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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.217-250.

Types of Autism Spectrum Disorders/ Pervasive

Developmental Disorders

• Autistic Disorder • Asperger’s Disorder • Rett’s Disorder • Childhood Disintegrative Disorder • Pervasive Developmental Disorder-

Not 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 laterImpairment, 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 DisorderPersistent difficulties – social use of verbal &

nonverbal communication– Social– Change with context/ listener– Rules of conversation/ story-telling– Non explicit

Functional limitationsOnset, 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):368-83. 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 - Often clumsy - poor body awareness

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

• 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

1944 - 1981

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

• 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

Issues with lack of consensual criteria

Autism Spectrum Disorders

Persistent deficits– Social communication/ interaction– Restricted, repetitive pattern of behavior, interests, activities

Present, early developmental period; may manifest laterImpairment, 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 DisorderPersistent difficulties – social use of verbal &

nonverbal communication– Social– Change with context/ listener– Rules of conversation/ story-telling– Non explicit

Functional limitationsOnset, early developmental period

Depression

• 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

A particularly common problem in adolescents/adults

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

• 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

Don’t loose sight of the big picture

Goals for Education