How Asperger's Syndrome / High-Functioning Autism Affects Adults

This is one of the lengthier articles on this site. At first I considered breaking it up, but that didn't seem to work too well. I guess there's nothing stopping anyone from skimming it, or skipping around to the parts they're interested in.

The group that probably has the most problem with socializing are people with Asperger's Syndrome or High-Functioning Autism (HFA). This article will give a summary of the many issues this condition can cause. A second article discusses some of the broad ways people with Asperger's Syndrome or HFA can work to improve their social skills. If you already know you have Asperger's Syndrome, there probably won't be a ton in here that you haven't heard already.

It's not clear whether Asperger's Syndrome (AS) and High-Functioning Autism are distinct conditions or not. This article will assume they're more or less equivalent. Also, for simplicity's sake, for now on I'll just use the term Asperger's Syndrome to refer to both of them.

Asperger's Syndrome isn't a mental health problem. It's a difference in brain wiring that a person is born with. It's considered a milder form of autism. Unlike people with more severe autism, those with Asperger's Syndrome don't have intellectual disabilities, and their ability to learn and use language is intact. They still have the classic triad of autistic impairments, showing problems in social situations, language, and repetitive/stereotyped activities.

The biggest issue Asperger's Syndrome causes is difficulties with socializing, in all kinds of ways. Kids with AS are frequently picked on and seen as weird and annoying. As adults they can wind up socially isolated and have a very hard time making friends or getting into a relationship. Because so many jobs require at least some element of people skills, it's not rare for them to have trouble finding and holding down a position, or be underemployed.

In general people with Asperger's Syndrome want to be social and connect with others. However, they find they don't have the skills to do so. People with AS often don't like certain aspects of socializing though, such as small talk or mingling. Some individuals with AS will tell you they're pretty indifferent to socializing, and that their main priorities are their hobbies.

I'll go into more detail about various AS-related social difficulties below. What's interesting is that because people with Asperger's are wired differently (not worse, differently), and look at the world in their own way, their social difficulties seem to be a mix of subjective and objective problems. With some of the social problems Asperger's causes, you have to wonder, "Well what if things were reversed and 99% of the population had Asperger's and the other 1% socialized in the way that is now considered 'normal'?"

The fact is the Asperger's 'way' of doing things only seems to be a problem in some cases because it clashes with the unwritten norm. However, some of their social weaknesses do seem to be objective problems. Even other individuals with Asperger's find certain behaviors off putting.

Diagnostic Criteria for Asperger's Syndrome

Below are the official criteria for diagnosing Asperger's Syndrome. They're taken from the fourth edition* of the DSM, the so-called diagnostic bible for psychologists and psychiatrists, and the ICD-10, a coding of diseases, which also includes mental health and developmental conditions.

* There's actually a DSM-5 out as of mid-2013. It doesn't include Asperger's Syndrome, and instead absorbed it and a few other conditions into a more general diagnosis of Autism Spectrum Disorder. However, the decision to take away the standalone status of Asperger's was somewhat controversial. Members of the public and professionals still mainly think in terms of Asperger's Syndrome too, so I'll continue to use it here as well.

There aren't proper diagnostic criteria for High-Functioning Autism. It's not an official condition, more just a subjective evaluation that someone shows some autistic traits, but they are 'higher functioning' in some ways. They may also clearly show some autistic features, but not enough to be formally diagnosed with one of the Autism Spectrum disorders.

Even if you recognize many of your own traits in the criteria below, it's never a great idea to self-diagnose. A professional who's experienced in working with Asperger's Syndrome needs to do that. Many people have a handful of autism-esque traits, but that's often a far cry from actually being diagnosable.

It's also important to mention that not everyone with Asperger's Syndrome is the same. The condition can vary in severity, and there will be a different mix of symptoms in each person. All the other facets of a person's past and personality and interests will come into play too. An outgoing 'Aspie' from a poor, abusive household may present very differently than one who's more naturally reserved and from a stable upper-middle-class background.

DSM-IV Criteria For Asperger's Syndrome:

A. Qualitative impairment in social interaction, as manifested by at least two of the following:

(1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
(2) failure to develop peer relationships appropriate to developmental level
(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
(4) lack of social or emotional reciprocity

B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(2) apparently inflexible adherence to specific, nonfunctional routines or rituals
(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
(4) persistent preoccupation with parts of objects

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.


ICD-10 Criteria for Asperger's Syndrome:

A disorder of uncertain nosological validity, characterized by the same kind of qualitative abnormalities of reciprocal social interaction that typify autism, together with a restricted, stereotyped, repetitive repertoire of interests and activities. The disorder differs from autism primarily in that there is no general delay or retardation in language or in cognitive development. Most individuals are of normal general intelligence but it is common for them to be markedly clumsy; the condition occurs predominately in boys (in a ratio of about eight boys to one girl). It seems highly likely that at least some cases represent mild varieties of autism, but it is uncertain whether or not that is so for all. There is a strong tendency for the abnormalities to persist into adolescence and adult life and it seems that they represent individual characteristics that are not greatly affected by environmental influences. Psychotic episodes occasionally occur in early adult life.

Diagnostic Guidelines

Diagnosis is based on the combination of a lack of any clinically significant general delay in language or cognitive development plus, as with autism, the presence of qualitative deficiencies in reciprocal social interaction and restricted, repetitive, stereotyped patterns of behavior, interests, and activities. There may or may not be problems in communication similar to those associated with autism, but significant language retardation would rule out the diagnosis.

Social difficulties Asperger's Syndrome can cause

Here's where I'll finally go into more detail about the many social issues Asperger's Syndrome can lead to. If I had to sum it up in one sentence I'd say, "Think of the most exaggerated, stereotypically awkward person you can. Someone with Asperger's Syndrome probably comes across a lot like that."

I can't cover every last social problem they have, because in one sense they can have trouble with all aspects of socializing. I'll go over some of the more well-known challenges they face though. Another thing is that I'll try to keep the discussion focused on the problems adults can have as much as possible, since that's what this site is focused on. A lot of material on Asperger's is based around how kids with it act. Adults still have many problems, but often learn to curb many of their socially inappropriate behaviors when they're younger.

Not 'getting' socializing on an intuitive level

Many of the symptoms of Asperger's Syndrome feed into this. Typical people just instinctively grasp many aspects of social situations. Even if they're a little awkward at times, even if there are still things they need to practice or have explained to them, they still understand way more than they realize without having to really think about it. Also, if they don't get something, once they've been told about it, it will often click into place pretty quickly.

When someone has Asperger's it's not nearly so easy. Even the smallest interaction can seem totally illogical, mystifying, or impossibly complicated. They don't know all the unspoken 'rules behind the rules' that typical people seem to have no problem picking up. A pretty common analogy is for people with AS to say they feel like aliens living on another planet and trying to comprehend the ways of the natives. All this isn't to say people with AS are lost causes when it comes to learning social skills, but it's usually a longer, slower process for them to learn what comes naturally to 'neurotypical' people.

One side effect of all this is that people with AS tend to get very drained by socializing, since it draws on so much of their mental resources. It would be like a regular person going for a stroll, but they had to think really hard in order to operate their legs to successfully make each step. You can imagine how tiresome that would get before they'd even gotten to the end of the block.

Difficulties with putting themselves in another person's shoes

This symptom has been described as 'mind blindness'. People with Asperger's Syndrome have trouble with taking on another person's perspective and figuring out what they may be thinking or feeling. It's not that they're totally oblivious to the idea that other people have their own way of looking at things, they just have a harder time arriving at what that is. They can sometimes default to acting as if everyone else thinks the same way they do.

An example would be someone with Asperger's who starts talking to someone about a topic, but just jumps into the middle of things, without taking the time to consider that the other person is unfamiliar with it and needs to first be told all kinds of background details to have any hope of following the conversation.

Note that even regular people aren't always great at the whole 'putting yourself in someone else's shoes' thing, and that's where a lot of hurt feelings and arguments and misunderstandings come from. It's just that people with Asperger's have an even trickier time with it. Also, this isn't to say that people with Asperger's are totally lacking in empathy. If they are able to pick on someone's thoughts and emotions, they're just as capable of feeling supportive and compassionate as the next person.

Ignorance of social rules

Since they don't automatically absorb many social rules, and are lacking the perspective-taking tools to arrive at them on their own, people with AS sometimes simply aren't aware of various guidelines and niceties. They may make simple mistakes like not thanking someone for a favor, because they don't know that's expected of them. They may also say inappropriate things in a conversation because they don't know which topics are acceptable to bring up in that context.

With time and life experience they can be acquire many of these rules, but they may still have the odd gap in their knowledge. They may also feel ill at ease in unfamiliar situations because they know there are probably lots of unwritten guidelines they won't be aware of, and are worried about inadvertently breaking one of them.

Difficulties in picking up on non-verbal communication

People with Asperger's Syndrome have a hard time reading the messages in other's body language, facial expressions and tone of voice. They may not intuitively understand what emotions certain expressions, vocal inflections, or postures are communicating. At times they may fail to pick up on certain cues because they're in their head and just not attending to other things.

The classic illustration of this is a person with Asperger's talking to a group about something that interests them, while totally missing the fact that everyone has bored, closed-off body language, and that their replies of, "Wow, that's super interesting" are being delivered in a caustic, sarcastic way. You could see how the person with Asperger's could get confused when it seems that they're having a nice conversation, but then everyone walks off seemingly out of nowhere.

Kids with AS are known for being bad at telling when they're being teased or misled. Another common example would be a person with AS chatting to someone and completely failing to pick up that the other person was flirting with them, only to be told what was going on after the fact by an onlooker.

When people with AS are younger and more socially inexperienced, it seems they're more oblivious than anything to other people's non-verbal communication. Once they're aware that it's something they need to pay attention to, they still struggle with consciously trying to decode it. They have to allocate some of their limited mental resources to it, and don't do it effortlessly and automatically like typical people do.

Difficulties with conversations

One area where people with AS seem to have a lot of trouble is with having a back-and-forth conversation. Here's a list of ways they can go off track in them.

Monologues focused on what they want to talk about

People with AS are very well known for talking 'at' people rather than with them. As the example a second ago illustrated, their default conversational style seems to be to deliver a monologue to their listener, usually about their favorite interest (more on that below). They often do this even when the recipient is clearly bored or not interested in the topic. Another thing they'll do is frequently try turn the conversation back to what they want to talk about.

Again, kids with AS are just benignly oblivious when they corner a classmate on the playground and deliver a one-sided speech about how the combat system in Final Fantasy X is different from the one in Final Fantasy XII. Adults know better and try not to bring up their interests around people too often. However sometimes they just feel like they have to do it anyways.

They're not doing this to deliberately try to annoy anyone. It's just that they're enthusiastic about their interest and want to talk about it. Everyone does that sometimes, people with AS just do it more. It's also an area where they feel comfortable, so if a discussion goes into other territory they may feel lost and left out and unable to contribute, so they'll try to steer things back into their comfort zone.

Responding to other's statements

People with AS often have a hard time thinking of what to say, and aren't good at seeing various ways they could respond to the statements other people throw out there. For example, if you asked how someone was and they mentioned how they had gotten into a minor car accident this morning, there's all kinds of possible things you could say in response:

However they decide to reply, a typical person would probably think of these possibilities pretty quickly and then just go with one of them without analyzing it too much. Someone with Asperger's may think, "Wait, how on Earth did you come up with those so fast? Why did you choose to go with that one instead of the other three?" Even if you gave them some conversational 'rules' for this kind of situation, they may still miss the gist of them. Like they may respond to a statement about an accident with some trivia about NASCAR crashes.

Back and forth dialogue

They can also have trouble with the back-and-forth give-and-take of a conversation. This is where they may revert to their habit of talking at people. They may not think to ask questions that give the other person a chance to speak, or have trouble coming up with them.

Topic changes

Another issue Aspies can have is with changing topics. There could be an exchange between three friends such as:

So the first person mentioned a certain bar, which reminded the second person of how they may be showing some playoff games there. That talk of sports reminded Person #3 to update everyone on the status of his brother's exercise-related injury. The leaps in topic aren't anything that crazy, but someone with AS may totally struggle to see the connection between those three things, let alone be able to follow the conversation or know what kinds of statements would be appropriate to chip in themselves. Their lack of understanding in this area may make their own, less-practiced, topic changes seem totally abrupt and out of the blue.

Keeping things coherent

When they're talking Aspies may not put everything together into a cohesive package that the listener understands. They may seem to ramble on, go off on tangents, or not arrive at any particular point. Partially this may be because they're not good at looking at things from the listener's point of view, and considering what type of information they would need to know. They may also be more thinking out loud to themselves, rather than trying to have a mutual conversation.



Special interests

This is the "encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus " part of the diagnostic criteria. People with Asperger's Syndrome will have one or two areas that they are intensely interested in and spend a lot of time pursuing. They don't just dabble in their interests either, they go full out. These interests can seem very random and esoteric to people as well. Some more typical-seeming ones could be for trains, video games, computers, history, or animals. The more esoteric ones could be anything. Someone with AS could know everything there is to know about Patsy Cline or traditional dye making. A special interest could last a life time, or someone could get bored of it after a few years and move on to something else.

Researchers have noted that people with AS often pursue their interests with a focus on accumulating facts, not necessarily understanding the big picture. For example, someone who was interested in The Beatles may be able to tell you the details of every talk show they appeared on, but not really get what their music was trying to say, or how it fit in with what other bands were doing at the time. Of course, that's all a value judgment about the 'right' way to be interested in something.

This is one area where it's a bit subjective to call it a social problem. There's nothing inherently wrong with having a quirky hobby, thought it may cause problems in a more practical sense, because other people see it as weird and are more rejecting of the person who does it. Many people with Asperger's manage to turn their expertise about their special interest into a rewarding career. As I already covered, the main social issue having a special interest leads to is when the person talks about it too much and puts people off.

Difficulty recognizing and expressing their own emotions

Aside from having trouble reading other people, someone with AS may not be totally plugged into what they're feeling themselves either. Even when they do know what they're experiencing, they may have trouble getting that message across to others. They may find themselves getting really upset out of nowhere because they didn't notice the milder emotions that led up to it.

A blunt, overly straightforward communication style

People with AS often offend people or are accused of being insensitive because they seem to have no mental filter. The stereotype is of a person with AS talking to someone at a party and then matter of factly pointing out that the other person has really bad teeth, and asking if they're going to go to a dentist to get them fixed. Part of this problem comes from the whole 'trouble with understanding another person's perspective' thing. People with AS also tend not see what the big deal with being direct is, not care when someone is blunt with them, and assume others feel the same way.

Again, kids may do this by default. By the time they reach adulthood people may have gotten enough instruction about this that they've learned not to do it as much. Like they'll have learned to apply the rule, "Don't comment on people's physical flaws". They may still struggle with a natural tendency towards straightforwardness though, and feel frustrated and confused with the indirect, roundabout way neurotypical people seem to communicate.

Valuing logic, truth, and accuracy

People with Asperger's Syndrome can place a lot of importance on whether something is true or correct. This can lead to them frequently correcting others. They can also value accuracy more than the idea of maintaining social harmony or keeping a conversation on its rails. Of course, people will often get annoyed at being corrected and see the person who does it as a condescending know-it-all.

Here's a stereotypical example:

The fact that the person was using 'bug' in a widely accepted informal way, or that the definition of the word wasn't really relevant to the overall statement didn't matter. They said something technically wrong, and the person with AS felt a need to rectify the error and restore balance to the universe.

This is one more area where adults learn to rein themselves in a bit. However, they may still find themselves compelled to correct people, and sometimes find themselves halfway through a lecture before they realize that they've done it again.

Literal thinking and trouble with understanding humor and figurative language

People with Asperger's Syndrome can be very literal and concrete in their thinking. Like you may ask them, "Could you go to the store and buy milk?", and they'll reply, "Yes" and then go back to what they were doing. From their perspective they were answering a hypothetical about whether it would technically be possible for them to buy milk or not.

They also may get confused by more figurative or metaphorical language. For example, two paragraphs above this one I used the term 'rein themselves in'. Someone with AS may picture themselves holding literal reins, and wonder why someone would ever do that to themselves.

They can also have a hard time grasping humor. It's not that they lack the capacity to laugh or make jokes or find things funny. It's just that when they're sitting around with a group of people who are telling stories and cracking each other up, they may have no idea what everyone finds so amusing. Or maybe they'll make a joke that seems funny to them, and everyone will stare at them blankly.

Rigid thinking / Getting Stuck

People with Asperger's can think in an overly rigid way. They can also sometimes become 'stuck' on a topic and have trouble moving on. Here's an example, that also shows the way people with AS can think too concretely: A person could tell someone with AS that if they were good at bowling it may help them meet people. The Aspie may then want to know exactly what you mean by 'good' at bowling. What average score would they need to get per game? What's the minimum score they would need to earn the 'good' label? Are there any particular tricks or techniques they have to learn to seem 'good'? If you told them you weren't sure, and that they should just understand what you meant by 'good' they may still want to know and be unable to drop the subject until you answered them. Even then they may keep coming back to it later on, asking for further clarification.

Another example may be if someone with AS was helping you make dinner, and asked them to cook the rice, and told them to stray from the recipe on the package a bit. Even if you explained why you needed to do things that way, they may insist on following the exact recipe and not be open to doing things any differently. It's not that they get where you're coming from and simply disagree with you, they may really not be able see to the other possibilities.

Use of language

People with Asperger's have no problem acquiring language, but they often use it in peculiar ways. They may be verbose and use unnecessarily big words. They can also talk in an overly formal, proper way. It's common to characterize kids who do this as 'little professors'. Sometimes they'll use metaphors that only make sense to them.

Liking structure, routine, and predictability

People with Asperger's Syndrome can have trouble being flexible and going with the flow. If they've got things planned out a certain way they can get pretty upset if it changes, or seems like it will. Obviously this doesn't mesh at all with many social situations, where simple plans like where everyone is going that night can change up until the last second. They can also have particular ways they like doing things, or daily routines they have to follow. They can be quite rigid about not deviating from them, and get very upset when they have to.

Planning problems

Asperger's can cause difficulties in things like planning or organizing their time. This can sometimes lead to them being seen as flaky or unreliable.

Body language

Aside from having trouble reading other people's body language, the non-verbal communication of people with AS isn't typical either. They often have trouble maintaining eye contact. They may stand too close to people, or use touch in inappropriate ways. Their posture and mannerisms may seem odd or stiff. Their walk may look awkward. Their facial expressions may seem lifeless or off, and I've seen references to an Asperger's 'look' people can have. They may have various tics.

Again, if caught early, many of these things can be trained out of kids. They can be taught to make eye contact, or continually be reminded not to invade other people's space until they get the picture.

Voice

The voices of people with Asperger's may seem odd too. Their voices may be droning or monotone, have a limited range of intonation, or have a strange inflection or rhythm.

Clumsiness

To further add to the awkward stereotype Asperger's seemingly makes people become, people who have it can be clumsy and uncoordinated. They may have a hard time throwing a ball, or learning to ride a bike. Basically, they suck at sports. We know how much that helps kids be welcomed and accepted in school.

Sensory sensitivities

People with AS can also have senses that seem to be wired differently. They may be sensitive to the feel of certain fabrics on their skin, or the flavor or texture of certain foods may totally nauseate them. This can come up in social situations when they're sensitive to things like the loud music and flashing lights in night clubs. Lots of typical people aren't exactly crazy about these things either, but someone with Asperger's who's susceptible to bright lights or certain sounds may find them much more painful and unpleasant than average.

Side effects of social failure and not fitting in

Kids with Asperger's often get teased and bullied pretty mercilessly. They can be endlessly nagged by parents and teachers to behave differently. They can get rejected and ignored over and over and over. They can constantly receive the message that they're defective and need to change to please others. As adults they can still struggle to make friends, while also getting flak at work for not having 'soft skills' or for being poor 'team players' or networkers. All of this can lead to problems that are indirectly caused by their Asperger's

Depression and anxiety

The first problem all this failure and rejection and discouragement can cause is depression and anxiety. The anxiety may mainly revolve around social situations and their fear of making yet another mistake or getting made fun of. I discuss these two issues more in these articles:

Depression
Social Anxiety Disorder / Social Phobia

Bitterness

By the time they reach adulthood many people with Asperger's Syndrome are also pretty bitter about neurotypical people, their rejecting, non-understanding ways, and their illogical social customs. All this understandable baggage may prevent them from improving their social skills further, or even be motivated to do so in the first place.