Difference Between Asperger's Syndrome and High Functioning Autism - Dr Tony Attwood's View

Is There a Difference Between Asperger's Syndrome and High Functioning Autism?

Dr Tony Attwood

We have been exploring the nature of autism, as described by Leo Kanner, for nearly 60
years. He described a severe form of autism, typified by the silent and aloof child. We
have only been exploring the profile of autism described by Hans Asperger for about 15
years. The children he described had speech and were active participants in social
interactions. There is currently some debate in the academic literature and between
clinicians as to whether Asperger's syndrome is a unique disorder with a profile of
abilities that does not occur in any other syndrome or simply a form of autism with a
higher intelligence quotient.

There is general agreement that autism as defined by Leo Kanner and 'autistic
psychopathy' (the original descriptive term of Hans Asperger which was later changed
to the term Asperger's syndrome by Lorna Wing) are two conditions within the range of
disorders known as Pervasive Developmental Disorders or Autistic Spectrum Disorders.
In 1994 the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) provided
diagnostic criteria for Asperger's syndrome. The opinion of the authors of the manual,
which was revised in 2000 (DSM-IV-TR) was that Asperger's syndrome could be
differentiated from autism by an examination of the child's early development and the
existence of some characteristics that were rare in children with autism. They considered
that early language and cognitive skills are not delayed significantly in children with
Asperger's syndrome. There is also no clinically significant delay in age-appropriate selfhelp
skills, adaptive behaviour and curiosity about the environment in childhood. The
clinical profile of a child with Asperger's syndrome is also less likely to include motor
mannerisms and preoccupation with parts of objects as occurs in autism but the child
can have a circumscribed interest that consumes a great deal of their time amassing
information and facts. They also noted that the profile of social skills in children with
autism includes self-isolation or rigid social approaches, while in Asperger's syndrome
there can be a motivation to socialise but this is achieved in a highly eccentric, one-sided,
verbose and insensitive manner. Should the child's profile of abilities and developmental
history be consistent with the criteria for both autism and Asperger's syndrome, the
authors of the DSM state that a diagnosis of autism should take precedence.

The diagnostic criteria in the DSM, which provide a differentiation between autism and
Asperger's syndrome, have been examined by several research studies over the last five
years. There has been some criticism from clinicians and research that the criteria do not
identify the disorder Hans Asperger originally described. The four cases he described in
his original paper would be diagnosed, according to DSM criteria, as having autism not
Asperger's syndrome. (Miller and Ozonoff 1997). If one was to use the DSM criteria,
Asperger's syndrome would be a very rare condition.

Research has also been conducted on whether delayed language in children with autism
can accurately predict later clinical symptoms. Three studies have cast considerable
doubt over the use of early language delay as a differential criterion between autism and
Asperger's syndrome (Eisenmajer, Prior, Leekam, Wing, Ong, Gould and Welham 1998,
Dickerson Mayes and Calhoun 2001 Manjiviona and Prior 1999). Any differences in
language ability that are apparent in the pre-school years between children with autism
and Asperger's syndrome has largely disappeared by early adolescence (Eisenmajer,
Prior, Leekam, Wing, Ong, Gould and Welham 1998, Ozonoff, South and Miller 2000).
There is general agreement that children with Asperger's syndrome may not show any
conspicuous cognitive delay in early childhood. Indeed, some can be quite precocious or
talented in terms of learning to read, numerical abilities and in some aspects of their
constructive play and memory. Children with autism can be recognised as having
developmental delay in their cognitive abilities from infancy and diagnosed as young as
18 months of age with a mean age of diagnosis of five years. Children with Asperger's
syndrome are often not diagnosed until after they start school with a mean age of
diagnosis of eleven years (Howlin and Asgharian 1999). However, the signs of
Asperger's syndrome in very young children may be more subtle and easily
camouflaged at home and school. On reflection, parents (especially mothers) and
teachers have often been concerned about some aspects of the child's cognitive
development, in particular their social reasoning, but their concerns may have been
intuitive, and difficult to describe to clinicians. It is not until the child is expected to
show more advanced cognitive abilities that formal assessments indicate significant
delay or an unusual profile in cognitive development.

There has been research comparing the cognitive profile of adolescents with autism and
Asperger's syndrome. The studies have examined the cognitive profile of what may be
called 'High Functioning Autism', that is children with a diagnosis of autism with an
Intelligence Quotient in the normal range, i.e. above 70. The term High Functioning
Autism has been used in the past to describe children who had the classic signs of
autism in early childhood but as they developed, formal testing of their cognitive skills
indicated a greater degree of intellectual ability with greater social and adaptive
behaviour skills than are usual with children with autism. Their clinical outcome was
better than expected. The cognitive abilities of this group of children were then
compared to the cognitive profile of children with Asperger's syndrome, who did not
have a history of early cognitive or language delay. The results of the research has not
established a distinct and consistent profile for each group. Ehlers, Nyden, Gillberg,
Dahlgren Sanberg, Dahlgren, Hjelmquist and Oden (1997) found that only a minority of
each diagnostic group showed a characteristic profile.

One group of researchers, based at Yale University in the United States have suggested,
on the basis of their research studies, that the neuropsychological profiles of children
with Asperger's syndrome and High Functioning Autism are different. (Klin, Volkmar,
Sparrow, Cicchetti and Rourke 1995). However, research by other scientists examining
diagnostic differentiation using neuropsychological testing has not identified a distinct
profile that discriminates between the two groups. (Manjiviona and Prior 1999, Miller
and Ozonoff 2000 Ozonoff South and Miller 2000).

The DSM criteria refer to children with Asperger's syndrome as having, in comparison
to children with autism, no clinically significant delay in age-appropriate self-help skills
and adaptive behaviour. Clinical experience indicates that parents, especially mothers of
children and adolescents with Asperger's syndrome, often have to provide verbal
reminders and advice regarding self-help and daily living skills. This can range from
problems with dexterity affecting activities such as learning to tie shoelaces to reminders
regarding personal hygiene, dress sense and time management. Clinicians have also
recognised significant problems with adaptive behaviour, especially with regard to
anger management, anxiety and mood. (Attwood 2002). Clinical experience and research
has confirmed that in terms of the child's behavioural profile, children and adults with
High Functioning Autism and Asperger's syndrome have a very similar presentation
(Ozonoff, South, and Miller 2000). Both groups benefit from the same behavioural
treatment programs.

The academic may decide whether a particular subject in a research study has a
diagnosis of autism or Asperger's syndrome to ensure that their research examines the
same clinical populations as in other studies. The clinician has other considerations and
decides whether the child has a diagnosis of autism or Asperger's syndrome to help
define and understand their differences to other children. However their
recommendations for treatment for both High Functioning Autism and Asperger's
syndrome are the same.

Clinicians have noted that as the clinical picture of Pervasive Developmental Disorders
or Autistic Spectrum Disorders changes over time, a child may receive a diagnosis of
severe autism or High Functioning Autism at one point in their developmental history
and Asperger's syndrome at a later stage. (Attwood 1998, Gillberg 1998). There is also
the opinion among clinicians that, contrary to DSM, if a child meets criteria for both
autism and Asperger's syndrome, the child is given a diagnosis of Asperger's syndrome
(Mahoney, Szatmari, MacLean, Bryson, Bartolucci, Walter, Jones and Zwaigenbaum
1998)

A dilemma for the clinician is whether a particular diagnosis enables the child to have
access to the government services that they need. In some countries, a child may only
have support in the classroom or the parents receive government allowances or medical
insurance coverage if the child has a diagnosis of autism. Clinicians may write reports
with a diagnosis of autism rather than the more accurate diagnosis of Asperger's
syndrome. This is particularly relevant when one considers the epidemiological research
suggests that one person in 250 has Asperger's syndrome, using the criteria being
adopted by clinicians (Kadesjo Gillberg and Hagberg 1999). Government and nongovernment
agencies, especially Education and Health departments, have usually not
been funded for such an incidence and are reluctant to 'open the floodgates'.

Conclusion

Having reviewed the literature, we may be able to answer the question, is there a
difference between Asperger's syndrome and High Functioning Autism? The reply is
that the research and clinical experience would suggest that there is no clear evidence
that they are different disorders. Their similarities are greater than their differences. We
appear to be taking, particularly in Europe and Australia, a dimensional view of autism
and Asperger' syndrome rather than a categorical approach. (Leekam, Libby, Wing
Gould and Gillberg 2000). At present both terms can be used interchangeably in clinical
practice.

 

References

Attwood T. Asperger's syndrome: A guide for parents and professionals. London Jessica
Kingsley Publications. 1998.
Attwood T. (2002) Frameworks for behavioural interventions. Child and Adolescent
Psychiatric Clinics of North America. 12 (in press).
Dickerson Mayes, S. and Calhoun, S.L. (2001) Non-significance of early speech delay in
children with autism and normal intelligence and implications for DSM-IV Asperger's
Disorder. Autism. 5, 81-94.
Ehler, S., Nyden A., Gillberg C. Dahlgren Sandberg A., Dahlgren S.O., Hjelmquist, E.,
and Oden A. (1997) Asperger syndrome, autism and attention disorders: A comparative
study of the cognitive profiles of 120 children. Journal of Child Psychology and
Psychiatry, 38 207-217.
Eisenmajer, R., Prior, M., Leekam, S., Wing L., Ong, B., Gould, J., and Welham M. (1998)
Delayed language onset as a predictor of clinical symptoms in Pervasive Developmental
Disorders. Journal of Autism and developmental Disorders, 28, 527-533.
Gillberg C. Asperger syndrome and High Functioning Autism. British Journal of
Psychiatry, 171, 200-209.
Howlin P. and Asgharian A. (1999) The diagnosis of autism and Asperger syndrome:
findings from a survey of 770 families. Developmental Medicine and Child Neurology,
41, 834-839.
Klin A., Volkmar F.R., , Sparrow S.S., , Cicchetti D. V., and Rourke B.P. (1995) Validity
and neuropsychological characterization of Asperger Syndrome: Convergence with
Nonverbal Learning Disabilities Syndrome. Journal of Child psychology and Psychiatry
36, 1127-40.
Kadesjo B., Gillberg C., and Hagberg B. (1999) Autism and Asperger syndrome in sevenyear-
old children: a total population study. Journal of Autism and Developmental
Disorders, 29, 327-331.
Leekam S., Libby S., Wing L., Gould J., and Gillberg C. (2000) Comparison of ICD-10 and
Gillberg's criteria for Asperger syndrome. Autism 4, 11-28.
Mahoney W. J., Szatmari P., , MacLean J.E., Bryson S. E., Bartolucci G., Walter S.D., Jones
M.B. and Zwaigenbaum L. (1998) Reliability and accuracy of differentiating Pervasive
Developmental Disorder subtypes. Journal of the American Academy of Child and
adolescent Psychiatry, 37, 278-285.
Manjiviona, J. and Prior M. (1999) Neuropsychological profiles of children with
Asperger syndrome and autism. Autism 3, 327-356.
Miller, J.N. and Ozonoff, S. (1997) Did Asperger's cases have Asperger Disorder? A
research note. Journal of Child Psychology and Psychiatry. 38. 247-251.
Miller, J.N. and Ozonoff,S. (2000) The external validity of Asperger Disorder: Lack of
evidence from the domain of Neuropsychology. Journal of Abnormal Psychology 109,
227-238.
Ozonoff S., South M., and Miller J.N. (2000) DSM-IV defined Asperger syndrome:
Cognitive, behavioural and early history differentiation from High Functioning Autism.
Autism 4, 29-46.

Copywrite 2003 Tony Attwood

 

[URL: http://www.sacramentoasis.com/docs/8-22-03/as_&_hfa.pdf]

 

Difference between Asperger's Syndrome and High-functioning Autism

1) About Asperger's Syndrom
一九四四年，在维也纳执业的小儿科医师汉斯"亚斯伯格，率先提出关于亚斯伯格症的案例报告。但是他的文章以德文发表，语言本身即造成藩篱；加上他研究的个案数目，又比肯纳医师在一九四三年发表的研究个案少；而且亚斯伯格医师描绘患者时的精确性以及概念性的陈述，均不及肯纳医生。以上种种原因，让亚斯伯格医师的报告，并未如肯纳医生类似的研究，获得学界广泛的关注。事实上，直至一九八一年，才有人陆续开始整理、发表其临床个案，并引用"亚斯伯格症"这个名词表述这些个案的临床特征，西方世界才真正开始关注这一群患者。

　　相关文献从此逐渐累积，但研究文章大量出现，则是一九九○年以后的事。这个障碍被列入自闭症的亚型，至今已有超过十年的历史；然而学界对这个障碍的界定，却不断有纷云的讨论。大多数学者同意将亚斯伯格症归纳在自闭症的诊断之下，但对于是否应将其独立为一个亚型，或应将之视为高功能自闭症的变异状况，至今仍有争议。争议的主因是高功能自闭症患者与亚斯伯格症的分界并不明确，即使长程追踪研究的结果，也无法清楚显现两者之间的差异。  

2) Difference between Asperger's Syndrome and High-functioning Autism

区分亚斯伯格症和婴幼儿自闭症（肯纳症），主要关键点为患者三岁前的语言发展与智能，是否均在正常的范围内。但是对于智力正常的高功能自闭症患者而言，若无法澄清早年的语言发展史，便会产生辨认上的困难。而且由于大部分亚斯伯格症患者发现、就医或接受诊断的时间较晚，因此这个亚型出现后，许多临床工作者便将某些语言发展出现轻度障碍、在临界接近正常范围的患者，或者智能轻度障碍、临界接近正常范围，但是有人际关系问题的患者，或者行为局限、固执与怪异的患者，甚至许多不明的人际、社交或社会情境学习困难的患者，通通归类在亚斯伯格症之下，导致亚斯伯格症的诊断，更不容易被人所了解。不过由于目前通用的诊断手册中，并无关于高功能自闭症操作定义的描述，因此亚斯伯格症也可以被视为目前唯一被界定的高功能自闭症。

　　亚斯博格症估计盛行率约在万分之二到二点五之间；美国一项对新泽西洲及特定小区的研究，则显示此症的盛行率约为万分之三左右。该症常见于男生，出现率约为女生的八倍。Safra指出瑞典的盛行率约为千分之七，而Neil指出在美国的出现率约为千分之二，近年的研究显示，每千名7-16岁的儿童中，约有3.6至7.1位为亚斯博格症，较自闭症患者多（大约每一万名出生的新生儿中，有7-16位为自闭症患者）。亚斯博格症病患的男女比例约在10-15：1，以男性居多。

　　一般而言，亚斯博格症儿童和高功能自闭症儿童的差异性很小，通常被称为自闭症的延续或是变异的自闭症因此有些亚斯博格症儿童，也常被误认为是自闭症，但其和自闭症之间仍存在着差异性。

 

　　语文智商是判断的标准

　　一般在定义亚斯博格症和高功能自闭症，通常以智商七十以上来作为范围。一九九八年，调查三百三十个个案研究发现，高功能自闭症儿童在语文智商方面，普遍低于亚斯博格症儿童，高功能自闭症儿童语文智商平均为七十七，亚斯博格症儿童则为九十八；在操作智商方面，亚斯博格症儿童为九十，高功能自闭症儿童为八十六。研究结论显示，语文智商是可以做为诊断亚斯博格症儿童和高功能自闭症儿童的标准。

　　自闭症儿童对于某些事情大多有特殊的兴趣或特殊的天赋，例如机械性计数的能力、机械性音乐的能力、机械性的判断能力，比较不属于思考性能力，而亚斯博格症儿童则不同，亚斯博格症儿童可能一直会思考诸如"美国应该有一州是没有空气的"。

　　国内有个典型的亚斯博格症儿童，他就是一直在专研印度橡树，连叶脉偏向几度时受风会比较大的问题都会去思考。

　　另外，在语言的流畅性方面，对亚斯博格症儿童没有困难，两岁前即会出现单字，三岁就会说整个句子，但四岁前，你、我、他还是会混淆，而且会有反复和重复对方话语的情况。相对于高功能自闭症所特有的机械性特殊能力，亚斯博格症儿童在特殊能力方面则属思考性的，例如曾有个国外知名的心脏科专家，即是亚斯博格症患者，他就是对于心脏特别感兴趣。

　　亚斯博格症者的鉴定方法

　　在语言方面，亚斯博格症和高功能自闭症最大的差异在，高功能自闭症的自发性语言非常少，不会流畅的表达，亚斯博格症儿童则在自发性语言和对谈上并没有问题，问题则在于对谈时，亚斯博格症儿童会有"冗长的对谈"，不管对方有没有兴趣，会和对话者一直谈同一件事情（例如印度橡树），而引起对方的反感，进而影响到其人际关系的互动。

　　在动作方面，高功能自闭症儿童的大肌肉动作没有问题，亚斯博格症儿童则动作非常笨拙，他们一般的标准有四项：一、模仿肢体动作有困难，二、无法顺利的接球，三、单脚站立有困难，四、两手无名指弯曲有困难。

　　在社会互动能力方面，和自闭症儿童不同的是，亚斯伯格症儿童是具有能力、有兴趣，且会去参与，但因为他的社会直觉和一般人有差异，所以无法了解人际互动的意义。例如请他举右手，他会举左手，原因是他面对着施令者，会以模仿的方式，跟着施令者举相同的手。

　　所以在教导亚斯博格症儿童时，应注意其"参考点"的问题，以教写字为例，不要面对着他写，而是到他身旁教导他，以免写出来的字左右上下相反，造成家长又要担心孩子是否还有视觉知觉统合的问题。

　　在攻击暴力行为方面，亚斯博格症儿童因有满高的道德标准，因此也会引发互动上的冲突。例如过马路时，看到有人闯红灯，他们会马上义正严词的制止："不行，叫警察来抓你喔！"也曾有一个亚斯博格症儿童常扬言："我要拿刀子来杀那些坏人。"像是发生类似的情况，就很容易和其它人发生冲突，而被误解有攻击暴力行为。有时候，他们是因为被"逼急"了，才会产生攻击暴力行为。

　　此外，有些过动儿也曾被误判为亚斯博格症儿童，一般正常儿童出现过动的机率为百分之四到百分之六。

　　

　　根据国际精神医学会的鉴定标准，亚斯博格症儿童鉴定的标准有：一、语言发展问题，二、社会互动，三、行为问题，四、非精神症状况的行为问题。前三项和自闭症的鉴定标准是相同的，主要是以第四项来作为判别的不同。利用视觉线索来解决问题。

　　亚斯博格症儿童的情感相当丰沛、敏感，很在意别人的看法、嘲弄或挑剔，有时候一个嘲弄或挑剔，会使其产生低自尊，甚至有忧郁症、焦虑症的症状；在教育上必须使其了解别人的意向、行动、态度有时并非是负面的。例如，曾经有一个亚斯博格症女童在过生日时，因看到蛋糕上的小裂痕，使得原本高兴的情绪，顿时转为嚎啕大哭，原来她从蛋糕上的裂痕，联想到山川河流的切割，以及自己的身世背景和不被他人接受的人际关系。

 

　　如何为亚斯博格症的孩子选择适当的治疗？

　　当父母首次由医师的口中得知，孩子罹患的是亚斯伯格症(以下简称AS)时，脑中闪过的第一道问题常是"接下来怎么办呢？"。真正的答案，其实还是在孩子身上。各种专家及医师都有满腹经典要协助你的AS孩子，但世界上真的没有某种治疗是放诸四海皆准，适合每一位病童的。父母的重责在于为自己的孩子找到最适合他的治疗策略。

　　截至目前，已发展出许多AS的治疗模式。但受限于研究对象的数目太少，父母将会发现许多治疗方案在执行时未必实用。最重要的是，至目前为止，世界各地的精神医学专家对AS的诊断标准仍未有一致的看法，治疗方式也因而五花八门。有的父母因而转向"有经验的父母"求助。总而言之，父母必须多方收集信息，先行筛选掉对孩子无帮助的治疗方式。在配合治疗师或医师治疗时，父母不必对于疗效过于惊慌或计较。记住，只要治疗方式是正确的，孩子的行为或情绪就会出现你所期望的转变。反之亦然。

　　当然，有些治疗需要数周以上才会出现疗效。如果在耐心等待一段时间，或问题没有改善、甚至是恶化时，父母就必须立即再与治疗师或医师讨论。休息一阵后，你可以选择另一种治疗方法，也可以再给旧方法一次机会。

　　在惊慌无助中，许多父母会选择性的注意到一些"治愈"的AS个案报导。父母满心期盼地打听，他们怎么"好的"？是什么神秘的治疗？维他命或稀有矿物质的补充？其实，AS的症状、轻重程度相差极大。某一位个案"痊愈"了，但他（或她）可能是症状与你的孩子完全不同的一位AS病童，或甚至是被误认为是AS的孩子。

　　因此，我们强烈建议父母们多看、多听、多比较，也多搜集讯息来协助自己及其它无助的家长。有时，治疗一般情障、智障、或正常儿童情绪问题的方法也都适用AS孩子。

 

　　［如何选择适合孩子的治疗？］

　　在开始任何一种治疗时，父母不妨先思考下列数个问题：

　　1）我选择的这种治疗是要针对孩子的什么问题，要改善什么问题？没有一种治疗是全方位的。不妨与治疗师或医师讨论即将进行的治疗（不论是行为治疗、感统治疗、职能治疗或语言治疗）对孩子的帮助及治疗极限。如果治疗师告诉你这种治疗可以改善孩子一切问题时，一定要请他详细说明改善症状的原因。如果他在解释时使用太多专有名词，就要进一步请他「翻译」成你听得懂的语句！

　　在与治疗师谈话时，最好可以做笔记。把你的疑问、你得到的解答及新的发现等都记好，才可有效率地利用每一项及每一次的治疗及治疗时间。最重要的是千万不要不好意思问问题。

　　举个例子，如治疗师告知你孩子有「精细动作障碍」时，你必须弄清楚，这个毛病会使孩子出现书写的困难，或不会自己扣扣子。因此，如果你不能体会「精细动作」对孩子的影响，就要问个明白！

　　2） 治疗到底要进行多久？

　　大部分针对AS的治疗都没有「结束」的时刻表。孩子的各种问题常纠缠不清（如：社交技巧不好导致情绪困扰；协调能力不好使得学习及写字能力变差）。因而许多治疗时间都是以月或年来计算。目前受限于保险制度，有的治疗会在进行一段时间后停止。这时如果孩子的进步仍有限，父母自己必须持续协助训练孩子。

　　3）除了到医院治疗外，老师在学校及父母在家中还有什么协助孩子的方法吗？

　　一旦孩子在治疗中学到某些技能，父母不妨立即在生活中或学校教室内强化他的印象。譬如孩子在职能治疗中学会分辨外形一样，但触感完全不同的物体时，我们就可以在超市与他一起进行同样的辨识练习。如治疗师以隔离法（time out）来处理孩子的情绪时，我们可以同时告知老师，当孩子在教室中有不当行为时，也可以time out方式来使他冷静下来。

　　4） 在家中治疗孩子时，父母要注意什么？

　　许多父母在"旁观"孩子治疗一段时间后，就会跃跃一试，在家中为孩子进行治疗的工作。其实许多治疗项目，尤其是牵扯到心理层面的治疗时（如：行为处理、情绪治疗），技巧常只是工具而已。好的治疗师还必须可以客观地观察孩子的改变，冷静地维持自己中立但坚定的态度。但父母在"治疗"孩子时，往往无法像治疗师一样，因为经过完整的训练，有能力审思自己的情绪，而在不知不觉中带给自己及孩子更多压力。有的父母则认为与AS孩子相处已够令人心烦了，就把治疗工作交给治疗师，自己只努力做好"父母"的角色。

　　不管你决定如何面对AS孩子的各种治疗选择，记着：

　　1.这是一场长期抗战，要随时保持客观，不要吝于寻找资源及发问，但也不要累坏自己。有时候你会对某一种治疗"意兴阑珊"或"忍无可忍"时。这时，至少先与治疗师谈一谈再中止治疗。因为往往是孩子或你最无法解决的问题，在治疗上最困难，带给父母的挫折也最大。记住！保持客观！

　　2 .孩子才是治疗的重心。孩子在成长过程中，会逐渐了解到，他一定是"有问题"的，才需要定期至某处"治疗"。想想看，他的压力有多大！？我们其它的人都只是在敲边鼓，他却必须在正确时间做出正确反应。所以，请常常用力称赞孩子既有的优点（记性好、会帮忙作家事…）、他对治疗的耐心及勇于改变的气魄。

 

Asperger Syndrome - A CNN Manager's View (转载)

 

Asperger's: My life as an Earthbound alien

One CNN manager, who asked to remain anonymous, recently learned -- at 48 -- that she has Asperger's syndrome, a form of autism. Today she shares an inside view of life with the condition.

ATLANTA, Georgia (CNN) -- Recently, at 48 years of age, I was diagnosed with Asperger's syndrome. For most of my life, I knew that I was "other," not quite like everyone else. I searched for years for answers and found none, until an assignment at work required me to research autism. During that research, I found in the lives of other people with Asperger's threads of similarity that led to the diagnosis. Although having the diagnosis has been cathartic, it does not change the "otherness." It only confirms it.

When I talk to people about this aspect of myself, they always want to know what it means to be an "Aspie," as opposed to a "Neurotypical" (NT). Oh, dear, where to start . ...

The one thing people seem to know about Asperger's, if they know anything at all, is the geek factor. Bill Gates is rumored to be an Aspie. We tend to have specialized interests, and we will talk about them, ad infinitum, whether you are interested or not. Recognizing my tendency to soliloquize, I often choose silence, although perhaps not often enough. Due to our extensive vocabularies and uninflected manner of speaking, we are called "little professors," or arrogant.

I don't quite understand small talk, and early in my adult life, solecisms were frequent. At meetings, I launch into business without the expected social acknowledgments. It's not that I don't care about people, I am just very focused on task. Do you have to rehearse greeting people to reinforce that you should do it? I do.

I am lucky to have a very dear friend who savors my eccentricities. She laughs, lovingly, about one particular evening at a restaurant. Before she could get seated, I asked her what she knew about the golden ratio and began to spew everything I know about it. I re-emphasize how lucky I am to have her as a friend, because this incident occurred long before I was diagnosed.

A misconception is that Aspies do not have a sense of humor. It is true that we can be very literal, so we often miss the humor in everyday banter, but we can and do enjoy even subtle humor. Our literal interpretations, however, can be problematic.

In first grade, whenever someone made a mess in the classroom, the teacher would ask a student to get the janitor. The student would come back with Mr. Jones (not really his name), who carried a broom and large folding dustpan. When I was asked to get the janitor, I looked all over the school and reported back to the teacher that I could not find it. After all, the person was Mr. Jones, so the janitor must be the object, right?

I lack the ability to see emotion in most facial expressions. I compensate for this deficiency by listening to the inflections in people's voices and using logic to determine emotional context. The words people choose, their movements, or even how quickly they exit a meeting can provide clues to emotion.

I also have intensified senses -- touch, taste, smell, sight, and sound -- so I am attuned to lights, noise, textures, and smells. In a "busy" environment, I will eventually go into sensory overload and my mind will go blank. When this happens, I have to "go away" mentally for a brief period to regain focus. When I "return," I have to piece together what occurred while I was "away." The additional mental processing I must do to function every day is fatiguing, and I don't handle "ad hoc" very well. Being asked to respond quickly in the midst of all this other processing is difficult, sometimes impossible.

I am so sensitive to touch that a tickle hurts me. This is the hardest concept for most people to understand. How can a tickle hurt? All I can tell you is that it does, so I avoid being touched except by those who have learned how to touch me.

Hugs are dispensed infrequently, but if I do hug someone, I resemble Frankenstein's monster, arms extended to control contact. When my dad (who I suspect is an Aspie, too) and I hug, we both have "the approach." We sometimes miss and have to re-approach a couple of times until a brief, awkward hug is achieved.

In school, other children noted my differences, and I was bullied (and tickled into fits of despair) for years. Already needing extended periods of time alone, my response was to become even more of a loner. Uh oh. When you are weird, you are a joke. When you are a loner, you frighten people. It's always the quiet ones. ...

I am married (wow!), and my brilliant husband is an absolute sweetheart. I don't know any other man who has the self-confidence to be pushed away (sometimes sharply), both physically and mentally, as often as he has been. He has been gentle and patient (and, yes, frequently emotionally depleted) as we both worked through my need for space, tendency to go so deep into my own world that the real world and everyone in it cease to exist, and sensitivity to touch during the 26 (soon to be 27) years of our marriage.

I live with anxiety, because the world can be overwhelming and people have expectations that I always, sooner or later, fail to meet. I cannot begin to tell you how many times I have been told that I am rude, inaccessible or cold, yet I have never purposely tried to harm anyone, nor do I mean to be, well, mean.

I could tell you so much more, but instead let me share one last insight. Don't pity me or try to cure or change me. If you could live in my head for just one day, you might weep at how much beauty I perceive in the world with my exquisite senses. I would not trade one small bit of that beauty, as overwhelming and powerful as it can be, for "normalcy."

 

[URL: http://www.cnn.com/2008/HEALTH/conditions/03/28/autism.essay/index.html]

(zz) about advanced edu in the states

(转载)

本人在学校里呆的时间比较长，在美国的大学里先是念书，再是教书，呆了不少年，几个学校，行话叫，'Been at both sides of the desk'。今天就谈谈我所了解的美国大学，希望能给有志于留学美国的青年才俊提供一点参考。 

      美国的高等院校一共有三千多所，可以分为三类。最多的是社区学院（Community College），它们一般是两年制学校，毕业时给一个副学士学位（Associate Degree），毕业生可以转到四年制大学继续深造，学过的课程学分也可以转过去。社区学院一般由州政府出资，学费很低，兼具成人教育的功能。第二类是教学型四年制大学（Teaching University），它们以教学为主，一般可以授予学士（和硕士）学位，这类大学中公立的和私立的都有。 

      最后一类叫做研究型大学（Research University），它们是研究和教学并重，可以授予博士学位。这类大学在美国有两百多所，最著名的大学绝大多数属于这一类，它们自然也就是中国学生留学深造的目标。这类大学有私立的，更多是公立的。私立大学的经费主要来自捐款和学费，所以学费要高一些。公立大学的一部分经费来自各州政府，学费就会低一点儿，但因为州政府出钱，州内学生的学费和州外的学费差距可能会很大。来自中国的学生要按州外学生付费，所以学费也不会比私立学校低多少。 

     如果按"US News"的排名，研究型大学的前二十名都是私立大学，例如哈佛、耶鲁、普林斯顿等常春藤名校等，公立大学中排名最前的伯克利（UC Berkeley）只能排到二十一、二名。这一排名更是注重于本科教育的比较，对于研究生、博士生教育来说并不一定准确。常春藤学校注重综合素质的培养，很多校友都身居高位，可能会给后辈同学提供一些帮助，所以，本科去那里确实很好。研究生却不一样，例如，伯克利几乎所有的博士专业都可以排在前十名，可以媲美任何其他学校，它的博士学位也可以说是含金量最高的。而且，还要看不同的专业，甚至不同的实验室。例如，哈佛的法学院和医学院很好，耶鲁的法学院很好，但如果说工科专业，哈佛不一定比得过排名五十以外的普渡大学。计算机（CS）、电子工程专业（EE）最好的是MIT，斯坦福，伯克利，CMU等等。 

    美国大学综合排名的好坏，主要看三大学院，法学院（Law School），医学院（Medical School），和商学院（Business School）。美国最好的学生多集中在这三个学院，不像中国的好学生多在工学院（Engineering School）。所以，工科的学生选择院校时，不用太看重大学的综合排名，更应注重本专业的排名。美国综合排名前五十（或前一百）的大学都相当不错，一般每个州都有一、两所不错的大学。每个州都有至少一所某州大学（University of X)和某州立大学（X State University），这些学校的主校区都不错（有的学校会有多个校区，不一定都好），前者一般好于后者（也有例外，如 Ohio State要好于Ohio University）。某州大学中比较好的有 University of California，University of Texas(Austin), University of Virginia，University of Michigan，University of Illinois 等，州立大学中好的有Pen State，Ohio State等。 

     美国是一个联邦制国家，其权利和财富不是集中在某个地方，而是分散在各地。好的大学也是分散在全国各地，基本上每个州都有一两所不错的、有全国性影响的大学，相互之间的差距也并不太大。由于公立大学学费低于私立大学，州内大学低于州外大学，所以，很多最优秀的学生会选择一个本州的州立大学，而不是去排名最高的大学。结果是最优秀的美国学生是分散在各个大学，而不是集中在某一两所大学内。 

     前面说每个州都有一、两所好的大学，但有两个州的好大学却远远超过两所，就是麻州和加州。麻州是美国最先发展的地方，号称"The Spirit of America"，大学有两百多所，波士顿地区最集中，如哈佛，MIT，东北，Boston College等等。加州也是美国经济、文化最发达的地区之一，好大学也很多。兄弟在美十多年，大多数时间出没于加州南北各地，这疙瘩咱比较熟，下面就专门介绍一下位于加州的大学。

1. 加州的大学
  加州的大学中，能排在全美前五十名的有九所，私立的有三所(加上公立的加大系统（UC System）六所)，北加州湾区的斯坦福大学（Stanford University），和南加州洛杉矶地区的加州理工学院（CalTech）和南加大（USC）。斯坦福大学称得上世界上最好的大学之一，各科都很强，足以抗衡东部的常春藤学校。斯坦福的工科很不错，大批斯坦福的毕业生在湾区开公司，才形成了硅谷这一世界级的高科技公司集中地。斯坦福人开的公司有惠普，思科，谷歌，雅虎，升阳（SUN）等等。
     CalTech 是一个小而精的学校，学生数少于两千，理科和工科都很好。按比例计算，CalTech的诺贝尔奖获得者世界最多。CalTech同时还管理着同在 Pasadena市的喷气推进实验室（JPL）。世界著名的JPL其实比CalTech还大，有五、六千研究人员，由CalTech的教授们创建，最初为军方研究火箭技术，现属于美国宇航局（NASA）。
     USC位于洛杉矶市中心地区，该地区治安不太好（USC是我见过的唯一有围墙的美国大学）。因为靠近好莱坞，USC的媒体专业非常好，工学院也不错。USC中的富家子弟很多，所以有人称之为 USC（University of Spoiled Children)。USC的死敌，同城的UCLA的学生们也把ＵＳＣ称为 University of Second Choice，其实两校的综合实力相当，体育都很强（USC是橄榄球的老大，UCLA是篮球的老大）。
    加州的公立大学包括社区学院，加州州立大学系统（Cal State System)和加州大学系统（UC System）。州大系统属于教学型大学，可以授予学士和硕士学位，有二十多所校区遍布加州各地（一所例外，圣迭戈州大（SDSU）属于研究型大学）。加大系统属于研究型大学，可以授予博士学位，有十所校区，北加州五所，南加州五所。一般认为，加大系统的学校分三个档次，第一档包括UC Berkeley，UCLA和UC San Diego；第二档包括UC Davis，UC Irvine和UC Santa Babara，这六所都可以排在全美前五十名；第三档包括 UC Riverside，UC Santa Cruz和UC Merced。其中Merced校区刚开张两三年，还有一个 UC San Francisco只有医学院，声誉很好，排名可居全美前十。
     亚裔家庭一般重视教育，小孩们也比较好学，所以加大系统中亚裔学生的比例很高，一般可以达到30%-40%（加州的亚裔人口低于总人口的10%）。亚裔比例最高的是尔湾加大（UC Irvine），将近 60%，所以UCI又有一个外号叫"中国移民大学"（UCI，University of Chinese Immigrants)。UCLA中亚裔也近半数，被称为"University of Chinese and Lots of Asians"。不光是加大系统，在美国各大名校中的亚裔学生都偏高，所以美国高等教育照顾少数民族的政策中从不包括亚裔，只照顾西裔和非裔学生。
      加州的学生中间流传着有一种说法，如果你又聪明家里又有钱，那你应该上斯坦福或CalTech；如果你只聪明但没钱，就去Berkeley或UCLA；如果你不太聪明但有钱，你就去USC；不太聪明也没钱，你去其他加大各校；如果你又不聪明又没钱，那你只好去州大或社区学院好了。

2.教授治校
    美国大学中实行所谓的" 教授治校"的政策，说的是大学中重大决策的权利大都掌握在教授们的手中，确切的说，是掌握在由教授组成的各种委员会的手中。校长的主要职责是筹款，系主任多为兼职，一般由资深教授们轮流担任，在管理系里的日常事务外，还需要担任一定的教学任务（我呆过的一个系，系主任的管理工作算30%工作量，也就是说，他还需要承担我们其他教授70%的教学任务）。换句话说，校长和系主任并非教授们的领导，一个教授的前途也不掌握在他们手中（这一点很重要）。
     美国大学一个系的教授并不太多，一般有二、三十个，这些教授有权成为终身教授，这叫"Tenure-Track Faculty"。教授有助理教授（Assistant Professor），副教授（Associate Professor）和正教授（Full Professor）。助理教授是还没有得到终身教职的教授，而大多数副教授和正教授都有终身教职（Tenured Professor）。一个教授的职责有三方面，教学（Teaching），科研（Research）和服务（Service）。教学好懂，每人必须教一定的课时，再大牌的教授也不能逃脱。科研就是申请研究经费，带研究生、博士生，发学术论文。服务指的是参加学校里的各种委员会，参加学生的指导答辩组，和参与组织学术会议等。一个助教授要评Tenure，这三方面都要做得比较好。
      教授中工作最勤奋的是助理教授（多为新毕业的博士），他们一般需要工作五、六年才能评Tenure。从第二年起，每年都要准备一份完整的材料，总结一年各方面的工作成果，上交给由资深教授组成的提升评审委员会（Tenure and Promotion Committee，权力很大的一个教授委员会）。如果到第五年还不能达到终身教授的标准，该同志就只能再呆一年，同时开始找工作，一年后走人。大多数学校还好，只要达到一定标准的助教授都可以晋升Tenure，不用和别人争位子。有些变态的学校，如MIT的工学院，一个Tenure的位置可能会招三个助理教授，让他们血拼几年，最后留下一个最好的（好像大家都喜欢拿MIT做反面典型，不过有一次我和一位 MIT机械系的助理教授聊起这事儿，他说，我们还好吧，你不知道，哈佛……）。
     当然，评为终身教授后也不能太松懈，要想有所作为，还是得不断努力。Tenure是铁饭碗，但犯了重大错误也会被开除，例如，论文剽窃、造假等。从助理教授开始，基本上每位教授都是自成一体（没有像中国那样的教研组），带一帮学生艰苦奋斗。一个教授干得好不好，不在于他和系主任或校长的关系，而在于学生们喜不喜欢他（每门课都有学生评语），他申请到了多少科研经费，发了多少高水平的论文。也就是说，他的前途由学生（教学评审），本系其他教授（晋升评审），和其他学校的同行（科研经费的评审）来共同决定。
     一个系的好坏，关键是看你能不能招到好的教授。所以，招聘教授是最重要的工作。决定聘请谁的权力，由所有教授共同掌握。美国的研究型大学只有两百多所，一个系平均一年也就有一个空缺，加上不是每个学校都有这个系，以计算机系为例，一年的教授空缺也就有大概一百个。所以，这种位置的竞争非常激烈，只要是有计算机博士学位的人都可以申请，竞争者往往来自世界各地，经常是一个位置有上百人申请。系里的招聘委员会进行第一次筛选，选出最优秀的几位，邀请他们来学校访问，做一场学术报告，与系里的各个教授单独进行半小时的面谈。最后，系里的所有教授投票，一人一票，决定聘请人选。
      以上说的都是教授，除他们外，高校教师中还有一些讲师（Lecture）。他们属于临时聘请（non-tenure track)，只负责讲课，不用承担教授们的其他责任，不能评Tenure，报酬也比较低。系里还会聘请一些助教（Teaching Assistant），大多由研究生，博士生担任，他们的工作是协助教授教学，例如批改作业，带本科生实验课等。

3.研究生入学申请
     研究生的录取由学院或系里的录取委员会决定（Application Committee），这个委员会由教授们轮流担任。通过这个委员会审查，获取录取通知书一般不太难，中国学生更关心的是怎样拿到奖学金。奖学金有三种，一种叫Fellowship，这是真正的奖学金，不需要干活，这种机会不多；还有一种叫TA（助教，Teaching Assistant），这是要帮助教授教学，基本每门课都有一个，这些位置由录取委员奖给最合格的申请学生；还有一种叫助研（RA，Research Assistant），帮助教授做科研，经费来自教授的科研基金，RA由各个教授自己决定。
     所谓全额奖学金，就是说包括学费和生活费（tuition and living expense)，一年大概有两、三万美元。听起来不少，但去掉学费后，也就是勉强温饱。美国大学倾向于把奖学金给博士研究生而不是硕士研究生，因为硕士在美国是一个中间学位，要求不高，很多人一年就可以毕业。而博士生要呆四、五年以上，这样才有时间做一点像样的研究。所以，要想拿奖学金，最好是申请读博士（本科毕业也可以申请直接读博士）。
     各种奖学金中，Fellowship的机会比较少，不干活只拿钱的事儿在哪都不多。TA和RA的位置多一些，RA更受学生们的欢迎，因为TA主要是干一些重复性的杂事，不太长本事，RA是科研工作，可以学功夫，发论文，有助于尽快拿到学位。所以，要想拿到RA的位置，在通过正常渠道申请的同时，还要记着和你感兴趣的教授套磁，这非常重要，也是一门需要掌握的艺术。
     给教授发信时，一定不要简单的"Copy and Paste"，只把第一行的 "Dr. A"换成"Dr. B"，然后发给所有的教授。美国的教授们每天都会受到大量的套磁Email，一眼就能识破这类信件。还有就是不要给系里的每个教授都发一份，因为几个教授中午一起吃饭时一聊天，发现人手一份同样的Email，您老马上就没戏了。某些好事的教授还会给所有的教授发一封信，警告不要再理会这个学生（我就收到过这种信）。
      所以，正确的做法是：上、中、下各个档次各选几个学校，每个学校选两、三个你最感兴趣的，与你的方向最接近的教授，仔细研究一下他的网页，下载他几篇论文，好好读一读，然后花功夫写一篇情深意切的Email，一定要提一提你对他的研究、论文的看法，观点对不对没关系，还有你曾经有的，和他的研究领域相关的经历。一定要下工夫，要精耕细作，而不是广种薄收。我认识的一位教授，他专门做了一个网页给申请的学生，在网页的最后有一个密码，写给他的申请信的标题中必须含有这个密码，否则他根本不看。你不仔细读他网页，辛辛苦苦准备的Email就会被他直接给删掉了。
    还有，有些教授要等你被录取后才会考虑给你RA，所以，一定要和系里多联系，查看你申请的当前状态，注意备齐所有的材料，该交申请费也就交了吧，不要因为一个小的细节而误了大事。通过录取关并不太难，国内学校成绩不错，材料齐备大概就行了，除非是排名前三的学校（例如，CS专业，MIT，Berkeley，Stanford的录取不太容易，可能需要下点儿功夫）。难点在于争取奖学金，这方面竞争相当激烈。

4.结论
   从总体国力来看，美国可能是在走下坡路，但在高等教育方面，美国的大学的质量至今还是无与伦比，尤其是研究生教育。所以美国大学吸引了来自世界各地最优秀的有志青年，竞争自然也就激烈，但物超所值。几分耕耘，几分收获，No Pains，No Gains。在美国大学里几年的良好教育，加上一、两个含金量高的学位，一定会帮你在以后的人生中打开几扇门，但进门后能走多远，就要看你本身的实力了.