Medical Marijuana and Asperger Disorder

Asperger syndrome (AS), also known as Asperger disorder (AD) or simply Asperger's, is an autism spectrum disorder (ASD) that is characterized by significant difficulties in social interaction and nonverbal communication, alongside restricted and repetitive patterns of behavior and interests. It differs from other autism spectrum disorders by its relative preservation of linguistic and cognitive development. Although not required for diagnosis, physical clumsiness and atypical (peculiar, odd) use of language are frequently reported.  Symptoms include social awkwardness, loud vocalizations, atypical speech, emotional detachment or over-attachment, anger management issues, and narrow interests that may become obsessive.  Those with AS usually feel like they don't "fit in" with society. They're often smarter, more creative, or more observant than their peers and can excel in life when given a chance.

The syndrome is named after the Austrian pediatrician Hans Asperger who, in 1944, studied and described children in his practice who lacked nonverbal communication skills, demonstrated limited empathy with their peers, and were physically clumsy.  The modern conception of Asperger syndrome came into existence in 1981 and went through a period of popularization,  becoming standardized as a diagnosis in the early 1990's.  Many questions remain about aspects of the disorder.  There is doubt about whether it is distinct from high-functioning autism (HFA),  partly because of this, its prevalence is not firmly established.  The diagnosis of Asperger's was eliminated in the 2013 fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and replaced by a diagnosis of autism spectrum disorder on a severity scale.

The exact cause is unknown. Although research suggests the likelihood of a genetic basis,  there is no known genetic cause and brain imaging techniques have not identified a clear common pathology.  There is no single treatment, and the effectiveness of particular interventions is supported by only limited data.  Intervention is aimed at improving symptoms and function. The mainstay of management is behavioral therapy, focusing on specific deficits to address poor communication skills, obsessive or repetitive routines, and physical clumsiness.   Most children improve as they mature to adulthood, but social and communication difficulties may persist.   Some researchers and people with Asperger's have advocated a shift in attitudes toward the view that it is a difference, rather than a disability that must be treated or cured.

As a pervasive developmental disorder, Asperger syndrome is distinguished by a pattern of symptoms rather than a single symptom. It is characterized by qualitative impairment in social interaction, by stereotyped and restricted patterns of behavior, activities and interests, and by no clinically significant delay in cognitive development or general delay in language.

Intense preoccupation with a narrow subject, one-sided verbosity, restricted prosody, and physical clumsiness are typical of the condition, but are not required for diagnosis

People with Asperger syndrome often display behavior, interests, and activities that are restricted and repetitive and are sometimes abnormally intense or focused. They may stick to inflexible routines, move in stereotyped and repetitive ways, or preoccupy themselves with parts of objects.

Pursuit of specific and narrow areas of interest is one of the most striking features of AS.   Individuals with AS may collect volumes of detailed information on a relatively narrow topic such as weather data or star names, without necessarily having a genuine understanding of the broader topic.  For example, a child might memorize camera model numbers while caring little about photography.  This behavior is usually apparent by age 5 or 6.   Although these special interests may change from time to time, they typically become more unusual and narrowly focused, and often dominate social interaction so much that the entire family may become immersed. Because narrow topics often capture the interest of children, this symptom may go unrecognized.

Stereotyped and repetitive motor behaviors are a core part of the diagnosis of AS and other ASDs.  They include hand movements such as flapping or twisting, and complex whole-body movements.  These are typically repeated in longer bursts and look more voluntary or ritualistic than tics, which are usually faster, less rhythmical and less often symmetrical.

According to the Adult Asperger Assessment (AAA) diagnostic test, a lack of interest in fiction and a positive preference towards non-fiction is common among adults with AS.

A lack of demonstrated empathy has a significant impact on aspects of communal living for persons with Asperger syndrome.   Individuals with AS experience difficulties in basic elements of social interaction, which may include a failure to develop friendships or to seek shared enjoyments or achievements with others (for example, showing others objects of interest), a lack of social or emotional reciprocity (social "games" give-and-take mechanic), and impaired nonverbal behaviors in areas such as eye contact, facial expression, posture, and gesture.

People with AS may not be as withdrawn around others compared to those with other, more debilitating, forms of autism; they approach others, even if awkwardly. For example, a person with AS may engage in a one-sided, long-winded speech about a favorite topic, while misunderstanding or not recognizing the listener's feelings or reactions, such as a wish to change the topic of talk or end the interaction.   This social awkwardness has been called "active but odd."   This failure to react appropriately to social interaction may appear as disregard for other people's feelings, and may come across as insensitive.   However, not all individuals with AS will approach others. Some of them may even display selective mutism, speaking not at all to most people and excessively to specific people. Some may choose to talk to only people they like.

The cognitive ability of children with AS often allows them to articulate social norms in a laboratory context,  where they may be able to show a theoretical understanding of other people's emotions; however, they typically have difficulty acting on this knowledge in fluid, real-life situations.  People with AS may analyze and distill their observations of social interaction into rigid behavioral guidelines, and apply these rules in awkward ways, such as forced eye contact, resulting in a demeanor that appears rigid or socially naive. Childhood desire for companionship can become numbed through a history of failed social encounters.

The hypothesis that individuals with AS are predisposed to violent or criminal behavior has been investigated, but is not supported by data.   More evidence suggests children with AS are victims rather than victimizers.  A 2008 review found that an overwhelming number of reported violent criminals with AS had coexisting psychiatric disorders such as schizoaffective disorder.

Individuals with AS often have excellent auditory and visual perception.  Children with ASD often demonstrate enhanced perception of small changes in patterns such as arrangements of objects or well-known images; typically this is domain-specific and involves processing of fine-grained features.  Conversely, compared to individuals with high-functioning autism, individuals with AS have deficits in some tasks involving visual-spatial perception, auditory perception, or visual memory.   Many accounts of individuals with AS and ASD report other unusual sensory and perceptual skills and experiences. They may be unusually sensitive or insensitive to sound, light, and other stimuli;  these sensory responses are found in other developmental disorders and are not specific to AS or to ASD. There is little support for increased fight-or-flight response or failure of habituation in autism; there is more evidence of decreased responsiveness to sensory stimuli, although several studies show no differences.

Hans Asperger's initial accounts and other diagnostic schemes  include descriptions of physical clumsiness. Children with AS may be delayed in acquiring skills requiring motor dexterity, such as riding a bicycle or opening a jar, and may seem to move awkwardly or feel "uncomfortable in their own skin". They may be poorly coordinated, or have an odd or bouncy gait or posture, poor handwriting, or problems with visual-motor integration.   They may show problems with proprioception (sensation of body position) on measures of developmental coordination disorder (motor planning disorder), balance, tandem gait, and finger-thumb apposition. There is no evidence that these motor skills problems differentiate AS from other high-functioning ASDs.

Children with AS are more likely to have sleep problems, including difficulty in falling asleep, frequent nocturnal awakenings, and early morning awakenings.   AS is also associated with high levels of alexithymia, which is difficulty in identifying and describing one's emotions.   Although AS, lower sleep quality, and alexithymia are associated, their causal relationship is unclear

Although individuals with Asperger syndrome acquire language skills without significant general delay and their speech typically lacks significant abnormalities, language acquisition and use is often atypical.  Abnormalities include verbosity, abrupt transitions, literal interpretations and miscomprehension of nuance, use of metaphor meaningful to only the speaker, auditory perception deficits, unusually pedantic, formal or idiosyncratic speech, and oddities in loudness, pitch, intonation, prosody, and rhythm.   Echolalia has also been observed in individuals with AS.

Three aspects of communication patterns are of clinical interest: poor prosody, tangential and circumstantial speech, and marked verbosity. Although inflection and intonation may be less rigid or monotonic than in classic autism, people with AS often have a limited range of intonation: speech may be unusually fast, jerky or loud. Speech may convey a sense of incoherence; the conversational style often includes monologues about topics that bore the listener, fails to provide context for comments, or fails to suppress internal thoughts. Individuals with AS may fail to monitor whether the listener is interested or engaged in the conversation. The speaker's conclusion or point may never be made, and attempts by the listener to elaborate on the speech's content or logic, or to shift to related topics, are often unsuccessful.

Children with AS may have an unusually sophisticated vocabulary at a young age and have been colloquially called "little professors", but have difficulty understanding figurative language and tend to use language literally.  Children with AS appear to have particular weaknesses in areas of nonliteral language that include humor, irony, teasing, and sarcasm.  Although individuals with AS usually understand the cognitive basis of humor, they seem to lack understanding of the intent of humor to share enjoyment with others.   Despite strong evidence of impaired humor appreciation, anecdotal reports of humor in individuals with AS seem to challenge some psychological theories of AS and autism

Asperger syndrome appears to result from developmental factors that affect many or all functional brain systems, as opposed to localized effects.  Although the specific underpinnings of AS or factors that distinguish it from other ASDs are unknown, and no clear pathology common to individuals with AS has emerged,  it is still possible that AS's mechanism is separate from other ASDs.   Neuroanatomical studies and the associations with teratogens strongly suggest that the mechanism includes alteration of brain development soon after conception.   Abnormal migration of embryonic cells during fetal development may affect the final structure and connectivity of the brain, resulting in alterations in the neural circuits that control thought and behavior.  Several theories of mechanism are available; none are likely to provide a complete explanation.

Diagnosis is most commonly made between the ages of four and eleven.   A comprehensive assessment involves a multidisciplinary team  that observes across multiple settings,  and includes neurological and genetic assessment as well as tests for cognition, psychomotor function, verbal and nonverbal strengths and weaknesses, style of learning, and skills for independent living.  The "gold standard" in diagnosing ASDs combines clinical judgment with the Autism Diagnostic Interview-Revised (ADI-R)—a semistructured parent interview—and the Autism Diagnostic Observation Schedule (ADOS)—a conversation and play-based interview with the child.   Delayed or mistaken diagnosis can be traumatic for individuals and families; for example, misdiagnosis can lead to medications that worsen behavior.   Many children with AS are initially misdiagnosed with attention deficit hyperactivity disorder (ADHD).   Diagnosing adults is more challenging, as standard diagnostic criteria are designed for children and the expression of AS changes with age;  adult diagnosis requires painstaking clinical examination and thorough medical history gained from both the individual and other people who know the person, focusing on childhood behavior.   Conditions that must be considered in a differential diagnosis include other ASDs, theschizophrenia spectrum, ADHD, obsessive–compulsive disorder, major depressive disorder, semantic pragmatic disorder, nonverbal learning disorder, Tourette's  syndrome,  stereotypic movement disorder, bipolar disorder.  and social-cognitive deficits due to brain damage from alcohol abuse.

Hans Asperger described common symptoms among his patients' family members, especially fathers, and research supports this observation and suggests a genetic contribution to Asperger syndrome. Although no specific gene has yet been identified, multiple factors are believed to play a role in the expression of autism, given the phenotypic variability seen in children with AS.   Evidence for a genetic link is the tendency for AS to run in families and an observed higher incidence of family members who have behavioral symptoms similar to AS but in a more limited form (for example, slight difficulties with social interaction, language, or reading.   Most research suggests that all autism spectrum disorders have shared genetic mechanisms, but AS may have a stronger genetic component than autism.   There is probably a common group of genes where particular alleles render an individual vulnerable to developing AS;  if this is the case, the particular combination of alleles would determine the severity and symptoms for each individual with AS.

A few ASD cases have been linked to exposure to teratogens (agents that cause birth defects) during the first eight weeks from conception. Although this does not exclude the possibility that ASD can be initiated or affected later, it is strong evidence that it arises very early in development.   Many environmental factors have been hypothesized to act after birth, but none has been confirmed by scientific investigation

Asperger syndrome treatment attempts to manage distressing symptoms and to teach age-appropriate social, communication and vocational skills that are not naturally acquired during development,  with intervention tailored to the needs of the individual based on multidisciplinary assessment.  Although progress has been made, data supporting the efficacy of particular interventions are limited

Medications

No medications directly treat the core symptoms of AS.   Although research into the efficacy of pharmaceutical intervention for AS is limited,  it is essential to diagnose and treat comorbid conditions.   Deficits in self-identifying emotions or in observing effects of one's behavior on others can make it difficult for individuals with AS to see why medication may be appropriate.   Medication can be effective in combination with behavioral interventions and environmental accommodations in treating comorbid symptoms such as anxiety disorder, major depressive disorder, inattention and aggression.  The atypical antipsychotic medications risperidone and olanzapine have been shown to reduce the associated symptoms of AS;  risperidone can reduce repetitive and self-injurious behaviors, aggressive outbursts and impulsivity, and improve stereotypical patterns of behavior and social relatedness. The selective serotonin reuptake inhibitors (SSRIs) fluoxetine, fluvoxamine, and sertraline have been effective in treating restricted and repetitive interests and behaviors.

Care must be taken with medications, as side effects may be more common and harder to evaluate in individuals with AS, and tests of drugs' effectiveness against comorbid conditions routinely exclude individuals from the autism spectrum.   Abnormalities in metabolism, cardiac conduction times, and an increased risk of type 2 diabetes have been raised as concerns with these medications, along with serious long-term neurological side effects.  SSRIs can lead to manifestations of behavioral activation such as increased impulsivity, aggression, and sleep disturbance.   Weight gain and fatigue are commonly reported side effects of risperidone, which may also lead to increased risk for extrapyramidal symptoms such as restlessness and dystonia  and increased serum prolactin levels.  Sedation and weight gain are more common with olanzapine which has also been linked with diabetes.  Sedative side-effects in school-age children  have ramifications for classroom learning.  Individuals with AS may be unable to identify and communicate their internal moods and emotions or to tolerate side effects that for most people would not be problematic

Therapies

The ideal treatment for AS coordinates therapies that address core symptoms of the disorder, including poor communication skills and obsessive or repetitive routines. While most professionals agree that the earlier the intervention, the better, there is no single best treatment package.  AS treatment resembles that of other high-functioning ASDs, except that it takes into account the linguistic capabilities, verbal strengths, and nonverbal vulnerabilities of individuals with AS.  A typical program generally includes:

1. Social skills training for more effective interpersonal interactions;
2. Cognitive behavioral therapy to improve stress management relating to anxiety or explosive emotions and to cut back on obsessive interests and repetitive routines;
3. Medication, for coexisting conditions such as major depressive disorder and anxiety disorder;
4. Occupational or physical therapy to assist with poor sensory integration and motor coordination;
5. Social communication intervention, which is specialized speech therapy to help with the pragmatics of the give and take of normal conversation;
6. Training and support of parents, particularly in behavioral techniques to use in the home.

Of the many studies on behavior-based early intervention programs, most are case reports of up to five participants and typically examine a few problem behaviors such as self-injury, aggression, noncompliance, stereotypes, or spontaneous language; unintended side effects are largely ignored. Despite the popularity of social skills training, its effectiveness is not firmly established.   A randomized controlled study of a model for training parents in problem behaviors in their children with AS showed that parents attending a one-day workshop or six individual lessons reported fewer behavioral problems, while parents receiving the individual lessons reported less intense behavioral problems in their AS children.   Vocational training is important to teach job interview etiquette and workplace behavior to older children and adults with AS, and organization software and personal data assistants can improve the work and life management of people with AS.

Some researchers have argued that AS can be viewed as a different cognitive style, not a disorder or a disability

There is some evidence that children with AS may see a lessening of symptoms; up to 20% of children may no longer meet the diagnostic criteria as adults, although social and communication difficulties may persist.  As of 2006, no studies addressing the long-term outcome of individuals with Asperger syndrome are available and there are no systematic long-term follow-up studies of children with AS.  Individuals with AS appear to have normal life expectancy, but have an increased prevalence of comorbid psychiatric conditions, such as major depressive disorder and anxiety disorder that may significantly affect prognosis.  Although social impairment is lifelong, the outcome is generally more positive than with individuals with lower functioning autism spectrum disorders;  for example, ASD symptoms are more likely to diminish with time in children with AS or HFA.   Although most students with AS/HFA have average mathematical ability and test slightly worse in mathematics than in general intelligence, some are gifted in mathematics and AS has not prevented some adults from major accomplishments such as winning the Nobel Prize.

Medical Marijuana and Asperger's Syndrome

Autism is a disorder that relates to neural development and is best characterized by impaired social interaction, restricted and repetitive behavior and lack of communication skills. The diagnostic criterion claims that symptoms become apparent within a child before they turn three years of age. Autism directly effects the processing of information in the brain by altering nerve cells and their proper synapses. Asperger's syndrome is a disorder that lies within the autism spectrum, and is best characterized by significant difficulties in social interaction.

Medical marijuana has been known to be a solution to alleviating outbursts of rage, seizures and temper tantrums among autism patients. Cannabis and cannabis-based products such as concentrates and tinctures can be responsible for the lessening of any erratic actions that may have occurred in the past. Patients who use medical marijuana to treat their symptoms become extremely relaxed and very attentive to what they are doing. Best put, medical marijuana can serve as an exceptional behavioral modification, which can protect both the health and safety of an autistic patient.

Medical Marijuana can be used to alleviate the negative symptoms and accentuate the positive aspects of Asperger's Syndrome.

Tetrahydrocannabinol (THC) and Cannabidiol (CBD) are the two main cannabinoids found in marijuana. THC is psychoactive, causing the "high" associated with marijuana use. CBD is non-psychoactive and has a calming effect.  Aspies should choose high quality medical marijuana that has a high CBD to THC ratio. Use tinctures and edibles for long-lasting effects. Smoke or vaporize marijuana for a quick fix.   Mix buds and leaf  together to get more CBD's in your medicine.

Anxiety issues can make it impossible to lead a productive life. CBD's calm the body and mind to relieve stress. but beware of high THC concentrations that can cause severe anxiety and panic attacks.

Aspies are often ruled by their emotions and can have temper-tantrums well into adulthood. Smoke or vaporize marijuana as soon as you feel the anger rising and you should be able to calm down enough to talk about your feelings.

Sufferers of AS can have stress management issues due to their inability to control emotions. This can lead to disorders of the gastrointestinal system, such as ulcerative colitis, inflammatory bowel disease, and Crohn's Disease. Marijuana has pain-relieving and anti-inflammatory properties that can ease discomfort. If you are malnourished, use marijuana to stimulate your appetite.

Stress and depression can make it impossible to get a good night's sleep. Marijuana can help you fall asleep and stay asleep.

Aspie brains can race out of control making it difficult to concentrate and communicate. Marijuana slows down your thought processes, enabling you to think clearly and focus on one subject at a time.

Marijuana can alleviate social phobias, allowing you to leave the house and interact with the world without worrying about feeling different.

Medical marijuana may not work for everyone diagnosed with Asperger's Syndrome. You may have to experiment with the THC to CBD ratios and methods of ingestion to find a treatment plan that works for you.