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How is Asperger's Disorder Related to Social Anxiety Disorder?

The Relationship Between Asperger's Disorder and SAD

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Updated April 23, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Asperger's disorder (or syndrome as it is also called) is a pervasive developmental disorder that belongs to the class of autism spectrum disorders, and involves impairment in certain basic aspects of communication and relationships. Although people with both Asperger's and social anxiety disorder (SAD) experience difficulty in social situations, the diagnostic criteria and symptoms of the disorders are markedly different.

The diagnosis of Asperger's disorder was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in 1994. Asperger's affects approximately one in 300 children, 90% of whom are male.

Asperger's is usually diagnosed in childhood. If your child has been diagnosed with this disorder, he or she might experience significant impairment in social interaction, such as problems with eye contact, facial expressions and body postures. He or she might have trouble developing friendships, sharing interests and understanding the social and emotional perspectives of others. He or she might also engage in restricted and repetitive patterns of behavior, such as becoming excessively preoccupied with interests, routines and rituals, the parts of objects or repetitive motor mannerisms such as hand twisting.

How Do SAD and Asperger's Differ?

If you suffer with SAD, anxiety is the driving force behind the difficulties that you experience in social and performance situations. Your ability to function is limited by your anxiety in those situations. A diagnosis of Asperger's, on the other hand, does not require the presence of anxiety. Behavior in social situations is instead impaired because of trouble reading and understanding social and emotional cues.

People with Asperger's might appear tactless and rude, be unable to take hints or understand humor, stand too close or talk too loud. They also have trouble understanding the meaning of gestures, tone of voice and facial expressions.

These characteristics are opposite of those displayed by the socially anxious; if you suffer with SAD your fear of embarrassment or humiliation most likely manifests in standing too far, talking too softly or being overly sensitive to the body language of others. Those with SAD are capable of forming relationships but are impaired by anxiety; on the other hand, people with Asperger's have difficulty with the nuts and bolts of communication that make relationships possible.

Neuroimaging research may shed some light on how the brains of people with SAD and Asperger's differ. Studies of brain function show that for most people, the amygdala (the emotion center of the brain) is activated when understanding facial expressions. On the other hand, for those with Asperger's, the prefrontal cortex (the center for judgment and planning) becomes active when processing facial images.

People with Asperger's try to logically discern the meaning of a facial expression rather than experience an automatic emotional reaction. Studies have also shown heightened sensitivity of the amygdala in those with SAD, further emphasizing the differences between the two disorders.

Treatment for Asperger's and SAD

Although there are no firm data, comorbid anxiety disorders are common among children with Asperger's. Thus, it is possible for a child to suffer with both Asperger's and SAD. Whether or not they appear together or separately, social skills training is one form of treatment that may offer promise for both disorders.

Although the cause of social impairment in Asperger's and SAD differs, many of the same symptoms are present in both disorders. If you suffer with Asperger's or SAD, you likely have a host of social skills deficits, such as problems with eye contact, body postures, gestures and speech qualities, such as tone, volume and rate. In addition, you probably have trouble building and maintaining friendships. Social skills training has been shown effective in treating social anxiety symptoms and may also offer promise for those with Asperger's in terms of developing basic skills for interacting socially.

Sources:

Cardaciotto L, Herbert JD. Cognitive behavior therapy for social anxiety disorder in the context of Asperger's syndrome: A single-subject report. Cognitive and Behavioral Practice.

Harvard Medical School Family Health Guide. Asperger's Syndrome. Accessed October 25th, 2011.

Kuusikko S, Pollock-Wurman R, Jussila K, Carter AS, Mattila M-L, Ebeling H, Pauls DL, Moilanen I. Social anxiety in high-functioning children and adolescents with Autism and Asperger syndrome. Journal of Autism and Developmental Disorders. 2008: 38; 1697-1709.

Social Anxiety Institute. How is social anxiety different than Asperger's disorder? Accessed October 25th, 2011.

White SW, Oswald D, Ollendick T, Scahill L. Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review. 2009: 29(3); 216–29.

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