Asperger’s syndrome Why do people say what they don’t mean, why do they mean what they don’t say?

Asperger’s Syndrome is a neuropsychiatric disorder that is generally detected in childhood. It shows similarities with AUTISM in general terms. (Related social communication and interaction; restricted and peculiar interests…) The main difference with autism is the absence of language-cognitive retardation. Semantic-pragmatic abilities are not developed. (We can say that social, cultural, tradition-custom, morality and norm types are missing.) Intelligence level is generally normal and sometimes even superior. The DSM-IV and ICD-10 dimensions are as follows:

DSM-IV diagnostic criteria:

• Change in hand, arm, eye, facial movement, body shape used for social communication

• Lack of fun, jealousy, self-definition, sharing, playing, liking in human relations.

• Lack of emotional clarity (yes-no)

• Developing unusual, stereotypical, limited patterns

• Excessive and frequent adaptation to daily tasks that are dysfunctional but to be done when appropriate

• Motor magnetism (finger snapping, excessive blinking, tongue sticking out, hand clapping)

• Excessive association with things, obsession

• Incompatibility in social and professional fields

• Normal language development

• Cognitive development, self-sufficiency, no clinical delay in adaptation

• Normalization in sexuality in general (no extreme difference.)

ICD-10 diagnostic criteria:

• No significant language and cognitive developmental retardation in the language

• Self-care, adaptive attitudes, environmental curiosity are compatible with mental development

• There is motor awkwardness

• Acquiring superior abilities if there is a special interest in a subject.

• Qualitative defect in mutual social interactions

• Narrow interests, excessively bizarre information, stereotypes

• Engine magnetism

• Excessive obsession with objects or play tools

• Obsessive-compulsive (anankastic) personality disorder, childhood attachment disorder, schizotypal disorder, disharmony, lack of gestures, motor clumsiness, low imaginative play, strange speech, different language, ADHD, depression, antisocial violent behaviors can also be added to clinical features.

AS is common in paternal grandparents. There is a frequency of 3/7 per thousand (USA). (Determinations of individuals with AS have not been made on the basis of proper and scientific criteria in our country. Almost no statistics are available. State and private health institutions, including universities related to the subject… Therefore, most of the available information has been obtained from the USA and Europe.) Normal If those who are lost in social life close to the borders are added, there may be 1 person in 250. In the USA, the ranking is 1% for school age and 9:1 for men and women.

Improvements in the diagnostic criteria of the disorder, decrease in maternal age, migration, infection, increase and spread of viral agents, decrease in immune level, chemical toxins and environmental pollution problems are the main factors of the increase in Asperger’s Syndrome. AS is generally detected between the ages of 10-11. Absence of language delay is sometimes not detected until adulthood because of the problems in social relations, especially in nurseries and kindergartens, due to the high incidence of ADHD cases. In this case, the person’s own search is determined by means such as the determination in the business world, the legal system. Sometimes it is not detectable at all.

In the detection of ace, kindergarten, primary school 3.-4. Class, high school, school graduation, job selection, spouse selection, prison situations are effective. Such that, AS should be taken into consideration for individuals who have problems such as not being able to find a job after completing 3-4 schools, not being able to withstand work stress, not being able to adapt, not being able to maintain a happy marriage, and difficulty in sexual relations.

Professor in human relations Dr. This syndrome should definitely be examined for many ECENTRIC people who experience a serious problem such as “Why people say what they don’t mean, why they mean what they don’t say” with the perfect definition of Barış Korkmaz.

In the same way, especially in school age, “gender, weird, annoying, hairy, nerdy sabbath, search engine, child like Google, man like property, gruff, disrespectful, moron, not understanding jokes, asking for service from everyone as if it is their natural right, age and AS in every individual who does not know the concept of status (who calls the school principal Izzet Bey Izzet…), who thinks and thinks that everyone is overjoyed when he is happy, who asks private questions to strangers or spills his family relations, does not share, apologize, borrow, borrow, have weak impulse control. should not be overlooked.

Many different emotional states can be seen one after the other in a relationship with AS. They may not feel superior, humility, shame, or guilt. On the other hand, it may also have basic principles such as being away from gossip, being innocent, honest, not having a sense of ownership, not cheating and flattery.

There are problems with non-verbal communication types, facial expression, tone of voice, gesture and gaze in AS. Grammar development is normal. He has a non-melodic tone in his speech, he is harsh, sometimes he speaks didactically as if he were giving a lecture. Eye contact is troublesome, his gaze is often tense, irritable, anxious, and aloof. While the eyes shine excessively while carrying the purpose of violence; In situations that require emotion, on the contrary, there are inappropriate, unfocused gazes.

Since the prosody (melody features of the language) is broken in Asli, the speed and intensity of speech are different. The sound is loud in situations such as funerals and meetings. There is language disorder at the semantic-pragmatic level. (The conceptual-understanding features of the language are not suitable for social usage).

At the speaking stage, the current situation, location, attachment, and appropriate inference cannot be made. He cannot choose the data learned in the past to be used in recognizing new situations, so his mind load increases and his attention is quickly distracted. Due to the difficulty of choosing the words appropriate for this purpose, there are often cases of frequent stance in speaking, waiting for help such as “iii”, “eee” in order to find the appropriate one at that moment.

There are tangential, diagonal, inappropriate speech patterns. He uses the meaningless words he creates. (While in childhood, it is normal for children to say “apat” for shoes and “chopat” for socks, it gradually improves, but this may become permanent in AS).

There are also problems in obtaining information. Attention is low, as said above. He focused on his own area of ​​interest. Different styles of learning are tried many times. More than once he “sees the tree but cannot see the forest”. Due to his obsessions, he often adopted a ritual (ceremony)-routine (daily living order) in order not to fall into difficulties according to his own understanding.

With serious problems in acquiring knowledge, he concentrates on knowledge that he can learn once. Country flags, train schedule, football match dates and results… Sometimes they have extreme photographic memory. However, this memory is often directed towards something specific. (The names of all violin makers, they know, but cannot play the violin.)

At the childhood level of AS, situations such as anger, destructive behavior, aggression, and non-compliance with rules are particularly striking. The anxiety level is often very high. It increases with cycloid psychosis, schizophrenia, paranoia, schizoid personality disorder, depression. Substance, drug, alcohol addiction increases. Panic attacks may occur. (Depression 40%, Mania 9%, Bipolar disorder 9%, Suicide 7%, schizophrenia 9%, OCD 14%, paranoia 9%, hypochondriasis 4%.) Sickness, nail biting, mucus mixing, wiping on the table, with stool playing, washing the body frequently, wiping with alcohol, tics and mannerism are common. Throat clearing, strange sound, tourette (especially swearing), winking, grimacing, tapping feet are often seen.

Problems at the cognitive-academic stage, specific learning disability, dyslexia, dyscalculia, macrography (use of capital letters), low non-verbal learning, inability to adjust time, accuracy, guilt and fussiness, ADHD, poor working memory (forget even the name that was said before), selective responding (hearing what you want).

In advancing age, the lack of close friends, low gesture, special face form, non-compliance with traditions, strange and subjective interests become clear. They stay away from control and manipulation. Childlike curiosity and the inability to be truthful and lie do not change.

AS, a type of autism, causes autistic basic symptoms;

• In the social relationship (socialization)

• In verbal communication (communication)

• He has types of inadequacy in imagination.

In terms of intelligence development, the difference is obvious. The rate of mental retardation in standard autism is around 70%. It can be defined as Atypical Autism (ADD-NOS: pervasive developmental disorder not otherwise specified) or predominantly verbal autism.

Although negative behaviors such as lack of education, not waiting in line (for example, at the bank), not complying with traffic, making loud noises, polluting the environment due to lack of education, family raising style disappear in normal children due to the effects of education, family and society, they continue in AS.

The feeling of failure, criticism, and the anxieties of not being accepted into the group, seen in the case of social phobia, are similar to this picture.

Childhood psychoses (schizophrenia, depression) have similar attitudes. Hallucinations and delusions are common. Avoidance of school, bedwetting-stool (nocturnal enuresis, encopresis), ADHD, excessive fantasy, lying, loneliness, introversion-extreme single interest seen in schizoids. Ceremonial relationship, autonomous finding, frightening thoughts are similar with OCD (anankastic). The avoidant type personality, despite its own nature, puts the problem to the opponent or the opposite group, and the way of showing oneself as a victim in case of being pushed and left alone is the same.

Psychometric, neuropsychological tests, laterilization (hand, foot, eye), motor skills (hand-eye, shape, visual motor), attention, visual perception, spatial perception, temporal perception, Rorschach, language problems (phonology, prosody, grammar) used in the AS examination , pragmatic, semantic), CT, MR, Positron Emission tomography, QEEG, QEEG evoked potentials some techniques used in psychotechnics are used.

There is no definitive treatment with medication. Psychotherapy, group therapy, family therapy are required. However, this process should be continued by people who have been seriously educated because they are extremely sensitive about the personality of the teacher or trainer. In the therapy of the person with AS, everything should be clearly explained, numbered and listed, as these people manage social adaptation with verbal intelligence.

Good physical education on motor inability and Mannerism is essential.

EMDR methods should be used to solve depression in behavioral cognitive therapy. With BIO-FEEDBACK techniques, personal feelings and their clear external expressions should be recognized.

In social communication skills, techniques of meeting, helping, complimenting, criticizing, openness to suggestions, reciprocity, sharing, solving problems, managing-listening, co-sensation, avoidance and termination should be used.

What is the neurobiological dimension in AS? The diagnosis specific to patient complaints or complaints is symptomatic, empirical and phenomenological diagnosis. The one that causes or causes the problem and is based on the cause is called the etiological diagnosis. In this respect, there is no genetic diagnosis of As yet. The diagnosis that determines where the damaged information responsible for the complaints that cause the disease is located in the brain is called localization-oriented diagnosis. The pathological diagnosis determines what kind of damage the factors causing the disease cause in which organ. (It is not clear in AS.) Prognostic diagnosis is about how the disease progresses and whether it will improve. (There is no full recovery in AS.) However, AS and brain structure are as follows;

Basic brain structures are the amygdala, superior temporal sulcus, orbital frontal sulcus (ventromedical sulcus), anterior cingulate cortex. There is a low level of metabolism in the frontal region, and neurotransmitters such as serotonin and dopamine are low.

Amygdala: provides fast automatic emotional resolution of uncertain situations and has little effect on Ace. Orbital frontal cortex: involved in giving social meaning to events. It provides access to new information through previous experiences. In AS, learning is disrupted, anxiety increases, and stress rises. The dorsalateral region of the prefrontal lobe is related to analytical thinking, planning and personality traits.

Mirror neurons (mirror neurons) in the premotor cortex provide imitation and empathy. The fusiform gyrus in the right hemisphere and the inferior occipital gyrus are related to face recognition. Superior temporal sulcus is related to facial expression recognition, recognizing others in emotions such as anger and disgust and is low in AS. In As, the right hemisphere of the brain is distressed. In the cerebellum, the part that regulates balance and body movements is seen as troubled.

As a result, the psychometric and neuropsychological tests mentioned above are applied. Therapies such as MR, NEUROBIOFEEDBACK are tried and basic brain structures should be examined with QEEG.

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