Unmasking Asperger's syndrome

'Individuals with AS are very gifted in certain skills, and their deficits are mostly in social interactions,' says Sameer Malhotra

Little Abhishek Dhar's ways seemed strange to his peers in the first standard class of a Delhi-based school, and as 6-year-olds often may, they responded with ridicule. When the boy could not focus on studies, struggled to communicate and lost his cool in the face of scorn, his parents sought professional help. Dhar's symptoms, they worried, could have resulted from any of various conditions - being bullied, or in a more serious scenario, autism. It was found the child suffered from Asperger's syndrome, a less-known, underdiagnosed type of pervasive developmental disorder.

Awareness, while on the rise, is still relatively low. To put Asperger's syndrome in popular consciousness, it takes an event such as the recent leaking of e-mails allegedly written by actress Kangana Ranaut where she admits to having 98 per cent symptoms of the condition. Like many who have it, young Dhar, who is now a college student, was in other ways a high-functioning child. He had a knack for numbers and easily picked up musical instruments. "Individuals with Asperger's syndrome are very gifted in certain skills, and their deficits are mostly in social interactions," says Sameer Malhotra, who heads the mental health department at Max Super-specialty Hospital in New Delhi. They sometimes display rare abilities like being able to tell on which day a particular date fell last year.

But the reason their actions may come across as unusual is because of their loose grasp of socially acceptable behaviour. They tend to show delay in speech or have clumsy body language, says clinical psychologist Seema Hingorrany. They could be hyperactive. Children with Asperger's syndrome engage in repetitive behaviour and they are generally uncomfortable in new environments. For instance, some carry a favourite blanket or toy everywhere they go. As the right and left hemispheres of the brain don't work together, their gait may be different. Often, they find it difficult to express warmth and reciprocate emotion.

It is unclear why such impairment occurs. Researchers are looking into various causes including genetic ones, serotonin levels, and issues of the immune system. Another cause they are investigating is the father's age at the time of conception. No theory has resulted in conclusive evidence, says Malhotra. Signs of Asperger's syndrome can appear onwards of ages three or four. A red flag parents should watch for is poor or no eye contact. This is typically dismissed as shyness but when it becomes the norm and is coupled with very reserved behaviour, it could be a symptom.

Hingorrany has had patients as old as 21 or 25 being diagnosed for the first time. Until then, the family thinks they suffer from social phobia and take them to classes for personality development. In some cases, they even try various sacred rituals before eventually seeking professional advice. Signs also go unnoticed if parents are too busy to spend time with their children, says child psychiatrist Sanghanayak Meshram. Schools, on their part, are taking initiative by employing counsellors who can identify offbeat behaviour, he adds.

One challenge in detecting Asperger's syndrome is that its symptoms overlap with autism. However, they are always milder. Individuals with Asperger's syndrome are generally more independent than those with autism, and less likely to indulge in disruptive behaviour. While tests are available that can more or less confirm the condition in a person, most counsellors offer a tentative diagnosis through interviews and observation.

For children with the condition, finding acceptance in school could be a problem. In their teens and adult years, the challenge moves to forming romantic relationships and fitting in at the workplace. They benefit from having a tight circle of friends and family who can understand and work with them. While there is medication to control attention deficit, anger and hyperactivity, a lot of the symptoms can be controlled with therapy and positive reinforcement, experts say. "With time, children learn to make eye contact and express love. If you accept them and treat them normally, they go on to handle the symptoms beautifully," says Hingorrany.

Some names have been changed