An Obscure Disorder Leaves Tragic Mystery

When a 19-year-old Orange County youth donned a costume on Halloween weekend and went on a shooting rampage, killing two Aliso Viejo neighbors and then himself, sheriff’s deputies were puzzled as to why.

Then news reports revealed that William Freund had visited an Internet message board for people with Asperger’s syndrome. There, he left a trail of messages contemplating suicide and foreshadowing the violence.

Asperger’s, an obscure developmental disorder, was also in the news early this year when it was raised as a defense in the eco-terrorism trial of Caltech graduate student William Cottrell, who was described by professors as being incredibly brilliant.

A judge disallowed that defense, however, and a federal court jury convicted Cottrell of firebombing sport utility vehicles at several San Gabriel Valley auto dealerships.

Medical experts say those who have Asperger’s are often social misfits -- but there are questions about whether the condition can lead to violent behavior.

Question: What is Asperger’s syndrome?

Answer: It is often confused with autism, but there are sharp differences between the two. While autism patients tend to withdraw into their own private world, Asperger’s patients are generally able to function, even though their social skills are dramatically impaired.

The disorder was recognized in 1944 -- a year later than autism -- by the Viennese physician Dr. Hans Asperger. It was not formally classified as a distinct mental disorder until 1994, however, and only more recently have many physicians and parents acknowledged its existence.

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Q: How common is it?

A: The syndrome is thought to affect two to three children per 1,000, with the majority of the cases occurring among males.

Unlike people with autism, who lose their ability to speak, those with Asperger’s typically develop good language skills. Their grammar and vocabulary can be very good, but their speech is sometimes stilted and repetitive, according to Dr. Stephen M. Edelson of the Center for the Study of Autism in Salem, Ore.

Their voices tend to be flat and emotionless, he said, and their conversations revolve around themselves, particularly their own area of interest.

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Q: Is high intelligence a characteristic?

A: Their IQs fall across the normal range, but many are unusually intelligent and obsessed with complex topics, such as patterns, weather, music, history and so forth. Children with Asperger’s want to know everything about their chosen topic and often sound like little professors, according to the National Institutes of Health.

Their obsession and intelligence often lead them to successful careers, particularly in academia, but their achievements are typically accompanied by a lack of common sense and concrete thinking. Until recently, such people were not diagnosed with a disorder, but seen as brilliant, eccentric, absent-minded, socially inept and a little awkward.

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Q: What’s the worst part about having this condition?

A: Perhaps the most disabling problem that patients face is a lack of empathy for other people and an inability to socialize normally. Young children might want to become friendly with another child, for example, but don’t realize the importance of saying hello or goodbye in a meeting.

Even if they know the correct thing to say, they may look away while saying it or display other contradictory behavior and they are often considered rude or poorly brought up.

Perhaps as a result, children with Asperger’s are often isolated because of their poor social skills and their narrow interests.

They may approach other people, but make normal conversation impossible by inappropriate or eccentric behavior, or by wanting to talk about only their singular interest. Online chat rooms can thus be a valuable outlet for them.

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Q: Is it common for patients to become violent?

A: There has been very little study about potential links between Asperger’s and violence, said Dr. Uta Frith of University College London, one of the leading experts in the field. “I think most experts would say that these kinds of incidents are exceptionally rare,” she said.

In fact, Asperger’s patients more often tend to be on the receiving end of violence, said Betty Jo Freeman, emeritus professor at the UCLA School of Medicine. “These kids tend to be the victims, not the perpetrators,” she said. “When they do get into trouble, it’s because they don’t understand [the situation] or somebody tells them what to do.”

Although Asperger’s apparently does not make an individual predisposed to violence, it is not unusual for the disorder to be accompanied by a second mental illness, such as schizophrenia or psychopathy.

“In development disorders, that is a general feature -- they tend to come in multiples,” Frith said.

For a young adult with Asperger’s and schizophrenia, the Asperger’s is almost irrelevant in controlling behavior, experts said.

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Q: Can the condition be overcome?

A: There is no cure for Asperger’s, but treatment can ameliorate the symptoms. At schools such as Village Glen in Sherman Oaks, young patients are taught how to read the facial expressions of others, how to conduct conversations, and generally how to behave in a number of social situations.

Medications are occasionally used to treat the repetitive behavior and obsessions associated with the syndrome, often with the same drugs used for attention deficit disorder or depression. Among them are Ritalin, amphetamines, anti-anxiety drugs such as Zoloft, and neuroleptics like Geodon, Risperdal and Zyprexa.

Many of the patients, however, report severe side effects from the drugs and quit taking them.