Dr Tillmann Jacobi outlines the key facts about Asperger's syndrome and how it affects a person's social interaction
1 What causes Asperger's syndrome? The precise cause is unknown and evidence is still mostly inconsistent. Parents often unnecessarily blame their parenting. There is no clear established genetic pattern. The recurrence rate is less than 7 per cent. Sometimes parents may blame environmental factors such as diet, pollution and other 'toxins', for example the MMR vaccination.
2 Establishing prevalence Currently it is estimated that Asperger's affects about 0.2-0.7 per cent
of children, meaning 2-7 per 1,000. Therefore any GP's list may include up to 10 cases. Undiagnosed Asperger's is probably common, as some children with this syndrome are
high-functioning – sometimes even brilliant.
3 What are the early indicators? Language and intellectual development might not be obviously delayed but some restrictions in interests or in some activities are often noticed early. Sometimes milestones are first achieved and then lost again, which should be taken seriously. Most children show clear features by the age of three.
4 Recognise the three key signs These are social interaction problems, poor understanding of the emotions of others and persistent repetitive or obsessive behaviour. There is no fixed pattern and the degree of intensity and disruption can vary greatly. Asperger's syndrome does not develop in adolescence, but might present as a missed diagnosis.
5 Don't rush a decision on diagnosis The assessment can take weeks or even months. The child needs to be seen in different contexts, at home, school or playgroup. Although an early diagnosis is often useful, 'labelling' a child early can be counter-productive as well.
6 Consider key differential diagnoses These are obsessive compulsory disorder or social anxiety. More severe psychiatric (such as schizoid disorders) or neurological conditions in disguise are fairly rare. Even nowadays there might still be missed ENT problems, such as deafness, as a reason for delayed learning or poor interaction.
7 Prepare practice staff Share the diagnosis with all relevant clinical and non-clinical practice members and educate them appropriately
(see useful resources for NAS advice). Book longer appointments, possibly before or after normal surgery hours to minimise waiting-time and stress caused by a full waiting room.
8 Adopt a suitable consulting style to suit the patient Adjust to the child's speed and speak slowly and in short sentences. Avoid euphemisms and ambiguities. Give enough time for responses. Establishing and keeping eye contact is essential even if there seems little response. Don't forget children with Asperger's syndrome cannot use intuition for social rules but have to learn them.
9 Be friendly but clear as well when it comes to physical examination It can be very difficult for the child with Asperger's to understand that you are there to help and how you need to do this. Pain thresholds may seem higher or lower than in other children.
10 Consider the social implications With a definite diagnosis, the child and family could qualify for disability living allowance (DLA) or other benefits, support and respite. The family may need help in filling in the form DLA1A for this. Don't forget that using public transport can be an issue for patients with Asperger's syndrome.
Tillmann Jacobi is a salaried GP in York, and a former GP lead for mental health at Selby and York PCT
Competing interests None declared