1: Rev Bras Psiquiatr. 2003 Jun;25(2):103-9.
Asperger syndrome: an update.
Klin A.
Child Psychology and Psychiatry Yale Child Study Center, New Haven, CT 06520,
USA. ami.klin@yale.edu
This article provides an overview of the history and clinical features of
Asperger syndrome, and considers guidelines for clinical assessment and
treatment. A review of issues related to external validity is provided, which
points out the limitations of current research, and lists several potentially
beneficial areas of investigation into the nosologic status of the condition. It
concludes with a discussion of the unequivocal need of individuals with severe
social disabilities for comprehensive and adequate educational services and
other treatments irrespective of the fact that the validity and the utility of
this specific diagnostic concept is far from resolved.
Publication Types:
Review
Review, Tutorial
PMID: 12975708 [PubMed - indexed for MEDLINE]
2: J Autism Dev Disord. 2003 Jun;33(3):259-69.
Further evidence of preserved priming and impaired recall in adults with
Asperger's syndrome.
Gardiner JM, Bowler DM, Grice SJ.
Psychology Group, School of Cognitive & Computing Sciences, University of
Sussex, Brighton BN1 9QH, England. johngar@cogs.susx.ac.uk
Two experiments compared incidental (implicit) and intentional (explicit) memory
performance in adults with Asperger's syndrome and individually matched
controls. Experiment 1 involved perceptual tests using word fragment cues,
following study tasks in which the participants either generated the words from
contextual cues or read the words alone, with no contextual cues. Experiment 2
involved conceptual tests using paired associate cues, following study tasks in
which the paired associates were rated either for their relatedness or for their
readability. Performance in both the incidental tests was similar for both
groups. Performance in both the intentional tests was also similar for both
groups, with one exception. The adults with Asperger's syndrome were more likely
to falsely recall words that had not actually been studied. These findings
further delimit the nature of memory impairments in adults with Asperger's
syndrome, which seem restricted to certain aspects of episodic memory that
include the tendency to make more intrusion errors in recall.
PMID: 12908829 [PubMed - indexed for MEDLINE]
3: J Autism Dev Disord. 2003 Jun;33(3):253-7.
The comprehension of humorous materials by adolescents with high-functioning
autism and Asperger's syndrome.
Emerich DM, Creaghead NA, Grether SM, Murray D, Grasha C.
Kenton County Public Schools, Erlanger Kentucky, USA. emericdm@isoc.net
This study investigated the ability of adolescents with Asperger's syndrome or
high-functioning autism and an age-matched group of typical adolescents to
comprehend humorous materials. The analysis of humor focused on picking funny
endings for cartoons and jokes. As expected, the adolescents with autism had
significantly poorer comprehension of cartoons and jokes. Both groups had more
difficulty with the joke than the cartoon task, but when compared with the
typical group, the adolescents with autism performed significantly poorer.
Examination of the error patterns revealed that subjects with autism had
difficulty handling surprise and coherence within humorous narratives.
PMID: 12908828 [PubMed - indexed for MEDLINE]
4: J Autism Dev Disord. 2003 Jun;33(3):239-51.
Narrative ability in high-functioning children with autism or Asperger's
syndrome.
Losh M, Capps L.
Department of Psychology, University of California at Berkeley, 3210 Tolman
Hall, #1650, Berkeley, California 94720-1650, USA. losh@socrates.berkeley.edu
This study examines the narrative abilities of 28 high-functioning children with
autism or Asperger's Syndrome and 22 typically developing children across two
different discourse contexts. As compared with the typically developing
children, the high-functioning group performed relatively well in the storybook
context but exhibited difficulty imbuing their narratives of personal experience
with the more sophisticated characteristics typically employed by the comparison
group. Furthermore, children with autism or Asperger's Syndrome demonstrated
impairments inferring and building on the underlying causal relationships both
within and across story episodes in both narrative contexts. Findings further
revealed that the narrative abilities of children with autism or Asperger's
Syndrome were associated with performance on measures of emotional
understanding, but not theory of mind or verbal IQ. Findings are discussed in
relation to the social and emotional underpinnings of narrative discourse.
PMID: 12908827 [PubMed - indexed for MEDLINE]
5: Gen Hosp Psychiatry. 2003 Jul-Aug;25(4):284-8.
Screening for autism spectrum disorder in adult psychiatric outpatients in a
clinic in Taiwan.
Chang HL, Juang YY, Wang WT, Huang CI, Chen CY, Hwang YS.
Department of Child Psychiatry, Chang Gung Children Hospital, Republic of China,
Kewi-Shan, Taiwan. chang0687@adm.cgmh.org.tw
Patients with adult autism spectrum disorder (ASD) continue to suffer from
impairment in socialization and communication skills, and a proportion of them
may develop psychiatric symptoms. It is thus likely that physicians in adult
psychiatric departments may see a number of patients with ASD. Identification of
patients with ASD is helpful and important for rehabilitation. This study
estimated the prevalence of ASD among adult psychiatric outpatients in a
Taiwanese medical center. A total of 660 patients were screened with Nylander
and Gillberg's "Autism Spectrum Disorder in Adult Screening Questionnaire."
Patients with high scores then underwent a diagnostic clinical interview
conducted by child psychiatrists. Four patients (0.6%) were found to have ASD.
PMID: 12850661 [PubMed - indexed for MEDLINE]
6: Dev Psychopathol. 2003 Winter;15(1):73-94.
Differences in assertive speech acts produced by children with autism, Asperger
syndrome, specific language impairment, and normal development.
Ziatas K, Durkin K, Pratt C.
Department of Psychology, The University of Western Australia, Crawley.
kathy@psy.uwa.edu.au
The assertive speech acts of children with autism (n = 12) and Asperger syndrome
(n = 12), individually matched to children with specific language impairment
(SLI; n = 24) and children with normal development (n = 24) were studied in the
context of gently structured conversation. These children also completed the
false belief test of theory of mind. The children with autism used significantly
lower proportions of assertions involving explanations and descriptions than the
children with SLI or normal development and significantly lower proportions of
assertions involving internal state and explanations than the children with
Asperger syndrome. The children with autism used a higher proportion of
assertions involving identifications than any other group. The assertions of the
children with Asperger syndrome were generally not different than those of the
children with SLI or normal development except for a higher proportion of
assertions involving own internal state. Further analysis of the mental
assertions revealed that the children with autism and Asperger syndrome
predominantly referred to desire and made few references to thought and belief,
whereas the children with SLI and those with normal development used a higher
proportion of references to thought and belief.
PMID: 12848436 [PubMed - indexed for MEDLINE]
7: J Child Psychol Psychiatry. 2003 May;44(4):520-8.
Predictors of outcome among high functioning children with autism and Asperger
syndrome.
Szatmari P, Bryson SE, Boyle MH, Streiner DL, Duku E.
McMaster University, Canada. szatmar@mcmaster.ca
BACKGROUND: The objective of this paper is to assess the extent to which
measures of cognitive abilities taken in an inception cohort of young high
functioning children with autism and Asperger syndrome predict outcome roughly
two and six years later. METHOD: Children who received a diagnosis of autism or
Asperger syndrome (AS) and who had a nonverbal IQ score in the 'non-retarded'
range were included in the inception cohort. Measures of language and nonverbal
skills were taken when the children were 4-6 years of age and outcome
assessments were completed when the children were 6-8 and 10-13 years of age.
The three outcome measures consisted of scales of adaptive behaviours in
socialisation and communication and a composite measure of autistic symptoms
(abnormal language, abnormal body and object use, difficulties relating to
others, sensory issues and social and self-help difficulties). RESULTS: The
explanatory power of the predictor variables was greater for communication and
social skills than for autistic symptoms. The power of prediction was stable
over time but did differ by PDD subtype. In general, the association between
language skills and outcome was stronger in the autism group than in the AS
group. CONCLUSIONS: These results support the emphasis of early intervention
programmes on language but more work needs to be done on understanding variables
that influence outcome in social skills and autistic behaviours, particularly in
those with AS.
PMID: 12751844 [PubMed - indexed for MEDLINE]
8: Autism. 2003 Mar;7(1):99-110.
Psychosocial functioning in a group of Swedish adults with Asperger syndrome or
high-functioning autism.
Engstrom I, Ekstrom L, Emilsson B.
Psychiatric Research Centre, Orebro, Sweden. ingemar.engstrom@orebroll.se
This study reports on psychosocial functioning in Swedish adults with Asperger
syndrome (AS) or high-functioning autism (HFA). A systematically selected sample
of patients and relatives was interviewed concerning their psychosocial
situation. The majority was living independently. All persons but one were
unemployed. None was married and none had children. Only a few had some kind of
partner. Most persons needed a high level of public and/or private support. The
overall adjustment was rated good in 12 percent, fair in 75 percent and poor in
12 percent. Adult persons with AS/HFA have extensive need for support from their
families and/or society. This information is important in order to provide
adequate interventions that are in accordance with the expressed needs of the
individuals themselves.
PMID: 12638767 [PubMed - indexed for MEDLINE]
9: J Paediatr Child Health. 2003 Mar;39(2):81-2.
Is there an increase in the prevalence of autism spectrum disorders?
Prior M.
Department of Psychology, University of Melbourne, Parkville, Victoria,
Australia. priorm@unimelb.edu.au
This report summarizes recent prevalence estimates for autism spectrum disorders
and outlines possible reasons for an apparent increase in the numbers of
children diagnosed with autism and Asperger syndrome.
Publication Types:
Review
Review, Tutorial
PMID: 12603792 [PubMed - indexed for MEDLINE]
10: Curr Biol. 2003 Feb 18;13(4):339-41.
Impaired mirror-image imitation in Asperger and high-functioning autistic
subjects.
Avikainen S, Wohlschlager A, Liuhanen S, Hanninen R, Hari R.
Brain Research Unit, Low Temperature Laboratory, Helsinki University of
Technology, FIN-02015 HUT, Espoo, Finland. avi@neuro.hut.fi
Imitation is crucial for proper development of social and communicative skills.
Here, we argue that, based on an error analysis of a behavioral imitation task,
adult Asperger and high-functioning autistic subjects suffer from an intriguing
deficit of imitation: they lack the natural preference for imitation in a
mirror-image fashion. The imitation task consisted of a simple movement sequence
of putting a pen with the left or right hand into a green or a blue cup using
one of two possible grips. The subjects were asked to imitate the experimenter's
hand movements either using the crossed hand (e.g., the subject's right hand
corresponding to the experimenter's right hand) for imitation or to imitate as
if looking in a mirror (e.g., the subject's left hand corresponding to the
experimenter's right hand). When people normally view other persons
face-to-face, they prefer to imitate as in a mirror, and observation of
mirror-image-like movements speeds up performance in nonimitative tasks.
However, our autistic subjects, defective in social cognition, did not profit
from mirror-image movements of others. These results provide a new insight into
the difficulties that autistic subjects face in viewing and understanding
actions of others.
PMID: 12593801 [PubMed - indexed for MEDLINE]
11: Pediatr Nurs. 2002 Nov-Dec;28(6):565-70.
Differences in stress and coping for mothers and fathers of children with
Asperger's syndrome and nonverbal learning disorders.
Little L.
Department of Nursing, University of New Hampshire, Durham, NH, USA.
Research conducted on families of children with disabilities shows that family
cohesion and positive family outcomes are influenced by how mothers and fathers
cope with raising their child with disabilities. This study was designed to
examine stress and coping differences between mothers and fathers (n = 103) of
children with Asperger's syndrome (AS) and nonverbal learning disorders (NLD). A
repeated measure design was used to compare how mothers and fathers cope with
caring for a particular child to control for differences in the severity and
nature of the disability across children. Few studies that compare mothers and
fathers do so at the couple level. Responses indicated that mothers had higher
rates of stress related to family problems and pessimism about their child's
future, higher rates of antidepressant use, and higher rates of therapy use than
did fathers. Mothers found some coping strategies more helpful than fathers did.
Maternal education and child's age also were related to some stress and coping
variables. Implications for nurses and future research are discussed.
PMID: 12593341 [PubMed - indexed for MEDLINE]
12: Int J Circumpolar Health. 2002;61 Suppl 2:80-9.
Asperger syndrome with comorbid emotional disorder--treatment with
psychoanalytic psychotherapy.
Mero MM.
Clinic of Child Psychiatry, University Hospital of Oulu, Oulu, Finland.
mervi-marja.mero@pp.inet.fi
The purpose of psychoanalytic psychotherapy is to help the child to grow and
develop normally. Children who are able to play, process their problems in the
play. The therapist's role is to engage with the play and verbalize the emotions
and the interactions demonstrated in it. This case-presentation illustrates how
the child can express and work his inner fears and anxieties in play-situations
with the therapist and shows how this interaction helps the child to develop and
individuate. Children diagnosed as having Asperger syndrome may have emotional
problems, in which case psychoanalytical psychotherapy is one of the means of
helping the child and the family.
Publication Types:
Case Reports
PMID: 12585823 [PubMed - indexed for MEDLINE]
13: Neurosci Lett. 2003 Mar 6;338(3):197-200.
Deficient auditory processing in children with Asperger Syndrome, as indexed by
event-related potentials.
Jansson-Verkasalo E, Ceponiene R, Kielinen M, Suominen K, Jantti V, Linna SL,
Moilanen I, Naatanen R.
Department of Finnish, Saami and Logopedics, University of Oulu, Oulu, Finland.
eiro.jansson-verkasalo@oulu.fi
Asperger Syndrome (AS) is characterized by normal language development but
deficient understanding and use of the intonation and prosody of speech. While
individuals with AS report difficulties in auditory perception, there are no
studies addressing auditory processing at the sensory level. In this study,
event-related potentials (ERP) were recorded for syllables and tones in children
with AS and in their control counterparts. Children with AS displayed
abnormalities in transient sound-feature encoding, as indexed by the obligatory
ERPs, and in sound discrimination, as indexed by the mismatch negativity. These
deficits were more severe for the tone stimuli than for the syllables. These
results indicate that auditory sensory processing is deficient in children with
AS, and that these deficits might be implicated in the perceptual problems
encountered by children with AS.
PMID: 12581830 [PubMed - indexed for MEDLINE]
14: Acta Psychiatr Scand. 2003 Jan;107(1):73-5; discussion 75-6.
Asperger's disorder: a case report of repeated stealing and the collecting
behaviours of an adolescent patient.
Chen PS, Chen SJ, Yang YK, Yeh TL, Chen CC, Lo HY.
Department of Psychiatry, National Cheng Kung University Medical College and
Hospital, Taipei, Taiwan. chenps@mail.ncku.edu.tw
OBJECTIVE: To discuss special behavioural problems shown by a patient with
Asperger's disorder from adolescence onward. METHOD: The case and treatment of a
21-year-old male patient is described. RESULTS: A 21-year-old male developed
obstinate stealing behaviours when he was 17 years old. He was regarded as a
schizophrenic at first, and was suspected of kleptomania later. Asperger's
disorder was diagnosed after we reconsidered the relationship between the
schizoid psychopathy in childhood and the stealing behaviours which occurred in
adolescence. CONCLUSION: A wide variety of bizarre behaviours and so-called
borderline behaviours occur in late adolescence and adult life of patients with
Asperger's disorder. But classic schizophrenia is very rare. Psychiatrists
unacquainted with the clinical diagnosis/context may find it difficult to
evaluate 'concrete', 'childish', or 'bizarre' symptoms in patients with
Asperger's disorder, and thus are prone to misdiagnose them as having
schizophrenia disorders or other similar disorders.
Publication Types:
Case Reports
PMID: 12558546 [PubMed - indexed for MEDLINE]
15: J Autism Dev Disord. 2002 Dec;32(6):611-4.
Review of the Asperger Syndrome Diagnostic Scale.
Goldstein S.
Neurology, Learning, and Behavior Center, Salt Lake City, Utah 84102-2015, USA.
info@samgoldstein.com
The Asperger's Syndrome Diagnostic Scale (2001) was reviewed to determine it's
reliability, validity, and clinical utility in the diagnostic process for
pervasive developmental disorder, specifically Asperger's syndrome. Concerns
were raised about validity of the instrument, population upon which the
instrument was normed, capability of the instrument to provide accurate
differential diagnoses, and properties of the scale. The measure was determined
to hold promise as a research tool, but there appears to be little evidence that
it can distinguish among the various types of pervasive developmental disorder
or diagnosis Asperger syndrome specifically.
Publication Types:
Validation Studies
PMID: 12553597 [PubMed - indexed for MEDLINE]
16: Child Adolesc Psychiatr Clin N Am. 2003 Jan;12(1):143-63, vii-viii.
The challenge of adolescents and adults with Asperger syndrome.
Tantam D.
Centre for the Study of Conflict and Reconciliation, School of Health and
Related Research, University of Sheffield, Regent's Court, 30 Regent Street,
Sheffield S1 4DA, United Kingdom. d.tantam@sheffield.ac.uk
Despite the rapid growth of interest in Asperger disorder in children, there
continues to be a lack of awareness of the diagnosis and its implications for
adolescents and adults. The reasons for this lack of awareness lie in the
history of the disorder and in the historical development of mental health
services. Because, as Santayana wrote, "Those who cannot remember the past are
condemned to repeat it," this article reprises some of the history given
elsewhere in this issue, but in a highly partial way, to bring out what the
author believes to be the historically grounded prejudices that are the first
challenge to anyone wanting to help adolescents and adults with Asperger
syndrome.
Publication Types:
Case Reports
PMID: 12512403 [PubMed - indexed for MEDLINE]
17: Child Adolesc Psychiatr Clin N Am. 2003 Jan;12(1):123-41.
Behavioral forms of stress management for individuals with Asperger syndrome.
Myles BS.
Department of Special Education, University of Kansas, Joseph R. Pearson Hall,
1122 West Campus Road, 5th Floor, Lawrence, KS 66045-3101, USA. bmyles@ku.edu
Although many children and youth with AS exhibit anxiety that may lead to
challenging behaviors, stress and subsequent behaviors should be viewed as an
integral part of the disorder [36]. As such, it is important to understand the
cycle of behaviors to prevent seemingly minor events from escalating. Although
understanding the cycle of tantrums, rage, and meltdowns is important, behavior
changes will not occur unless the function of the behavior is understood and the
student is provided instruction and support in using (1) strategies that
increase social understanding and problem solving, (2) techniques that
facilitate self-understanding, and (3) methods of self-calming. Because little
research exists on the cycle of behaviors exhibited by students with AS and
interventions appropriate at each stage, a systematic program of research is
required to identify which techniques are most appropriate for children and
youth, the context in which they can be used, and methods to ensure that
individuals with AS generalize these skills to home, school, and community.
PMID: 12512402 [PubMed - indexed for MEDLINE]
18: Child Adolesc Psychiatr Clin N Am. 2003 Jan;12(1):47-63, vi.
Outcome research in Asperger syndrome and autism.
Tsatsanis KD.
Harvard Medical School, Yale Child Study Center, 149 Thirteenth Street, Floor
10, Charlestown, MA 02129, USA. ktsatsanis@partners.org
This article presents findings from the outcome literature on autism, Asperger
syndrome (AS), and related disorders. The discussion of outcome principally
focuses on life adaptation, but also considers outcome in AS in relationship to
other diagnostic groups and across time. The current research in this area is
neither substantial nor systematic. Thus, in this examination of the literature,
the goal is to highlight salient findings, but also to put forward questions
that might direct meaningful research in this area for the future and to
consider implications for treatment.
PMID: 12512398 [PubMed - indexed for MEDLINE]
19: Child Adolesc Psychiatr Clin N Am. 2003 Jan;12(1):23-45.
Strategies for pharmacologic treatment of high functioning autism and Asperger
syndrome.
Towbin KE.
Departments of Psychiatry and Behavioral Sciences, and Pediatrics, George
Washington University School of Medicine, Children's National Medical Center,
111 Michigan Avenue NW, Washington, DC 20010, USA. Kenneth.Towbin@nih.gov
The treatment of complex, polymorphous disorders like HFA/AS always brings a
particular challenge to pharmacotherapy. Additionally, the specific
characteristics presented by HFA/AS introduce unique complications to patient
care and place unusual demands on a clinician's skill and experience. To provide
safe and effective treatment, the clinician must understand the core features of
the disorder and the manifestations of the condition in his or her patient.
Furthermore, a thorough understanding of the family, school, and community
resources and limitations is necessary. Once an assessment has been made,
focusing on target symptoms provides a crucial framework for care. Knowing
manifestations of symptoms and characterizing their distribution and behavior in
that patient is most important. For patients with HFA/AS it is particularly
essential to coordinate behavioral and pharmacologic objectives. The target
symptoms should be tracked carefully and placed into a priority system that is
based on the risks and disability they create for the patient. The skill of
pharmacotherapy also means setting out realistic expectations, keeping track of
the larger systems of care at school and home, and collaboration with parents
and care providers. There is an expanding range and pace of biologic and
intervention research into HFA/AS. The genetic work has produced exciting leads
that are likely to be helpful to future generations [82-84], but the task of
clinicians is to tend to today's patients. As we discover more about the complex
neural circuitry subserving repetitive behaviors, reward systems, and social
cognition, there are good reasons to believe our treatments will become more
sophisticated and specific. Psychopharmacology is also moving to design
medications that target more specific populations of receptor and brain
functions. This is likely to produce medicines that have fewer side effects, are
more effective, and are more symptom-specific. Pharmacotherapy is not the
ultimate treatment for HFA/AS but it has a definite place. Medication can be a
critical element in a comprehensive treatment plan. There is a wider range of
medications with more specific biologic effects than ever before. For patients
with HFA/AS these newer agents are safer and less disruptive. When paired with
clinicians who are becoming more skilled at recognizing and managing symptoms,
patients have a greater opportunity to reach their potential and lead
pleasurable lives.
PMID: 12512397 [PubMed - indexed for MEDLINE]
20: Child Adolesc Psychiatr Clin N Am. 2003 Jan;12(1):1-13, v.
Asperger syndrome: diagnosis and external validity.
Klin A, Volkmar FR.
Yale Child Study Center, 230 South Frontage Road, New Haven, CT 06520, USA.
ami.klin@yale.edu
This article provides an overview of the history and clinical features of
Asperger syndrome and considers guidelines for clinical assessment and
treatment. A review of issues related to external validity is provided that
points out the limitations of current research and lists several potentially
beneficial areas of investigation into the nosologic status of the condition. It
concludes with a discussion of the unequivocal need of individuals with severe
social disabilities for comprehensive and adequate educational services and
other treatments, regardless of the fact that the validity and usefulness of
this specific diagnostic concept is far from resolved.
Publication Types:
Review
Review, Tutorial
PMID: 12512395 [PubMed - indexed for MEDLINE]
21: MCN Am J Matern Child Nurs. 2002 Nov-Dec;27(6):349-54.
Maternal discipline of children with Asperger Syndrome and nonverbal learning
disorders.
Little L.
Department of Nursing, University of New Hamphire, Durham, NH 03824, USA.
llittle@hopper.unh.edu
PURPOSE: This study investigated how often mothers of children with Asperger
Syndrome and nonverbal learning disorders reported using either psychological
aggression (shouting, cursing, name calling) or corporal punishment (spanking,
hitting) when disciplining their children, and also examined the correlates of
these methods of discipline. DESIGN AND METHODS: A descriptive study of 41l
mothers with children between ages 4 and 17 years. Mothers were recruited by
placing an invitation on two national Web sites; one for parents of children
with Asperger syndrome and one for parents of children with nonverbal learning
disabilities. An anonymous, mailed survey was used and a 70% response rate was
obtained. The Conflict Tactics Scale-Child Form was used to measure
psychological aggression and corporal punishment. Univariate analyses were used
to describe the child and maternal characteristics and maternal rates of
discipline. The correlates of maternal discipline were measured using bivariate
analyses. RESULTS: The overall reported use of any corporal punishment (slaps on
the hand, arm, and leg; hitting on the buttocks with a belt or brush; spanking
on the buttocks with a hand; pinching and shaking) during the past year was 58%.
The yearly use of any psychological aggression (screaming and yelling, cursing,
threatening to hit or spank, threatening to kick out or send away, calling the
child "dumb" or "lazy") was 95%. Spanking declined with increasing age of the
child and the mother. Mothers who used psychological aggression were more likely
to use corporal punishment with their child. CLINICAL IMPLICATIONS: Informed
nurses working with these populations can use the results of this study to help
address the stresses felt by these mothers, and to teach alternative strategies
of coping to mothers who are in danger of using psychological aggression and
corporal punishment.
PMID: 12439137 [PubMed - indexed for MEDLINE]
22: Aust N Z J Psychiatry. 2002 Dec;36(6):762-70.
A clinical and neurobehavioural review of high-functioning autism and Asperger's
disorder.
Rinehart NJ, Bradshaw JL, Brereton AV, Tonge BJ.
School of Psychology, Psychiatry, and Psychological Medicine, Monash University,
Victoria, Australia. nicole.rinehart@med.monash.edu.au
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.
Publication Types:
Review
Review, Tutorial
PMID: 12406118 [PubMed - indexed for MEDLINE]
23: Arch Gen Psychiatry. 2002 Oct;59(10):885-91.
Asperger syndrome: a proton magnetic resonance spectroscopy study of brain.
Murphy DG, Critchley HD, Schmitz N, McAlonan G, Van Amelsvoort T, Robertson D,
Daly E, Rowe A, Russell A, Simmons A, Murphy KC, Howlin P.
Department of Psychological Medicine, St George's Hospital Medical School,
London, England. sphadgm@iop.kcl.ac.uk
BACKGROUND: Asperger syndrome (AS; an autistic disorder) is associated with
impaired social skills and obsessional/repetitive behavior. Patients with autism
have significant abnormalities in the frontal lobe and frontoparietal
connectivity. Nobody has examined the relationship between abnormalities in the
frontal and parietal lobes and clinical symptoms in people with AS. METHODS: We
used in vivo proton magnetic resonance spectroscopy to examine neuronal
integrity of the medial prefrontal and parietal lobes in 14
non-learning-disabled adults with AS and 18 control subjects (of similar sex,
age, and IQ). We obtained measures of the prefrontal lobe in 11, the parietal
lobe in 13, and both lobes in 10 subjects with AS. We measured concentrations
and ratios of N-acetylaspartate (NAA), creatine and phosphocreatine (Cr + PCr),
and choline (Cho). Levels of NAA, Cr + PCr, and Cho are indicators of neuronal
density and mitochondrial metabolism, phosphate metabolism, and membrane
turnover. Frontal metabolite levels were correlated with scores on the
Yale-Brown Obsessive Compulsive Scale and the Autism Diagnostic Interview.
RESULTS: Subjects with AS had a significantly higher prefrontal lobe
concentration of NAA (z = -3.1; P =.002), Cr + PCr (z = -2.2; P =.03), and Cho
(z = -2.9; P =.003). Increased prefrontal NAA concentration was significantly
correlated with obsessional behavior (tau = 0.67; P =.005); increased prefrontal
concentration of Cho, with social function (tau = 0.72; P =.02). We found no
significant differences in parietal lobe metabolite concentrations. CONCLUSION:
Subjects with AS have abnormalities in neuronal integrity of the prefrontal
lobe, which is related to severity of clinical symptoms.
PMID: 12365875 [PubMed - indexed for MEDLINE]
24: Issues Ment Health Nurs. 2002 Sep;23(6):605-15.
Asperger's syndrome: implications for nursing practice.
Marshall MC.
University of Texas Health Science Center-San Antonio, San Antonio, Texas, USA.
PeggyMarshall@bigplanet.com
The most common disorders within the category of Pervasive Developmental
Disorders (PDD) are the Autistic Disorders. In the 1994 Diagnostic and
Statistical Manual-IV, Asperger's Disorder became a distinct diagnosis within
the Autistic category, as part of the disorders first diagnosed in childhood and
adolescence. The terms Asperger's Disorder and Asperger's Syndrome are used
interchangeably. Attention to and knowledge of Asperger's Syndrome (AS) are
necessary to differentiate it from closely related disorders that have
overlapping symptoms. There is much discussion about different definitions of
Asperger's, different viewpoints of experts in the field, and the diagnostic
dilemmas related thereto. Last, and most important, are the nursing
implications. Nurses are in a position to identify children with Asperger's
early. After identification, the necessary referrals, treatment options,
support, and follow-up are essential for these children. Nurses need more
knowledge about this disorder and need to be proactive in defining their role to
help children with the disorder in the schools and the community.
Publication Types:
Review
Review, Tutorial
PMID: 12217224 [PubMed - indexed for MEDLINE]
25: Autism. 2002 Sep;6(3):287-97.
Temperament and character in adults with Asperger syndrome.
Soderstrom H, Rastam M, Gillberg C.
Department of Forensic Psychiatry, Goteborg University, Sweden.
henrik.soderstrom@rmv.se
To study the personality characteristics of adults with Asperger syndrome, and
investigate the value of self-rating personality inventories, we administered
the Temperament and Character Inventory (TCI) to 31 outpatients with Asperger
syndrome.The TCI is a self-rating personality inventory that has been validated
in the Swedish general population. The results were compared with age- and
sex-matched norm groups. Participants with Asperger syndrome scored
significantly higher on harm avoidance and lower on self-directedness and
cooperativeness. Reward dependence and novelty seeking tended to be low. They
also had significantly higher rarity scores, reflecting idiosyncratic
perspectives. The most common temperament configurations were 'obsessional',
'passive-dependent' and'explosive'. Character, reflecting conceptual maturity,
was poorly developed in the majority of our subjects. The self-ratings of
persons with Asperger syndrome thus indicated anxious personalities with coping
difficulties in the areas of social interaction and self-directedness, a picture
corresponding to the clinical descriptions of Asperger syndrome.
PMID: 12212919 [PubMed - indexed for MEDLINE]
26: Med Sci Law. 2002 Jul;42(3):237-44.
Case history of co-morbid Asperger's syndrome and paraphilic behaviour.
Milton J, Duggan C, Latham A, Egan V, Tantam D.
East Midlands Centre for Forensic Mental Health, Arnold Lodge, Cordelia Close,
Leicester LE5 0LE. John.Milton@arnoldl.cnhc-tr.trent.nhs.uk
We report a case of a man with Asperger's syndrome, paraphilic behaviour and
convictions for sexual offences. We describe his assessment within a secure
mental health setting to determine issues of diagnosis, treatment and risk. We
also highlight the difficulty in reducing the risk of further offending because
of the apparent ineffectiveness of interventions for the small group with
Asperger's syndrome and an offending history. Consequently, they are likely to
face long periods in institutional settings.
Publication Types:
Case Reports
PMID: 12201069 [PubMed - indexed for MEDLINE]
27: J Autism Dev Disord. 2002 Aug;32(4):263-81.
Asperger syndrome: tests of right hemisphere functioning and interhemispheric
communication.
Gunter HL, Ghaziuddin M, Ellis HD.
School of Psychology, Cardiff University, Cardiff, UK.
The primary aim of this investigation was to assess to what extent Rourke's
(1989, 1995) nonverbal learning disabilities syndrome (NLD) model resembles the
pattern of assets and deficits seen in people with Asperger syndrome (AS). NLD
can be characterized by a cluster of deficits primarily affecting nonverbal
aspects of functioning, in the presence of proficiency in single word reading
and a superior verbal memory. The neurological underpinnings of this syndrome
may be dysfunction of white matter affecting right hemisphere functioning and
interhemispheric communication. To explore this hypothesis, eight participants
with AS (ages 10 to 41 years) were assessed in the following areas: the
pragmatics of language and communication, verbal and visual memory,
visual-spatial abilities, and bimanual motor skills. Results confirmed the close
similarity in the neuropsychologic profiles of NLD and AS.
PMID: 12199132 [PubMed - indexed for MEDLINE]
28: Kaohsiung J Med Sci. 2002 Apr;18(4):198-204.
Asperger's syndrome and aberrant neurofunctional organization--a case report.
Huang HL, Shieh YL, Wu HJ, Chuang SF, Yang P, Jong YJ.
Department of Psychology, Kaohsiung Medical University, No. 100, Shin-Chun 1st
Road, Kaohsiung, Taiwan.
Asperger's Syndrome(AS) is a severe developmental disorder characterized
primarily by marked and sustained difficulties in social interaction and unusual
patterns of circumscribed interests and behavioral peculiarities. AS differs
from autism primarily in that there is no general delay or retardation in
language. A 3. 5 year-old boy with AS was referred for psychological assessment
and treatment. When the boy was 23 months old, he was assessed with Bayley
Scales of Infant Development (2nd ed.). Both MDI and PDI were within normal
limits. After the referral, this boy was assessed with WPPSI-R and then
prescribed 5 weekly intervention sessions consisting of communication skills
training. At a one week's follow-up the boy was reassessed with Leiter-R. The
results of WPPSI-R and Leiter-R showed the boy was in the normal intelligence
range. From the second session to the fifth session, the boy's mother recorded
526 of his utterances. According to the analysis of these speech data, the
language development for this boy was at Stage V, which indicated that his
language development was in the superior range for his age. After 5 intervention
sessions, the improvements in the child's communication skills were such that no
further sessions were warranted. This boy might represent a case of aberrant
neurofunctional organization. He has defects in perceptual organization but has
good pattern recognition, which is based on features. It is theorized that his
excellent verbal ability competed with the perceptual organization, so that he
compensated for perceptual organization with verbal ability. An intervention
designed to inhibit verbal compensation and facilitate configural processing is
recommended.
Publication Types:
Case Reports
PMID: 12164013 [PubMed - indexed for MEDLINE]
29: Brain. 2002 Aug;125(Pt 8):1839-49.
Autism, Asperger syndrome and brain mechanisms for the attribution of mental
states to animated shapes.
Castelli F, Frith C, Happe F, Frith U.
Institute of Cognitive Neuroscience, University College London, UK.
Ten able adults with autism or Asperger syndrome and 10 normal volunteers were
PET scanned while watching animated sequences. The animations depicted two
triangles moving about on a screen in three different conditions: moving
randomly, moving in a goal-directed fashion (chasing, fighting), and moving
interactively with implied intentions (coaxing, tricking). The last condition
frequently elicited descriptions in terms of mental states that viewers
attributed to the triangles (mentalizing). The autism group gave fewer and less
accurate descriptions of these latter animations, but equally accurate
descriptions of the other animations compared with controls. While viewing
animations that elicited mentalizing, in contrast to randomly moving shapes, the
normal group showed increased activation in a previously identified mentalizing
network (medial prefrontal cortex, superior temporal sulcus at the
temporo-parietal junction and temporal poles). The autism group showed less
activation than the normal group in all these regions. However, one additional
region, extrastriate cortex, which was highly active when watching animations
that elicited mentalizing, showed the same amount of increased activation in
both groups. In the autism group this extrastriate region showed reduced
functional connectivity with the superior temporal sulcus at the
temporo-parietal junction, an area associated with the processing of biological
motion as well as with mentalizing. This finding suggests a physiological cause
for the mentalizing dysfunction in autism: a bottleneck in the interaction
between higher order and lower order perceptual processes.
PMID: 12135974 [PubMed - indexed for MEDLINE]
30: J Child Psychol Psychiatry. 2002 Jul;43(5):679-90.
Conversational behaviour of children with Asperger syndrome and conduct
disorder.
Adams C, Green J, Gilchrist A, Cox A.
Human Communication and Deafness Group, University of Manchester, UK.
catherine.adams@man.ac.uk
BACKGROUND: Social communication problems in individuals who have Asperger
syndrome constitute one of the most significant problems in the syndrome. This
study makes a systematic analysis of the difficulties demonstrated with the use
of language (pragmatics) in adolescents who have Asperger syndrome. METHOD:
Recent advances in discourse analysis were applied to conversational samples
from a group of children with Asperger syndrome and a matched control group of
children with severe conduct disorder. Two types of conversation were sampled
from each group, differing in emotional content. RESULTS: The results showed
that in these contexts children with Asperger syndrome were no more verbose as a
group than controls, though they showed a tendency to talk more in more
emotion-based conversations. Children with Asperger syndrome, as a group,
performed similarly to control subjects in ability to respond to questions and
comments. However, they were more likely to show responses which were
problematic in both types of conversation. In addition, individuals with
Asperger syndrome showed more problems in general conversation than during more
emotionally and socially loaded topics. The group with Asperger syndrome was
found to contain a small number of individuals with extreme verbosity but this
was not a reliable characteristic of the group as a whole.
PMID: 12120863 [PubMed - indexed for MEDLINE]
31: J Child Psychol Psychiatry. 2002 May;43(4):517-28.
A new 'advanced' test of theory of mind: evidence from children and adolescents
with Asperger syndrome.
Kaland N, Moller-Nielsen A, Callesen K, Mortensen EL, Gottlieb D, Smith L.
Lillehammer College, Norway. nils.kaland@hil.no
BACKGROUND: The aim of the present study was to assess the ability of children
and adolescents with Asperger syndrome (AS) (N = 21) to infer physical versus
mental states on a new 'advanced' test of theory-of-mind - Stories from Everyday
Life. The participants in the AS group were of normal intelligence and were
compared with an age-matched control group (N = 20) of normally developing
children and adolescents. METHOD: The test materials comprised 26 short stories
or 13 pairs of different types of stories. This contextually complex
theory-of-mind battery aimed to record the participants' ability to make
inferences about physical as well as mental states. The first part of each story
described a physical or mechanical event, and a test question then tested the
participants' ability to make an inference about a physical state. The last part
of the stories contained two questions, testing the ability to infer a mental
state from the story context, e.g., understanding social communication such as a
lie, white lie, figure of speech, misunderstanding, double bluff, irony,
persuasion, contrary emotions, forgetting, jealousy, intentions, empathy and
social blunders. The participants' reaction time and number of prompt questions
were also recorded. RESULTS: The participants in the AS group showed
significantly more problems attributing mental state inferences relative to the
control group. They performed considerably better on tasks involving a physical
state, but still did less well than the controls. They had a tendency to
interpret behaviour and utterances literally, without regard to context, and to
choose a physical explanation when a mental state answer was more appropriate.
They also needed significantly more prompt questions and used significantly more
time than the controls to solve the tasks, especially those involving mental
state inference. CONCLUSIONS: This study supports earlier findings that
individuals with AS/HFA have difficulties attributing mental states in context,
but seem to have significantly fewer difficulties inferring physical states. The
fact that the clinical group also used significant longer reaction time and
needed significantly more prompt questions to solve the tasks relative to the
control group may also be related to their problems in understanding mental
states. However, the possibility remains that these difficulties could represent
a separate factor - or a distinct 'cognitive style'- suggesting that at least
some individuals with AS may be generally slow in solving cognitive tasks.
PMID: 12030597 [PubMed - indexed for MEDLINE]
32: Psychol Med. 2000 Sep;30(5):1169-87.
Linguistic processing in high-functioning adults with autism or Asperger's
syndrome. Is global coherence impaired?
Jolliffe T, Baron-Cohen S.
Department of Experimental Psychology, University of Cambridge.
BACKGROUND: Linguistic processing was explored in normally intelligent adults
with either autism or Asperger's syndrome, to test if global coherence was
impaired. Global coherence is the ability to establish causal connections and
interrelate local chunks into higher-order chunks so that most linguistic
elements are linked together thematically. Since individuals with autism are
hypothesized to have weak central coherence then one would predict that the
clinical groups would have difficulty integrating information globally so as to
derive full meaning. METHODS: Two experiments were designed to test global
coherence. Experiment 1 investigated whether individuals on the autism spectrum
condition could arrange sentences coherently. Experiment 2 investigated whether
they were less able to use context to make a global inference. RESULTS: The
clinical groups were less able to arrange sentences coherently and use context
to make a global inference. CONCLUSIONS: The results suggest that individuals on
the autism spectrum have impaired global coherence. Arranging sentences and
making global inferences correlated highly, suggesting that central coherence
may be a unitary force in these different tasks. Of the two clinical groups, the
autism group had the greater deficit. The effect that such a deficit would have
on one's daily life is discussed, along with possible explanations for the
clinical groups' greater difficulty, and suggestions for future research.
PMID: 12027052 [PubMed - indexed for MEDLINE]
