Asperger’s Syndrome and Asperger’s Syndrome and Adult Outcomes.Adult Outcomes.

Asperger’s Syndrome Conference (Autism Asperger’s Syndrome Conference (Autism Cymru),Cymru),

66thth June 2005. June 2005.

Millennium Stadium, Cardiff. Millennium Stadium, Cardiff.

Prof. Michael Fitzgerald.Prof. Michael Fitzgerald.

Outcome of Asperger’s syndrome / High Outcome of Asperger’s syndrome / High Functioning AutismFunctioning Autism

1.1. Ludwig Wittgenstein (Tractatus – Philosophical Ludwig Wittgenstein (Tractatus – Philosophical investigations).investigations).

2.2. Isaac Newton – One paranoid psychotic episode.Isaac Newton – One paranoid psychotic episode.

3.3. W. B. Yeats – Late marriage, special wife of persons W. B. Yeats – Late marriage, special wife of persons with Asperger’s syndrome.with Asperger’s syndrome.

Outcome of Asperger’s syndrome / High Outcome of Asperger’s syndrome / High Functioning AutismFunctioning Autism

4.4. Bruce Chatwin – AIDS.Bruce Chatwin – AIDS.

5.5. Vincent van Gogh (+ Bipolar).Vincent van Gogh (+ Bipolar).

6.6. George Orwell – Poor care of health.George Orwell – Poor care of health.

Outcome of Asperger’s syndrome / High Outcome of Asperger’s syndrome / High Functioning AutismFunctioning Autism

7.7. Simone Weil – Eating disorder.Simone Weil – Eating disorder.

8.8. Erik Satie – Alcoholism.Erik Satie – Alcoholism.

9.9. Andy Warhol – Neglect of health.Andy Warhol – Neglect of health.

10.10. Ramanujan – Neglect of health.Ramanujan – Neglect of health.

Outcome of Asperger’s syndrome / High Outcome of Asperger’s syndrome / High Functioning AutismFunctioning Autism

I.Q.I.Q.

1.1. Relatively stable over time – mean scores varying by Relatively stable over time – mean scores varying by less than 10 points.less than 10 points.

2.2. More variability – individual children 10 – 20 point More variability – individual children 10 – 20 point variation usually in positive direction.variation usually in positive direction.

3.3. Two year olds studied – less stability – greater gains.Two year olds studied – less stability – greater gains.

4.4. Significant increases in I.Q. for those participating in Significant increases in I.Q. for those participating in early intervention programmes.early intervention programmes.

Outcome 30 Year Follow-up in Denmark (F. Outcome 30 Year Follow-up in Denmark (F. W. Larsen, 1997)W. Larsen, 1997)

1.1. 9 childhood Autism ICD-10.9 childhood Autism ICD-10.

9 Asperger’s syndrome ICD-10.9 Asperger’s syndrome ICD-10.

2.2. Persons with Asperger’s syndrome had better Persons with Asperger’s syndrome had better outcome in terms of education, employment, outcome in terms of education, employment, autonomy, marriage.autonomy, marriage.

Outcome 30 Year Follow-up in Denmark (F. Outcome 30 Year Follow-up in Denmark (F. W. Larsen, 1997)W. Larsen, 1997)

3.3. Asperger: Asperger: - 56% had own homes (5).- 56% had own homes (5).

- (2) lived with parents.- (2) lived with parents.

4.4. Autism:Autism: 33% own homes.33% own homes.

5.5. Over half still very considerably challenged in many Over half still very considerably challenged in many ways.ways.

Outcome Lord & Verter (1992) Szatmari Outcome Lord & Verter (1992) Szatmari (1989)(1989)

1.1. Better outcome now High Functioning Autism / Better outcome now High Functioning Autism / Asperger’s syndrome possibly due to better treatment Asperger’s syndrome possibly due to better treatment now.now.

Adult Outcome (Howlin, 2004)Adult Outcome (Howlin, 2004)

1.1. 12% very good outcome.12% very good outcome.

2.2. 10% good outcome.10% good outcome.

3.3. 19% fair outcome.19% fair outcome.

Adult Outcome (Howlin, 2004)Adult Outcome (Howlin, 2004)

4.4. IQ 70+ better outcome. But IQ not a consistent factor IQ 70+ better outcome. But IQ not a consistent factor with outcome.with outcome.

5.5. Some adults with initial IQ of 100+ functioning much Some adults with initial IQ of 100+ functioning much less well than those of IQ 70.less well than those of IQ 70.

6.6. Rituals / stereotyped behaviours and anxiety Rituals / stereotyped behaviours and anxiety problems. Major impact on outcome for some.problems. Major impact on outcome for some.

Adult Outcome (Howlin, 2004)Adult Outcome (Howlin, 2004)

7.7. Communication generally improved.Communication generally improved.

8.8. 15% epilepsy.15% epilepsy.

9.9. 40% of those with no language when first assessed 40% of those with no language when first assessed average 7 years (3 – 15 range) had developed useful average 7 years (3 – 15 range) had developed useful language as adults.language as adults.

Adolescent Outcome Autism (2005, USA) Adolescent Outcome Autism (2005, USA) (C. McGovern / M. Sigman)(C. McGovern / M. Sigman)

1.1. Social involvement with peers improved and adaptive Social involvement with peers improved and adaptive behaviour skills.behaviour skills.

2.2. Early intervention improves cognitive ability and Early intervention improves cognitive ability and social skills in high functioning individuals.social skills in high functioning individuals.

Adolescent Outcome Autism (2005, USA) Adolescent Outcome Autism (2005, USA) (C. McGovern / M. Sigman)(C. McGovern / M. Sigman)

3.3. Mid childhood to adolescence – less symptomatic.Mid childhood to adolescence – less symptomatic.

4.4. Need cognitive skills of good early and adolescence Need cognitive skills of good early and adolescence interventions.interventions.

5.5. Howlin (1997) ‘Intervention in childhood can have a Howlin (1997) ‘Intervention in childhood can have a major impact on life in adulthood’.major impact on life in adulthood’.

Many Follow-up studies (Howlin) report:Many Follow-up studies (Howlin) report:

1.1. Increases in verbal IQ.Increases in verbal IQ.

2.2. Improvements in self awareness and self control.Improvements in self awareness and self control.

3.3. Decreases in autistic symptomatology.Decreases in autistic symptomatology.

4.4. No increase in schizophrenia as compared to general No increase in schizophrenia as compared to general population.population.

Psychiatric Problems AssociatedPsychiatric Problems Associated with with Autism / Asperger’s syndromeAutism / Asperger’s syndrome

1.1. Attention Deficit Hyperactivity Disorder (most Attention Deficit Hyperactivity Disorder (most common second diagnosis) 6 – 12 years 50% ADHD.common second diagnosis) 6 – 12 years 50% ADHD.

2.2. Depression (30%) and anxiety (plus PTSD) Asperger’s Depression (30%) and anxiety (plus PTSD) Asperger’s syndrome misdiagnosed as Bipolar because of mood syndrome misdiagnosed as Bipolar because of mood lability.lability.

3.3. Psychiatric episodes.Psychiatric episodes.

Psychiatric Problems AssociatedPsychiatric Problems Associated with with Autism / Asperger’s syndromeAutism / Asperger’s syndrome

4.4. Tourette syndrome.Tourette syndrome.

5.5. Eating disorder (full criteria not common).Eating disorder (full criteria not common).

6.6. Obsessive Compulsive Disorder (full criteria not Obsessive Compulsive Disorder (full criteria not common).common).

Psychiatric Problems AssociatedPsychiatric Problems Associated with with Autism / Asperger’s syndromeAutism / Asperger’s syndrome

7.7. Gender Identity Disorder.Gender Identity Disorder.

8.8. Violent outbursts.Violent outbursts.

9.9. School refusal.School refusal.

Psychiatric Problems AssociatedPsychiatric Problems Associated with with Autism / Asperger’s syndromeAutism / Asperger’s syndrome

10.10. Selective Mutism (Autism can be misdiagnosed as Selective Mutism (Autism can be misdiagnosed as Selective Mutism).Selective Mutism).

11.11. Social Anxiety Disorder (DSM-IV does not allow co-Social Anxiety Disorder (DSM-IV does not allow co-occurrence with Autism but it does co-occur).occurrence with Autism but it does co-occur).

Forensic ProblemsForensic Problems

1.1. 3 out of 132 (Ghaziuddin).3 out of 132 (Ghaziuddin).

2.2. Lower than 7% of general population who commit Lower than 7% of general population who commit crimes USA (20 – 24 age group).crimes USA (20 – 24 age group).

3.3. Fascination with poisons, chemicals, fire setting, Fascination with poisons, chemicals, fire setting, dislike babies or noise, sexual offences i.e. touching.dislike babies or noise, sexual offences i.e. touching.

Forensic ProblemsForensic Problems

4.4. Lack of awareness of social impact.Lack of awareness of social impact.

5.5. Misunderstanding social cues.Misunderstanding social cues.

6.6. Lack of remorse (although most persons with Lack of remorse (although most persons with Asperger’s syndrome / High Functioning Autism have Asperger’s syndrome / High Functioning Autism have extremely high moral standards).extremely high moral standards).

Create Autism Friendly Environment Create Autism Friendly Environment (Howlin)(Howlin)

1.1. Use visual cues and structure.Use visual cues and structure.

2.2. Unconventional, controllable, predictable, and Unconventional, controllable, predictable, and

consistent.consistent.

Prevention / Intervention (Early Prevention / Intervention (Early Intervention)Intervention)

1.1. Pragmatic Language Therapy.Pragmatic Language Therapy.

2.2. Education.Education.

3.3. Social Skills Therapy.Social Skills Therapy.

4.4. Mind Reading Skills plus Mind Reading Skills CD ROM.Mind Reading Skills plus Mind Reading Skills CD ROM.

5.5. ‘‘Teach’ empathy.Teach’ empathy.

6.6. Supported employment.Supported employment.

ReferencesReferences

1.1. Howlin P. (1997). Prognosis in Autism: Do specialist Howlin P. (1997). Prognosis in Autism: Do specialist treatments affect long term outcome. European Child treatments affect long term outcome. European Child and Adolescent Psychiatry, 6, 2, 55 – 72.and Adolescent Psychiatry, 6, 2, 55 – 72.

2.2. Morgan H. (1996). Adults with Autism. A guide to Morgan H. (1996). Adults with Autism. A guide to theory and practice. Cambridge University Press.theory and practice. Cambridge University Press.

3.3. McGovern C., Sigman M. (2005). Continuity and McGovern C., Sigman M. (2005). Continuity and change from early childhood to adolescence. In change from early childhood to adolescence. In Autism Journal Child Psychology and Psychiatry, 46, 4, Autism Journal Child Psychology and Psychiatry, 46, 4, 409 – 419.409 – 419.

ReferencesReferences

4.4. Howlin P. (2004). Adult outcome for children with Howlin P. (2004). Adult outcome for children with autism. Journal of Child Psychology and Psychiatry, autism. Journal of Child Psychology and Psychiatry, 45, 2, 212 – 229.45, 2, 212 – 229.

5.5. Gilchrist A. (2001). Development and current Gilchrist A. (2001). Development and current functioning in adolescents with Asperger’s syndrome: functioning in adolescents with Asperger’s syndrome: Comparative study. Journal of Child Psychology and Comparative study. Journal of Child Psychology and Psychiatry, 42, 2, 227 – 240.Psychiatry, 42, 2, 227 – 240.

6.6. Ghaziuddin M. (2005). Mental health aspects of Ghaziuddin M. (2005). Mental health aspects of Autism and Asperger’s syndrome. Jessica Kingsley Autism and Asperger’s syndrome. Jessica Kingsley Press: London.Press: London.

ReferencesReferences

7.7. Fitzgerald M., Matthews P., Birkbeck G., O’Connor J. Fitzgerald M., Matthews P., Birkbeck G., O’Connor J. (1997). Irish Families Under Stress, Volume 6. Autism (1997). Irish Families Under Stress, Volume 6. Autism a prevalence and psychosocial study in the Eastern a prevalence and psychosocial study in the Eastern Health Board area of Dublin. Dublin: Eastern Health Health Board area of Dublin. Dublin: Eastern Health Board.Board.

8.8. Coulthard P., Fitzgerald M. (1999). In God we trust? Coulthard P., Fitzgerald M. (1999). In God we trust? Organised religion and personal beliefs as resources Organised religion and personal beliefs as resources and coping strategies, and their implications for and coping strategies, and their implications for health in parents with a child on the autistic spectrum. health in parents with a child on the autistic spectrum. Mental Health, Religion and Culture Journal, 2, 1, 19 – Mental Health, Religion and Culture Journal, 2, 1, 19 – 33.33.

ReferencesReferences

9.9. Coulthard P., Fitzgerald M. (1999). Parenting Coulthard P., Fitzgerald M. (1999). Parenting adolescents on the autistic spectrum. European Child adolescents on the autistic spectrum. European Child and Adolescent Psychiatry Journal, 8, 2, 464.and Adolescent Psychiatry Journal, 8, 2, 464.

10.10. Doherty K., Fitzgerald M., Matthews P. (2000). Doherty K., Fitzgerald M., Matthews P. (2000). Services for autism in Ireland. Irish Journal of Services for autism in Ireland. Irish Journal of Psychology, 21, 1 – 2, 50 – 69.Psychology, 21, 1 – 2, 50 – 69.

ReferencesReferences

11.11. Fitzgerald M. (Ed). Material on Asperger’s syndrome / Fitzgerald M. (Ed). Material on Asperger’s syndrome / Autism in the following volumes: Irish Families Under Autism in the following volumes: Irish Families Under Stress Volume 1 (1991) ISBN 0948 562 048, Volume II Stress Volume 1 (1991) ISBN 0948 562 048, Volume II (1991) ISBN 0948 562 056, Volume III (1991) ISBN (1991) ISBN 0948 562 056, Volume III (1991) ISBN 0948 562 064, Volume IV (1995) ISBN 0948 562 099, 0948 562 064, Volume IV (1995) ISBN 0948 562 099, Volume V (1996) ISBN 0948 562 897, Volume VI Volume V (1996) ISBN 0948 562 897, Volume VI (1996) ISBN 0948 562 34X. Eastern Health Board: (1996) ISBN 0948 562 34X. Eastern Health Board: Dublin. Volume VIII (2003) ISBN 0948 562 706.Dublin. Volume VIII (2003) ISBN 0948 562 706.

ReferencesReferences

12.12. Fitzgerald M., Birkbeck G., Matthews P. (2002). Fitzgerald M., Birkbeck G., Matthews P. (2002). Maternal burden in families with children with Autistic Maternal burden in families with children with Autistic Spectrum Disorder. The Irish Journal of Psychology, Spectrum Disorder. The Irish Journal of Psychology, 33, 1-2, 2 – 17.33, 1-2, 2 – 17.

13.13. Fitzgerald M., Kinsella A. (1990). The burden on a Fitzgerald M., Kinsella A. (1990). The burden on a family having a child with special needs. Irish Journal family having a child with special needs. Irish Journal of Psychological Medicine, 7: 109 – 113.of Psychological Medicine, 7: 109 – 113.