Treatment coordinates therapies that address the core symptoms of AS: poor communication skills, obsessive or repetitive routines, and physical clumsiness. AS and high-functioning autism may be considered together for the purpose of clinical management.
A typical treatment program generally includes:
The techniques described above will not cure AS, but help those diagnosed with AS better function in society.
Many studies have been done on early behavioral interventions. Most of these are single case with one to five participants. The single case studies are usually about controlling non-core autistic problem-behaviors like self-injury, aggression, noncompliance, stereotypies, or spontaneous language. Packaged interventions such as those run by UCLA or TEACCH are designed to treat the entire syndrome and have been found to be somewhat effective.
Behavioral interventions, such as Applied Behavior Analysis (ABA), have been researched for many years. Empirical data demonstrate its effectiveness in the treatment of autism spectrum disorders because it is an individualized set of programs. In addition, ABA has the benefits of individualized functional analyses of exhibited behaviors. In 1982 Becker and Gersten found that ABA techniques were indeed educationally beneficial because they provide "motivational programs based on positive reinforcement such as a token system and a systematic task analysis for developing academic skills". ABA also promotes the foundation for academic and living skills. Once certain skills have been acquired, it is possible through ABA to generalize these skills and add new skills to the "existing repertoire through various techniques of shaping, extinction, backwards chaining, and prompting". (Schreibman, 1975, Sulzer & Mayer, 1972, Wolery et al, 1988)
Glen Dunlap, Lee Kern and Jonathan Worcester reviewed studies of the effects of Applied Behavior Analysis and academic instruction, structuring existing studies into one article. The researchers noted that in a 1981 study by Weeks and Gaylord, subjects with severe disabilities who were given difficult tasks became self injurious and aggressive. When they incorporated the use of "errorless learning", a technique used in ABA treatment which eliminates a "wrong" answer through prompting and fading, there was an observable reduction in the challenging behaviors.
TEACCH is a teaching methodology developed primarily by Gary Mesibov and Eric Schopler at UNC-Chapel Hill. The TEACCH methodology believes in some appliction of behavioral methodologies, however another tenet of this teaching system is to instruct in "real life" settings and that children learn best when the instruction is personalized and thus, more meaningful. Most TEACCH programs and replication sites are designed with work stations in which activities have been developed and chosen for each child. The TEACCH approach is designed for younger age children and requires a substantially separate program for implementation. TEACCH, as a method, is less intrusive and aggressive toward students and their existing behaviors; a parent's comfort level watching this method may be higher. The model also offers various manuals and supports to help new programs establish themselves and supports existing programs implementing positive changes. However, research as to the efficacy of TEACCH over ABA is limited to anecdotal reports without empirical data to support this. ABA has been supported to be more effective in teaching functional and social language, bridging the gap of cognitive skills, and teaching self-help and functional independence. TEACCH presents with some challenges. Replication of the original program and the curriculum can be challenging although many of the programs can now be purchased. Training staff to implement this method requires significant time and personnel with excellent background knowledge. To be effectively implemented, classroom sizes and student to staff ratios must be small. However, this is a challenge of most educational programs and academic and social interventions.
Persons with AS appear to have normal lifespans, but have an increased prevalence of comorbid psychiatric conditions such as depression, mood disorders, and obsessive-compulsive disorder.
Children with AS can learn to manage their differences, but they may continue to find social situations and personal relationships challenging. Many adults with AS are able to work successfully in mainstream jobs, although they may continue to need encouragement and moral support to maintain an independent life.
Individuals with AS may make great intellectual contributions: published case reports suggest an association with accomplishments in computer science, mathematics, and physics. The deficits associated with AS may be debilitating, but many individuals experience positive outcomes, particularly those who are able to excel in areas less dependent on social interaction, such as mathematics, music, and the sciences.
Most patients presenting in clinical settings with AS have other comorbid psychiatric disorders. Children are likely to present with attention-deficit hyperactivity disorder (ADHD), while depression is a common diagnosis in adolescents and adults.[71] A study of referred adult patients found that 30% presenting with ADHD had ASD as well.
Research indicates people with AS may be far more likely to have the associated conditions. People with AS symptoms may frequently be diagnosed with clinical depression, oppositional defiant disorder, antisocial personality disorder, Tourette syndrome, ADHD, general anxiety disorder, bipolar disorder, obsessive compulsive disorder or obsessive-compulsive personality disorder.[74] Dysgraphia, dyspraxia, dyslexia or dyscalculia may also be diagnosed.[75]
The particularly high comorbidity with anxiety often requires special attention. One study reported that about 84 percent of individuals with a Pervasive Developmental Disorder (PDD) also met the criteria to be diagnosed with an anxiety disorder. Because of the social differences experienced by those with AS, such as trouble initiating or maintaining a conversation or adherence to strict rituals or schedules, additional stress to any of these activities may result in feelings of anxiety, which can negatively affect multiple areas of one's life, including school, family, and work. Treatment of anxiety disorders that accompany a PDD can be handled in a number of ways, such as through medication or individual and group cognitive behavioral therapy, where relaxation or distraction-type activities may be used along with other techniques in order to diffuse the feelings of anxiety.
The prevalence of AS is not well established, but conservative estimates using the DSM-IV criteria indicate that two to three of every 10,000 children have the condition, making it rarer than autistic disorder itself. Three to four times as many boys have AS compared with girls. The universality of AS across races, and validity of epidemiologic studies to date, is questioned.
A 1993 broad-based population study in Sweden found that 36 per 10,000 school-aged children met Gillberg's criteria for AS, rising to 71 per 10,000 if suspected cases are included. The estimate is convincing for Sweden, but the findings may not apply elsewhere because they are based on a homogeneous population. The Sweden study demonstrated that AS may be more common than once thought and may be currently underdiagnosed. Gillberg estimates 30-50% of all persons with AS are undiagnosed. A survey found that 36 per 10,000 adults with an IQ of 100 or above may meet criteria for AS.
Leekam et al. documented significant differences between Gillberg's criteria and the ICD-10 criteria. Considering its requirement for "normal" development of cognitive skills, language, curiosity and self-help skills, the ICD-10 definition is considerably more narrow than Gillberg's criteria, which more closely matches Hans Asperger's own descriptions.
Like other autism spectrum disorders, AS prevalence estimates for males are higher than for females, but some clinicians believe that this may not reflect the actual incidence rates. Tony Attwood suggests that females learn to compensate better for their impairments due to gender differences in the handling of socialization.[ The Ehlers & Gillberg study found a 4:1 male to female ratio in subjects meeting Gillberg's criteria for AS, but a lower 2.3:1 ratio when suspected or borderline cases were included.
The prevalence of AS in adults is not well understood, but Baron-Cohen et al. documented that 2% of adults score higher than 32 in his Autism Spectrum Quotient (AQ) questionnaire, developed in 2001 to measure the extent to which an adult of normal intelligence has the traits associated with autism spectrum conditions. All interviewed high-scorers met at least 3 DSM-IV criteria, and 63% met threshold criteria for an ASD diagnosis; a Japanese study found similar AQ Test results.