NEEDING A WORLD OF ORDER; Focus on One Subject Just a Part of Asperger's Syndrome

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Byline: Karen Goldberg Goff, THE WASHINGTON TIMES

Patrick McCardell feels safe at the mall. It may be the symmetry of the shopping bags he collects, or it may be the soothing sounds of the fountain. Perhaps it is the orderly fashion in which the stores are laid out, stretching in many directions like neat rows of dominoes.

In any event, the mall is the 14-year-old's favorite place and favorite subject. School? Not so much. Popular music? The teenage pursuit of going along with the crowd? They mean nothing. The number of stores at the Mall in Columbia? Now that is interesting, Patrick says.

"This one has 217 stores," Patrick recounts while sitting by a fountain there one recent Saturday. "There is a new mall going up in Cecil County that will have almost 500 stores. They changed the fountain here. It used to have steps all around. They have to paint it every year."

Patrick, who lives in Columbia, Md., has Asperger's syndrome. Asperger's is a developmental disorder that was identified by Dr. Hans Asperger, an Austrian pediatrician, in the 1940s but only became a legitimate diagnosis in the American psychiatric community a decade ago. Asperger's, a segment of the autism spectrum, is marked by impaired social skills, odd speech patterns, difficulty reading nonverbal communication and, sometimes, an intense absorption in a particular subject.

Asperger's differs from classic autism in that Asperger's children are generally of normal - sometimes even advanced - intelligence, says Stewart Mostofsky, a pediatric developmental neurologist with the Kennedy Krieger Institute in Baltimore. They also do not have the lag in language skills that doctors see in children with autism.

That is why children with Asperger's are often not diagnosed until they reach school age, Dr. Mostofsky says.

"Autism is a significant delay that is picked up [by doctors] around age 2 or 3," he says. "Asperger's is different because there is not the history of early delays. It is not until they are in situations with a lot of social interaction that the repetitive, overfocused behavior is noticed."

A generation ago, people with Asperger's might have been called quirky. Now, about one in 5,000 people is estimated to have the disorder, says Brenda Smith Myles, associate professor of special education at the University of Kansas and author of several books on Asperger's.

"It is hard to count the number of people who have Asperger's because many people are never diagnosed," Ms. Smith Myles says.

It also is hard to say what causes Asperger's, says Fred R. Volkmar, professor of child psychiatry and pediatrics at Yale University and one of the leading researchers on the disorder. Dr. Volkmar says he believes there is a genetic component.

"If you look at a child with Asperger's, usually about one-third of his immediate family members will have similar difficulties," Dr. Volkmar says.

Dr. Volkmar and researchers at Yale recently found that magnetic resonance imaging (MRI) scans of the brains of people with Asperger's differed from MRI scans of a typical brain. When most people look at a face, certain areas of the brain are activated in a way that differs from when they look at an object. People with Asperger's, however, read a face the same way they read an inanimate object, the researchers say.

That might explain why a lack of empathy is a marker of Asperger's. Or why a typical Asperger's child will interrupt a conversation with facts about his pet interest. Or why figures of speech such as "keep your eye on the ball" can be baffling to a literal-thinking Asperger's child.

It also can be why Patrick McCardell's mother says her family feels isolated.

"Our extended family and friends don't comprehend that Patrick has a significant disability," says Patrick's mother, Genevieve McCardell. "They misunderstand his lack of social skills as rudeness. …