Asperger syndrome from childhood into adulthood

Asperger syndrome, a form of autism with normal ability and normal syntactical speech, is associated with a variety of comorbid psychiatric disorders. The disorder is well known to child psychiatry, and we are beginning to recognise the extent of its impact in adulthood. The article reviews the diagnosis and assessment of Asperger syndrome and its links with a wide range of psychiatric issues, including mental disorder, offending and mental capacity. It also describes the broader, non-psychiatric management of Asperger syndrome itself, which includes social and occupational support and education, before touching on the implications the disorder has for our services.

A comparative study of the spontaneous social interactions of children with high-functioning autism and children with Asperger's disorder

A comparative observational study was undertaken of the spontaneous social interactions of children with high-functioning autism and Asperger's disorder. The sample comprised 20 children with high-functioning autism, 19 children with Asperger's disorder and 17 typically developing children matched on chronological age and overall mental age. A one–zero time sampling technique was used in live coding of the children's spontaneous social and play behaviours in the schoolyard. Few differences were found between children with high-functioning autism and Asperger's disorder on the dimensions of social interaction investigated. In contrast, the social behaviour of both clinical samples often deviated markedly from that of the typically developing children. The findings confirmed that although children with high-functioning autism or Asperger's disorder are often socially isolated relative to their typically developing peers, they are capable of spontaneously engaging socially with other children. The results were supportive of the hypothesis that Asperger's disorder is on a continuum with autistic disorder.

Can the Children's Communication Checklist differentiate autism spectrum subtypes?

The study explored whether children with high functioning autism (HFA), Asperger syndrome (AS), and pervasive developmental disorder not otherwise specified (PDD-NOS) can be differentiated on the Children's Communication Checklist (CCC). The study also investigated whether empirically derived autistic subgroups can be identified with a cluster analytic method based on the Autism Diagnostic Interview–Revised. Fifty-seven children with HFA, 47 with AS, 31 with PDD-NOS, and a normal control group of 47 children between 6 and 13 years participated. Children with HFA,AS, and PDDNOS showed pragmatic communication deficits in comparison to the controls. Little difference was found between the three subtypes with respect to their CCC profile.A three-cluster solution explained the data best.The HFA cluster showed most autism characteristics, followed by the combined HFA + AS cluster, and then the PDD-NOS cluster. The findings support the autism spectrum concept based on severity of symptom impairment rather than distinct categories.

Neuroanatomy of Individual Differences in Language in Adult Males with Autism

One potential source of heterogeneity within autism spectrum conditions (ASC) is language development and ability. In 80 high-functioning male adults with ASC, we tested if variations in developmental and current structural language are associated with current neuroanatomy. Groups with and without language delay differed behaviorally in early social reciprocity, current language, but not current autistic features. Language delay was associated with larger total gray matter (GM) volume, smaller relative volume at bilateral insula, ventral basal ganglia, and right superior, middle, and polar temporal structures, and larger relative volume at pons and medulla oblongata in adulthood. Despite this heterogeneity, those with and without language delay showed significant commonality in morphometric features when contrasted with matched neurotypical individuals (n = 57). In ASC, better current language was associated with increased GM volume in bilateral temporal pole, superior temporal regions, dorsolateral fronto-parietal and cerebellar structures, and increased white matter volume in distributed frontal and insular regions. Furthermore, current language-neuroanatomy correlation patterns were similar across subgroups with or without language delay. High-functioning adult males with ASC show neuroanatomical variations associated with both developmental and current language characteristics. This underscores the importance of including both developmental and current language as specifiers for ASC, to help clarify heterogeneity.

DSM-5 ASD moves forward into the past

The fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5) (APA in diagnostic and statistical manual of mental disorders, Author, Washington, 2013) has decided to merge the subtypes of pervasive developmental disorders into a single category of autism spectrum disorder (ASD) on the assumption that they cannot be reliably differentiated from one another. The purpose of this review is to analyze the basis of this assumption by examining the comparative studies between Asperger's disorder (AsD) and autistic disorder (AD), and between pervasive developmental disorder not otherwise specified (PDDNOS) and AD. In all, 125 studies compared AsD with AD. Of these, 30 studies concluded that AsD and AD were similar conditions while 95 studies found quantitative and qualitative differences between them. Likewise, 37 studies compared PDDNOS with AD. Nine of these concluded that PDDNOS did not differ significantly from AD while 28 reported quantitative and qualitative differences between them. Taken together, these findings do not support the conceptualization of AD, AsD and PDDNOS as a single category of ASD. Irrespective of the changes proposed by the DSM-5, future research and clinical practice will continue to find ways to meaningfully subtype the ASD.

Asperger's disorder will be back

This review focuses on identifying up-to-date number of publications that compared DSM-IV/ICD-10 Asperger's disorder (AspD) to Autistic Disorder/High-functioning Autism (AD/HFA). One hundred and twenty-eight publications were identified through an extensive search of major electronic databases and journals. Based on more than 90 clinical variables been investigated, 94 publications concluded that there were statistically significant or near significant level of quantitative and/or qualitative differences between AspD and AD/HFA groups; 4 publications found both similarities and differences between the two groups; 30 publications concluded with no differences between the two groups. Although DSM-5 ASD will eliminate Asperger's disorder. However, it is plausible to predict that the field of ASD would run full circle during the next decade or two and that AspD will be back in the next edition of DSM.

Working memory in early-school-age children with Asperger's syndrome

Using a battery of working memory span tasks and n-back tasks, this study aimed to explore working memory functions in early-school-age children with Asperger's syndrome (AS). Twelve children with AS and 29 healthy children matched on age and IQ were recruited. Results showed: (a) children with AS performed better in digit and word recall tasks, but worse in block recall task and variant-visual-patterns test; (b) children with AS took longer time in most conditions of n-back tasks, and showed larger effects of task load. These findings indicated imbalance of working memory development in AS children: they had advantage in the phonological loop storing, but disadvantage in the visuospatial sketchpad storing, and partial deficit in central executive.

Re-presenting autism: the construction of 'NT syndrome'

Autism is a widely researched area and much emphasis has been placed in research on the differences between the autistic and non-autistic populations. Such research commonly draws on proposed deficits within people with autism in order to explain differences. This paper seeks to present an alternative understanding of differences and draws on writings of people with autism in such a discussion. The construction of 'Neurologically Typical syndrome' (NT) will be presented as an inverted construction of diagnosis, which serves to challenge the dominant position of 'NTs' and 'NT traits' over autistic traits. It will be argued that such an alternative representation of people with and without autism has important implications for our construction of and understanding of autism.

Social skills and problem behaviours in school aged children with high-functioning autism and Asperger's Disorder

The social skills and problem behaviours of children with high-functioning autism and Asperger's Disorder were compared using parent and teacher reports on the Social Skills Rating System. The participants were 20 children with high-functioning autism, 19 children with Asperger's Disorder, and 17 typically developing children, matched on chronological and overall mental age. The children with autism and Asperger's Disorder were not differentiated on any social skill or problem behaviour based either on teacher or parent report. However, both clinical groups demonstrated significant social skill deficits and problem behaviours relative to the typically developing children, and the original standardization sample. The findings were compatible with the view that autism and Asperger's Disorder belong on a single spectrum of disorder.

Decoding of Emotion through Facial Expression, Prosody and Verbal Content in Children and Adolescents with Asperger’s Syndrome

This study examined differences in the ability to decode emotion through facial expression, prosody, and verbal content between 14 children with Asperger's Syndrome (AS) and 16 typically developing peers. The ability to decode emotion was measured by the Perception of Emotion Test (POET), which portrayed the emotions of happy, angry, sad, and neutral among the modalities of static and dynamic facial expression, prosody, verbal content, and all modalities combined. Results revealed that children with AS had more difficulty identifying emotions through static facial expression, dynamic facial expression, and prosody than typically developing children. Results are discussed in relationship to an over-reliance on verbal content as a compensatory strategy in social interactions. Treatment implications for individuals with AS are also discussed.

Executive Functioning in Children with an Autism Spectrum Disorder: Can We Differentiate Within the Spectrum?

The aim of this study was to investigate whether children with high-functioning autism (HFA), Asperger's syndrome (AS), and pervasive developmental disorder not otherwise specified (PDDNOS) can be differentiated from each other and from normal controls on their neurocognitive executive functioning (EF) profile. Children with HFA and AS showed the most EF deficits. The EF profile of the PDDNOS group was more disturbed that the normal control group, but was less disturbed than the profile of the HFA and AS groups. Little difference was found between the three PDD subtypes with respect to EF. This study supports the view that executive dysfunctioning plays an important role in autism. The usefulness of a distinction between different PDD subtypes was not demonstrated.

Annotation: The similarities and differences between autistic disorder and Asperger's disorder: a review of the empirical evidence

BACKGROUND

The ongoing controversy over the distinction between autistic disorder and Asperger's disorder is important to resolve because of the implications regarding an understanding of the aetiology and prognosis, and the diagnostic and clinical practices relating to these conditions. This paper provides a critical evaluation of current published research evidence.

METHOD

Databases, such as PsychINFO and Medline, as well as book chapters, reference lists from relevant articles, and recent editions of key journals were searched for all relevant studies (until 2002) which incorporated participants diagnosed with high-functioning autism and Asperger's disorder using either cluster analysis or comparative approaches to examine similarities and differences between these groups. Keywords used in the searches included autistic disorder, Asperger's disorder, autism, high-functioning autism, and pervasive developmental disorder.

RESULTS

On the basis of the available evidence, there seem to be few qualitative differences between autistic disorder and Asperger's disorder.

CONCLUSION

There is currently insufficient evidence to establish the validity of Asperger's disorder as a syndrome distinct from high-functioning autism. The findings are consistent with the view that these disorders belong on an autism spectrum.

A clinical and neurobehavioural review of high-functioning autism and Asperger's disorder

OBJECTIVE

To compare, contrast and review clinical and neuropsychological studies of high-functioning autism and Asperger's disorder.

METHOD

This paper reviews past and contemporary conceptualizations of autism and Asperger's disorder, together with epidemiological information, genetic and neurobehavioural findings. This paper focuses on neurobehavioural studies, in particular, executive functioning, lateralization, visual-perceptual and motor processing, which have provided an important source of information about the potential neurobiological dissociation that may exist between autism and Asperger's disorder.

RESULTS

The clinical profiles of autism and Asperger's disorder contain a mixture of psychiatric and neurological symptoms: for example, movement abnormalities (i.e. stereotyped behaviours, hand flapping, toe walking, whole-body movements), atypical processing of parts and wholes, verbal and non-verbal deficits, ritualistic/compulsive behaviour, disturbances in reciprocal social interaction and associated depression and anxiety. The considerable clinical overlap between autism and Asperger's disorder has led many to question whether Asperger's disorder is merely a mild form of autism, or whether it should be considered as a separate clinical entity.

CONCLUSION

In light of the growing body of epidemiological information, genetic, and neurobehavioural evidence that distinguishes autism from Asperger's disorder, it is premature to rule out the possibility that these disorders may be clinically, and possibly neurobiologically separate.

The CAST (Childhood Asperger Syndrome Test): preliminary development of a UK screen for mainstream primary-school-age children

The article describes a pilot and follow-up study of the preliminary development of a new tool to screen for Asperger syndrome (AS) and related social and communication conditions (the Childhood Asperger Syndrome Test, CAST) in children aged 4-11 years, in a non-clinical setting. In the pilot study, parents of 13 children with AS and of 37 typically developing children completed the CAST. There were significant differences between the AS and typical sample means. The pilot was used to establish preliminary cut-off scores for the CAST. In the main study, parents of 1150 primary-school-age children were sent the CAST, and 174 took part in the full data analysis. Results suggest that compared with other tools currently available, the CAST may be useful for identifying children at risk for AS and related conditions, in a mainstream non-clinical sample. Further research is ongoing.

Clinical considerations in the diagnosis of autism spectrum disorders

The diagnosis of autistic spectrum disorders (ASD) is being made more frequently in children and at younger ages. This paper discusses various factors to be considered in the screening of autism, early features of presentation, relevant to assessment and diagnosis, subtypes or different syndromes within the spectrum of autistic conditions including Asperger syndrome, the differential diagnosis from learning and language disorders and the medical and behavioural commonly associated disorders.

Autism: a novel form of mercury poisoning

Autism is a syndrome characterized by impairments in social relatedness and communication, repetitive behaviors, abnormal movements, and sensory dysfunction. Recent epidemiological studies suggest that autism may affect 1 in 150 US children. Exposure to mercury can cause immune, sensory, neurological, motor, and behavioral dysfunctions similar to traits defining or associated with autism, and the similarities extend to neuroanatomy, neurotransmitters, and biochemistry. Thimerosal, a preservative added to many vaccines, has become a major source of mercury in children who, within their first two years, may have received a quantity of mercury that exceeds safety guidelines. A review of medical literature and US government data suggests that: (i) many cases of idiopathic autism are induced by early mercury exposure from thimerosal; (ii) this type of autism represents an unrecognized mercurial syndrome; and (iii) genetic and non-genetic factors establish a predisposition whereby thimerosal's adverse effects occur only in some children.

Autism--an evolving concept

BACKGROUND

The rapid increase in research endeavour has not kept pace with the advent of well-publicized theories and treatments for autism.

AIMS

To explore some of the newer developments in biological research into autism.

METHOD

A review of recent publications and presentations.

RESULTS

The concept is shifting from the narrow perception of aloof autism, described by Kanner, to a wider one that includes a spectrum extending to a broader, subclinical phenotype. The genetic basis has been established; now we need to discover the location and interaction of the relevant sites. There is considerable interest in the bowel as a pathogenetic agent, particularly in the effects of exogenous opioids and multiple viral infection (the latter posing a public health problem). Also of concern is the role of (potentially treatable) epilepsy, analogous to the Laudau-Kleffner syndrome.

CONCLUSIONS

In the absence of a cure, the implementation of ideas will continue to outstrip factual evidence. Clinicians are challenged by the availability of information (and misinformation), particularly on the internet.