Asperger’s Syndrome and
Adult Outcomes.
Asperger’s Syndrome Conference (Autism Cymru),
6th June 2005.
Millennium Stadium, Cardiff.
Prof. Michael Fitzgerald.
Outcome of Asperger’s syndrome / High
Functioning Autism
1.
Ludwig Wittgenstein (Tractatus – Philosophical
investigations).
2.
Isaac Newton – One paranoid psychotic episode.
3.
W. B. Yeats – Late marriage, special wife of persons with
Asperger’s syndrome.
Outcome of Asperger’s syndrome / High
Functioning Autism
4.
Bruce Chatwin – AIDS.
5.
Vincent van Gogh (+ Bipolar).
6.
George Orwell – Poor care of health.
Outcome of Asperger’s syndrome / High
Functioning Autism
7.
Simone Weil – Eating disorder.
8.
Erik Satie – Alcoholism.
9.
Andy Warhol – Neglect of health.
10.
Ramanujan – Neglect of health.
Outcome of Asperger’s syndrome / High
Functioning Autism
I.Q.
1.
Relatively stable over time – mean scores varying by less than
10 points.
2.
More variability – individual children 10 – 20 point variation
usually in positive direction.
3.
Two year olds studied – less stability – greater gains.
4.
Significant increases in I.Q. for those participating in early
intervention programmes.
Outcome 30 Year Follow-up in Denmark (F. W.
Larsen, 1997)
1.
9 childhood Autism ICD-10.
9 Asperger’s syndrome ICD-10.
2.
Persons with Asperger’s syndrome had better outcome in
terms of education, employment, autonomy, marriage.
Outcome 30 Year Follow-up in Denmark (F. W.
Larsen, 1997)
3.
Asperger: - 56% had own homes (5).
- (2) lived with parents.
4.
Autism:
5.
Over half still very considerably challenged in many ways.
33% own homes.
Outcome Lord & Verter (1992) Szatmari (1989)
1.
Better outcome now High Functioning Autism / Asperger’s
syndrome possibly due to better treatment now.
Adult Outcome (Howlin, 2004)
1.
12% very good outcome.
2.
10% good outcome.
3.
19% fair outcome.
Adult Outcome (Howlin, 2004)
4.
IQ 70+ better outcome. But IQ not a consistent factor with
outcome.
5.
Some adults with initial IQ of 100+ functioning much less well
than those of IQ 70.
6.
Rituals / stereotyped behaviours and anxiety problems. Major
impact on outcome for some.
Adult Outcome (Howlin, 2004)
7.
Communication generally improved.
8.
15% epilepsy.
9.
40% of those with no language when first assessed average
7 years (3 – 15 range) had developed useful language as
adults.
Adolescent Outcome Autism (2005, USA)
(C. McGovern / M. Sigman)
1.
Social involvement with peers improved and adaptive
behaviour skills.
2.
Early intervention improves cognitive ability and social skills in
high functioning individuals.
Adolescent Outcome Autism (2005, USA)
(C. McGovern / M. Sigman)
3.
Mid childhood to adolescence – less symptomatic.
4.
Need cognitive skills of good early and adolescence
interventions.
5.
Howlin (1997) ‘Intervention in childhood can have a major
impact on life in adulthood’.
Many Follow-up studies (Howlin) report:
1.
Increases in verbal IQ.
2.
Improvements in self awareness and self control.
3.
Decreases in autistic symptomatology.
4.
No increase in schizophrenia as compared to general
population.
Psychiatric Problems Associated with Autism /
Asperger’s syndrome
1.
Attention Deficit Hyperactivity Disorder (most common
second diagnosis) 6 – 12 years 50% ADHD.
2.
Depression (30%) and anxiety (plus PTSD) Asperger’s
syndrome misdiagnosed as Bipolar because of mood lability.
3.
Psychiatric episodes.
Psychiatric Problems Associated with Autism /
Asperger’s syndrome
4.
Tourette syndrome.
5.
Eating disorder (full criteria not common).
6.
Obsessive Compulsive Disorder (full criteria not common).
Psychiatric Problems Associated with Autism /
Asperger’s syndrome
7.
Gender Identity Disorder.
8.
Violent outbursts.
9.
School refusal.
Psychiatric Problems Associated with Autism /
Asperger’s syndrome
10.
Selective Mutism (Autism can be misdiagnosed as Selective
Mutism).
11.
Social Anxiety Disorder (DSM-IV does not allow co-occurrence
with Autism but it does co-occur).
Forensic Problems
1.
3 out of 132 (Ghaziuddin).
2.
Lower than 7% of general population who commit crimes
USA (20 – 24 age group).
3.
Fascination with poisons, chemicals, fire setting, dislike babies
or noise, sexual offences i.e. touching.
Forensic Problems
4.
Lack of awareness of social impact.
5.
Misunderstanding social cues.
6.
Lack of remorse (although most persons with Asperger’s
syndrome / High Functioning Autism have extremely high
moral standards).
Create Autism Friendly Environment (Howlin)
1.
Use visual cues and structure.
2.
Unconventional, controllable, predictable, and
consistent.
Prevention / Intervention (Early Intervention)
1.
2.
3.
4.
5.
6.
Pragmatic Language Therapy.
Education.
Social Skills Therapy.
Mind Reading Skills plus Mind Reading Skills CD ROM.
‘Teach’ empathy.
Supported employment.
References
1.
Howlin P. (1997). Prognosis in Autism: Do specialist
treatments affect long term outcome. European Child and
Adolescent Psychiatry, 6, 2, 55 – 72.
2.
Morgan H. (1996). Adults with Autism. A guide to theory
and practice. Cambridge University Press.
3.
McGovern C., Sigman M. (2005). Continuity and change
from early childhood to adolescence. In Autism Journal Child
Psychology and Psychiatry, 46, 4, 409 – 419.
References
4.
Howlin P. (2004). Adult outcome for children with autism.
Journal of Child Psychology and Psychiatry, 45, 2, 212 – 229.
5.
Gilchrist A. (2001). Development and current functioning in
adolescents with Asperger’s syndrome: Comparative study.
Journal of Child Psychology and Psychiatry, 42, 2, 227 – 240.
6.
Ghaziuddin M. (2005). Mental health aspects of Autism and
Asperger’s syndrome. Jessica Kingsley Press: London.
References
7.
Fitzgerald M., Matthews P., Birkbeck G., O’Connor J. (1997).
Irish Families Under Stress, Volume 6. Autism a prevalence
and psychosocial study in the Eastern Health Board area of
Dublin. Dublin: Eastern Health Board.
8.
Coulthard P., Fitzgerald M. (1999). In God we trust?
Organised religion and personal beliefs as resources and
coping strategies, and their implications for health in parents
with a child on the autistic spectrum. Mental Health, Religion
and Culture Journal, 2, 1, 19 – 33.
References
9.
Coulthard P., Fitzgerald M. (1999). Parenting adolescents on
the autistic spectrum. European Child and Adolescent
Psychiatry Journal, 8, 2, 464.
10.
Doherty K., Fitzgerald M., Matthews P. (2000). Services for
autism in Ireland. Irish Journal of Psychology, 21, 1 – 2, 50 –
69.
References
11.
Fitzgerald M. (Ed). Material on Asperger’s syndrome /
Autism in the following volumes: Irish Families Under Stress
Volume 1 (1991) ISBN 0948 562 048, Volume II (1991) ISBN
0948 562 056, Volume III (1991) ISBN 0948 562 064, Volume
IV (1995) ISBN 0948 562 099, Volume V (1996) ISBN 0948
562 897, Volume VI (1996) ISBN 0948 562 34X. Eastern
Health Board: Dublin. Volume VIII (2003) ISBN 0948 562
706.
References
12.
Fitzgerald M., Birkbeck G., Matthews P. (2002). Maternal
burden in families with children with Autistic Spectrum
Disorder. The Irish Journal of Psychology, 33, 1-2, 2 – 17.
13.
Fitzgerald M., Kinsella A. (1990). The burden on a family
having a child with special needs. Irish Journal of
Psychological Medicine, 7: 109 – 113.