Tag Archives: asperger syndrome

Autism Awareness Month

Autism spectrum disorders (ASDs) are a group of developmental disabilities that can cause significant social, communication and behavioral challenges.

ASDs are “spectrum disorders” which means ASDs affect each person in different ways, and can range from very mild to severe. People with ASDs share some similar symptoms, such as problems with social interaction. But there are differences in when the symptoms start, how severe they are, and the exact nature of the symptoms.


Types of ASDs
There are three different types of ASDs:

  • Autistic Disorder (also called “classic” autism)
    This is what most people think of when hearing the word “autism.” People with autistic disorder usually have significant language delays, social and communication challenges, and unusual behaviors and interests. Many people with autistic disorder also have intellectual disability.
  • Asperger Syndrome
    People with Asperger syndrome usually have some milder symptoms of autistic disorder. They might have social challenges and unusual behaviors and interests. However, they typically do not have problems with language or intellectual disability.
  • Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS; also called “atypical autism”)
    People who meet some of the criteria for autistic disorder or Asperger syndrome, but not all, may be diagnosed with PDD-NOS. People with PDD-NOS usually have fewer and milder symptoms than those with autistic disorder. The symptoms might cause only social and communication challenges.


Signs and Symptoms
ASDs begin before the age of 3 and last throughout a person’s life, although symptoms may improve over time. Some children with an ASD show hints of future problems within the first few months of life. In others, symptoms might not show up until 24 months or later. Some children with an ASD seem to develop normally until around 18 to 24 months of age and then they stop gaining new skills, or they lose the skills they once had.

A person with an ASD might:

  • Not respond to their name by 12 months
  • Not point at objects to show interest (point at an airplane flying over) by 14 months
  • Not play “pretend” games (pretend to “feed” a doll) by 18 months
  • Avoid eye contact and want to be alone
  • Have trouble understanding other people’s feelings or talking about their own feelings
  • Have delayed speech and language skills
  • Repeat words or phrases over and over (echolalia)
  • Give unrelated answers to questions
  • Get upset by minor changes
  • Have obsessive interests
  • Flap their hands, rock their body, or spin in circles
  • Have unusual reactions to the way things sound, smell, taste, look, or feel


Diagnosis
Diagnosing ASDs can be difficult since there is no medical test, like a blood test, to diagnose the disorders. Doctors look at the child’s behavior and development to make a diagnosis.

ASDs can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable. However, many children do not receive a final diagnosis until much older. This delay means that children with an ASD might not get the help they need.


Treatment
There is currently no cure for ASDs. However, research shows that early intervention treatment services can greatly improve a child’s development. Early intervention services help children from birth to 3 years old (36 months) learn important skills. Services can include therapy to help the child talk, walk, and interact with others. Therefore, it is important to talk to your child’s doctor as soon as possible if you think your child has an ASD or other developmental problem.

Even if your child has not been diagnosed with an ASD, he or she may be eligible for early intervention treatment services. The Individuals with Disabilities Education Act (IDEA) says that children under the age of 3 years (36 months) who are at risk of having developmental delays may be eligible for services. These services are provided through an early intervention system in your state. Through this system, you can ask for an evaluation.

In addition, treatment for particular symptoms, such as speech therapy for language delays, often does not need to wait for a formal ASD diagnosis.

Learn about types of treatments »


Causes and Risk Factors
We do not know all of the causes of ASDs. However, we have learned that there are likely many causes for multiple types of ASDs. There may be many different factors that make a child more likely to have an ASD, including environmental, biologic and genetic factors.

  • Most scientists agree that genes are one of the risk factors that can make a person more likely to develop an ASD.
  • Children who have a sibling or parent with an ASD are at a higher risk of also having an ASD.
  • ASDs tend to occur more often in people who have certain other medical conditions. About 10% of children with an ASD have an identifiable genetic disorder, such as Fragile X syndrome, tuberous sclerosis, Down syndrome and other chromosomal disorders.
  • Some harmful drugs taken during pregnancy have been linked with a higher risk of ASDs, for example, the prescription drugs thalidomide and valproic acid.
  • We know that the once common belief that poor parenting practices cause ASDs is not true.
  • There is some evidence that the critical period for developing ASDs occurs before birth. However, concerns about vaccines and infections have led researchers to consider risk factors before and after birth.

ASDs are an urgent public health concern. Just like the many families affected in some way by ASDs, CDC wants to find out what causes the disorder. Understanding the risk factors that make a person more likely to develop an ASD will help us learn more about the causes. We are currently working on one of the largest U.S. studies to date, called Study to Explore Early Development (SEED). SEED is looking at many possible risk factors for ASDs, including genetic, environmental, pregnancy, and behavioral factors.


Who is Affected
ASDs occur in all racial, ethnic, and socioeconomic groups, but are almost five times more common among boys than among girls. CDC estimates that about 1 in 88 children has been identified with an autism spectrum disorder (ASD).

More people than ever before are being diagnosed with an ASD. It is unclear exactly how much of this increase is due to a broader definition of ASDs and better efforts in diagnosis. However, a true increase in the number of people with an ASD cannot be ruled out. We believe the increase in ASD diagnosis is likely due to a combination of these factors.

Within the past decade, CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network has been estimating the number of people with an ASD in the U.S. We have learned a lot about how many children in the U.S. have an ASD. It will be important to use the same methods to track how the number of people with an ASD is changing over time in order to learn more about the disorders.


If You’re Concerned
If you think your child might have an ASD or you think there could be a problem with the way your child plays, learns, speaks, or acts,contact your child’s doctor, and share your concerns.

If you or the doctor is still concerned, ask the doctor for a referral to a specialist who can do a more in-depth evaluation of your child. Specialists who can do a more in-depth evaluation and make a diagnosis include:

  • Developmental Pediatricians (doctors who have special training in child development and children with special needs)
  • Child Neurologists (doctors who work on the brain, spine, and nerves)
  • Child Psychologists or Psychiatrists (doctors who know about the human mind)

At the same time, call your state’s public early childhood system to request a free evaluation to find out if your child qualifies for intervention services. This is sometimes called a Child Find evaluation. You do not need to wait for a doctor’s referral or a medical diagnosis to make this call.

Where to call for a free evaluation from the state depends on your child’s age:

  • If your child is not yet 3 years old, contact your local early intervention system.You can find the right contact information for your state by calling the National Dissemination Center for Children with Disabilities (NICHCY) at 1-800-695-0285.Or visit the NICHCY website. Once you find your state on this webpage, look for the heading “Programs for Infants and Toddlers with Disabilities: Ages Birth through 3″.
  • If your child is 3 years old or older, contact your local public school system.Even if your child is not yet old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated.If you’re not sure who to contact, call the National Dissemination Center for Children with Disabilities at 1.800.695.0285 or visit the NICHCY website. Once you find your state on this webpage, look for the heading “Programs for Children with Disabilities: Ages 3 through 5″.

Research shows that early intervention services can greatly improve a child’s development. In order to make sure your child reaches his or her full potential, it is very important to get help for an ASD as soon as possible.

Asperger Syndrome

About AS:

  • It is a neurological disorder that affects the way information is processed in the brain.
  • AS is a hidden disability. Many people appear very competent, but they have difficulties in the areas of communication and social interaction.
  • AS has a genetic and hereditary component and may have additional or interactive environmental causes as yet unknown.
  • AS is a developmental disability. All individuals have social/emotional delays, but continued growth seems to be life-long.
  • The incidence of AS is thought to be 1 in 250. As many as 50% of people with AS may be undiagnosed.
  • There are currently four males diagnosed with AS for every one female, but the true ratio may be as high as one female for every two males.

AS affects each person differently, although there is a core set of features that most people with AS have, to different extents:

  • People with AS have normal to very high intelligence and have good verbal skills.
  • Challenges with the use and understanding of language in a social context.
  • Trouble understanding what someone else is thinking and feeling (called theory of mind or perspective taking).
  • Needing to be taught social behavior that is “picked up on” intuitively by others.
  • Difficulty understanding non-verbal cues such as hand movements, facial expressions, and tone of voice.
  • Challenges with organization, initiation, prioritizing, all called executive functioning tasks.
  • Focusing on small details rather than the bigger picture
  • Most people with AS have intense interest areas such as movies, geography, history, math, physics, cars, horses, dogs or reptiles. These interest areas change every 3 months to several years
  • Friendships are usually formed through mutual interest areas or activities.
  • Most people with AS view the world in black and white with difficulty compromising or seeing the gray areas.
  • Most individuals with AS describe themselves as feeling different, like aliens in our world.
  • Anxiety and/or depression are major components for many people with AS and may affect their ability to function.
  • Some individuals with AS have extreme and debilitating hyper- or hypo-sensitivity to light, noise, touch, taste, or smell. The environment can have a profound impact on their ability to function.

Autism Spectrum Disorders

Autism spectrum disorders (ASDs) are a group of developmental disabilities that can cause significant social, communication and behavioral challenges.

ASDs are “spectrum disorders” which means ASDs affect each person in different ways, and can range from very mild to severe. People with ASDs share some similar symptoms, such as problems with social interaction. But there are differences in when the symptoms start, how severe they are, and the exact nature of the symptoms.


Types of ASDs
There are three different types of ASDs:

  • Autistic Disorder (also called “classic” autism)
    This is what most people think of when hearing the word “autism.” People with autistic disorder usually have significant language delays, social and communication challenges, and unusual behaviors and interests. Many people with autistic disorder also have intellectual disability.
  • Asperger Syndrome
    People with Asperger syndrome usually have some milder symptoms of autistic disorder. They might have social challenges and unusual behaviors and interests. However, they typically do not have problems with language or intellectual disability.
  • Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS; also called “atypical autism”)
    People who meet some of the criteria for autistic disorder or Asperger syndrome, but not all, may be diagnosed with PDD-NOS. People with PDD-NOS usually have fewer and milder symptoms than those with autistic disorder. The symptoms might cause only social and communication challenges.


Signs and Symptoms
ASDs begin before the age of 3 and last throughout a person’s life, although symptoms may improve over time. Some children with an ASD show hints of future problems within the first few months of life. In others, symptoms might not show up until 24 months or later. Some children with an ASD seem to develop normally until around 18 to 24 months of age and then they stop gaining new skills, or they lose the skills they once had.

A person with an ASD might:

  • Not respond to their name by 12 months
  • Not point at objects to show interest (point at an airplane flying over) by 14 months
  • Not play “pretend” games (pretend to “feed” a doll) by 18 months
  • Avoid eye contact and want to be alone
  • Have trouble understanding other people’s feelings or talking about their own feelings
  • Have delayed speech and language skills
  • Repeat words or phrases over and over (echolalia)
  • Give unrelated answers to questions
  • Get upset by minor changes
  • Have obsessive interests
  • Flap their hands, rock their body, or spin in circles
  • Have unusual reactions to the way things sound, smell, taste, look, or feel


Diagnosis
Diagnosing ASDs can be difficult since there is no medical test, like a blood test, to diagnose the disorders. Doctors look at the child’s behavior and development to make a diagnosis.

ASDs can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable. However, many children do not receive a final diagnosis until much older. This delay means that children with an ASD might not get the help they need.


Treatment
There is currently no cure for ASDs. However, research shows that early intervention treatment services can greatly improve a child’s development. Early intervention services help children from birth to 3 years old (36 months) learn important skills. Services can include therapy to help the child talk, walk, and interact with others. Therefore, it is important to talk to your child’s doctor as soon as possible if you think your child has an ASD or other developmental problem.

Even if your child has not been diagnosed with an ASD, he or she may be eligible for early intervention treatment services. The Individuals with Disabilities Education Act (IDEA) says that children under the age of 3 years (36 months) who are at risk of having developmental delays may be eligible for services. These services are provided through an early intervention system in your state. Through this system, you can ask for an evaluation.

In addition, treatment for particular symptoms, such as speech therapy for language delays, often does not need to wait for a formal ASD diagnosis.

Learn about types of treatments »


Causes and Risk Factors
We do not know all of the causes of ASDs. However, we have learned that there are likely many causes for multiple types of ASDs. There may be many different factors that make a child more likely to have an ASD, including environmental, biologic and genetic factors.

  • Most scientists agree that genes are one of the risk factors that can make a person more likely to develop an ASD.
  • Children who have a sibling or parent with an ASD are at a higher risk of also having an ASD.
  • ASDs tend to occur more often in people who have certain other medical conditions. About 10% of children with an ASD have an identifiable genetic disorder, such as Fragile X syndrome, tuberous sclerosis, Down syndrome and other chromosomal disorders.
  • Some harmful drugs taken during pregnancy have been linked with a higher risk of ASDs, for example, the prescription drugs thalidomide and valproic acid.
  • We know that the once common belief that poor parenting practices cause ASDs is not true.
  • There is some evidence that the critical period for developing ASDs occurs before birth. However, concerns about vaccines and infections have led researchers to consider risk factors before and after birth.

ASDs are an urgent public health concern. Just like the many families affected in some way by ASDs, CDC wants to find out what causes the disorder. Understanding the risk factors that make a person more likely to develop an ASD will help us learn more about the causes. We are currently working on one of the largest U.S. studies to date, called Study to Explore Early Development (SEED). SEED is looking at many possible risk factors for ASDs, including genetic, environmental, pregnancy, and behavioral factors.


Who is Affected
ASDs occur in all racial, ethnic, and socioeconomic groups, but are almost five times more common among boys than among girls. CDC estimates that about 1 in 88 children has been identified with an autism spectrum disorder (ASD).

More people than ever before are being diagnosed with an ASD. It is unclear exactly how much of this increase is due to a broader definition of ASDs and better efforts in diagnosis. However, a true increase in the number of people with an ASD cannot be ruled out. We believe the increase in ASD diagnosis is likely due to a combination of these factors.

Within the past decade, CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network has been estimating the number of people with an ASD in the U.S. We have learned a lot about how many children in the U.S. have an ASD. It will be important to use the same methods to track how the number of people with an ASD is changing over time in order to learn more about the disorders.


If You’re Concerned
If you think your child might have an ASD or you think there could be a problem with the way your child plays, learns, speaks, or acts,contact your child’s doctor, and share your concerns.

If you or the doctor is still concerned, ask the doctor for a referral to a specialist who can do a more in-depth evaluation of your child. Specialists who can do a more in-depth evaluation and make a diagnosis include:

  • Developmental Pediatricians (doctors who have special training in child development and children with special needs)
  • Child Neurologists (doctors who work on the brain, spine, and nerves)
  • Child Psychologists or Psychiatrists (doctors who know about the human mind)

At the same time, call your state’s public early childhood system to request a free evaluation to find out if your child qualifies for intervention services. This is sometimes called a Child Find evaluation. You do not need to wait for a doctor’s referral or a medical diagnosis to make this call.

Where to call for a free evaluation from the state depends on your child’s age:

  • If your child is not yet 3 years old, contact your local early intervention system.You can find the right contact information for your state by calling the National Dissemination Center for Children with Disabilities (NICHCY) at 1-800-695-0285.Or visit the NICHCY website. Once you find your state on this webpage, look for the heading “Programs for Infants and Toddlers with Disabilities: Ages Birth through 3″.
  • If your child is 3 years old or older, contact your local public school system.Even if your child is not yet old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated.If you’re not sure who to contact, call the National Dissemination Center for Children with Disabilities at 1.800.695.0285 or visit the NICHCY website. Once you find your state on this webpage, look for the heading “Programs for Children with Disabilities: Ages 3 through 5″.

Research shows that early intervention services can greatly improve a child’s development. In order to make sure your child reaches his or her full potential, it is very important to get help for an ASD as soon as possible.

World Autism Awareness Day: Light It Up Blue

Light It Up Blue - World Autosm Awareness Day

Every April 2, Autism Speaks celebrates World Autism Awareness Day with a global autism awareness campaign called Light It Up Blue. It’s easy (and fun!) to be a part of it — you can do anything from wearing blue to lighting your whole office or school up blue.

Add your name to say you’ll be a part of it, and we’ll be in touch with resources and ideas to get your friends involved. Thanks for helping shine a light on autism.

World Autism Awareness Day - Light It Up Blue

What Is Autism?
Autism spectrum disorder (ASD) and autism are both general terms for a group of complex disorders of brain development. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors. With the May 2013 publication of the DSM-5 diagnostic manual, all autism disorders were merged into one umbrella diagnosis of ASD. Previously, they were recognized as distinct subtypes, including autistic disorder, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS) and Asperger syndrome.

ASD can be associated with intellectual disability, difficulties in motor coordination and attention and physical health issues such as sleep and gastrointestinal disturbances. Some persons with ASD excel in visual skills, music, math and art.

Autism appears to have its roots in very early brain development. However, the most obvious signs of autism and symptoms of autism tend to emerge between 2 and 3 years of age. Autism Speaks continues to fund research on effective methods for earlier diagnosis, as early intervention with proven behavioral therapies can improve outcomes. Increasing autism awareness is a key aspect of this work and one in which our families and volunteers play an invaluable role.

What is Asperger Syndrome?

What is Asperger Syndrome?

AANE - Asperger SyndromeAsperger Syndrome (AS) is a neurological condition. People who have AS are born with it, and have it for life, although as they mature they may gain new skills, outgrow some of their AS traits, or use their strengths to compensate for their areas of disability. AS is generally considered a form of autism, an autism spectrum disorder (ASD). Other closely related autism spectrum disorders include HFA (High-Functioning Autism), PDD-NOS (Pervasive Developmental Disorder Not Otherwise Specified) and NLD or NVLD (Nonverbal Learning Disorder). The boundaries among these diagnoses—and whether in fact they are all on the same spectrum with each other and with profound, classical, or Kanner’s autism—remain open to discussion.

Current research indicates that there is a genetic foundation for AS, involving a number of different genes. So it’s not surprising that when a person gets an AS diagnosis, the family often realizes that many relatives also have AS or other forms of autism. At AANE we have met or talked with well over 6,000 families. We see that in many families where a child has AS, one or both biological parents will also have AS, or have AS traits to some degree. People also report that many relatives from previous generations (when AS was unknown) were eccentric or quirky, were diagnosed with a mental illness or hospitalized, lived a reclusive life, were chronically unemployed, or married and divorced multiple times. At the same time, many relatives may have shown high intelligence, superior memory, single-minded focus, original thinking, or unusual interest areas. Some may have achieved great success in engineering, math, writing, composing, philosophy, or other fields. These relatives, whether quirky, gifted, or both, may well have been people with undiagnosed AS.

No one really knows how prevalent AS is; perhaps one in every 250 people has AS—and maybe more. Dr. Tony Attwood estimates that as many as 50% of people with AS remain undiagnosed, in part because AS has only recently been publicly recognized on a broad scale. (It only became an official diagnosis in the United States in 1994.) Some people with AS continue to be misdiagnosed, while others “fly under the radar.” That is, they have traits that are mild enough so that they manage to adapt and function sufficiently well to be considered merely eccentric or quirky.

AS is a “pervasive developmental disability.” That is, people with AS may often appear or act younger than others of the same age. Children with AS often show delays in multiple areas of functioning, such as gross or fine motor coordination, social skills, or executive functioning (organization, prioritizing, and follow-through). However, they also continue to develop and mature—on their own time-table. Some people with AS may have specific gifts in mathematics, literature, or the arts. There is strong evidence that such superstars as Vincent Van Gogh, Emily Dickinson, Albert Einstein, code-breaker Alan Turing, and musician Glen Gould, among many others, all had Asperger Syndrome. Today, too, there are adults with AS who are successful as professors, lawyers, physicians, artists, authors, and educators. For this reason, many people with AS, and professionals who know them, consider AS a difference rather than a disability. The brains of people with AS seem to process information and sensory stimuli differently than the brains of neurotypical (NT) people. This can be a source of difficulty, but it can also be a strength. For example, people with AS are often very good at noticing visual details or remembering facts, skills that are useful in many professions. On the other hand, the same people may be too perfectionistic, become too obsessed with details, or have so much trouble seeing the big picture that they cannot complete a project.

While respecting the abilities and humanity of people with AS, one should not underestimate their struggles and suffering. A society designed for and dominated by the neurotypical majority (i.e., people who do not have AS) can feel uncongenial and even overwhelming for a person with AS. In particular, living in the United States in the modern information age—in a crowded, complex, industrial society—can pose real challenges for people with AS. American children are generally expected to “play well with others” and grow up fast. Adults are expected to work 40-60 hour weeks under fluorescent lights, to attend meetings, work on teams, rapidly absorb oceans of information, and multi-task. Solitary pursuits such as hunting, farming, or tending a light house are less available today. On the other hand, some people with AS have found employment (and sometimes mates) in the computer industry and the global economy.

People with Asperger Syndrome usually experience:

  • Difficulty knowing what to say or how to behave in social situations. Many have a tendency to say the “wrong thing.” They may appear awkward or rude, and unintentionally upset others.
  • Trouble with “theory of mind,” that is, trouble perceiving the intentions or emotions of other people, due to a tendency to ignore or misinterpret such cues as facial expression, body language, and vocal intonation.
  • Slower than average auditory, visual, or intellectual processing, which can contribute to difficulties keeping up in a range of social settings—a class, a soccer game, a party.
  • Challenges with “executive functioning,” that is, organizing, initiating, analyzing, prioritizing, and completing tasks.
  • A tendency to focus on the details of a given situation and miss the big picture.
  • Intense, narrow, time-consuming personal interest(s) — sometimes eccentric in nature — that may result in social isolation, or interfere with the completion of everyday tasks. (On the other hand, some interests can lead to social connection and even careers. For example, there are children and adults with an encyclopedic knowledge of vacuum cleaners.)
  • Inflexibility and resistance to change. Change may trigger anxiety, while familiar objects, settings, and routines offer reassurance. One result is difficulty transitioning from one activity to another: from one class to another, from work time to lunch, from talking to listening. Moving to a new school, new town, or new social role can be an enormous challenge.
  • Feeling somehow different and disconnected from the rest of the world and not “fitting in”—sometimes called “wrong planet” syndrome.
  • Extreme sensitivity—or relative insensitivity—to sights, sounds, smells, tastes, or textures. Many people outgrow these sensory issues at least to some extent as they mature.
  • Vulnerability to stress, sometimes escalating to psychological or emotional problems including low self-esteem, depression, anxiety, and obsessive-compulsive behaviors.

AS affects people lifelong, but many can use their cognitive and intellectual abilities to compensate for some of the challenges they face, so as people grow, AS can be managed. At AANE, we have seen countless people with AS who, given the proper supports, have used their AS traits to their advantage to accomplish feats beyond what the “typical” mind could muster. Traits and talents from which individuals with AS often benefit include:

  • Normal to very high intelligence
  • Good verbal skills, including rich vocabularies
  • Originality and creativity including a propensity for “thinking outside the box”
  • Honesty and ingenuity
  • Careful attention to details
  • Strong work ethic, with particular attention to accuracy and quality of work
  • Special interests that can be tailored toward productive work or hobbies; individuals with AS who have intensive knowledge in one or more specific areas can channel their expertise toward new discoveries and creations in their chosen field
  • Keen senses allow some people with AS to see, hear or feel subtle changes in the environment that others do not, resulting in phenomenal powers of observation

The gap between intellectual ability and functional presentation complicates the AS experience. Friends and family members often see a highly intelligent, talented individual, and cannot comprehend why the person with AS struggles during routine social or organizational experiences.

One of the frustrations of an Asperger diagnosis is that because people with AS are often extremely bright, with excellent rote memories and verbal skills, overall expectations for these individuals are high. Those around them may be surprised to see how deeply people with AS struggle in certain areas, such as the social realm, and may not understand that such difficulties are valid and real. Many times, people with AS are blamed for behaviors they cannot control.

Dr. Stephen M. Shore says, “When you meet one person with AS—you’ve met one person with AS.” That is, it is very important to remember that people with AS can differ greatly from one other. Everyone with AS is affected by a common cluster of traits, but the intensity of each trait lies along a continuum. As a result, the extent to which AS shapes an individual’s life course and experiences is highly variable.

We hope this information helps your awareness of Asperger Syndrome. Knowledge is the first step toward positive change in the lives of you and your loved ones. Good luck on your journey to understanding the role AS has played in your life.