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The following extracts are from research
studies published in scientific journals. They are a personal selection
but have been chosen because the results and discussion have important
implications for parents and professionals. The brief quotations must
be considered within the context of the complete article but the reader
is provided with the reference for more information. Some of the studies
have included subjects with autism, High Functioning Autism or PDD-NOS
rather than Asperger’s Syndrome but the results may be applicable
to those with Asperger’s Syndrome.
A complete listing of the extract
titles are below. This page contains the most recent extracts.
You may choose to view an extract by clicking on its title or by continuing
to scroll down the page. The remainder of the extracts are now
seven pages beginning with the page titled Archives
- Research Reports.
I am planning a section on Current
Research Studies. If you are conducting research into Asperger’s
Syndrome and would like information on your study posted on the web page,
send me the details. This can be a useful way to identify similar investigations
and contact other researchers during the design of the study and analysis
of the results. This is for both undergraduate and postgraduate research.
There will also be a section
entitled Aspects of Asperger’s Syndrome. That is designed
to suggest interesting topics for future research. If you have noticed
a characteristic or association that should be investigated or a strategy
that should be evaluated, let me know. I will post the suggestion
to notify academics and clinicians and to determine whether anyone can
provide further information or confirmation.
Narrative Ability
in High-Functioning Children with Autism or Asperger's Syndrome
The Comprehension
of Humorous Materials by Adolescents with High-Functioning Autism and
Asperger's Syndrome
Further Evidence of
Preserved Priming and Impaired Recall in Adults with Asperger's Syndrome
Enhanced Salience and
Emotion Recognition in Autism: A PET Study Hall
Evidence
of Brain Overgrowth in the First Year of Life in Autism
Adults
With Asperger Disorder Misdiagnosed as Schizophrenic
Peer
Interaction and Loneliness in High-Functioning Children with Autism
The
Friendship Questionnaire: An Investigation of Adults with Asperger Syndrome
or High-Functioning Autism, and Normal Sex Differences
Validation
of the Child and Adolescent Perception Measure
Asperger's Disorder:
a case report of repeated stealing and the collecting behaviours of an
adolescent patient
Advancing Advanced
Mind-reading Tests: Empathic Accuracy in Adults with a Pervasive Developmental
Disorder
Brain Anatomy and Sensorimotor
Gating in Asperger's Syndrome
Autism, Asperger Syndrome
and Brain Mechanisms for the Attribution of Mental States to Animated
Shapes
Defining the Broader
Phenotype of Autism: Genetic, Brain, and Behavioural Perspectives
A
Clinical and Neurobehavioural Review of High-Functioning Autism and Asperger's
Disorder
Asperger
Syndrome: A Proton Magnetic Resonance Spectroscopy Study of the Brain
Middle-Class Mother's
Perceptions of Peer and Sibling Victimization among Children with Asperger's
Syndrome and Non-Verbal Learning Disorders
Computer Mediated Interaction
in Asperger's Syndrome: the Bubble Dialogue Program
Treating a child with
Asperger's Disorder and Comorbid Bipolar Disorder
Attributional
Style and Depression in Adolescents with Asperger Syndrome
Autistic
Traits in the General Population
Autism,
Regression, and the Broader Autism Phenotype
Deficient
auditory processing in Children with Asperger Syndrome, as indexed by
event-related Potentials
Impaired
Olfactory Identification in Asperger's Syndrome
Impaired
Mirror-Image Imitation in Asperger and High-Functioning Autistic Subjects
The
use of Social Stories as a preventative Behavioural Intervention in a
home Setting with a Child with Autism
Changes
in Cerebral Blood Flow in Asperger Syndrome during Theory of Mind Tasks
Ten-Year
Follow Up of Adolescent Onset Anorexia Nervosa: Personality Disorders
Comorbidity and
Asperger's Syndrome
Asperger
Syndrome: A Proton Magnetic Resonance Spectroscopy Study of Brain
Case-Control
Family Study of Lesser Variant Traits in Autism
Asperger Syndrome
and Sensory Processing: A Conceptual Model and Guidance for Intervention
Planning
Asperger
Syndrome and the Development of Social Competence
An
Update on Neurocognitive Profiles in Asperger Syndrome and High-Functioning
Autism
Asperger
Syndrome or Autistic Disorder?
Asperger
Syndrome: An Overview of Characteristics
Asperger
Syndrome: Associated Psychiatric and Medical Conditions
Stability
and Change Among High-Functioning Children with Pervasive Developmental
Disorders: A 2-Year Outcome Study
A Retrospective
Analysis of the Clinical Case Records of Autistic Psychopaths Diagnosed
by Hans Asperger and his Team at the University
Children's Hospital, Vienna K. Hippler and C. Klicpera, Phil. Trans. R.
Soc. London, B (2003) 358, Pages 291 - 301.
To date, it is questionable whether the diagnostic criteria
for Asperger's Syndrome (AS) as stated by ICD-10 or DSM-IV still reflect
Asperger's original account of 'autistic psychopathy' (AP) from the 1940's.
The present study examined 74 clinical case records of children with AP
diagnosed by Hans Asperger and his team at the Vienna Children's Clinic
and Asperger's private practice between 1950 and 1986. The characteristic
features of the children are outlined, including reasons for referral,
parental background, behavioural problems, cognitive functioning, communication
and interests. Results show that the patients of Asperger described in
our study represent a subgroup of children with very high intellectual
functioning, specific circumscribed interests and talents but impaired
social, communication and motor skills. Sixty-eight per cent of the sample
met ICD-10 criteria for AS, while 25% fulfilled the diagnostic for autism.
Implications for the diagnosis of AS are discussed.
Asperger (1944, 1952) believed that AP was a constitutionally
based personality disorder merging into the 'normal' continuum, that is,
a group of eccentric, withdrawn, but often highly gifted, individuals
who manage social integration despite their somewhat odd social interaction
or communication. He saw AP as a life-long, stable type of personality
without the quality of a progressing fragmentation of personality typically
seen in schizophrenia. Also, he stated that it was possible for 'autistic
psychopaths' to form certain close interpersonal relationships in the
course of their life while schizophrenia psychotic individuals were more
likely to lose their ability to form close relationships over time. Wing
observed some additional items in the developmental history of children
with AS (e.g. a lack of interest or pleasure in human company in the first
year of their life) and pointed out that AP may also occur in individuals
with learning disabilities. This was, in fact, mentioned by Hans Asperger
in his 1944 paper but seems to have been overlooked by researchers and
even Asperger himself in his later papers.
In contrast to DSM-IV and ICD-10, the criteria of Gillberg
& Gillberg (1989) and those of Szatmari at al. (1989) do not require
'normal' early development for a diagnosis of AS to be made, and view
language and communication peculiarities as a defining feature. Additionally,
Gillberg & Gillberg proposed that motor control problems (poor performance
on a neurodevelopmental examination) have to be present. In the German
language, 'psychopathy' did not quite have the negative connotation it
now has in English. It was merely a term for describing personality disorders
and did not seek to stress the patients' proneness to criminality. What
Asperger called 'autistic malice' was observed in seven patients (15%);
these children were described as seemingly good observers, showing intentional
acts of malice, with malicious pleasure and apparent pride in what they
had done. Some of the children were said to 'experiment' on others, that
is, they seemed to do things on purpose to see how others reacted or to
provoke a certain reaction. Eight children (17%) were reported as being
hypersensitive towards criticism and jokes by others. For nine patients
(20%) sensory deviancies were so striking that they were mentioned in
the files (e.g. hypersensitivity to certain noises, obsession with smells).
For 38 cases, measured VIQ and PIQ could be compared. VIQ and PIQ were
rated as discrepant if a 9-point difference or higher could be observed
between the two measures. Applying this rule, 48% showed a higher VIQ
than PIQ, whereas 18% demonstrated the opposite pattern. For 38%, VIQ
and PIQ measures showed no significant differences.
Special gift and abilities
Nineteen per cent of the 46 children with detailed files
were reported as being capable of original, sometimes even philosophical,
thinking processes. Fourteen per cent were said to have a special gift
for abstract thinking and logical reasoning. A special insight into themselves
(self-reflection and conciseness) was reported for another 17%. These
children were described as being capable of looking at themselves from
an outside or dispassionate view, but Asperger often mentioned that they
did not draw conclusions from these insights and could not use them in
the social context (i.e. see themselves through the eyes of others and
behave accordingly). An outstanding mathematical talent was reported in
23%. Some children were said to invent their own calculation methods that
were highly complicated but did not always lead to correct results. Other
abilities mentioned included eidetic memory (14%) and musical or artistic
talent (12%).
The most common profession among the fathers of children
with AP was technical professions, which is significantly different from
the control group. The most frequently seen profession for fathers in
our sample group was engineer or electrical engineer. In 32 files, a short
description of the impression the staff had of the parent's personality
was available. Some resemblance between the child with AP and one or more
family members was observed in 53% of the sample. Fourteen fathers (52%)
were reported as being similar to their child in personality (e.g. aloof,
odd, nervous) showing deviant behaviours or low social competence. Additionally,
for four mothers (15%) and two siblings (7%) similarities with the presented
child were mentioned. Information about the mother's pregnancy, the child's
birth and his/her early development was available for the 46 cases with
detailed files from the ward. Twenty-eight percent of the mothers had
had difficulties during pregnancy, including bleeding, infection, or extreme
nausea. In 33% of the cases, difficulties during the birth were reported.
Twenty-six percent of the children were late in being potty trained, or
had phases of enureses or soiling during their early childhood. Only 11%
were reported s having been delayed in their motor development. By contrast,
20% of the children showed language delay (first words after 2 years).
It was mentioned that seven children (15%) started to talk quite unexpectedly,
that is, they did not talk at all until a certain age and were then suddenly
capable of saying a number of words or even whole sentences. Four of these
cases had been significantly delayed in saying their first words (2 years
or more) but then rapidly developed a good use of phrases before the age
of three.
The greatest behavioural difficulty of the 46 children
admitted to the ward consisted of lack of integration into the peer group.
Over 90% were reported as having severe deficits in this area. For the
great majority, these problems consisted of a combination of being 'out
of the group', having no friends, being ignored, disliked, or bullied
by the others. It was not so much that they were not interested in their
peers but rather that they approached them in an inappropriate way or
that their unpredictable behaviour (i.e. aggressive outbursts) made them
unpopular with the others. Three-quarters of the children were described
as being clumsy during their stay on the ward (i.e. it was mentioned in
their files that they showed impaired fine and gross motor skills, poor
motor co-ordination or difficulty in participating in sports and games)
although not all of them received a diagnosis of apraxia. Other frequently
seen problems concerned the children's difficulty in finishing school
work. They were reported as being too slow, too pedantic, or too careless
because they were preoccupied with other things (i.e. their special interests)
or had major attention deficits. Asperger often regarded the children
as being 'distracted from within/or by themselves'. Furthermore, half
of the children displayed disciplinary problems, negativism or conduct
difficulties, particularly at school; they did not listen to what the
teacher said or only followed their own 'spontaneous' idiosyncratic ideas.
They were described as disrespectful towards authority, and could come
across as being impudent and blunt because they would speak out freely
without thinking while being quite unaware of the situation or the status
of the person to whom they were talking. Sometimes disciplinary problems
went so far that s/he had to be expelled from school or excluded from
PE lessons (20%).
Eighty-two percent were reported as having special,
original and narrow interests and hobbies. Asperger and his team often
described these interests as highly scientific and distinctive, while
other interests were rather obscure or atypical for children that age
(e.g. eye muscles, rubbish bins, earthworms, religious hymns, gangsters).
Ninety-five percent of the admitted patients displayed some kind of language
and communication deviancies that can be regarded as typical for AS. Asperger
considered the 'autistic psychopath's' language peculiarities as one of
the most dominant characteristics of the disorder. For many children,
deviant prosody and quality of voice was reported (e.g. monotonous speech,
singing quality of the voice, high pitched tone, over precise articulation).
The children were frequently regarded as ignorant of the social situation
when speaking, and sometimes seemed to talk to themselves, commenting
on their own actions or giving monologues without needing a listener.
Facial expression was regarded as limited or different
in 80% of the additional children. More than one-third of these children
lacked emotional expression; 13% seemed tense; 17% had facial twitches/tics
or an unnatural expression (e.g. permanent smile or grin); 17 % appeared
usually serious and not child-like in their facial expression. In order
to determine whether Asperger's patients would fit the diagnostic criteria
for Asperger's disorder today, 44 children with AP were analysed according
to ICD-10 research criteria (World Health Organization 1993) The results
show that 68% of the children would be diagnosed with AS according to
current ICD-10 criteria. Twenty-five percent of the children (n=11) did
not meet the requirement of normal development before the age of three.
After systematically analysing 74 descriptions of 'autistic psychopaths'
delineated by Asperger and his team from 1950 to 1986, we hope that a
somewhat clearer picture of what Asperger meant may arise.
Only 5% of the analysed cases were females. Typically,
the children were first referred in middle childhood (mean age 8 years).
The children were described with several diagnostic labels, most commonly
'contact and instinct disorder', i.e. a combination of low social competence
and a lack of instinctive knowledge about how to solve everyday problems
or how to behave appropriately in a variety of situations. The most dominant
behavioural difficulty of the children consisted of lack of integration
into the peer group. The children seemed to others to be isolated and
were often ignored, bullied or disliked by their classmates. The ability
to concentrate on schoolwork was usually poor, and disciplinary problems
and conduct disorder were seen in half of the children in the sample.
Usually, typical pedagogical measures proved to have no effect on the
child's behaviour, but rather made it worse. Over 80% of the children
had special interests, most of which consisted of a fascination for certain
animals and aspects of nature or were a technical kind.
Although, in the present sample, early motor development
was not found to be delayed very often, 59% had an additional diagnosis
of motor apraxia, almost three quarters showed motor clumsiness during
their stay on the ward and another third displayed awkward or gauche body
language and gait. Both language deviancies and motor clumsiness, however,
seemed crucial for a diagnosis of AP in the present sample. However, ICD-10
criteria appeared too narrow, as 25% of the children examined (some of
which were described as 'classic autistic psychopaths') did not fit the
diagnosis due to early developmental delays, mostly regarding language.
The authors would therefore agree with the point of view of Wing (2000)
that AS cannot be clearly distinguished from autism but may still be clinically
useful for a diagnostic category. In any case, current ICD-10 and DSM-IV
criteria for AS do not quite capture the individuals originally described
by Asperger and his team. They appear to differentiate AS from autism
solely based on the onset criteria, regardless of the patient's social
impairment later in life. In particular, motor and social clumsiness as
well as speech and communication deviancies should be taken into consideration
in further discussion of diagnostic criteria for AS.
Back to Contents
Narrative
Ability in High-Functioning Children with Autism or Asperger's Syndrome
M. Losh and L. Capps, Journal of Autism and Developmental Disorders, Volume
33, No.3, June 2003.
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 casual 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.
Back to Contents
The Comprehension
of Humorous Materials by Adolescents with High-Functioning Autism and
Asperger's Syndrome
David M. Emerich, Nancy A. Creaghead, Sandra M. Grether, Donna Murray
and Carol Grasha, Journal of Autism and Developmental Disorders, Volume
33, No.3, June 2003.
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 humour 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.
Why are complex forms of humour challenging for individuals
with autism? Most research has emphasized that individuals with autism
have an impairment of coherence, including difficulties in integrating
content across narratives and discourse (Ozonoff & Miller, 1996).
This explains some of the responses of individuals with autism when asked
to pick humorous endings to jokes. Non sequitur endings or incorrect endings
that are unrelated to the content of the joke were preferred by adults
with high-functioning autism (Ozonoff & Miller, 1996). In particular,
individuals with autism seem to enjoy slapstick comedy (Ricks & Wing,
1975) and often incorrectly choose humorous non sequitur endings (Ozonoff
& Miller, 1996). However, Ozonoff and Miller (1996) also discovered
that subjects with autism picked straightforward endings that did not
make a joke humorous. This implies that adults with high-functioning autism
may not achieve a feeling of surprise if and when they understand the
punch line. If they do achieve a feeling of surprise, it may not be converted
to one of humour. Previous research on adults with high-functioning autism
has indicated that some impairment exists in their use and comprehension
of humour. The goal of this study was to investigate the ability of adolescents
with Asperger's Syndrome or high-functioning autism and age-matched typical
adolescents to comprehend humorous materials. This research focused on
the ability to pick humorous endings to jokes and cartoons.
Back to Contents
Further Evidence
of Preserved Priming and Impaired Recall in Adults with Asperger's Syndrome
John M. Gardiner, Dermot M. Bowler, and Sarah J. Grice, Journal of Autism
and Developmental Disorders, Volume 33, No.3, June 2003.
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 familiar 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.
Back to Contents
Enhanced
Salience and Emotion Recognition in Autism: A PET Study Hall,
Geoffrey B.C. PhD, Szechtman, Henry Ph.D., Nahmias, Claude PhD, American
Journal Psychiatry, Volume 160 (8), August 2003, Pages 1439 - 1441.
This study examined neural activation of facial stimuli
in autism when the salience of emotional cues was increased by prosodic
information. Regional cerebral blood flow (rCBF) was measured while eight
high-functioning men with autism and eight men without autism performed
an emotion-recognition task in which facial emotion stimuli were matched
with prosodic voices and a baseline gender-recognition task.
Emotion processing in autistic subjects, compared to
that in comparison subjects, resulted in lower rCBF in the inferior frontal
and fusiform areas and higher rCBF in the right anterior temporal pole,
the anterior cingulate, and the thalamus. Even with the enhanced emotional
salience of facial stimuli, adults with autism showed lower activity in
the fusiform cortex and differed from the comparison subjects in activation
of other brain regions. The authors suggested that the recognition of
emotion by adults with autism is achieved through recruitment of brain
regions concerned with allocation of attention, sensory gating, the referencing
of perceptual knowledge, and categorization.
Back to Contents
Evidence
of Brain Overgrowth in the First Year of Life in Autism
Eric Courchesne, PhD, Ruth Carper, PhD, and Natacha Akshoomoff, PhD. JAMA,
July 16, 2003 - Vol 290, No. 3.
The clinical onset of autism appears to be preceded
by 2 phases of brain growth abnormality: a reduced head size at birth
and a sudden and excessive increase in head size between 1 to 2 months
and 6 to 14 months. Abnormally accelerated rate of growth may serve as
an early warning signal of risk for autism.
Back to Contents
Adults
With Asperger Disorder Misdiagnosed as Schizophrenic
Lawrence Perlman, Professional Psychology: Research and Practice, 2000,
Vol 31, No. 2, 221-225.
Psychologists have a prominent role in the diagnosis
and treatment of developmental disorders. With the inclusion of Asperger
disorder in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders,
4th Edition: American Psychiatric Association, 1994), there is an explosion
of interest in mild autistic disorders. This syndrome, which is characterized
by problems in interpersonal relatedness, empathetic communication, and
imagination, has only recently become known in this country. Practicing
psychologists may encounter adult psychiatric patients who have erroneously
been diagnosed as having chronic schizophrenia when a careful examination
and history would reveal that they have lifelong deficit conditions within
the autistic spectrum. Opportunities are available for psychologists to
contribute to the proper diagnosis and treatment of these individuals.
Some case illustrations and suggestions for the role of psychologists
in providing more appropriate treatment of these individuals is provided.
Many psychologists have encountered patients diagnosed
with chronic undifferentiated schizophrenia who do not properly fit the
criteria for this disorder. Working in a day program for chronic psychiatric
patients, I met several such individuals. They had the appearance of people
with the negative symptoms of schizophrenia, for example, social withdrawal,
apathy, lack of ambition, and communication difficulties. Yet their way
of relating was curiously unlike that of the other schizophrenic patients.
Their histories revealed a lifelong pattern of relational problems, without
psychotic episodes or acute exacerbations. Furthermore, several of them
did not take neuroleptic medications. Individuals who were not diagnosed
with pervasive developmental disorders in childhood may subsequently be
misdiagnosed as chronic, undifferentiated schizophrenics.
Individuals with Asperger disorder grow up experiencing
the world in a quite different way from the rest of us. They are consistently
handicapped in those developmental tasks that require affective attunement
and social relatedness. Over the years, they often become aware of their
differentness and develop defences against feelings of social isolation.
Thus, secondary withdrawal and depression are commonly seen. These symptoms
are well suited to psychological interventions. Accurate differential
diagnosis is important because the more passive, high-functioning autistic
people can easily be overlooked in an institutional setting. Maintenance
on neuroleptic medication may be unnecessary for these patients because
they do not manifest acute, positive symptoms and do not suffer from a
deteriorative condition. It is fruitless to try to remove symptoms that
are, in effect, their baseline functioning. On the other hand, they may
experience tremendous anxiety in response to stress, which eventuates
in their internal fantasy life spilling over into reality.
Back to Contents
Use
of a Social Story Intervention to Improve Mealtime Skills of an Adolescent
with Asperger Syndrome
R Bledsoe, Smith-Myles, B and Simpson, R.L., Autism, Volume 7, (3), Pages
289-295.
This study assessed the utility of a Social Story intervention
to improve the lunchtime eating behaviours of an adolescent diagnosed
with Asperger's Syndrome. Using an ABAB design, the Social Story program
appeared to result in a decrease in the number of food and drink spills
and an increase in the frequency of appropriate mouthwiping during lunch
at school.
Back to Contents
Peer
Interaction and Loneliness in High-Functioning Children with Autism
N. Bauminger, C. Shulman and G. Agam, Journal of Autism and Developmental
Disorders, Volume 33, No 5, October 2003, 489 - 507.
Social interaction with peers and the understanding
and feelings of loneliness were examined in 18 high-functioning children
with autism and 17 typically developing children matched for IQ, chronological
age, gender, and maternal education. Observations were conducted on children's
spontaneous social initiations and responses to their peers in natural
settings such as recess and snack time, and children reported on their
understanding and feelings of loneliness and social interaction. Overall,
children with autism revealed a good understanding of both social interaction
and loneliness, and they demonstrated a high level of social initiation.
However, they spent only half the time in social interactions with peers
compared to with their matched counterparts, and they interacted more
often with a typically developing child than with another special education
child. Despite the intergroup differences in frequency of interaction,
a similar distribution of interactions emerged for both groups, who presented
mostly positive social behaviours, fewer low-level behaviours, and very
infrequent negative behaviours. Children with autism reported higher degrees
of loneliness than their typical age-mates, as well as lower association
between social interaction and loneliness, suggesting their poorer understanding
of the relations between loneliness and social interaction. Research and
practice implications of these findings are discussed.
Several findings are of particular interest regarding
differences found between the children with autism and their typically
developing peers. Indeed, as expected, children with typical development
revealed a higher level of participation in peer interaction (both initiations
and responses) compared with high-functioning children with autism, both
in the general categories of social interaction (positive, negative and
low-level) and in most of the specific social behaviours in each general
category. However, the distribution of social interaction behaviours was
identical for the two groups, whereby the majority of behaviours were
positive (eye contact, sharing, social communication); second were low-level
interactions (mostly looking, functional communication, and close proximity);
and last, very few negative behaviours (such as physical or verbal aggressiveness)
were noted in either group. This profile corroborates Hauck et al 's (1995)
findings regarding low-functioning children with autism, suggesting that,
similar to the typical children, this profile may universally characterise
autism regardless of functioning level. However, in contrast with the
low-functioning children with Hauck's research, the high-functioning children
in our study were much more socially active with peers.
In this study, high-functioning children with autism
initiated and responded to peers at about half the rate of typical controls,
even during unstructured outdoor recess activity, which is considered
the most challenging social framework for these children. A surprising
finding was the relatively high rate of social initiations revealed by
the children with autism in this study. Loneliness is a strong social
motivation-actually the strongest drive in typically developing children
to initiate or to take part in social relationships and interactions with
peers. This study probed whether children with autism would be able to
understand the complexity of loneliness, including its more emotional
aspect of closeness and affective ties. Surprisingly, these children were
as good as their typically developing counterparts in understanding that
a close friend might protect them from loneliness and that the presence
of many people without a close friend would not protect them from lonely
feelings.
In terms of social versus emotional nature of loneliness
feelings, contrary to our expectations, children with autism in this study
reported themselves to be lonelier compared with typically developing
children on both the emotional and social dimension of loneliness. The
dual roots of these children's loneliness hold implications for conceptualising
the social/emotional deficit in autism.
We would like to conclude the study with an emphasis
on several of its implications, both for research and practice. The lower
frequency and quality of social interaction, combined with the higher
reported loneliness in high-functioning children with autism as compared
with typical controls, may indicate that these children would like to
take part in more satisfying social interactions - but probably do not
have the knowledge of how to do so. Furthermore, the poor associations
between a good understanding both of peer interaction and of loneliness
with the actual manifestations of social interactions with peers found
for the children with autism may suggest that these children lack an intersubjective
understanding of social relationships and interactions with peers.
Back to Contents
The
Friendship Questionnaire: An Investigation of Adults with Asperger Syndrome
or High-Functioning Autism, and Normal Sex Differences
S. Baron Cohen and S. Wheelwright, Journal of Autism and Developmental
Disorders, Volume 33, No 5, October 2003, 509 - 517.
Friendship is an important part of normal social functioning,
yet there are precious few instruments for measuring the individual differences
in this domain. In this article, we report a new self-report questionnaire,
the Friendship Questionnaire (FQ), for use with adults of normal intelligence.
A high score on the FQ is achieved by the respondent reporting that they
enjoy close, empathetic, supportive, caring friendships that are important
to them; that they like and are interested in people; and that they enjoy
interacting with others for its own sake. The FQ has a maximum score of
135 and a minimum of zero. In study 1, we carried out a study of n = 76
(27 males and 49 females) adults from a general population, to test for
previously reported sex differences in friendships. This confirmed that
women scored significantly higher than men. In study 2, we employed the
FQ with n + 68 adults (51 males, 17 females) with Asperger Syndrome or
high-functioning autism to test the theory that autism is an extreme form
of the male brain. The adults with Asperger Syndrome or high-functioning
autism scored significantly lower on the FQ than both male and female
controls from study 1. The FQ thus reveals both a sex difference in the
style of friendship in the general population, and provides support for
the extreme male brain theory of autism.
The FQ was designed to be short, easy to use, and easy
to score. It is shown in the Appendix. The FQ comprises 35 questions,
on 27 of which it is possible to score. The maximum score for each item
on the FQ is 5 points, with fewer points also available for some items.
In the general population, women scored significantly higher than men
(study 1), the results replicating the findings from previous observational
studies concerning the differences in friendships experienced by men and
women.
Back to Contents
Validation
of the Child and Adolescent Perception Measure
C. Koning and J. Magill-Evans, The Occupational Therapy Journal of Research,
Winter 2001; 21, 1, Pages 49 - 67.
The Child and Adolescent Social Perception Measure (CASP)
was developed to assess children's ability to identify the emotions of
others based on non-verbal cues. Adolescent boys with social skills deficits
consistent with the diagnosis of Asperger's Syndrome were compared to
controls matched on age and intelligence quotient (IQ). Significant differences
were found between groups on CASP scores. Correlations between CASP scores
and general social skills scores were moderate and positive; lower significant
correlations were found with language scores; and significant negative
correlations were found with problem behaviour scores. Validility for
the CASP was demonstrated by the measure's ability to distinguish differences
between groups and by correlations between scores on the CASP and scores
on constructs related to social perception. Implications for occupational
therapy assessment and treatment of social skill deficits are discussed.
A new measure of social perception, the Child and Adolescent
Social Perception has attempted to overcome the limitations of other measures
of social perception in children by examining social perception through
use of videotaped scenes where nonverbal cues must be interpreted from
many channels to understand what is happening.
The CASP (Magill-Evans et al., 1995) consists of 10-videotaped
scenes depicting situations that children and adolescents frequently encounter.
The sound has been audio filtered so that verbal content is unintelligible,
but tone and rate of speech are still evident. The student must rely on
nonverbal and situational cues understand the scene. Each scene contains
two to five actors and lasts 19 to 40 seconds. After each scene the student
identifies the emotions portrayed by each of the characters. Using the
labels identified by the student, the examiner asks the student which
cues he or she used to identify the emotions.
Back to Contents
Asperger's
Disorder: a case report of repeated stealing and the collecting behaviours
of an adolescent patient
P.S. Chen, S.J. Chen, Y.K. Yang, T.L. Yeh, C.C. Chen and H.Y. Lo, Acta
Psychitatrica Scandinavica, 2003; 107; 73 - 76.
The case and treatment of a 21-year-old male patient
is described. 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.
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 misdiagnosing them as having schizophrenia disorders
or other similar disorders. He repeatedly committed theft after he learned
how to teal from his elder classmates when he was 17 years old. He even
collected objects such as paper, boxes, cups and plastic bags. The objects
he had stolen or collected were hoarded in his living room. He was easily
annoyed if others touched his collections. His explanation for the stealing
was self-centred, showing limited understanding of its consequences and
little empathy for the distress he might have caused. He admitted that
he enjoyed stealing. He obviously did have a conduct problem. However,
he had no other behaviour usually associated with the diagnosis of conduct
disorder, his presentation did not meet the diagnostic criteria for a
secondary diagnosis of conduct disorder.
Back to Contents
Advancing
Advanced Mind-reading Tests: Empathic Accuracy in Adults with a Pervasive
Developmental Disorder
H. Roeyers, A. Buysse, K. Ponnet and B. Pichal, Journal of Child Psychology,
Volume 42, No 2, pp 27- 278, 2001.
Research using advanced but static mind-reading tests
with high-functioning adults with a pervasive developmental disorder (PDD)
provided evidence for subtle social cognitive deficits. In the present
study, adults with PDD were unimpaired on such tasks, relative to individually
matched normal controls. Significant differences between the two groups
were, however, found on a more naturalistic empathic accuracy task developed
for this study. Participants viewed two videotaped interactions that both
depicted a male and female stranger having an initial conversation and
were asked to infer the unexpressed thoughts and feelings of the four
targets. Subjects with PDD performed significantly worse on the second
video. These findings suggest that the mind-reading deficit of a sub-group
of able adults with PDD may only be apparent when a sufficiently complex
naturalistic assessment method is being used.
Back to Contents
Brain
Anatomy and Sensorimotor Gating in Asperger's Syndrome
M. Grainne and Mc Alonan et al., Brain (2002), 127, 1594 - 1606.
There are few studies on brain anatomy of Asperger's
Syndrome, and no focal anatomical abnormality has been reliably reported
from brain imaging studies of autism, although there is increasing evidence
for differences in limbic circuits. These brain regions are important
in sensorimotor gating, and impaired 'gating' may partly explain the failure
of people with autistic with autistic disorders to inhibit repetitive
thoughts and actions. Thus, we compared brain anatomy and sensorimotor
gating in healthy people with Asperger's Syndrome and controls. We included
21 adults with Asperger's Syndrome and 24 controls. All had normal IQ
and were aged 18 - 49 years. We studied brain anatomy using quantitative
MRI, and sensorimotor gating using prepulse inhibition of startle in a
subset of 12 individuals with Asperger's Syndrome and 14 controls. We
found significant age-related differences in volume of cerebral hemispheres
and caudate nuclei (controls, but not people with Asperger's Syndrome,
had age-related reductions in volume). Also, people with Asperger's Syndrome
had significantly less grey matter in fronto-striatal and cerebellar regions
than controls, and widespread differences in white matter. Moreover, sensorimotor
gating was significantly impaired in Asperger's Syndrome. People with
Asperger's Syndrome most likely have generalised alterations in brain
development, but this is associated with significant differences from
controls in the anatomy and function of specific brain regions implicated
in behaviours characterising the disorder. We hypothesize that Asperger's
Syndrome is associated with abnormalities in fronto-striatal pathways
resulting in defective sensorimotor gating, and consequently characteristic
difficulties inhibiting repetitive thoughts, speech and actions.
We found that, compared with controls, people with Asperger's
Syndrome have age-related differences in brain anatomy, structural abnormalities
in fronto-striatal systems and the cerebellum, and impaired sensorimotor
gating. We suggest that Asperger's Syndrome probably arises from a generalised
abnormality in brain development (causing widespread white matter abnormalities).
This neurodevelopmental abnormality may, in turn, be modulated by environmental
factors such as social isolation. Some regions are more affected than
others, ad our findings support the hypothesis that a proportion of autistic
symptomatology may be explained by frontostriatal disorder.
Back to Contents
Autism,
Asperger Syndrome and Brain Mechanisms for the Attribution of Mental States
to Animated Shapes
F. Castelli, C. Frith, F. Happe and U. Frith, Brain (2002), 125, 1839
- 1849.
Ten able adults with autism or Asperger's 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,
(clashing, 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 temporoparietal 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.
The claim that individuals with autism spectrum disorders,
regardless of general intelligence, have an impairment in the attribution
of mental states, has been confirmed once again. Able individuals with
high-functioning autism or Asperger's Syndrome gave fewer and less accurate
interpretations of animations that elicited mentalizing.
Back to Contents
Defining
the Broader Phenotype of Autism: Genetic, Brain, and Behavioural Perspectives
Geraldine Dawson, Sara Webb, Gerard D. Schellenberg, Stephen Dager, Seth
Friedman, Elizabeth Aylward, and Todd Richards, Development and Psychopathology,
14 (2002), 581 - 611.
In this article, the current state knowledge of the
cognitive neuroscience of social and language impairments in autism is
reviewed. Following from this, six candidate broader phenotype autism
traits are proposed: (a) face processing, including structural encoding
of facial features and face movements, such as eye gaze; (b) social affiliation
or sensitivity to social award, pertaining to the social motivational
impairments found in autism; (c) motor imitation ability, particularly
imitation of body actions; (d) memory, specifically those aspects of memory
mediated by the medial temporal lobe - prefrontol circuits; (e) executive
function, especially planning and flexibility; and (f) Language ability,
particularly those aspects of language that overlap with specific language
impairment, namely, phonological processing.
Back to Contents
A
Clinical and Neurobehavioural Review of High-Functioning Autism and Asperger's
Disorder
N. Rinehart, J.L Bradshaw, A.V. Brereton and B.Tonge, Australian and New
Zealand Journal of Psychiatry 2002, 36: 762 - 770.
This paper reviews past and contemporary conceptualisations
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.
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.
Back to Contents
Asperger
Syndrome: A Proton Magnetic Resonance Spectroscopy Study of the Brain
G. Declan and Murphy et al., Archives of General Psychiatry, October 2002,
59, 885 - 891.
We used in vivo proton magnetic resonance spectroscopy
to examine neutronal 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. Subjects with AS had significantly
higher prefrontal lobe concentration of NAA (x = -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 behaviour
(t = 0.72; P=.02). We found no significant differences in parietal lobe
metabolite concentrations. Subjects with AS have abnormalities in neuronal
integrity of the prefrontal lobe, which is related to severity of clinical
symptoms.
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Middle-Class
Mother's Perceptions of Peer and Sibling Victimization among Children
with Asperger's Syndrome and Non-Verbal Learning Disorders
L, Little, Issues in Comprehensive Paediatric Nursing, 25: 43 - 57, 2002.
This article describes the yearly prevalence and frequency
of peer and sibling victimisation as reported by a large national sample
of middle-class mothers of children with Asperger's Syndrome and nonverbal
learning disorders. An anonymous mailed survey was sent to families solicited
from two national Internet sites for parents of children with Asperger's
and nonverbal learning disorders using the Comprehensive Juvenile Victimisation
scale and three questions designed to measure peer shunning. The overall
prevalence rate reported by mothers of peer victimisation was 94%. Mothers
reported that almost three quarters of their children had been hit by
peers or siblings in the last year and 75% had been emotionally bullied.
On the more severe end of peer victimisation, 10% of the children were
attacked by a gang in the past year and 15% were victims of nonsexual
assaults to the genitals. Peer shunning also was common. A third of the
children had not been invited to a single birthday party in the past year,
and many were eating alone at lunch or were picked last for teams. Peer
shunning was significantly correlated with peer bullying and assault.
The high rates of peer shunning and peer victimisation reported suggest
that children with Asperger's and nonverbal learning disorders may require
further scrutiny and attention concerning their victimisation experiences
by peers and siblings. Implications for nursing professionals are reviewed.
The aim of this study were twofold: one was to explore
and describe preliminary data on mother's perceptions of the prevalence
and frequency of peer victimisation and peer shunning of their children
with AS and NLD. Two, the study was to examine the relationship between
such child characteristics as age, gender, and diagnosis with peer victimisation.
Knowledge resulting from this study may help to expand professional understanding
of the social and structural determinants of peer victimisation in children
with AS and NLD. Family participation was obtained by posting a letter
of invitation to parents on two international Internet web sites for parents
and children with NLD and AS. Of the 728 surveys mailed out, 509 parents
responded, yielding a 70% response rate. Among families who met the eligibility
requirements, a total of 411 surveys were completed by mothers and used
for this data analysis. A total of 411 youth between the ages of 4 and
17 were in the sample, with a mean age of 10.48 years (SD = 3.30). Peer
and sibling victimisation were measured using a scale from the Juvenile
Victimisation Questionnaire (JVQ) (Hamby & Finkelhor, 1999).
Peer victimisation was common. Fully 94% of the mothers
reported that peers had victimised their child in some fashion within
the past year. The most frequently reported method of peer victimisation
was bullying by peers and siblings, reported by 75% of the respondents.
This was followed by peer or sibling assaults (73%). The least reported
type of victimisation, and the most severe, was peer gang attacks, where
10% of the parents reported that their child had been attacked by a gang
of kids in the past year. The overall prevalence rates for peer shunning
show that in the past year, 33% of the sample (35%) respondents reported
that their child had not been invited to a friend's birthday part, 31%
reported that their child was almost always picked last for teams, and
11% reported that their child sat alone at lunchtime everyday. When specific
types of peer victimisation from this study were compared with rates from
two national samples of children, the differences were notable. Peer and
sibling assault was eight times higher for the sample of children with
AS and NLD than for a national sample of youth in a large Internet safety
study. They also were twice as high as a large representative sample of
children in a National Youth Victimisation Project. The rate of gang attacks
was five times higher for children with AS or NLD than the national Internet
sample. Reported bullying rates for the children with AS and NLD were
four times as high as those in the national Internet sample. Finally,
nonsexual genital assaults also were higher for the children with AS and
NLD. Data on age differences and peer victimisation suggest that junior
high school and high school children with AS and NLD are at greater risk
for peer shunning, bullying and gang attacks. This is a time when social
skills are increasingly in demand and become more sophisticated.
Back to Contents
Computer
Mediated Interaction in Asperger's Syndrome: the Bubble Dialogue Program
Gnanathusharan Rajendran and P. Mitchell, Computers and Education, 35,
(2000), 189 - 207.
This paper reports use of a computer application, Bubble
Dialogue, with two primary aims: (1) to assess the experience of computer-mediated
role-taking on the interpersonal understanding, executive abilities and
verbal abilities of two young male adults with Asperger's Syndrome (a
diagnosis given to higher-functioning individuals with autism); (2) to
investigate whether blind raters judged differently between Bubble Dialogue
scripts produced by individuals with Asperger's Syndrome and scripts produced
by individuals with emotional and behavioural difficulties. The results
show that there was no detectable improvement in the interpersonal understanding
of the participants with Asperger's Syndrome, but there was an improvement
in their executive function scores. Additionally, the blind ratings revealed
that only one of the 'Asperger' Bubble Dialogue scripts was different
from the scripts generated by individuals with emotional and behavioural
difficulties. Conceivably, Bubble Dialogue helps to regulate interaction,
such that the social impairments characteristics of Asperger's Syndrome
are less conspicuous. With the aim of assessing and improving interpersonal
understanding in individuals with Asperger's Syndrome, we utilised the
Bubble Dialogue program (Gray, Creighton, McMahon & Cunningham, 1991).
The application creates the experience of role-play in a comic strip world,
in which two users each role-play a character. The users have opportunity,
by clicking on icons, to insert text into a speech Bubble above the head
of their character and then to insert text into a thought Bubble which
subsequently replaces the speech bubble. The Dialogue thus alternates
between the users and each has access to the speech and thoughts generated
by the other.
When using Bubble Dialogue, thoughts (which are normally
private and hidden) become public and visible and so the users have access
to the thoughts of each other's character. The users are literally able
to mindread. If a user plays 'correctly', then their character will not
act upon the knowledge that resides in the private thoughts of the other
user's character.
Back to Contents
Treating
a child with Asperger's Disorder and Comorbid Bipolar Disorder
J Frazier, R. Doyle, S. Chiu, J. Coyle, The American Journal of Psychiatry;
January 2002; 159, 1, Pages 13 - 21.
This report summarises a clinical case conference presented
at McLean Hospital in Belmont, Mass. The presentation was used to inform
clinicians about the occurrence of psychiatric disorders among developmentally
disabled children, with an emphasis on those with Pervasive Developmental
Disorder. It also serves as an illustration of how aggressive and self-injury
can be symptoms of comorbid psychiatric disorders and underscores the
necessity of proper diagnostic formulation in these children. For this
child, the proper diagnosis was not recognised for years. Once he was
diagnosed with comorbid bipolar disorder, appropriate treatment led to
a decrease in problematic behaviours, an improvement in quality of life
for the child, and a decrease in family burden. Bipolar disorder should
be entertained as a possible diagnosis when there is deterioration in
cognition, language, behaviour, or activity; when there is a clear pattern
of fluctuation or cyclicity in activity, behaviour, and interests (with
'good times' and 'bad times'); and when observed behaviour indicates a
mood problem. (As examples of the latter, an increase in crying, self-injury,
sleep disturbances, and social withdrawal, a decrease in activity, and
a loss of interest of in activities of daily living may indicate depression;
an increase in silliness, distractibility, poor judgement, intrusiveness,
laughing, aggression, pressured speech, non-compliance and agitation may
represent symptoms of mania. It is important to emphasise that there are
a limited number of controlled trials regarding the use of psychopharmacological
interventions in this population. Therefore, pharmacological intervention
should be chosen judiciously, and patients should be closely monitored
for symptom improvement and side effects. Given that these patients are
often treated with psychotropic medications, there is a crucial need for
systematic controlled trials to establish both the safety and efficacy
of pharmacological agents in children with Asperger's Disorder and with
developmental disabilities in general.
Abraham had symptoms of an active illness beginning
at an early age. For him, delayed diagnosis and treatment led to 5.5 years
of progressive dysfunction and a worsening of symptoms. His affective
disorder exacerbated the underlying symptoms of Asperger's Disorder. For
example, when he was manic, Abraham became more intrusive and engaged
in more socially inappropriate behaviours; his pedantic speech became
more pressured, he engaged in lengthy monologues, and his obsessionality
became intense. Once comorbid bipolar disorder was diagnosed and appropriate
treatment occurred, Abraham gradually began to recover and his self-injury,
aggression, and intense pressured obsessiveness disappeared.
Back to Contents
Attributional
Style and Depression in Adolescents with Asperger Syndrome
G.P Barnhill and B. Smith-Myles, Journal of Positive Behaviour Interventions,
Volume 3, No 3, Summer 2001, Pages 175 - 182.
Despite research indicating that adolescents with Asperger
Syndrome are prone to depression, there is no research investigating the
attributions of these individuals and the possibility of a learned helplessness
attributional style that may predispose these persons to depression or
to maintain depressive symptoms. This study investigated the relationship
between level of depressive symptoms and general attributional or explanatory
style in 33 adolescents with Asperger Syndrome. Support was found for
the reformulated theory of learned helplessness in adolescents with Asperger
Syndrome. The more depressive symptoms the adolescents reported, the more
adolescents explained negative events by internal, stable, and global
causes. One third of the participants obtained scores on the Children's
Attributional Style Questionnaire composite for positive events that are
considered to be suggestive of a very pessimistic, failure prone style.
However, only 9% of the participants rated themselves as having substantially
more depressive symptoms than peers on the Children's Depression Inventory.
Given that 70% of the participants were taking medication for depression,
these findings may suggest that the medication controlled depressive symptoms
but did not affect the maladaptive attributional style. Findings of the
study are discussed relative to implications for practitioners in designing
positive behaviour interventions.
Suicidal ideation and gestures in children and adolescents
with developmental disabilities, such as Asperger Syndrome and nonverbal
learning disabilities is an understudied phenomenon. Yet research has
indicated that adolescents and young adults with Asperger Syndrome are
prone to depression and anxiety. Likewise, there is an under appreciation
of the presence of developmental disabilities, including Asperger Syndrome,
in individuals who seek assistance for psychiatric difficulties such as
depression and anxiety. In fact, Tantam reported that some older persons
were not diagnosed as having Asperger Syndrome until a serious crisis,
such as a suicide attempt or involvement with the legal system, occurred
and a diagnostician reviewed the individual's developmental history. All
cognitive theories of depression propose that depression is, in part,
the consequence of negative beliefs and maladaptive information processing,
and different theories focus on different aspects of cognition. One cognitive
theory that has been researched extensively is the reformulated learned
helplessness model. Seligman (1975) defined helplessness as "the
physiological state that frequently results when events are uncontrollable".
The individual learns that responding is independent of reinforcement
and comes to believe that action is futile. The reformulated theory of
learned helplessness hypothesises that when people perceive lack of control
and find themselves helpless, they implicitly or explicitly ask why they
are helpless. The casual attributions they make regarding this lack of
control influence whether the helplessness entails self-esteem and generalises
across situations and time. The reformulated learned helplessness theory
proposes the presence of individual differences in attributional styles
and hypothesises that certain attributional styles make an individual
more vulnerable than others to depression. This study was designed to
investigate general attributional or explanatory style and level of depression
in individuals between 12 and 18 years of age who have been diagnosed
with Asperger Syndrome.
The most salient finding of this study was the significant
relationship between attributional style and depression. This was consistent
across IQ and age. Specifically, support was found for the reformulated
theory of learned helplessness with adolescents diagnosed as having Asperger
Syndrome. The participants seemed to blame themselves for a negative event
or outcome, considered the cause to be consistent over time, and also
generalised the cause across situations. Conversely, the fewer depressive
symptoms participants reported, the less they attributed negative events
to internal, stable, and global reasons. In other words, adolescents who
reported the least depressive symptoms also attributed negative events
to more external, unstable, and specific causes. This more adaptive attributional
style suggests that they did not blame themselves for the negative event,
considered the cause to vary over time, and specified the cause to that
particular situation rather than to all situations. The results of this
study point to strong implications for the use of positive behaviour supports
for children and youth with Asperger Syndrome. Specifically, individuals
with this exceptionality require comprehensive interventions that are
designed to have meaningful long-term outcomes with social validity. These
interventions should directly address the issues identified in this study:
perceived lack of control, poor self-esteem, assumption of responsibility
for negative events, an idea that no one specific reason may account for
problems, and hopelessness - the feeling of being doomed for failure.
Researchers have found that reattribution training is
a successful intervention strategy with individuals who displayed a learned
helplessness style related to academic and social failures. Attribution
retraining is a cognitive training approach explicitly designed to change
maladaptive attributions. Several strategies suggested by Williams (1995)
directed at addressing several of the characteristics typical of individuals
with Asperger Syndrome - such as poor concentration, emotional vulnerability,
and academic difficulties - are recommended to assist the individual in
persisting at tasks perceived to be difficult.
Back to Contents
Autistic
Traits in the General Population
J.N Constantino M.D., and R.D. Todd, PhD, MD, Archives of General Psychiatry,
May 2003, 60, 524 - 530.
These data indicate that the social deficits characteristic
of autistic spectrum disorders are common. Given the continuous distribution
of these traits, it may be arbitrary where cut-offs are made between research
designations "affected" vs "unaffected" with a pervasive
developmental disorder. The genes influencing autistic traits appear to
be the same for boys and girls. Lower prevalence (and severity) of autistic
traits in girls maybe the result of increased sensitivity to early environmental
influences that operate to promote social competency.
Back to Contents
Autism,
Regression, and the Broader Autism Phenotype
J. E. Lainhart, S. Ozonoff, H. Coon, L. Krasny, E. Dinh, J. Nice and W.
McMahon, American Journal of Medical Genetics, 113: 231 - 237 (2002).
The broader autism phenotype (BAP) is a subclinical
set of personality and other features that is thought to index familiarity
and/or genetic liability to autism. Eighteen parents of autistic probands
with a history of language regression and 70 parents of autistic probands
without regression were assessed for features of the BAP and compared
with published rates in parents of nonautistic subjects. Parents of probands
with regressive and nonregressive autism demonstrated similar rates of
the BAP (27.8% vs. 32.9%; P = 0.33). The rate of the BAP was significantly
higher in both groups of autism parents than in parents of nonautistic
subjects (P ³ 0.01). Thus, this measure of genetic liability is increased
equally in families with both forms of autism when compared with controls.
Environmental events are therefore unlikely to be the sole cause of regressive
autism in our sample. Environmental events, however, may act in an additive
or "second-hit" fashion in individuals with a genetic vulnerability
to autism. About 20% of children with autism appear to have relatively
normal development during the first 12-24 months of life. This period
of relative normalcy gradually or suddenly ends and is followed by a period
of regression, characterized most prominently by a significant loss of
language skills. Then the full autism "syndrome" soon becomes
evident. If regressive autism is solely caused by environmental events,
such as adverse reactions to vaccines, rates of the BAP in the relatives
of children with regressive autism should be no greater than in the general
population. If environmental events do not independently cause regressive
autism, or if they act as "second-hit" phenomena in children
who already have the genetic liability to autism, rate of the BAP should
be similar in relatives of autistic children with and without regression.
Signs of the BAP in parents were measured using instruments specifically
developed for this purpose: the Modified Personality Assessment Schedule-Revised
(MPAS-R) the Pragmatic Rating Scale (PRS) and the Friendship Interview.
There were two interesting differences between the regressive and nonregressive
autistic probands. The first difference was in head size. In the nonregression
group, there were 10 probands with macrocephaly and 1 proband with microcephaly.
All probands in the regression group were normocephalic. The second interesting
difference between the regressive and nonregressive autism probands was
in dysmorphology. All of the regression subjects were classified as nondysmorphic.
Because the rates of the macrocephaly and dysmorphology were both increased
in the nonregression group, we explored the relationship between them.
The rate of autistic subjects who were equivocally in the subjects with
macrocephaly, compared with the subjects who were normocephalic. Further,
liability to autism, as measured by the BAP, is increased to the same
degree in the parents of children with regressive and nonregressive autism.
Environmental events are therefore unlikely to be a sole cause of regressive
autism in our sample. Our data cannot rule out that environmental events
may act in an additive or "second-hit" fashion in individuals
with a genetic vulnerability to autism. We have observed that the BAP
is often associated with functional impairment, particularly affected
social relationships with other at home and at work. Though our clinical
observation needs to be further systematically tested, it seems that when
features of the BAP, as measured in this study, occur in combination,
they may make it difficult for at least some individuals to achieve a
professional level commensurate with their IQ.
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Deficient
auditory processing in Children with Asperger Syndrome, as indexed by
event-related Potentials
E. Jansson-Verkasalo, R. Ceponiene, M. Kielinen, K. Suominen, V. Jantti,
S. Liisa Linna, I. Moilanen, R. Naatanen, Neuroscience Letters, 338 (2003),
197 - 200.
Asperger Syndrome (AS) is characterised 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 ERP'S, 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.
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Impaired
Olfactory Identification in Asperger's Syndrome
Y. Suzuki, H.D. Critchley, A. Rowe, P. Howlin, and D. G.M. Murphy, The
Journal of Neuropsychiatry and Clinical Neurosciences; Winter 2003; 15,
1, 105 - 107.
The authors measured odor detection threshold and odor
identification in 12 males with Asperger's Syndrome and 12 matched control
subjects. Relative to control subjects, Asperger's Syndrome subjects were
not impaired at odor detection but were significantly impaired at olfactory
identification. We report normal odor detection, but impaired olfactory
identification, in people with AS. Medial temporal lobe structures are
implicated in odor detection, whereas orbitofrontal cortex is implicated
in olfactory identification, therefore, our results suggest that AS is
associated with orbitofrontal, but not medial temporal lobe, dysfunction.
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Impaired
Mirror-Image Imitation in Asperger and High-Functioning Autistic Subjects
S. Avikainen, A. Wohlsclager, S. Liuhanen, R. Hanninen and R.
Hari, Current Biology, Volume 13, February 2003, Pages 339 - 341.
Imitation is crucial for proper development of social
and communicative skills. Here, we argue that, based on an error analysis
of a behavioural imitation task, adult Asperger and high-functioning autistic
subjects suffer from 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 blue 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 subjects right hand corresponding to
the experimenter's right hand) for imitation or to imitate as if looking
in a mirror (e.g. the subjects left hand corresponding to the experimenter's
right hand). When people normally view other people's face-to-face, they
prefer to imitate as in a mirror and observation of mirror-image-like
movements speeds up performance in nominated 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.
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The
use of Social Stories as a preventative Behavioural Intervention in a
home Setting with a Child with Autism
P. A. Lorimer, R. Simpson, B. Smith-Myles an Jennifer B. Ganz, Journal
of Positive Behaviour Interventions, Winter 2002, Volume 4, Pages 53 -
60.
The purpose of this study was to determine the efficacy
of a social story intervention implemented in a home setting to decrease
precursors to tantrum behaviour in a 5-year-old boy with autism. Using
an ABAB design, two social stories were presented and withdrawn while
using an event recording procedure in which interrupting verbalisations,
determined to be precursors to tantrum behaviour, were tallied. Data revealed
a decrease in interrupting verbalisations and tantrums when the social
stories were available and an increase in these behaviours when the social
stories were withdrawn.
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Changes
in Cerebral Blood Flow in Asperger Syndrome during Theory of Mind Tasks
Presented by the Auditory Route T. Nieminen-Von Wendt, L. Metsahonkala,
S. Aalto, T. Autti, R. Vanhala and L. Von-Wendt, European Child and Adolescent
Psychiatry, 2003, 12: 178 - 189.
Lack of theory of mind (ToM) has been considered to
be a key feature in Asperger Syndrome (AS). The main aim of the present
study was to determine whether an exclusively auditory input of ToM stories
activated the same brain areas as demonstrated previously using individual
stimuli. Eight right-handed otherwise healthy men with AS and eight healthy
right-handed male controls participated in the PET activation study using
auditory given ToM stories and stories about physical events for induction.
Both subjects with AS and controls showed increased activation in the
occipitotemporal area bilaterally and in thalamus during ToM tasks. Both
groups also showed activation in the medial frontal area during ToM tests.
However, this activation was more intensive and extensive in the control
group, especially when a more sensitive analysis method was used. As a
group, unrelated unrelated to the tasks, the AS subjects showed increased
activation of the cerebellum. It was concluded that the activation pattern
was mainly in agreement with earlier studies using comparable stimuli
administered differently. There was no support for a right hemisphere
specific dysfunction.
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Ten-Year
Follow Up of Adolescent Onset Anorexia Nervosa: Personality Disorders
E. Wentz Nilsson, C. Gillberg, Christopher Gillberg, Carina Gillberg and
M. Rastam, Journal of the American Academy of Child and Adolescent Psychiatry,
November 1999, Volume 38, Issue 11, Pages 1389.
Objective: To study the development of personality disorders,
especially those involving obsessions, compulsions, and social interaction
problems, in a representative group of anorexia nervosa (AN) cases. Method:
The prevalence of personality disorders, obsessive-compulsive disorder,
and autism spectrum disorders at mean age 24 years (10 years after reported
onset) was examined in 51 adolescent-onset AN cases recruited after community
screening and 51 comparison cases matched for age, sex, and school. All
102 cases had originally been examined at age 16 years and followed up
at 21 years. At 24 years, structured and validated psychiatric diagnostic
interviews were performed by a psychiatrist who was blind to original
diagnosis. The majority of AN cases (94%) were weight-restored. Results:
Personality disorders, particularly cluster C, and autism spectrum disorders
were over represented in the AN group. Obsessive-compulsive personality
disorder and/or autism spectrum disorder was diagnosed in a subgroup of
AN cases in all 3 studies. This subgroup had a very poor psychological
outcome.
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Comorbidity
and Asperger's Syndrome
T. Berney and P. Shannon, Inaugural Autism Conference, Melbourne, Australia,
10 - 14th November 2002, European Services for People with Autism (ESPA),
Sunderland, UK.
ESPA has developed a specialist residential college
from the Further Education of People with Asperger's Syndrome. It has
been open for four years and this reviews the high level of comorbidity,
particularly obsessive compulsive and affective disorders, and the relationship
to the person's progress through the college. ESPA is a charity that has
established a variety of community resources for adults with autism that
include two Further Education colleges. One of these is for young people
who are of normal IQ comprising the college itself (Tasker House) and
a residential hall (Westfield Hall). It has been open for four years and
90 students have been to Tasker House of whom 55 have been residential.
Who does well?
(1) Those with a psychiatric disorder where there is acceptance and agreement
to
(a) the diagnosis - openness - reports from all
(b) the plan of management - family support for the plan
(2) Those who are able to cope with the relative autonomy of a
College placement
(3) Those who are confident of their future plan - i.e. the continued
Commitment of their community agencies
(4) Those who want to use the college as an educational placement and
who
Want to be there
(5) Those who understand and accept the FE culture
(a) attend college
(b) move on after 2-3 years
Who doesn't do well
(1) Those with unidentified/ concealed problems ('a fresh start')
(2) Those with entrenched patterns of behaviour that require a high
Level of supervision and external control
(a) OCD
(b) Conduct disorders and personality disorders
(3) Those who do not want to use the college - who have
been sent by others.
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Asperger
Syndrome: A Proton Magnetic Resonance Spectroscopy Study of Brain
Declan G.M. Murphy et al., Archives of General Psychiatry, Volume 59,
October 2002.
Asperger Syndrome (AS; an autistic disorder) is associated
with impaired social skills and obsessional/repetitive behaviour. 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. Subjects with AS have abnormalities in neuronal integrity of the prefrontal
lobe, which is related to severity of clinical symptoms.
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Case-Control
Family Study of Lesser Variant Traits in Autism,
J. A. Wilcox, M. Tsaung, T, Schnurr, and N. Baida-Fragoso, Neuropsychobiology:2003;
47, 4: Proquest Medical Librar, Pages 171 - 177.
Family data were obtained from the relatives of 30 autistic
patients, 30 patients with other pervasive developmental disorder and
30 healthy controls. Detailed interviewing was conducted to document any
evidence of psychiatric illness of the family members of these probands.
Anxiety disorders and obsessive-compulsive illness stood out as being
closely associated with having autistic individuals in the family. The
findings suggest that autism is a spectrum disorder that may be associated
with anxiety and obsessive-compulsive illness. This type of association
is consistent with a polygenic threshold effect for this group of conditions.
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Asperger
Syndrome and Sensory Processing: A Conceptual Model and Guidance for Intervention
Planning
W. Dunn, J. Saitter and L. Rinner, Focus on Autism and Other Developmental
Disabilities, 2002, Pages 172 - 185.
The purpose of this article is to discuss sensory processing
concepts and their application to the needs of children who have Asperger's
Syndrome (AS). First we will outline the basic characteristics of the
sensory systems, then discuss a model for sensory processing, and, finally,
present a summary of the data supporting the application of this model
in work with children who have AS. A framework is outlined for incorporating
sensory processing concepts into practice and research programs that address
the needs of children with AS. Finally, we will present case studies demonstrating
the application of sensory processing principles.
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Asperger
Syndrome and the Development of Social Competence
S.E. Gutstein and T. Whitney, Focus on Autism and Other Developmental
Disabilities, Fall 2002, page 161 - 171.
The hallmark of Asperger Syndrome is a failure to develop
social competence despite relatively normal language and cognitive development.
Extensive research in this area points to a deficit in a key area of social
development - experience-sharing relationships- as the primary factor
in limiting the social development of individuals with Asperger's Syndrome.
Experience sharing appears to develop in a manner different from attachment
and instrumental interaction. The authors review the critical components
of experience sharing, relate them to the specific social deficits found
in children and adolescents with Asperger's Syndrome, then propose factors
in developing a relationship intervention program that would incorporate
these essential components.
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An
Update on Neurocognitive Profiles in Asperger Syndrome and High-Functioning
Autism
J. A. Meyer and N.J. Minshew, Focus on Autism and Other Developmental
Disabilities, Fall 2002, Pages 152 - 160.
This article provides an overview of the similarities
and distinctions between individuals with autism and those with Asperger's
Syndrome (AS). First, we review the cognitive and neurocognitive profile
underlying deficits characteristic of autism spectrum disorders. Particular
emphasis is placed on recent comparisons of high-function autism to AS
on the basis of neuropsychological testing, and implications of neuropsychological
profiles for the cognitive deficits and clinical presentations of AS.
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Asperger
Syndrome or Autistic Disorder?
B.J. Freeman, P. Cronin and P. Candela, Focus on Autism and Other Developmental
Disabilities, Fall 2002, Pages 145 - 151.
The diagnosis of Asperger's Syndrome (AS) has been plagued
with controversy and confusion since it was introduced into the psychiatric
nomenclature, in the Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition (DSM-IV; American Psychiatric Association [APA], 1994).
This quandary has been portrayed in both the popular media, including
newsmagazines, and movies, and the scientific literature. Similarly, different
views of the syndrome have emerged over the years as different diagnostic
criteria were developed and investigated. Connotations that have become
popular include high-functioning autism, adults with autism, eccentric
people, and 'nerds'. Confusion remains as to whether AS is in fact a sperate
diagnostic category, distinct from autistic disorder (AD), or is on a
spectrum of social communication learning disability with autistic disorder.
The latter question results directly from the significant overlap of diagnostic
criteria for AS and AD in DSM-IV and its text revision (DSM-IV-TR; APA,
2000). Klin, Volkmar, and Sparrow (2000) recently summarised the state
of the science regarding Asperger's Syndrome and its relationship to other
disorders. The purpose of the present article is to provide a brief overview
of the diagnostic concept of AS and to help clinicians with the diagnostic
decisions. Regardless of the diagnostic category, a significant number
of children and adults with social communication learning disability require
intervention.
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Asperger
Syndrome: An Overview of Characteristics
B. Smith Myles and R. L. Simpson, Focus on Autism and Other Developmental
Disabilities, Fall 2002, Pages 132 - 137.
Although the prevalence of Asperger's Syndrome (AS)
is increasing, many children and youth who exhibit characteristics associated
with this disability are not diagnosed until their later years. Because
early intervention appears to be critical for individuals with AS, it
is important that educators, families and physicians have a comprehensive
understanding of this complex exceptionality. This article, is an attempt
to meet the aforementioned need, describes the characteristics of Asperger's
Syndrome and the syndrome's impact in the home, school and community.
Only recently has AS been showing up on the educational radar. Ever-increasing
numbers of children and youth are being identified with the disorder,
and teachers, administrators, counsellors, and other educational professionals
are quickly discovering that children and youth with AS are extremely
challenging to serve effectively. This challenge is often related to a
lack of understanding of the perplexing and sometimes seemingly contradictory
characteristics of AS. For example, educators often have difficulty separating
verbosity from a true understanding of language. Educational placement
is problematic for children and youth with AS. They spend the majority
of their time in general education with professionals who do not generally
have specialised training with students and with disabilities. Furthermore,
their placement in general education classrooms means that they will share
space and experiences with normally developing and achieving classmates,
who can be expected to have limited tolerance (at least without instruction
and other interventions) for peers who fail to understand and follow the
oftentimes complex and frequently unstated rules of their classroom and
school.
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Asperger
Syndrome: Associated Psychiatric and Medical Conditions
M. Ghaziuddin, Focus on Autism and Other Developmental Disabilities, Fall
2002; 17, 3: pages 138 - 144.
Asperger Syndrome (AS) is a pervasive developmental
disorder characterised by social dysfunction and idiosyncratic interests
in the presence of normal intelligence. There is no history of language
delay. Persons with AS are often described as being active but odd, with
a pedantic manner of speaking. In addition, they often present with a
variety of medical and psychiatric conditions, a topic that has not received
systematic study. This review summarises the literature on this topic,
with particular reference to publications in the last two decades. The
purpose is to underscore the need for early identification and treatment
of these conditions.
In summary, a high proportion of patients with AS suffer
from additional psychiatric disorders. These disorders are of various
types, but range in severity, but in general they seem to consist of disruptive
behaviours and hyperactivity in younger children and depressive symptoms
in adolescents and young adults. Because the data are mostly derived from
clinic samples, the true prevalence of these disorders in the community
is not known.
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Stability
and Change Among High-Functioning Children with Pervasive Developmental
Disorders: A 2-Year Outcome Study
E. Starr, P. Szatmari, S. Bryson and L. Zwaigenbaum, Journal of
Autism and Developmental Disabilities, Volume 33, No 1, February 2003,
Pages 15 - 22.
This study prospectively compared the 2-year outcome
of children diagnosed with autism or Asperger's Syndrome at age 6 - 8
years in terms of symptoms from the Autism Diagnostic Interview. Significant
differences were seen in the three-domain summary scores of social interaction,
communication, and repetitive activities, with the Asperger Syndrome group
demonstrating fewer and/or less severe symptoms at both times. There was
a trend for the Trajectories to come together over time on the socialisation
and communication domains, but not the repetitive activities domain. Differences
were not attributable to IQ. Analysis of individual items indicated that
the autism group improved over time on seven items and showed increased
symptom severity on three items. On the other hand, the Asperger's Syndrome
group improved on only two items and showed increased symptom severity
on six items. Results suggest that the two PDD subtypes represent similar
developmental trajectories, although the Asperger's Syndrome group maintains
its advantage. Educational and clinical implications of the results are
discussed.
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