Asperger’s Syndrome and the Problem of Empathy

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People with Asperger's do feel empathy although they have trouble expressing it.
People with Asperger’s do feel empathy although they have trouble expressing it.

Can a person with Asperger’s Syndrome have empathy for other people?

The short answer is yes.

But a longer answer to this question is necessary to explain why people who lack the ability to put themselves into someone else’s shoes, to imagine their thoughts and feelings, and to predict what they will do next could be said to have empathy.

The Empathy of Asperger’s Syndrome

Why is a lack of empathy so frequently associated with Asperger’s? It has to do with the definition of empathy. Empathy is made up of two important parts: the first is the ability to see the world from the perspective of another. This is the thinking or cognitive part of empathy. It is about identifying what is going on in another person’s mind.

The second part of empathy is more emotional—the ability to imagine what another person is feeling and then to care about it.

These two aspects of empathy require different skills. In a nutshell, people with Asperger’s Syndrome have more difficulty than the average person with the first part of empathy—seeing the world from someone else’s perspective. The second part, caring about what someone else feels is as developed and present as anyone else.

Appropriate Reactions in Asperger’s Syndrome

While I say that caring about someone else’s feelings is the same for people with Asperger’s, another distinction is necessary to make this statement completely accurate.

What is critical to understanding empathy in those with Asperger’s is the idea of having an appropriate emotional response to another person’s thoughts and feelings. A person may care that someone else feels hurt or pain, is confused and worried, has doubts and wants comfort, but at the same time not know how to respond in a way that fits that particular situation. This is what makes those with Asperger’s different and where the idea that they lack empathy comes from.

Asperger’s makes it hard to know what it takes to address someone else’s concerns. The desire to respond may be there, the wish to help, to reach out and comfort may be there, however understanding how to may not. The resulting effect is, as so often occurs, the stigma of having no empathy, of being callous or unfeeling.

Asperger’s and Too Much Empathy

Swiss researchers Henry and Kamila Markram argue that the fundamental problem in Asperger’s is a hypersensitivity to experience. Everything is overwhelming. Lights, sounds, smells, tastes, and emotional experiences are intensified. The person easily feels overpowered, anxious and fearful.

The Markrams believe that people with Asperger’s Syndrome, rather than not feeling enough, feel too much. What looks like coldness and aloofness to the outside world is actually a response to being overwhelmed by emotion. It is an excess of empathy, not a lack of it, that plagues those with Asperger’s.

Furthermore, feeling so much intensity leads to intense fear, according to the Markrams, along with withdrawal and self-soothing behavior, exactly the sort of repetitive movements and failure to make eye contact that is typical of those with Asperger’s. Behavior like this interferes with normal social behavior. Other people begin to withdraw, thereby limiting the social contact that could help the person with Asperger’s learn more effective social skills. The resulting cycle of mutual withdrawal leaves the person with Asperger’s appearing uninterested, and unempathetic.

Clearly, understanding what another person is thinking and feeling is difficult for someone with Asperger’s. But this is different from not having the capacity to care and be concerned about people’s feelings. Asperger’s does not rob someone of empathy, it just makes it more difficult to experience and to express.

Psychologist

Dr. Kenneth Roberson

Dr. Kenneth Roberson is an Asperger’s psychologist in San Francisco with over 30 years of experience. To ask a question or schedule an appointment, please call 415-922-1122.

18 thoughts on “Asperger’s Syndrome and the Problem of Empathy”

  1. Crap. I think I have asperger’s. Honestly most people who knew me as a child would probably say that I did. I was withdrawn and awkward and was bullied severely. People thought I was clueless about the subtle mockery and inuindos about me (and sometimes this still happens) but I am painful aware but I let then think I am stupid as a way to protect myself and because I don’t know how to respond. My friend who is a doctor told me that I take everything so literally and was wondering why I don’t pick up on sarcasm. Actually I am very aware of it but just don’t know how to respond properly. I can see someone and immediately know how they feel and what kind of person they are. I was driving today and passed someone and just saw her out of my periphial vision but was immediately disturbed by the calous, angry energy she was radiating. This is my life all day long every day. I am bombarded by the emotions of others. The few friends I have are very kind people since I have a hard time being around people who aren’t kind. I have wondered my whole life what is wrong with me and my family calls me the “alien princess” since I don’t seem to fit it and I have never felt like I belong on this planet or in this society. It has always felt foreign to me. I spend a lot of time in the woods alone or painting. My parents always told me to make eye contact but it was just so painful and at first I just didn’t know you were supposed to. I can see too much when I make eye contact. Then when I got older and wanted to fit in I tried to make eye contact but I would just stare like a deer in the headlights at people feeling a sense of absolute terror but trying to act as I thought was normal. Now I don’t care as much. If I don’t feel like making eye contact I don’t and when I do I just kind of look through them and try to block off too much feeling. My parents and others constantly told me I was over sensitive too. I just felt everything so acutely and still do. The fighting in the house was torture to me. I used to just hide in my back yard in the wood pile with my rabbit sometimes well into the night. I didn’t like people and didn’t play with other kids unless forced to. I liked animals and I liked and still love art and nature. I read about àspies a few years ago but decided there was no way that was me even though I fit most symptoms, including selective mutism as a child, because I know that I am night empathic and highly imaginative which supposedly are impossible with asperger’s. I don’t watch TV or read novels much because if I need some downtime I just prefer to be alone and go into my own head which is car more interesting than anything on TV. I am also a published poet and artist. I dunno. Maybe I have asperger’s, maybe I’m just wierd but I guess I don’t like labels anyhow. I’m just a different kind of person and I’m ok with that. Anyhow thanks for letting me think “aloud”.

    Reply
    • Hi , good to know there is someone else like me out there I’ve known I’m different for a while but have never been diagnosed (have no interest in it either) but have been curious yet everytime I take an online test for aspergers it comes back negative but like you I have loads of empathy and seem to be able to feel peoples mood very easily and deeply and can see and feel their mood change in relation to mine changing to thiers! Like a back-and-to effect as I guess like me your face is very honest and you find it hard to hide your mood and emotions so instead of feeling and seeing that change in people when you look at them it’s easier to not look at them and connect, it seems better for them and me. But then I do have anxiety and depression issues too which complicates things further, in fact it may have developed social anxiety in me as I didn’t have social anxiety when I was younger however was a mute when I saw very young.
      My theory is everyone is on the spectrum and people like us are further up , if you get me? I’ve had that idea for a while that so called aspergers is a defense mechanism against sensory overload. I think sometimes how society has evolved so hectic and rushed and busy is not natural which is why it goes against our natural ‘default’ state and that it’s not us that has a disorder it’s society that has the disorder!
      Good to know you’re comfortable with yourself. The older I get the more I realise that everyone is fucking weird in their own right, weird is the new cool nowadays anyway isn’t it!? ‘Normal’ looks so boring!

      Reply
  2. Hello, I’m a 25 year old female Aspie who has been diagnosed for right around 10 years (a little more, but I feel old enough, so I won’t count those extra few months).

    I have never understood why Aspies are labeled as unempathetic. I’ve always been empathetic to the point of being nearly empathic. True, I am unable to “walk a mile in another person’s shoes,” however, when I see someone hurting, physically or emotionally (it doesn’t matter), it’s as if I can actually feel their pain. I don’t know why, I don’t know how. I always just figured it was a gift from God to help me know who needs me. Sometimes, when my own life is a mess and I’m nearing meltdown mode… Sometimes I wish I had no empathy at all. Shortly thereafter I come to my senses and realize how different (negatively different) I would be if I lost such a huge part of me. I’ve never hated anyone in my life, and I believe it is because of my empathetic blessings. Also, I don’t tend to judge others either. And i forgive very easily (but i dont forget… I think its a quality Aspies share with elephants)

    My level of empathy has helped me develop the ability to hide, fake or even create different emotions inside myself. (Like if I am scared, I can turn that fear into hyperactively joyful by pretending g and then I just gotta fake it til I make it.

    How do I get rid of or combat this label that people who have never met before try to place on me?

    I am fairly certain I sound insane, or at least Bipolar, so telling them of my level of empathy as I have laid out for you (honestly and bluntly like only an Aspie has the guts to do), is sort of out of the question.

    Reply
  3. Oh, and I don’t get angry much either. If I do get angry, it’s gone in about 60 seconds. Any advice about how to battle the assumption that all Aspies are gonna a thrown *violent* tantrums if they have a meltdown ?

    Reply
  4. Thank you for pointing out that Aspies like myself do indeed have empathy. I fully agree with the intense world theory. Lack of empathy is not part of autism. What appears like lack of empathy is actually depression due to being overwhelmed.

    Reply
    • Thank you for your suggestion. I read your post on empathy and while I don’t agree with all of what you wrote I did found it overall very helpful. Please keep communicating your thoughts about Asperger’s.

      Reply
      • Dr. Roberson,
        Thank you so much for taking the time to read my unnecessarily long rant, I am about to launch into another and use your website as the platform; although this really is directed at you in the hopes of finding a mutually beneficial understanding that can accomplish the goal we both have… to help those with Asperger’s syndrome and their partners find happiness.

        I admit I was a tad dramatic when I opted to say, “God help us all…” but I am a rather dramatic person. I am just so saddened by the negative depictions of those with Asperger’s syndrome that I want to passionately scream out how misunderstood this whole thing is. I am a self-proclaimed “highly empathetic neurotypical” and also an avid research-junkie who has spent years reading blogs, books, peer-reviewed articles and research studies. All of this has led me to the current (strong) beliefs I hold. I certainly appreciate why others would not agree with all of my sweeping conclusions.

        Too often I find myself concerned that the majority of mental health professionals delivering information on the subject matter are only utilizing data and inferences obtained in their practice setting or from things they have read. The problem with this is that NOTHING I have ever read (written by a licensed professional) ever pays mention to their own experience that qualifies them to make such generalizations or deliver “practical” advice.

        There is a “human-factor” that is lacking and it causes a (potentially) unnecessary pause in trusting the advice or opinions they have to share. As a society we trust the medical professionals out there to steer us in the right direction and “get it right.” I doubt if you could honestly confirm that history has gotten much of it “right” when talking about Asperger’s syndrome. In fact, I am going to boldly assume you would agree that the grip on identifying and helping those with AS in the past 30 years has fallen short in a profound way by the mental health professionals entrusted to do the opposite.

        It was this lack of comprehension about AS across the board that justified the creators of the DSM-5 to group Asperger’s syndrome into Autism Spectrum Disorder. They claimed that in doing such, they would ease the misdiagnosis and misunderstanding within the mental health community; the community who found it impossible to tease out those with Aspergers from all of the other disorders that affected social communication challenges. To directly quote this admittance that history seriously screwed over those with AS by their own omission…. “Researchers found that these separate diagnoses were not consistently applied across different clinics and treatment centers.” This was the DSM-5 committee’s justification for lumping a bunch of previously separated mental health diagnoses (even if poorly understood) into a giant pool of confusion. This was their answer for the fix to the mental health professional’s failure to do this in the first place. All they really did is make sure Aspies no longer “slipped between the cracks” but rather… got lost in a sea of confusion where no identified cause or therapeutic intervention could ever be uncovered for that specific subgroup.

        My point in bringing this up is that anyone who has the wherewithal to truly investigate the history of Asperger’s syndrome or what the diagnosis “means” is going to come up with far more questions than they had going in after researching the topic. They are going to develop a disturbing distrust (as I did) in the mental health community’s ability to diagnose them (or their loved one) appropriately or construct beneficial therapeutic interventions, cognitive behavioral therapies, or general assistance in navigating the confusing world they already find themselves in. I am speaking on behalf of those like myself who desperately tried to find assistance and came up short. One way or another, those people who stumble upon this website are going to be expecting answers. You are a licensed professional who has suggested you have the knowledge to help them. If those people have also exhausted themselves in searching for answers prior to reaching your site, they are going to need some transparency from you to buy into anything you have to say.

        I do apologize if I seem crass in my words, but I have opted to be unfiltered and blunt in my advocacy for helping people like my husband, people like myself, and the children who do not have to suffer the way either of us have in their future. I had half a decade to build up enough animosity toward those who failed us in the past. Abolishing the fear that I feel for everyone’s future hinges on directly vocalizing what others do not know how or want to say. If you say you have the tools to heal us, please be open and make good on those claims. I promise that any educated neurotypical wife desperate to get real assistance for her husband and marriage, has likely already developed a distaste for the professionals entrusted to have helped her husband long ago. It will not take long for her to develop a resentment for those in the mental health community for indirectly causing the horrific pain and misery that she is now finding herself in.

        I know that the discipline of mental health is lightyears behind every other practice. I know that the majority of people who go into this field are not doing it for financial gain. I know that the ultimate goal of the vast majority is to advocate for more research, more funding, and ultimately more assistance for all of those suffering from a mental health diagnosis.

        I still have faith in people like yourself who have dedicated your life to those with Asperger’s syndrome. I believe you have done this for altruistic purposes and I am so thankful for your existence. I am just desperate for you to start vocally advocating for all of us with more than vague “advice.” We are so deflated by this. We are so desperate that a highly visited website like yours could serve as the final decision-maker for whether an Aspie-NT marriage ends or those involved keep fighting. If you have only vague information to offer, that sounds like the same regurgitated crap we have been reading every day since we began our quest for help… we are going to submit to the hostile, angry, depressed, and defeated neurotypical and Aspie individuals out there who tell us there is no hope and it is time to just cut our losses and run.
        I highly doubt that was your intention in created this so I hope you will consider what I have to say so we can be a part of the efforts to truly make a difference.

        So here is where I stand: I sit back day after day and wonder how many of the self-proclaimed “Asperger Experts” ever had an interpersonal relationship where they were emotionally invested in someone who warranted the diagnosis. I would like to believe that they have, and that is what motivated them to dedicate their lives to the subject… but I find myself doubting it more each day. I pay mention to this because I could read all day (every day) from outside the box about AS and still not comprehend what I do being in love with a man who was undiagnosed until he reached the age of 31. Those involved in an Aspie-NT relationship speak to our hearts and our pain… while those professionals who claim to have answers lack the emotionally empathetic words to enable our trust. Can you see why this may cause us to choose the ones who identify with our feelings more, even if they are giving us poor advice to run?

        Having to navigate the journey first hand and have both of our happiness hinging on truly understanding this diagnosis… it changes a lot for a person.

        Due to my assumption that most of these “experts” do not actually have first-hand experiences, I would like to find a way to link them up with those who do. Not those who are in the initial stages of the discovery, but those who have lived it long term, learned everything they can about it, and have significantly relevant observations to share. I would like to see those who comprehend the way the human mind works through education and clinical experience join forces with those who have the knowledge obtained from social accounts and personal experience. Both have equally meaningful information to exchange that combined can enable realistic interventions in the future.

        I fear that those with a title behind their name may shun those who haven’t one. Regardless of how much a person observes in a clinical setting, or the extent of professional literature they review, there is going to be a significant gap in comprehension unless they have been personally exposed to it. We are not talking about a readily identifiable deficit in neurological function here, we are talking about empathy. This is a concept so abstract, even the most empathetic of mankind finds challenge in processing it. Despite all of the great strides in neurology, psychiatry, sociology, psychology, genetics, behavioral forensics, etc. none of these “scientists “are able to definitively identify the lobes of the brain, chemical composition, environmental, genetic, or social factors that determine a person’s individual capacity for utilizing empathy.
        With that being said, I am fully aware that no one can discount the theories I currently have (and want to share) any more than they could validate them.

        So here is what I have to offer:

        Having a decent grasp of medicine in general and also being inexplicably in love with an adult who has Asperger’s syndrome, and without question suffering the ill-effects of the Cassandra Phenomena; I egotistically believe my conclusions make a little more sense than most of the literature available. I have utilized all of my research to come to the conclusion that the sole deficit in someone with Asperger’s syndrome (and I absolutely do not endorse or agree with the catch-all diagnosis of Autism Spectrum Disorder) is an absence in cognitive empathy.

        I do not deny all of the other comorbidities or observed behaviors that frequently exist in Aspies (ADHD, OCD, tics, focused special interests, tactile/audible/visual sensitivities, repetitive behaviors, etc.) as they are most certainly present in a vast majority of those who rightfully warrant the diagnosis. Though they are readily identified, they are NOT defining characteristic of ALL Aspies. The more logical explanation is that these other neurologic and behavioral traits are seen equally in the general population of neurotypical children as they are in those with Asperger’s syndrome. They just “appear” to be linked to those with Asperger’s syndrome because of how pronounced and severe they present themselves.

        A neurotypical child who may have similar diagnoses or behaviors can often diminish the impact they have in their daily function by utilizing alternate coping mechanisms, cognitive behavioral therapies, and positive social interactions to offset them. Every mental health professional knows that stress both triggers and elevates the severity of all of those behaviors and neurologic anomalies. If they all agree on that common knowledge, they should also be able to easily realize that a child/adult with Asperger’s syndrome endures a far greater assault on their psyche that manifests into a stress-reaction. If that Aspie also has the genetic predisposition for ADHD or Tourette’s Syndrome (or any other named commonality) … it is certainly going to effect the severity and impact of those things in their daily life, right?

        I do not think I have all of the answers, nor do I discount the possibility that there will be proven causes found that may conflict with my current beliefs. I am open to anyone who can challenge my theories. The problem is… I have yet to find any. I feel incredibly disheartened that the potential for anyone validating or disproving my theories with scientifically-significant data is now non-existent. The grouping of Asperger’s syndrome into Autism Spectrum Disorder has made the chance of any relevant progress in AS unlikely.

        My theory: I took all of my compiled data from the last five years and did my best to negate or confirm previous information put out about Asperger’s syndrome. In the end I had only one commonality that served to explain EVERY OTHER “characteristic, trait, behavior, or comorbidity” responsible for everything that goes wrong in the life of an Aspie. Cognitive Empathy.

        That is, it.

        After years of trying to implement every piece of advice, altering every behavior I could, adapting every way I attempted to communicate, and exhausting every single thing the “professionals” suggested would help or at least salvage the failing marriage I had with the man I loved… they ALL FAILED. The only thing that every worked, the only thing that ever enacted immediate change… and the only thing that saved my marriage was when I chose to apply the concept that my husband DID NOT have cognitive empathy.

        When I finally educated and disciplined myself enough to communicate with this concept in the back of my mind… my marriage immediately began to transform into everything I always wanted.
        Everything that I was told was impossible or non-existent was becoming my reality.

        The moment the transformation began, I began to reflect on everything I had been doing wrong all those years to prevent us from having an intimate and happy marriage.

        My husband and I are both unique individuals. Neither of us are perfect and neither of us have mastered this new method of communicating. He has over 35 years of standing firm in his view of reality, and I have the same. But we love one another, we always have. Despite our daily lives having had an emotionally volatile and hostile foundation… despite the gallons of tears I have cried and the inexcusable and horrific things we have said to and about one another… we loved each other. When every single bit of sense in our brain told us to stop fighting for something that was impossible, and every rational observation concluded we were incompatible with one another… we still loved one another. Neither could make sense of it, and neither wanted to keep suffering in an attempt to try to.

        But we did. We had no good reason for doing this that would make sense to others outside of saying we were self-deprecating and insecure humans (which neither believed was true of themselves).
        We fought hard, and we fought with all of the physical and emotional energy we could muster for a marriage that most would have thrown away long ago. We didn’t know why.

        Finding the love, emotional reciprocity, humor, intimacy, shared interests, desire to motivate one another, internal self-motivation, and general sense of fulfillment that both of us now share… THAT WAS WHY. We both inherently knew it was there waiting to be uncovered, just as the desperate NT wives who have spent 30 years clinging to a marriage that causes them pain also know there is a reason not to give up.

        I am not bound to marriage by religious conviction. I divorced my first husband who I loved very much because I felt he was an emotional threat to my daughter and self. I am not financially dependent on my spouse (I am the source of income), I do not have children with my husband, I am not insecure in believing no one else would want me (I know I am still desirable). I had no reason to stay in an unhappy marriage with a man the literature and web-world said “could never love me.”

        I could have left, and by all reasonable accounts… I should have left.
        I didn’t leave because I KNEW who my husband was despite the inept communication we had that kept telling me otherwise.
        This is the main reason that highly empathetic neurotypical women do not leave their Aspie husband. It is not about all the other excuses they make to try to find rational sense that coincides with society’s expectation of a strong woman’s behavior. These women are NOT WEAK.

        I did not have validation for this underlying belief until I applied the theory that my husband had no cognitive empathy into the way I communicated with him…

        Everything changed from that day forward, little by little, until I knew for a fact that everything I believed in my gut about the man I married perfectly mirrored the man I was now sharing a bed with.

        My husband and I are so very in love with one another. My husband… the cold, selfish, and non-empathetic man I once thought he was… is the kindest, gentlest, and most empathetic individual I have ever met.

        My husband has emotional empathy; he does not have cognitive empathy. I don’t NEED cognitive empathy to be happy, and nor does he. We just had to figure out a way around it when I only knew how to communicate by using it.

        So in conclusion Dr. Roberson, (and thank you with all of my might for allowing this novel to be posted), I may not have the answers. I may be wrong in the conclusions I have drawn about Asperger’s syndrome. All I KNOW is that the only thing that ever made a difference for my husband and I was the silly theory I invented that everything was directly related to cognitive empathy and my husband having no capacity to comprehend it. Everything else failed. I have never found success otherwise, and we ARE very “successful” now.

        If you can make sense of why this has worked for us when nothing else did… if you can combat anything I have to say with scientifically proven evidence or clinically proven success… please, I want to hear it. Everyone wants to hear it. Maybe this is a deficit that only my husband has and it will not work for everyone. Maybe you could give information that will make us even closer and happier. This is a process and not easy because I am learning to communicate in a whole different language that was once instinctual to me.

        Please, tell us what made you go into this field… what firsthand experience you have. Please be transparent. You have said you have over 30 years of experience directly dedicated to those with Asperger’s syndrome. You even point out that when you do diagnostic testing you differentiate between the two (AS and ASD). This is why I trust in what you have to say.

        I read everything you wrote, I respect you and I am beyond trusting that you can help fill a lot of voids I have in understanding my husband. I also think you may have the ability to prove or disprove my simple explanation for what the true defining characteristic of Asperger’s syndrome is.

        I realize a lot of internet bloggers who are disclosing advice are being vague in order to generate profit, business, and a larger clientele. I give you my word… disclosing what you know is NOT going to drive away profit, it is going to do the opposite. We neurotypical wives have spent an embarrassing amount of money on books and tools to save our marriages. We are not going to stop reading what you have to say if you are giving us beneficial information and tools. We are only going to seek you out further for individualized assistance with our own unique relationships. We are desperate for honesty.

        Please be the one professional who does not fail us.

        http://www.happyaspergermarriage.com

        Reply
        • HEAR HEAR Thank you Kenneth and Kara, thank you for saying this, spelling it out, expressing it clearly even if it’s longer than the average comment! (about the cognitive empathy being separate from caring). Kara I agree with every loving word you wrote and I wish you had the attention of every NT wife because these words are very helpful!

          I’d like to add that Emotional NT wives do go through cyclic phases during which they see everything as much worse and panic, and then their hormones settle down and they see the same things differently. so there are like Moon-periods for each NT wife when she’s desperately researching Aspie-ness, and then she stops, because she was calmer for other reasons, or she got a job or hung out with friends, and he didn’t matter so much and things calmed down and then she naturally expressed things with more appropriateness for a cognitive-empathy-blind man and then he was nicer, and she never realized that her experience was so much part of the bigger picture.

          Reply
  5. Yup, I’ve long suspected that I’m an Aspie, although there are other childhood factors which may or may not be involved.

    The emotional overload followed by withdrawal describes me very well, and causes tremendous difficulties. It’s nice to see it described like this, rather than promoting the idea that “aspies don’t have empathy” when, in fact, the opposite is true. In my case, it was always my inability to make sense of my feelings that caused a problem, rather than any lack of them.

    However, where once people were an enigma to me, I’ve made a kind of personal study of them in later life. As a result, I find I can figure people out very quickly and shockingly well. It frightens me occasionally — I can feel like Ray Milland in the movie “The man with x-ray eyes”. Sometimes I wish I did not see.

    I still have moments when I forget to think analytically in social situations (usually when I’m happy and excited) and the result is almost always misunderstanding by others which I find upsetting and sad. Nevertheless, I think I have certain insights and abilities not commonly shared. My outlook on life and people is positive overall, and I’d never change the way I am. I’m far more interested in finding better ways of dealing with any difficulties and getting the most out of life.

    Reply
  6. The increased sensitivity, including emotional, of ASpies does not equal heightened empathy. More often than not, they are acutely sensitive to, and overwhelmed by, their own feelings and nobody else’s.

    Reply
    • I don’t agree with that at all. I know I have heightened empathy. Ask any of the people who turn to me when they need help or just someone to cry to. I am known for it. Some people are only my friends when they are in need, because they know I’m not so good in a light-hearted social setting.

      Reply
        • I suspect I am an Aspie.
          I feel sad for others, but will avoid any fights, tense situations because I can’t handle them. My last relationship was pretty much ruined as I could never understand how to act properly when required, ie; if partner was upset, or upset over something, I could never see why. I couldn’t feel angry if someone wronged me or her, it’s like that part of my brain just wasn’t there.

          Reply
          • Thank you for reaching out. I’m sorry to hear of your troubles. May I suggest, if you haven’t already, that you seek some professional help. Given your experiences, I think it would benefit you. Let me know if I can be of any assistance.

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Dr. Kenneth Roberson

Dr. Kenneth Roberson

Dr. Kenneth Roberson is an Asperger’s psychologist in San Francisco with over 30 years of experience. To ask a question or schedule an appointment, please call 415-922-1122.

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Diagnosing Asperger’s is a fairly easy process in principle. But in practice it is complicated and necessities a professional who understands thoroughly not just the characteristics of Asperger’s but how they are played out in real life. Reading about Asperger’s in a book or articles generally makes it seem that Asperger’s is a clear cut, well defined and easily identifiable condition. In truth, people with Asperger’s behave in many different ways and not always exactly how it is defined.

For example, someone with Asperger’s can be quite intelligent and have mastery over numerous facts, yet have much less comprehension emotions and how they are expressed. The person may be able to identify basic emotions, such as intense anger, sadness or happiness yet lack an understanding of more subtle expressions of emotions such as confusion, jealousy or worry.

How is it possible to tell for sure if someone doesn’t understand subtle emotions? They often don’t come up while sitting in an office speaking to a professional and because the person is not aware of their presence it’s unlikely that person would volunteer how hard it is to understand them. Relying on a spouse’s or friend’s report about how someone recognizes emotions is not always advisable since those reports are filtered through the spouse or friends’ own biases and their own ways of understanding emotions.

The only way to tell is to be around someone long enough to experience what they are like, to see how they respond in situations that test the features of Asperger’s and ask the right kinds of questions to clarify whether they have those features. There is test yet developed that can be used to make a diagnosis of Asperger’s, no instrument that measures Asperger’s nor any procedure that can objectively sort out those with Asperger’s from those without it. Brain scans, blood tests, X-rays and other physical examinations cannot tell whether anyone has Asperger’s.

The bottom line is that Asperger’s is a descriptive diagnosis. A person is diagnosed based on the signs and symptoms he or she has rather than the results of a specific laboratory or other type of test. Those signs and symptoms are often subtle and it takes someone with considerable experience to tell whether they are present and, if so, whether there is enough of a case to say confidently that the person has Asperger’s. It is all a matter of confidence, that is, with very few exceptions no one can say that someone else has Asperger’s only that one has a certain degree of certainty that a person does have Asperger’s.

Diagnosing Asperger’s

With this in mind, what is the actual process of finding out whether someone has Asperger’s?

Other professionals may take different steps but I have a clear-cut procedure that I go through when asked to assess Asperger’s. I first determine whether it makes reasonable sense to undertake an assessment of Asperger’s. The assessment process itself is time consuming and it can be costly. Why go through with it if there is no good reason to assume there might be some likelihood of finding the behaviors and signs of Asperger’s? After all, you wouldn’t go to the trouble of evaluating whether you have a broken foot if, in the first place, there is absolutely nothing wrong with your foot.

Screening Questionnaires:

Currently there are nine screening questionnaires that are used to identify adults who may have Asperger’s. Most require the respondent to indicate whether he or she agrees with a statement related to Asperger’s. 

Examples of actual statements are:

  • I find it difficult to imagine what it would be like to be someone else.
  • The phrase, “He wears his heart on his sleeve,” does not make sense to me.
  • I miss my best friends or family when we are apart for a long time.
  • It is difficult for me to understand how other people are feeling when we are talking.
  • I feel very comfortable with dating or being in social situations with others.
  • I find it easy to “read between the lines” when someone is talking to me.

Completing one or more of these questionnaires can identify abilities, inclinations and behavior that could be indicative of Asperger’s syndrome. The results might suggest that it makes sense to investigate further if enough criteria are present to indicate a diagnosis of Asperger’s.

The questionnaires and scales for adults are as follows, in alphabetical order:

  • Adult Asperger Assessment (AAA) (include link, for each test below)
  • Aspie Quiz (AQ)
  • Autism Spectrum Quotient (AQ)
  • Empathy Quotient for Adults (EQA)
  • Friendship and Relationship Quotient (FQ)
  • Ritvo Autism Asperger Diagnostic Scale (RAADS)
  • Social Stories Questionnaire (SSQ)
  • Systematizing Quotient (SQ)
  • The Reading the Mind in the Eyes Test (RMET)

These questionnaires indicate whether a person has characteristics that match those of people with Asperger’s but that, in and of itself, doesn’t prove someone has or doesn’t have Asperger’s. The person filling out the questionnaire may be responding to the questions with the intention, conscious or not, of demonstrating that they don’t have, or for that matter they do have, Asperger’s. Often people answer these questions based on what they know about Asperger’s, they’ve read or been told about it, or what they imagine it is, and what they are indicating in their answers is not a accurate reflection of the characteristics they actually have.

Again, screening questionnaires are designed to identify potential cases of Asperger’s syndrome but they are not a substitute for a thorough diagnostic assessment.

To do that, an experienced professional needs investigate two things: the person’s medical, developmental, social, family and academic history; and how the person responds to a face-to-face assessment of social reasoning, communication of emotions, language abilities, focused interests, and non-verbal social interaction.

Personal History

Diagnoses are most valid and accurate when they are based on multiple sources of information. One highly important source are any documents, including reports, evaluations, notices, or assessments, that speak to the person’s social, emotional, language, and physical growth. An example is previous medical reports documenting signs of early language delays and/or peculiarities, coordination problems, behavioral difficulties or unusual physical problems. School reports might indicate past social and emotional difficulties, along with academic tendencies, that could be relevant to any indications of Asperger’s syndrome. Tutoring reports, evaluations of group activities, personal diaries, family recordings and other such records often provide valuable insights about the likelihood of Asperger’s.

It is often the case that a person seeking an evaluation does not have any documentation, formal or informal, that is relevant to the assessment process. That is not an insurmountable problem. We work with what we have, and a diagnosis, either way, doesn’t depend upon any one piece of the assessment process. I have had many cases where I was able to conclude with confidence whether the person had Asperger’s without seeing one single piece of written evidence about that person’s past. It helps when that evidence is available but it is not critical.

Clinical Interview

Sitting down and talking to someone makes the difference between an assessment of Asperger’s that has a high degree of confidence and one that is questionable. When I assess someone for Asperger’s I ask to meet face-to-face for three meetings.

The first meeting covers general facts about the person, particular those relating to his or her present life. I want to find out about the person’s significant relationships, whether they are friends, work colleagues, spouse or partner, children or anyone else with whom the person interacts regularly. I am interested in how the person gets along at work and his or her work performance, how the person manages daily living, what initiative the person takes in planning and achieving life goals, and how satisfied the person is with his or her life. These questions help me assess whether the person’s attitudes towards life, conduct in relationships, and general success in achieving life goals reveal any of the characteristics that typically are found in people with Asperger’s.

The second meeting focuses on the person’s background, particularly information about the person’s early family life; previous school experiences; past friendships, employment and intimate relationships; childhood emotional development and functioning, and significant interests throughout the person’s life. Because Asperger’s is a condition that exists at or before birth, clues about the presence of Asperger’s are found in the history of the person’s childhood. Hence a thorough understanding of early social, emotional, family, academic and behavioral experiences are essential to the diagnostic process.

The third and final meeting is a time to clarify questions that were not completely answered in the previous meetings, gather additional information and raise additional questions that have emerged from the information collected so far. When everything has been addressed to the extent allowed in this timeframe, the final part of the clinical interview is the presentation of my findings.

Presenting these findings is a multi-step process. First, I explain that certain characteristics are central to Asperger’s syndrome. If those characteristics are not present in the person then he or she doesn’t have Asperger’s and if they are present a diagnosis of Asperger’s is much more viable.

There are also characteristics that are related to Asperger’s but are also shared by other conditions. An example of this is difficulty noticing whether people are bored or not listening in conversations. Lots of people don’t pay much attention to whether people are listening to them, but that doesn’t mean they have Asperger’s. On the other hand, in combination with other signs of Asperger’s, not noticing how people respond in conversations, could be a significant confirmation of an Asperger’s diagnosis.

To diagnosis and adult with Asperger’s requires that the person have:

  • Persistent difficulty in communicating with, and relating to, other people. Their conversations have to be generally one-sided. There has to be reduced sharing of interests and a lack of emotional give-and-take. Superficial social contact, niceties, passing time with others are of little interest. Little or too much detail is included in conversation, and there is difficulty in recognizing when the listener is interested or bored.
  • Poor nonverbal communication, which translates into poor eye contact, unusual body language, inappropriate gestures and facial expressions.
  • Difficulty developing, maintaining and understanding relationships.
  • Narrow, repetitive behaviors and interests. Examples of these are insisting on inflexible routines, eating the same foods daily, brushing teeth the same way, following the same route every day, repeatedly rejecting changes in one’s life style, being either very reactive or hardly reactive at all to changes in one’s environment like indifference to temperature changes, hypersensitivity to sounds, fascination with lights or movement.
  • Signs of these characteristics as early as 12-24 months of age, although the difficulties with social communication and relationships typically become apparent later in childhood.
  • Indications that these characteristics are causing significant problems in relationships, work or other important areas of the person’s life.
  • Clear evidence that these characteristics are not caused by low intelligence or broad, across-the-board delays in overall development.

What happens if someone has some of these difficulties but not all? Do they qualify for a diagnosis of Asperger’s, or not?

The answer lies in how much these characteristics affect the person’s social, occupational or other important areas of functioning. If, for example, the core characteristics of Asperger’s lead a person to speak in few sentences, interact with people only around very narrow, special interests and communicate in odd, nonverbal ways, we can say that these are indicators that a diagnosis of Asperger’s is correct.

If, on the other hand, the person engages in limited back-and-forth communication, attempts to make friends in odd and typically unsuccessful ways, and is not especially interested in reaching out to others, a diagnosis of Asperger’s could be considered but not assured.

A diagnosis is most assured when the signs of Asperger’s are present in the person all the time, they have an obvious effect on the person’s ability to be successful in life, and don’t vary much. Additionally, when the information used to make a diagnosis comes from multiple sources, like family history, an expert’s observations, school, medical and other reports, questionnaires and standardized test instruments the diagnosis is likely to be more accurate and reliable.

Advantages and Disadvantages of an Asperger’s Diagnosis

The advantages of having an accurate, reliable diagnosis of Asperger’s are many. It can eliminate the worry that a person is severely mentally ill. It can support the idea that the person has genuine difficulties arising from a real, legitimate condition. Other people, once they are aware that the person has Asperger’s are often able to be more accepting and supportive. A new, and more accurate, understanding of the person can lead to appreciation and respect for what the person is coping with.

Knowing someone has Asperger’s opens up avenues to resources for help as well as access to programs to improve social inclusion and emotional management. Acceptance by friends and family members is more likely. An acceptable explanation to other people about the person’s behavior is now available leading to the possibility of reconciliation with people who have had problems with the person’s behavior.

In the workplace and in educational settings, a diagnosis of Asperger’s can provide access to helpful resources and support that might otherwise not have been available. Employers are more likely to understand the ability and needs of an employee should that employee make the diagnosis known. Accommodations can be requested and a rationale can be provided based on a known diagnosis.

Having the diagnosis is a relief for many people. It provides a means of understanding why someone feels and thinks differently than others. It can be exciting to consider how one’s life can change for the better knowing what one is dealing with. There can be a new sense of personal validation and optimism, of not being defective, weird or crazy. With the knowledge that one has Asperger’s, joining a support group, locally or through the Internet can provide a sense of belonging to a distinct and valued culture and enable the person to consult members of the group for advice and support.

Acceptance of the diagnosis can be an important stage in the development of successful adult intimate relationships. It also enables therapists, counselors and other professionals to provide the correct treatment options should the person seek assistance.

Liane Holliday Willey is an educator, author and speaker. She was diagnosis with Asperger’s syndrome in 1999. In her 2001 book, “Asperger’s Syndrome in the Family: Redefining Normal in the Family, she wrote the following self-affirmation pledge for those with Asperger’s syndrome.

– I am not defective. I am different.– I will not sacrifice myself-worth for peer acceptance.– I am a good and interesting person.– I will take pride in myself.– I am capable of getting along with society.– I will ask for help when I need it.– I am a person who is worthy of others’ respect and acceptance.– I will find a career interest that is well suited to my abilities and interests.– I will be patient with those who need time to understand me.– I am never going to give up on myself.– I will accept myself for who I am.(Willey 2001. p. 164)

Are there disadvantages to a diagnosis of Asperger’s? Yes, but the list is shorter than the list of advantages.

Some people receive a diagnosis of Asperger’s with discouragement and disapproval, believing they necessarily will be severely limited in how they can lead their lives. No longer will they be able to hope to have a satisfying, intimate relationship. Instead, their future will be filled with loneliness and alienation from others with no expectation of improvement. This, of course, is an unrealistic and exaggerated depiction of what living with Asperger’s is like.

Of course, it is possible that people in someone’s life will react to the diagnosis of Asperger’s by alienating themselves from that person. Stigmatizing and disapproval, based on the knowledge that a person has Asperger’s is still prevalent in our society. Damage to one’s self-esteem as a result of disapproval, ridicule, discrimination and rejection is possible when knowledge of an Asperger’s diagnosis is disseminated.

Job discrimination is a realistic possibility in the event that an applicant reveals an Asperger’s diagnosis. While it is not legally acceptable to do so, we know that silent discrimination happens, hiring decisions are not always made public and competition can leave someone with a different profile out of the picture.

Similarly, having a diagnosis of Asperger’s may lead others to assume the person will never be able to be as successful in life as neurotypical people. It is commonly assumed that Asperger’s makes someone too difficult to be around, unable to get along with people, too narrowly focused on their own interests, and too stubborn, self-absorbed and lacking in empathy to be a contributing member of society, a view that is narrow in its own right and sadly mistaken in many cases. Nevertheless, attitudes like this can arise when a diagnosis of Asperger’s is made public.

Dual Diagnoses

Often, people tell me when we meet to discuss an Asperger’s evaluation that the symptoms of Asperger’s they have seen, usually online, match what they notice in themselves. Just as often other people, in researching Asperger’s symptoms, believe the person coming to see me has those very characteristics and therefore must have Asperger’s.

The problem with this is that several other conditions share many of the same symptoms with Asperger’s. Just knowing how the person behaves, thinks and feels does not, in and of itself, tell you whether he or she has Asperger’s. It very well might be that some other condition is the real problem or, more likely, two or more conditions are overlapping. In this case, it is more accurate to say the person has co-existing conditions rather than it being a straightforward matter of Asperger’s.

Here is a description of the psychiatric conditions most frequently associated with Aspergers’:

Attention Deficit Hyperactivity Disorder (ADHD)

People with ADHD typically have difficulty paying attention to what’s going on around them, they are easily distracted, they tend to do things without thinking about the results, they are often forgetful, have trouble finishing what they intended to do, are disorganized, jump from one activity to another, are restless and have poor social skills.

Many of these symptoms overlap with those of Asperger’s. Research has shown growing evidence for a connection between Asperger’s and ADHD. Genetic studies suggest the two disorders share genetic risk factors, and studies of the incidence and distribution of both conditions confirm that many people with Asperger’s have symptoms of ADHD and vice versa. Brain imaging and studies of the brain structure show similarities between the two disorders.

Having said that, there are important differences between the two. People with ADHD often try to do multiple activities at the same time. They get distracted easily and jump from one interest or activity to another. Focusing on one thing for a long time is hard for them. On the other hand, people with Asperger’s tend to focus on only one activity at a time, and they focus on that activity intensely with little regard for anything else going on around them. They are hyper-focused rather than unfocused.

There is a similar difference with respect to impulsivity. People with ADHD will do things without considering the outcome of their actions. They act immediately and have trouble waiting. They interrupt, blurt out comments and seem unable to restrain themselves.

People with Asperger’s think through their actions more carefully. They may interrupt and say things without regard for whatever else is going on but it is because they don’t understand how conversations are carried out rather than not being able to restrain themselves.

There is a big difference in how adults with ADHD use language compared to adults with Asperger’s. They do not tend to have specific weaknesses in their understanding and use of language. They readily understand when a statement such as, “it’s raining cats and dogs” is being used as a figure of speak and not as a literal statement. They also speak with a normal tone of voice and inflection.

In contrast, adults with Asperger’s tend not to understand non-literal language, slang or implied meanings. They may talk a lot and have more one-sided conversations as do adults with ADHD but they do so because lacking an understanding of how the person they are talking to is grasping what they are saying they are, in effect, talking to themselves.

Difficulty interpreting non-verbal communication and subtle aspects of how people relate to each other is characteristic of adults with Asperger’s. They confuse behaviors that may be appropriate in one setting from those that are appropriate in another, so that they often act in appropriate for the situation they are in. They find it hard to interpret the meanings of facial expressions and body posture, and they have particular difficulty understanding how people express their emotions.

Adults with ADHD, on the other hand, understand social situations more accurately and they engage much easier in social situations even though they are easily distracted and often not observant of what’s going on around them. They can consider what other people are thinking much easier than adults with Asperger’s and they participate in the give-and-take of social interactions more readily.

Adults with ADHD tend to express their feelings directly and fairly clearly whereas adults with Asperger’s do not show a wide range of emotions. When they do communicate their feelings they are often out of synch with the situation that generated the feeling.

Adults with ADHD tend to process sensory input in a typical manner. They may have preferences for how they handle sensory input like music, touch, sounds, and visual sensations but generally the way they handle these situations is much like other adults.

In contrast, adults with Asperger’s have more specific preferences about the kind of sensations they like and dislike. They may be overly sensitive to one kind of sensation and avoid that persistently. Or they may prefer a certain type of sensation and, a certain type of music, for example, and seek it over and over. Overall, sounds, temperature differences, visual images and tastes more easily overwhelm adults with Asperger’s than adults with ADHD.

Obsessive-Compulsive Disorders

The core features of obsessive-compulsive disorder (OCD) are frequent and persistent thoughts, impulses or images that are experienced as unwelcomed and uninvited. It occurs to the person that these intrusive thoughts are the produce of his or her own mind but they can’t be stopped. Along with these thoughts are repetitive behaviors or mental acts that the person feels driven to perform in order to reduce stress or to prevent something bad from happening.

Some people spend hours washing themselves or cleaning their surroundings in order to reduce their fear that germs, dirt or chemicals will infect them. Others repeat behaviors or say names or phrases over and over hoping to guard against some unknown harm. To reduce the fear of harming oneself or others by, for example, forgetting to lock the door or turn off the gas stove, some people develop checking rituals. Still others silently pray or say phrases to reduce anxiety or prevent a dreaded future event while others will put objects in a certain order or arrange things perfects in order to reduce discomfort.

These behaviors, to repeat the same action over and over, are similar to the repetitive routines associated with Asperger’s. Individuals with both conditions engage in repetitive behaviors and resist the thought of changing them. The difference is that people with Asperger’s do not view these behaviors are unwelcomed. Indeed, they are usually enjoyed. In addition, whereas Asperger’s occurs early in the person’s life, OCD develops later in life. People with OCD have better social skills, empathy and social give and take than those with Asperger’s.

Social Anxiety Disorder

Social Anxiety Disorder, also called social phobia, occurs when a person has a fear of social situations that is excessive and unreasonable. The dominate fear associated with social situations is of being closely watched, judged and criticized by others. The person is afraid that he or she will make mistakes, look bad and be embarrassed or humiliated in front of others. This can reach a point where social situations are avoided completely.

Asperger’s and Social Anxiety Disorder share the common element of discomfort in social situations. Typically, along with this discomfort is lack of eye contact and difficulty communicating effectively.

The difference between these two conditions is that people with Social Anxiety Disorder lack self-confidence and expect rejection if and when they engage with others. Adults with Asperger’s, on the other hand, don’t necessarily lack self-confidence or are afraid of being rejected, they are simply not able to pick up on social cues. They don’t know how to act appropriately in social situations and thus tend to avoid them. In addition, Social Anxiety Disorder may be present in children but more commonly it develops in adolescence and adulthood whereas Asperger’s can be traced back to infancy.

Schizoid Personality Disorder

People with Schizoid Personality Disorder (SPD) avoid social relationships and prefer to spend time alone. They have a very restricted range of emotions, especially when communicating with others and appear to lack a desire for intimacy. Their lives seem directionless and they appear to drift along in life. They have few friends, date infrequently if at all, and often have trouble in work settings where involvement with other people is necessary. They are the type of person that is others think of as the typical “loner.”

A noticeable characteristic of someone with SPD is their difficulty expressing anger, even when they are directly provoked. They tend to react passively to difficult circumstances, as if they are directionless and are drifting along in life. They are withdrawn because it makes life easier. They don’t gain a great deal of happiness from getting close to people. Often this gives others the impression that they lack emotion.

While this may strike some as similar to Asperger’s people with SPD can interact with others normally, if they want to, and can get along with people. They don’t have the strong preference for logical patterns in things and people, an inability to read facial expressions or “blindness” to what is going on in other people’s minds that characterizes Asperger’s.

In addition, people with SPD typically do not show these features until late adolescence or adulthood. The characteristics of Asperger’s must be noticeable in infancy or early childhood to receive the diagnosis of Asperger’s.

Most importantly, Asperger’s is a form of autism whereas people with SPD have a “neurotypical” brain and have developed into a personality of extreme introversion and emotional detachment.

Antisocial Personality Disorder

Individuals with Antisocial Personality Disorder (APD) disregard and violate the rights of others. They don’t conform to social norms with respect to lawful behavior, such as destroying property, stealing, harassing others, and cheating. They are frequently deceitful and manipulative so as to obtain money, sex, power of some other form of personal profit or pleasure. They tend to be irritable and aggressive and to get into physical fights or commit acts of physical assault (including spousal or child beating).

They are consistently and extremely irresponsible financially, in their employment, and with regard to their own safety and the safety of others. They show little remorse for the consequence of their actions and tend to be indifferent to the hurt they have caused others. Instead, they blame victims of their aggression, irresponsibility and exploitation. They frequently lack empathy and tend to be callous, cynical and contemptuous of the feelings, rights and suffering of others.

They often have an inflated and arrogant view of themselves, and are described as excessively opinionated and cocky. They can appear charming and talk with superficial ease, attempting to impress others and appear experts on numerous topics.

There may appear to be some overlap between Asperger’s and APD, but the resemblance is superficial. Individuals with Asperger’s have trouble understanding how people operate but they do respect others, whereas people with APD have no regard for people. Individuals with Asperger’s are rarely deceitful, in fact, they are often considered excessively, even naively honest, quite unlike those with APD who are predictably deceitful and unremorseful, and unlike people with Asperger’s they are incapable of feeling genuine love. Asperger’s people do show and feel remorse whereas people with APD do not.

Bipolar Disorder

People with Bipolar Disorder (BD) have distinct ups and downs in their mood. At one point, they will have extreme energy, be unusually happy, energetic, talkative, feel wonderful about themselves and “on top of the world, have little need for sleep, be drawn to unimportant or irrelevant activities, and generally act unlike themselves. When they are down, they feel sad, empty, hopeless, worthless and inappropriately guilty. They have little interest in their usual activities, have little appetite, sleep more than usual, are slowed down, have difficulty concentrating and sometimes have suicidal thoughts.

When someone with Bipolar Disorder is in a manic state or depressed they may not interact socially as they might if they were feeling normal, they might be withdrawn, lack much emotional response to situations in their life and lose interest in relationships but the changes in their emotional condition is much different than people with Asperger’s.

Someone with Asperger’s is socially awkward, cannot read or use body language or facial expressions well, have difficulty making eye contact, cannot understand sarcasm and jokes, tend to take things literally, may display socially inappropriate behavior without realizing it, have obsessive interests and may have problems with sensory issues.

While they may feel down at times or at other times be unusually happy, their concerns have much less to do with emotional ups and downs.

Author spotlight

I am a clinical psychologist in San Francisco with 30 years of experience evaluating and treating adults with Asperger’s Syndrome and Autism Spectrum Disorders (ASD). For people who suspect they have Asperger’s or ASD and want a professional evaluation, I provide a comprehensive assessment of these conditions.

Kenneth Roberson, Ph.D.

What Readers say

 “This is an excellent overview for both the clinical reader and for parents. I was particularly appreciative of the compassion that Dr. Roberson shows for the patient with this disorder.”

“This would be a good first book for someone who wants to learn more about Asperger’s Syndrome (AS). Dealing with people suffering from AS can be challenging, which is why having the right source of information is necessary.”