The Curious Incident of the Dog in the Night-Time, has, among other recent writings about Asperger Syndrome, brought that condition to particular public prominence. The Mark Haddon novel is narrated from the perspective of an adolescent with Asperger Syndrome.
Fifteen-year-old Christopher Boone (or as he would say with Asperger-accuracy and exactitude, he is 15 years, three months and three days) sets out in the story to solve the mystery of who murdered his neighbour's dog, Wellington.
In so doing, he invites us into the labyrinthine experiences of life from one perspective of Asperger's. We are also privileged to participate in his parents' attempts to adapt to, accommodate and cope with their son's difference in relating to the world and to them.
Asperger Syndrome, so named by Lorna Wing in 1981, was first outlined in 1944 by paediatrician Hans Asperger as 'autistic psychopathy' but is of relatively recent recognition in everyday clinical work. It is most often described and understood in relation to autism, usually as a higher functioning or less severe manifestation of that condition but also involving the triad of significant social, communicative and behavioural impairments.
The syndrome is complex because it is a cluster of characteristics along the continuum of what are described as autistic-spectrum disorders, communication spectrum disorders or disorders of empathy.
Indeed, many clinicians draw links between Asperger's and a range of speech, language, attention, motor, perception, learning, social and communicative difficulties.
Clinicians have also drawn connections with a host of language, neurodevelopmental, neuropsychiatric or medical syndromes including Landau-Kleffner, Klinefelter's, Tourette's Syndrome, DAMP, OCD, sensory-integration dysfunction, hyperlexia, panic disorder and depression.
The development of difficulties which parents describe when a child has Asperger's, or allied syndromes, often includes a history of low birth-weight, problems feeding, colic and crankiness, failure to babble, to respond, to turn-take, to wave bye-bye, to use spoken language, to engage parents, to get on with other children and to cope in new situations.
There may be peculiar pitch, tone or prosody in the child's speech, which may be loud or hoarse, monotonous or just 'never right' for the situation the child is in. There may have been a failure to crawl, late walking, clumsiness, left-handedness, high activity or isolated, 'loner' interests and activities. There may be semblances of the problem in other family members. Some researchers report a higher incidence of twins in the extended family.
There may be food fads, complaints about the itchiness, scratchiness or the colour of clothes, terrible sensitivity to noise, new places, new activities and amazing sensitivity or absolute insensitivity to pain. There may be deep distress if objects are moved, if the routine is changed and an absolute need to know precisely what is happening at all times.
There may be poor eye-contact, gaze avoidance and the child may seem to look at people's mouths instead of their eyes and fail to read facial or atmospheric cues.
There may be few expected emotional responses, neither visible joy nor sadness or any sense the child is truly attuned to other people. The child may violate the rules of social distance, stand too close, change topic, interrupt insensitively, display no gestures, take everything literally, provide exhaustive detail about his current, often unusual obsessive interest or ask questions to which he already knows the answers.
Some parents say that despite their love for their child they never quite feel that they can connect; their child may flinch from touch, may be wooden to cuddle or may resist or ignore demonstrations of affection. They are often wounded by what appears to be callous indifference. Disheartened, they 'blame' themselves.
Of course, there are people with Asperger Syndrome who have extraordinary encyclopaedic knowledge and cognitive gifts. Some have an astonishing appreciation of number, capacity to play chess, computer literacy, intense interest in astronomy, in palaeontology, in retaining minutiae of information or engaging in quaint original use of language.
Because of this, there have been creative constructions of Asperger Syndrome that have called upon us, as clinicians, to turn the syndrome upon its head, to define it positively in terms of its strengths, not its strangeness, to say that these are people who dare to be different, to seek the truth, who are unable to lie, who will not engage in trivial chit-chat, who are loyal, to a fault, who delight in detail, who are persistent, orderly, accurate and without guile.
And that is so. But we must also remember that being different was not their choice but by chance. Christopher conveys that in the novel. He conveys the confusion and discomfort in the 'thin partitions' between his gifted abilities and 'disability'.
It would be too easy to become enthralled by the particular parade of privileged, public people, politicians, physicists, academics or esteemed inventors now regarded, retrospectively as having Asperger Syndrome, to remember the Einsteins and the Asimovs, and to forget the ordinary sufferers of this confusing condition.
It would be too easy to romanticise and revel in the extraordinary range of perspectives and challenges people with Asperger Syndrome provide, their engaging eccentricities and astonishing capacities, although one cannot help but appreciate and admire these aspects too.
Who knows, Newton may have asked why apples fell down while his friends raided the orchard? But more likely he sat on his own in the orchard, under a tree, alone. This is the aspect of Asperger Syndrome we must address and assist.
Parents want clarity, swift diagnosis and intervention. Any parent struggling with a child who seems 'different' should consult their GP for referral.
- Marie Murray is director of psychology at St Vincent's Hospital, Fairview, Dublin.