The Wechsler intelligence scale
is the best known of these.
More commonly known as the "intelligence quotient (IQ) test", this scale includes a set of sub-tests to assess reasoning, abstraction and logical abilities.
Several versions of the Wechsler scales are available depending on the age of the participant: for example, the WPPSI-IV test is reserved for children from 2 years old, while the WAIS-IV test is only offered from 16 years old.
“
For these types of tests, people with Asperger's syndrome generally have scores that range from normal to superior.
However, it remains insufficient to assess social intelligence,
” insists Professor Brilhault.
To assess socio-relational performance, there are many tests such as the
ClaCoS battery of tests
(Consensus around social cognition).
The principle is based on an evaluation of social cognition using a subjective test in the form of a questionnaire (ACSo) and 4 objective tests to determine the ability to recognize emotions, the ability to attribute states mental ("theory of mind") and attribution bias, "
that is to say the errors made when one tries to attribute causes to his behavior or that of others
", indicates the child psychiatrist.
” READ ALSO –
Asperger's Syndrome: explosion of diagnoses, no means
What are the causes of this syndrome?
In case of diagnosis of Asperger, the
hereditary track
remains privileged.
However, there is not a single cause for this disorder, but rather a complex interaction of
genetic
and
environmental
factors , still largely misunderstood.
"
So far, autism research has identified a number of candidate genes, including allele variations (the different versions of a gene induced by mutation) that may promote atypical brain development
," says Professor Brilhault.
In a study published in 2022 in
Nature genetics
, American researchers highlighted the existence of 72 genes associated with this disorder In 2012, a series of articles published in the journal
Nature
mentioned for its part the potential implication of more of 1000 genes.
In addition to genetic causes, we now know that people suffering from an autism spectrum disorder have
anatomical abnormalities
of the brain, including an excess of synapses, the areas of contact between neurons.
This is what a team of neurobiologists reported in a study published in
Neuron
in 2014. The scientists explain that this overabundance of synapses results from a malfunction in the normal processes of elimination of these junction points during development.
Regarding the
environmental part
, several studies have found a close link between the appearance of autism disorders and exposure to certain pollutants (such as pesticides) during pregnancy and the early period of development.
“
Others also implicate certain inflammatory processes via excessive activation of immune cells or prenatal stress factors
,” adds Professor Brilhault.
What treatment and what care?
Currently there is no specific drug treatment for autism.
Management is essentially based on functional rehabilitation of social communication.
"
For this, there are developmental and behavioral approach programs that are based on individual or group sessions
," explains the doctor.
The earlier these interventions are, the more the improvements are visible and lasting.
Regarding
schooling
,
Asperger's children
go to school like other children but benefit from specialized support as well as specific adaptations to facilitate their social integration: adapted teaching units, pedagogical, educational or therapeutic interventions thanks to a team including teachers and medico-social professionals.
Communication assistance sessions in specialized centers are organized in parallel with school.
Parents are on the front line.
“
The medico-social teams give parents information, advice and offer training on how to better interact with their child and understand their behavior.
“explains the doctor.
Depending on the centre, parents also have access to a documentation centre.
All of this is taken care of in the aftermath of the announcement of the diagnosis.
For adults
with this disorder, “
we also offer social rehabilitation programs to help them decode emotions and understand social scenarios,
” adds Professor Brilhault.
Finally, there are programs to guide the professional integration of students in universities “
although we try to ensure that they themselves become actors in their life course
”.
