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Just In: Aspergers
Prevalence Predicted
To Fall To Zero
PHARMA & HEALTHCARE
12/04/2012
Classic Autism
A child labeled today as having an Autism
Spectrum Disorder may look very different
from the child diagnosed 30 years ago with
Autism. At that time we diagnosed children
who more closely resembled the children first
described by Dr. Leo Kanner, in the seminal
paper, Kanner, L. (1943), Autistic Disturbances
of Affective Contact, Nervous Child 2, pp.217250.
Types of Autism Spectrum
Disorders/ Pervasive
Developmental Disorders
Autistic Disorder
Asperger’s Disorder
Rett’s Disorder
Childhood Disintegrative Disorder
Pervasive Developmental DisorderNot otherwise specified
Asperger’s Disorder
Impairments in social interaction
Problems with nonverbal social interactions such as eye gaze,
facial expression, gestures and/or body posture
Problems with peer relationships and an inability to form
peer relationships appropriate to his/her age
Problems with shared pleasure or enjoyment and a failure to
seek such interaction with other people. (For example not
pointing out interesting objects or not bringing a toy or
object to an adult to share in the interest.)
Problems with normal give-and-take of social interactions like
taking turns or expressing emotions when socially
appropriate
Autism Spectrum Disorders
Persistent deficits
– Social communication/ interaction
– Restricted, repetitive pattern of behavior, interests, activities
Present, early developmental period; may manifest later
Impairment, assess each deficit separately
Severity (each deficit)
– Requiring support, requiring substantial support, requiring very substantial support
Specifiers
– With/ without accompanying intellectual impairment
– With/ without accompanying language impairment
– Associated with known medical or genetic condition or
environmental factor
– Associated with another neurodevelopmental, mental, or
behavioral disorder
– With catatonia
Communication Disorders
Social (Pragmatic) Communication Disorder
Persistent difficulties – social use of verbal &
nonverbal communication
–
–
–
–
Social
Change with context/ listener
Rules of conversation/ story-telling
Non explicit
Functional limitations
Onset, early developmental period
Changes
Consolidation of all variants into 1 disorder
Specifiers to indicate specific characteristics
J Am Acad Child Adolesc Psychiatry. 2012 Apr;51(4):36883. doi: 10.1016/j.jaac.2012.01.007. Epub 2012 Mar 14.
Sensitivity and specificity of proposed DSM-5 diagnostic
criteria for autism spectrum disorder.
McPartland JC, Reichow B, Volkmar FR.
Asperger - 1944
“Autistic Psychopathy”
• Series of cases – all male
• Marked social problems
• Good cognitive/language skills
• Motor problems
• Circumscribed interests
• Positive family hx (esp. fathers)
Asperger: 1944
• Unusual circumscribed interests
- all absorbing, interfered with functioning
- family life would revolve around these
• Motor Skills
awareness
- Often clumsy
- poor body
Asperger: 1944
Social Disability
• couldn’t join groups
• lack of friends even though interested in others
• intellectualization of affect
• conduct problems (noncompliant/negativistic)
Communication Problems
• verbosity, one sided style
• impaired nonverbal skills
• idiosyncratic communication
• “little professors”
Asperger Syndrome
1944 - 1981
• Limited Interest until early 1980’s
- Van Krevelen in 1970’s – emphasized personality trait
• Wing (1981) synthesis and case series
• modifications in Asperger’s description
- some features
- mild MR
- possible language problems
• possible continuity with autism
• case reports
Asperger’s 1981 - 1994
• Lack of consistent criteria
- markedly different views of the
syndrome developed
• Issue of risk psychosis/violence
• Comparisons to Autism
Other Diagnostic Constructs
• From Neuropsychology
- Nonverbal Learning Disabilities (NLD)
• From Neurology
- Right Hemisphere Syndromes
- Developmental Disabilities of the Right Hemisphere
• From Psycholinguistics
- Semantic-Pragmatic Disorder
• Also
- “Hyperplexia”, Schizoid Personality in Childhood,
OC Behaviors, . . .
Asperger’s Syndrome
Inconsistencies in Use
Issues with lack of consensual criteria
• AS = higher functioning autism (without MR)
• AS = adults with autism
• AS = PDD-NOS/ “mild autism”
• AS = shyness/ “nerds” (shades into normalcy)
• AS = complex profiles associated with social
problems
• AS = distinctive disorder
Autism Spectrum Disorders
Persistent deficits
– Social communication/ interaction
– Restricted, repetitive pattern of behavior, interests, activities
Present, early developmental period; may manifest later
Impairment, assess each deficit separately
Severity (each deficit)
– Requiring support, requiring substantial support, requiring very substantial support
Specifiers
– With/ without accompanying intellectual impairment
– With/ without accompanying language impairment
– Associated with known medical or genetic condition or
environmental factor
– Associated with another neurodevelopmental, mental, or
behavioral disorder
– With catatonia
Communication Disorders
Social (Pragmatic) Communication Disorder
Persistent difficulties – social use of verbal &
nonverbal communication
–
–
–
–
Social
Change with context/ listener
Rules of conversation/ story-telling
Non explicit
Functional limitations
Onset, early developmental period
Depression
A particularly common problem in
adolescents/adults
• Growing awareness may risk for depression
• ? Genetic vulnerability
• Drug Treatments
- Importance of careful diagnosis (difficulties in dx)
- Track changes over time in mood and symptoms
- Agents: SRIs, tricycle antidepressants
- Need for appropriate monitoring, keep in mind time
course and potential side effects
Anxiety
• Risk for anxiety problems
- Origins unclear - social limitations? Intrinsic?
- Frequent victimization, difficulties in dealing with
transitions, lack of empathy yet sufficient ability to
realize that they are not “ getting it”
• Various agents available
- SSRIs
-minor tranquilizers, buspirone
- alpha-adrenergic agonist medications
- issues of disinhibition
Anxiety
• Risk for anxiety problems
- Origins unclear - social limitations? Intrinsic?
- Frequent victimization, difficulties in dealing with
transitions, lack of empathy yet sufficient ability to
realize that they are not “ getting it”
• Various agents available
- SSRIs
-minor tranquilizers, buspirone
- alpha-adrenergic agonist medications
- issues of disinhibition
Academic
Curriculum
Goals for Education
Don’t loose sight of the big picture
• Long-term goals
- each item evaluated in terms of benefits for
socialization, vocational potential, and quality of life
- avoid curriculum inflexibility (i.e. strict adherence
to credit system)
- curriculum modification: the concept of “secondary gains”
• Emphasis on strengths that may serve vocational goals
• Mentorship, specific projects
• Foster motivation, self-initiative, and positive self-concept