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The distress and disability caused by Asperger syndrome are a consequence of the core syndrome itself, and any neurological or physical disorders which may be associated with it. Distress and disability are also influenced, to a much greater degree than has previously been recognized, by the personal reactions of the sufferer and the social reactions of those around him or her. One important type of personal reaction is the development of a psychological disorder secondary to Asperger syndrome. There is growing evidence that these reactions are commoner and more severe than has been thought previously. They include affective disorders, anxiety-related disorders and conduct disorders. Their manifestations may be altered by the presence of Asperger syndrome. Treatment usually involves a combination of psycho- education, social change, psychotropic medication and counselling.