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Asperger syndrome

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Asperger syndrome
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Asperger syndrome – also called Asperger's syndrome, AS, or just Asperger's – is one of five neurobiological pervasive developmental disorders (PDD), and is characterized by normal intelligence and language development, but deficiencies in social and communication skills.

The diagnosis of Asperger syndrome is complicated by the lack of a standardized diagnostic screen, and the use of several different screening instruments and sets of diagnostic criteria. The exact cause of Asperger syndrome is currently unknown, and the prevalence is not firmly established, due partly to differing sets of diagnostic criteria.

Management of Asperger syndrome consists of therapies that address the core symptoms of the disorder: poor communication skills, obsessive or repetitive routines, and physical clumsiness. Most children and adults with AS can learn to cope with their differences, but may continue to need support to maintain an independent life.

Asperger's syndrome was named in honor of Hans Asperger, an Austrian psychiatrist and pediatrician, by researcher Lorna Wing, who first used the eponym in a 1981 paper. In 1994, Asperger's syndrome was recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

File:Hans Asperger.jpg
Hans Asperger, whom Asperger syndrome is named after, described his patients as "little professors".

Classification and diagnosis

See also: Autism spectrum disorder

Asperger syndrome (AS) is an autism spectrum disorder (ASD), among a group of five neurological conditions characterized by impairment in language and communication skills, as well as repetitive or restrictive patterns of thought and behavior. Other ASDs are autism, Rett syndrome, childhood disintegrative disorder, and PDD-NOS (pervasive developmental disorder not otherwise specified).[1]

Asperger syndrome is defined in section 299.80 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) by six main criteria. These criteria generally define Asperger syndrome as a condition not accounted for by another specific pervasive developmental disorder or schizophrenia in which there is impairment in nonverbal behaviors and social interaction that affects important areas of functioning, repetitive behavior and intense focus of interest, and no significant delay in language, cognitive development, self-help skills, or adaptive behavior (other than social interaction).[2]

The diagnosis of Asperger's syndrome is complicated by the lack of a standardized diagnostic screen or schedule, and the use of several different screening instruments.[1] The diagnostic criteria of the Diagnostic and Statistical Manual are criticized for being vague and subjective.[3][4] Other sets of diagnostic criteria for Asperger's are the ICD 10 World Health Organization Diagnostic Criteria, Szatmari Diagnostic Criteria, Gillberg Diagnostic Criteria, and T. Attwood & C. Gray Discovery Criteria.[5]

Some doctors believe that AS is not a separate and distinct disorder, calling it high functioning autism (HFA) instead.[1][6] The diagnoses of AS or HFA may be used interchangeably, complicating prevalence estimates: the same child could receive different diagnoses, depending on the screening tool the doctor uses, and some children will be diagnosed with HFA instead of AS, and vice versa.[1]

Christopher Gillberg argues that although there may well be significant delays in some areas of language development, it is often combined with exceptionally high functioning in other language-related areas.[7][citation needed] Gillberg has his own set of diagnostic criteria, which emphasizes linguistic peculiarities which go unmentioned in the DSM-IV criteria. Another definition is by a team of Canadian researchers, often called the Szatmari definition, after the first listed author of the paper in which these criteria first appeared.[4] Finally, there is the ICD-10 definition, which has similar criteria to the DSM-IV version.[5] In the ICD-10 the phrase Asperger's syndrome is synonymous with Autistic psychopathy and Schizoid disorder of childhood.

Characteristics

Asperger syndrome is characterized by:[1][2]

  • limited interests or preoccupation with a subject to the exclusion of other activities
  • repetitive routines or rituals
  • peculiarities in speech and language
  • socially and emotionally inappropriate behavior and the inability to interact successfully with peers
  • problems with non-verbal communication
  • clumsy and uncoordinated motor movements.

The most common and important characteristics of Asperger syndrome can be divided into several broad categories: social impairments, narrow but intense interests, and speech and language peculiarities. Other features are commonly associated with this syndrome but not always held to be necessary for diagnosis. This section reflects mainly Attwood, Gillberg, and Wing's thinking on the most important characteristics of Asperger; the DSM-IV criteria represent a slightly different view. Unlike most forms of PDD's, Asperger Syndrome is often camouflaged, and many people with the disorder often blend in with those that do not have Asperger syndrome. The effects of Asperger syndrome also depends on the individual as some deal with the characteristics differently than others with Asperger syndrome.[5]

Social impairments

Although there is no single feature that all people with Asperger syndrome share, difficulties with social behavior are nearly universal and are perhaps the most important criteria that define the condition. People with Asperger syndrome lack the natural ability to see the subtexts of social interaction (sometimes resulting in well-meaning remarks that may offend and so on, finding it hard to know what is "acceptable") and may also lack the ability to broadcast their own emotional state. The unwritten rules of social behavior which mystify so many with Asperger syndrome have been termed "The Hidden Curriculum".[8] People with Asperger syndrome must learn these social skills intellectually rather than intuitively.[9]

Non-autistics are able to gather a host of information about other people's cognitive and emotional states based on clues gleaned from the environment and the other person's facial expression and body language, but people with Asperger syndrome have an impairment in this ability, sometimes called mind-blindness.[10] Mind-blindness involves an impaired ability to: read others' feelings, understand intended meanings and gauge level of interest in a conversation; take into account others' level of knowledge and predict someone's reaction to a comment or action.[11]

Some with AS make very little eye contact because they find it overwhelming, whereas others have unmodulated, staring eye contact that can cause discomfort to other people.[12] Similarly, the use of gestures may be almost nonexistent or may seem exaggerated and differ from what would normally be considered the most appropriate for a situation.[13]

Narrow, intense interests

Asperger syndrome can involve an intense and obsessive level of focus on things of interest. For example, one person might be obsessed with 1950s professional wrestling, another with national anthems of African dictatorships, or another with building models out of matchsticks. Particularly common interests are means of transport (for example, trains), computers, mathematics, astronomy, geography, history, and dinosaurs. Note that all of these last items are normal interests in ordinary children; the difference in Asperger children is the unusual intensity of their interest.[14]

Sometimes these interests are lifelong; in other cases, they change at unpredictable intervals. In either case, there are normally one or two at any given time. In pursuit of these interests, the person with Asperger's often manifests extremely sophisticated reason, an almost obsessive focus, and great memory for apparently trivial facts (occasionally even eidetic memory).[15][16] Hans Asperger called his young patients "little professors" because he thought his thirteen-year-old patients had as comprehensive and nuanced an understanding of their field of interest as university professors.[17]

Some clinicians would not entirely agree with this description; for example, Wing and Gillberg both argue that there is often more rote memorization than real understanding of these areas of interest,[15] despite occasional appearances to the contrary. However, such a limitation is part of the diagnostic criteria, even under Gillberg's criteria.[18]

Speech and language peculiarities

People with Asperger syndrome often are noted for having a highly pedantic way of speaking, using language far more formal and structured than the situation normally would be thought to call for. A five-year-old child with this condition may regularly speak in language that could easily have come from a university textbook, especially on his or her special area of interest.[19]

Literal interpretation is another common but not universal hallmark of this condition. Attwood gives the example of a girl with Asperger syndrome who answered the telephone one day and was asked, "Is Paul there?" Although the Paul in question was in the house, he was not in the room with her, so after looking around to ascertain this, she simply said "no" and hung up. The person on the other end had to call back and explain to her that he meant for her to find him and get him to pick up the telephone.[20]

People with Asperger syndrome also make idiosyncratic use of words, including new coinages and unusual juxtapositions. This can develop into a rare gift for humor (especially puns, wordplay, doggerel, satire) or writing. Another potential source of humor is the eventual realization that their literal interpretations can be used to amuse others. Some are so proficient with written language as to qualify as hyperlexic. Tony Attwood refers to a particular child's skill at inventing expressions, e.g. "tidying down" (the opposite of tidying up) or "broken" (when referring to a baby brother who cannot walk or talk).[21]

Another noted behavioural characteristic that may be present is echolalia, which causes the subject to repeat words, or parts of words, when they speak, like an echo, or palilalia repeating one's own words.[22] Children with Asperger's may display advanced abilities for their age in language, reading, mathematics, spatial skills, or music, sometimes into the 'gifted' range, although as noted above, they may be counterbalanced by appreciable delays in other developmental areas.

Writing peculiarities

Further information: Dysgraphia

A 2003 study investigated the written language of children and youth with Asperger's syndrome. They were compared by use of a standardized test of written language skills and overall legibility of handwriting. In written language skills, no significant differences were found between standardized scores of both groups; however, in hand writing skills, the group of individuals with AS produced significantly fewer legible letters and words than the neurotypical group. Another analysis of written samples found that people with AS appear to be able to write quantitatively similar to their neurotypical peers using grammatical rules but have difficulty producing qualitative writing.[23]

Tony Attwood mentions that a teacher may spend considerable time interpreting and correcting the child's indecipherable scrawl. The child is also aware of the poor quality of their handwriting, and may be reluctant to engage in activities that involve extensive writing. Unfortunately for some children and adults, high school teachers and prospective employers may consider the neatness of handwriting a measure of intelligence and personality. The person with AS then becomes embarrassed or angry at their inability to write neatly. The child may require assessment by an occupational therapist and remedial exercises, but modern technology can help minimise this problem. A parent or teacher aide could also act as the child's scribe or proofreader to ensure the legibility of the child's written answers or homework.[24]

People with Asperger's may be very skilled at using computers and keyboards. This allows for possible special dispensation in schoolwork to type rather than write homework and examinations. The presentation of their work is then comparable to other children.[24]

Emotional peculiarities

A person with Asperger syndrome may have trouble understanding the emotions of other people, and the subtle messages that are sent by facial expression, eye contact and body language are often missed. They also might have trouble showing empathy with other people. Because of this, a person with Asperger syndrome might be seen as egotistical, selfish or uncaring. In most cases these are unfair labels, because the affected person is neurologically unable to understand other people's emotional states. They are usually shocked, upset and remorseful when told their actions were hurtful or inappropriate. It is clear that people with Asperger's Syndrome do not lack emotions. However, the concrete nature of attachments they might have (i.e. to objects rather than to people) often seems curious, or even can be cause of concern, to people who do not share their perspective.[25]

However, not showing affection (or not doing so in conventional societally-acceptable ways) does not necessarily mean that he or she does not feel it. Understanding this can lead the significant other to feel less rejected and be more understanding. There are usually ways to work around the problems, such as being more explicit about one's needs. For instance, when describing emotions, it can be helpful to be direct and to avoid vague terms such as "upset" when the emotion being described is anger (some individuals with Asperger's would interpret "upset" as mere annoyance, or even nausea). It is often effective to lay out in clear language what the problem is and to ask the partner with Asperger's to describe what emotions are being felt or ask why a certain emotion was being felt. It is very helpful if the family member or significant other reads as much as he or she can about Asperger’s syndrome and any comorbid disorders.[26] In a minority of situations the opposite problem occurs; the person with Asperger's is unusually affectionate to significant others and misses or misinterprets signals from the other partner, causing the partner to get annoyed and leave the person with Asperger syndrome feeling depressed and alone.[27]

Other characteristics

Those affected by Asperger's may also manifest a range of other sensory, developmental, and physiological anomalies. Children with Asperger's may evidence a slight delay in the development of fine motor skills. In some cases (although with many exceptions) people with AS may have an odd way of walking, or display compulsive finger, hand, arm or leg movements.[28]

In general, orderly things appeal to people with Asperger's. Some researchers mention the imposition of rigid routines (on self or others) as a criterion for diagnosing this condition. It appears that changes to their routines cause inordinate levels of anxiety for some people with this condition.[29]

Some people with Asperger's experience varying degrees of sensory overload and are extremely sensitive to touch, smells, sounds, tastes, and sights. They may prefer soft clothing, familiar scents, or certain foods. Some may even be pathologically sensitive to loud noises (as some people with AS have hyperacusis) or strong smells or dislike being touched; for example, certain children with Asperger's exhibit a strong dislike of having their head touched or their hair disturbed while others like to be touched but dislike loud noises. Sensory overload may exacerbate problems faced by such children at school, where levels of noise in the classroom can become intolerable for them.[28] Some are also unable to block out certain repetitive stimuli, such as the constant ticking of a clock. Whereas most children stop registering this sound after a short time and can hear it only if they consciously listen for it, the child with Asperger's can become distracted, agitated, or even (in cases where the child has problems with regulating emotions such as anger) aggressive if the sound is not removed.[30]

Additionally, people with Asperger's exhibiting severe symptoms may frequently be diagnosed with clinical depression, oppositional defiant disorder, antisocial personality disorder, Tourette syndrome, ADHD, general anxiety disorder, bipolar disorder, obsessive compulsive disorder, or obsessive-compulsive personality disorder. Dysgraphia, Dyspraxia, Dyslexia, or Dyscalculia may also be diagnosed; however, while elements from all of these conditions are associated with Asperger syndrome, the cause is usually Asperger's itself and not a separate condition.[31] While there may be a correlation between them, the disorders are in fact distinct from one another. There is research which indicates people with Asperger's may in fact be far more likely to have the associated conditions, but for now the connection appears to be largely one of resemblance. For example, the "obsessions" common to those with AS are usually focused on a special interest; these differ in nature than those specific to OCD, which tend to be based on anxieties, such as fears of germs.[32]

Causes

Main article: Causes of autism

Twin and family studies suggest there is a genetic factor to AS and the other ASDs, but a specific gene for AS hasn’t been identified. It is likely that multiple genes cause AS, since the symptoms and the severity of symptoms vary so widely among individuals. Multiple genes are thought to be responsible.[1]

Current research speculates about structural abnormalities in the brain as a cause of AS. Researchers speculate that gene/environment interactions cause some genes to turn on or turn off, or turn on too much or too little, and this is speculated to interfere with the normal migration and wiring of embryonic brain cells during early development.[1]

Researchers at the University of California have speculated the disorder stems from abnormal changes that happen during critical stages of fetal development. Speculated defects in the genes that control and regulate normal brain growth create abnormal growth patterns, which cause overgrowth in some brain structures and reduced growth, or excessive cell loss, in others.[1]

Using advanced brain imaging techniques, scientists have revealed structural and functional differences in specific brain regions between the brains of normal versus AS children. One study found a lack of activity in the frontal lobe of AS children when asked to respond to tasks that required them to use their judgment. Another found differences in brain activity when children were asked to respond to facial expressions. Other methods of investigating brain function have revealed abnormal levels of particular proteins in the brains of adults with AS, which correlate with obsessive and repetitive behaviors.[1]

Treatment

Main article: Autism therapies

Treatment for AS coordinates therapies that address the core symptoms of the disorder: poor communication skills, obsessive or repetitive routines, and physical clumsiness. There is no one best treatment modality for all persons with AS, but most professionals agree that early intervention is beneficial for children.[1]

An effective treatment program generally includes:[1]

  • social skills training, to teach children with AS skills to interact more successfully with other children
  • cognitive behavioral therapy, to help explosive or anxious children to manage their emotions better and cut back on obsessive interests and repetitive routines
  • medication, for co-existing conditions such as depression and anxiety
  • occupational or physical therapy, for children with sensory integration problems or poor motor coordination
  • specialized speech/language therapy, to help children who have trouble with the give and take of normal conversation
  • parent training and support, to teach parents behavioral techniques to use at home.

Asperger's and high-functioning autism may be considered together for the purpose of clinical management.[33]

Prognosis

Persons with AS appear to have normal lifespans, but an increased prevalence of comorbid psychiatric conditions, such as depression, mood disorders, and obsessive-compulsive disorder.[33]

Children with AS can learn to manage their differences, but they may continue to find social situations and personal relationships challenging. Many adults with AS are able to work successfully in mainstream jobs, although they may continue to need encouragement and moral support to maintain an independent life.[1]

Individuals with Asperger's may make great intellectual contributions: published case reports suggest an association with accomplishments in computer science, mathematics, and physics. The deficits associated with Asperger's may be debilitating, but many individuals experience positive outcomes, particularly those who are able to excel in areas not dependent on social interaction, such as mathematics, music, and computer sciences.[33]

Epidemiology

The prevalence of AS is not well established, but conservative estimates using the DSM-IV criteria indicate that 2-3 out of every 10,000 children have the condition, making it more rare than autistic disorder, with three to four times as many boys having AS as girls.[1][34] AS occurs equally across all races.[33] [35]

A 1993 broad-based population study in Sweden found that 36 per 10,000 school-aged children met Gillberg's criteria for Asperger syndrome, with the prevalence rising to 71 per 10,000 if suspected cases are included.[4] The estimate is convincing for Sweden, but the findings may not apply elsewhere because they are based on a homogeneous population. The Sweden study demonstrates that Asperger's may be more common than once thought and underdiagnosed.[33] Gillberg estimates 30-50% of all Asperger's is undiagnosed.[36][citation needed] A survey found that 36 per 10,000 of adults with IQ of 100 or above may meet criteria for Asperger's.[37]

Leekam et al. documented significant differences between Gillberg's criteria and the ICD-10 criteria.[38] Considering its requirement for "normal" development of cognitive skills, language, curiosity and self-help skills, ICD-10 is considerably more narrow than Gillberg's criteria, which more closely matches Hans Asperger's own descriptions.

Like other autism spectrum disorders, Asperger syndrome prevalance estimates for males are higher than for females,[1] but some clinicians believe that this may not reflect the actual incidence among females. Tony Attwood suggests that females learn to better compensate for their impairments because of differences in socialization.[39] The Ehlers & Gillberg study[4] found a 4:1 male to female ratio in subjects meeting Gillberg's criteria for Asperger's, but a lower 2.3:1 ratio when suspected or borderline cases were included.

The prevalence of AS in adults is not well understood, but Baron-Cohen et al. documented that 2% of adults score higher than 32 in his Autism Spectrum Quotient (AQ) questionnaire, developed in 2001 to measure the extent to which an adult of normal intelligence has the traits associated with autism spectrum conditions.[40] All interviewed high-scorers met at least 3 DSM-IV criteria, and 63% met threshold criteria for an ASD diagnosis; a Japanese study found similar AQ Test results.[41]

Most patients presenting in clinical settings with Asperger's syndrome have other comorbid psychiatric disorders.[42] Children are likely to present with attention-deficit hyperactivity disorder (ADHD), while depression is a common diagnosis in adolescents and adults.[42] A study of referred adult patients found that 30% presenting with ADHD had ASD as well.[43]

History

File:Asperger kl2.jpg
Asperger syndrome is named after Hans Asperger.

In 1944, Hans Asperger, an Austrian pediatrician, observed four children in his practice who had difficulty integrating socially. Although their intelligence appeared normal, the children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Their way of speaking was either disjointed or overly formal, and their all-absorbing interest in a single topic dominated their conversations. Dr. Asperger called the condition “autistic psychopathy” and described it as a personality disorder primarily marked by social isolation. [17]

In the 1940s, Leo Kanner and Hans Asperger, working independently in the United States and Austria, identified essentially the same population, although the group identified by Asperger was perhaps more "socially functional" than Kanner's as a whole.[44] Some of Kanner's originally identified autistic children might today get an Asperger syndrome diagnosis, and vice versa. Traditionally, Kannerian autism is characterized by significant cognitive and communicative deficiencies, including delays in or lack of language.[45] On the other hand, a person with Asperger's will not show delays in language.

File:Kanner kl2.jpg
Leo Kanner identified another form of autism around the same time as Hans Asperger.

Asperger’s observations, published in German, were not widely known until 1981, when an English doctor named Lorna Wing published a series of case studies of children showing similar symptoms, which she called “Asperger’s” syndrome. [15] Wing’s writings were widely published and popularized. AS became a distinct disease and diagnosis in 1992, when it was included in the tenth published edition of the World Health Organization’s diagnostic manual, International Classification of Diseases (ICD-10), and in 1994 it was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the American Psychiatric Association’s diagnostic reference book.[2]

Uta Frith (an early researcher of Kannerian autism) has written that people with Asperger's seem to have more than a touch of autism to them.[46] Others, such as Lorna Wing and Tony Attwood, share in Frith's assessment. Dr. Sally Ozonoff, of the University of California at Davis's MIND institute, argues that there should be no dividing line between "high-functioning" autism and Asperger's,[47] and that the fact that some people do not start to produce speech until a later age is no reason to divide the two groups because they are identical in the way they need to be treated.

Cultural and sociological aspects

Further information: Autistic culture

People with Asperger syndrome may refer to themselves in casual conversation as "aspies", a name first used in 1999 by Liane Holliday Willey,[48] one of the first females with Asperger syndrome to speak publicly about the challenges and rewards of living with the condition. Another common term is "Aspergian".[49] The term neurotypical (NT) describes a person whose neurological development and state are typical, and is often used to refer to people who are non-autistic.

Researcher Simon Baron-Cohen has argued that high-functioning autism is a difference and not necessarily a disability.[50] He contends that the term "difference" is more neutral and value-free, and that this small shift in a term could mean the difference between a diagnosis of Asperger's being received as a family tragedy, or interesting information, such as learning that a child is left-handed.

A Wired magazine article, The Geek Syndrome,[51] suggested that AS is more common in the Silicon Valley, a haven for computer scientists and mathematicians. It posited that Asperger syndrome may be the result of assortative mating by geeks in mathematical and technological areas. However, Asperger syndrome can be found in all occupations, and is not limited to those in the math and science fields.[52]

Social impact

See also: Autistic culture

Asperger syndrome may lead to problems in social interaction with peers. These can be severe or mild depending on the individual. Children with Asperger syndrome are often the target of bullying at school because of their idiosyncratic behavior, language, interests, and their lowered or delayed ability to perceive and respond in socially expected ways to nonverbal cues, particularly in interpersonal conflict. Additionally, children with AS may be extremely literal and can have difficulty interpreting sarcasm. A child or teen with Asperger syndrome is often puzzled by this mistreatment, unaware of what has been done incorrectly. Unlike other pervasive development disorders, most children with Asperger Syndrome want to be social but fail to socialise successfully, which can lead to later withdrawal and asocial behavior, especially in adolescence.[53]

Children with Asperger syndrome often display advanced abilities for their age in language, reading, mathematics, spatial skills, and/or music – sometimes into the "gifted" range – but this may be counterbalanced by considerable delays in other developmental areas. This combination of traits can create problems with teachers and other authority figures. A child with Asperger’s might be regarded by teachers as a "problem child" or a "poor performer". The child’s extremely low tolerance for what they perceive to be ordinary and mediocre tasks (such as typical homework assignments) can easily become frustrating; the teacher may well consider the child arrogant, spiteful, and insubordinate. Lack of support and understanding, in combination with the child's anxieties, can result in problematic behavior (such as severe tantruming, violent outbursts, and withdrawal.[54]

Adults with AS are not treated as regularly as children, yet may have similar problems. They may find it difficult gaining a job or getting into undergraduate or graduate schools because of poor interview skills or a low score on standardized or personality tests. They may be more vulnerable to poverty than the general population.[37] If they do get a job they might be misunderstood and become subject to bullying. They may also have difficulty finding a life partner and getting married because of poor social skills. Even later in life, people with Asperger's report a feeling of being unwillingly detached from the world around them. On the other hand there is a large group of Asperger adults who do get married, get a doctorate from a fine university, and hold a job.[55] More research is needed on adults with Asperger syndrome.[56]

Notable cases

Further information: List of autistic people
Albert Einstein may have had Asperger syndrome.

Asperger syndrome is sometimes viewed as a syndrome with both advantages and disadvantages,[57] and notable adults with Asperger syndrome or autism have achieved success in their fields. Prominent Asperger-diagnosed individuals include Nobel Prize-winning economist Vernon Smith,[58] industrial rocker Gary Numan,[59] Vines frontman Craig Nicholls,[60] and Satoshi Tajiri, the creator of Pokémon.[61]

Speculation about notable cases

Further information: People speculated to have been autistic

Asperger's researchers speculate that well-known figures including Albert Einstein, Isaac Newton and philosopher Ludwig Wittgenstein had Asperger syndrome because they showed some Asperger's-related tendencies or behaviors, such as intense interest in one subject, or social problems.[62][63][64][65] Stanley Kubrick[66] is also speculated to have had the syndrome. However, posthumous diagnoses remain controversial, and autistic rights activists use such speculative diagnoses to argue that it would be a loss to society if autism were cured.[67]

Notes

  1. ^ a b c d e f g h i j k l m n NINDS (May 11, 2006). Asperger Syndrome Fact Sheet. Accessed 2 July 2006.
  2. ^ a b c BehaveNet® Clinical Capsule™. DSM-IV & DSM-IV-TR: Asperger's Disorder (AD). Retrieved 28 June 2006.
  3. ^ Timini S. Diagnosis of autism: Adequate funding is needed for assessment services. BMJ. 2004 Jan 24;328(7433):226. PMID 14739199
  4. ^ a b c d Ehlers S, Gillberg C. The epidemiology of Asperger's syndrome: a total population study. J Child Psychol Psychiatry. 1993 Nov;34(8):1327-50. PMID 8294522 Full Text.
  5. ^ a b c AS-IF.org. Asperger Syndrome Information and features: Definition. Retrieved 29 June 2006.
  6. ^ Stoddart, Kevin P. (Editor) (2005). "Children, Youth and Adults with Asperger Syndrome: Integrating Multiple Perspectives". London: Jessica Kingsley Publishers. ISBN 1-84310-268-4. p. 239. Szatmari suggests AS was promoted as a diagnosis to spark more research into the syndrome: "It was introduced into the official classification systems in 1994 and has grown in popularity as a diagnosis, even though its validity has not been clearly established. It is interesting to note that it was introduced not so much as an indication of its status as a 'true' disorder, but more to stimulate research ... its validity is very much in question."
  7. ^ Christopher Gillberg (2002). A guide to Asperger Syndrome. Cambridge, UK: Cambridge University Press. ISBN 0521001838. p. number missing.
  8. ^ Myles, Brenda Smith; Trautman, Melissa; and Schelvan, Ronda (2004). The Hidden Curriculum: practical solutions for understanding unstated rules in social situations. Shawnee Mission, Kansas: Autism Asperger Publishing Co.
  9. ^ Levanthal-Belfer, Laurie; and Coe, Cassandra (2004). Asperger Syndrome in Young Children: A Developmental Approach for Parents and Professionals. London: Jessica Kingsley Publishers. ISBN 1-84310-748-1. p. 161.
  10. ^ Romanowski, Patricia; Kirby, Barbara L. Forewards by Simon Baron-Cohen and Tony Attwood (2005). "The Oasis Guide to Asperger Syndrome". New York: Crown Publishers. ISBN 1-4000-8152-1. pp. 335-336.
  11. ^ Romanowski and Kirby (2005) p. 336.
  12. ^ Romanowski and Kirby (2005) p. 24.
  13. ^ Levanthal-Belfer, Laurie; and Coe, Cassandra (2004). pp. 160-161.
  14. ^ Attwood, Tony. "Asperger's Syndrome: A Guide for Parents and Professionals". Jessica Kingsley, London, 1997. ISBN 1853025771 pp. 89-92.
  15. ^ a b c Wing, Lorna. Asperger syndrome: a clinical account. Accessed 2 July 2006.
  16. ^ Kathrin Hippler and Christian Klicpera (2003-01-08). "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" (PDF). The Royal Society. Retrieved 2006-07-04. {{cite journal}}: Check date values in: |date= (help); Cite journal requires |journal= (help)
  17. ^ a b Asperger, H. (1944), Die 'Autistischen Psychopathen' im Kindesalter, Archiv fur Psychiatrie und Nervenkrankheiten, 117, pp. 76-136.
  18. ^ Gillberg, C. and Gillberg I.C. (1989) 'Aspergers syndrome-Some epidemiological considerations: A research note,' Journal of Child Psychology and Psychiatry 30, pp. 631-638.
  19. ^ Attwood, Tony. (1997). pp. 80-82.
  20. ^ Attwood, (1997). p. 78.
  21. ^ Attwood (1997), p. 82.
  22. ^ Attwood (1997), p. 109.
  23. ^ Myles BS, Huggins A, et. al. Written language profile of children and youth with Asperger syndrome: From research to practice. Education and Training in Developmental Disabilities. 38:4 December 2003, 362-369. Abstract.
  24. ^ a b Attwood (1997), p. 106.
  25. ^ Attwood (1997), pp. 55-57.
  26. ^ Attwood (1997) pp. 57-66.
  27. ^ Attwood (1997) pp. 165-169.
  28. ^ a b Aquilla, Paula; Ellen Yack and Shirley Sutton. "Sensory and motor differences for individuals with Asperger Syndrome: Occupational therapy assessment and intervention" in Stoddart, Kevin P. (Editor) (2005). p. 198
  29. ^ Attwood (1997), p. 100.
  30. ^ Bashe, Patricia Romanowski; and Kirby, Barbara L. (2005). The Oasis Guide to Asperger Syndrome. New York: Crown Publishers. p. 420421 ISBN 1-4000-8152-1.
  31. ^ AS-IF.org. Asperger Syndrome Information and features: Overlap. Accessed 6 July 2006.
  32. ^ Stoddart, Kevin P. (Editor) (2005). p. 44.
  33. ^ a b c d e Brasic, JR. Pervasive Developmental Disorder: Asperger Syndrome. eMedicine.com (April 10, 2006). Accessed 7 July 2006.
  34. ^ Fombonne E. "Epidemiology of autistic disorder and other pervasive developmental disorders." J Clin Psychiatry. 2005;66 Suppl 10:3-8. PMID 16401144
  35. ^ WVU OT Clinical Connection - Asperger Syndrome. Accessed 7 July 2006.
  36. ^ Gillberg, 2002, p. number missing.
  37. ^ a b Barnard J, et al. "Ignored or Ineligible? : The reality for adults with ASD". The National Autistic Society, London, 2001. Full Text (PDF). Cite error: The named reference "IgIn" was defined multiple times with different content (see the help page).
  38. ^ Leekam S, et al. (2000). Comparison of ICD-10 and Gillberg’s Criteria for Asperger Syndrome. The National Autistic Society, SAGE Publications, 2000.
  39. ^ Attwood (1997), p. 151–2.
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References

  • AS-IF contains a complete listing of the different diagnostic criteria for Asperger's, which include ICD 10 World Health Organisation Diagnostic Criteria, DSM IV Diagnostic Criteria, Szatmari Diagnostic Criteria, Gillberg Diagnostic Criteria, and T. Attwood & C. Gray Discovery Criteria
  • Attwood, Tony. "Asperger's Syndrome: A Guide for Parents and Professionals". Jessica Kingsley, London, 1997. ISBN 1853025771
  • Baron-Cohen, Simon. "The Essential Difference: Male and Female Brains and the Truth About Autism". Basic Books, New York, 2003. ISBN 046500556X
  • Frey, Rebecca. Asperger's Disorder. eNotes.com. Accessed 1 May 2006.
  • Christopher Gillberg (2002). A Guide to Asperger Syndrome. Cambridge, UK: Cambridge University Press. ISBN 0521001838.
  • Gillberg IC, Gillberg C. Asperger syndrome-some epidemiological considerations: A research note. J Child Psychol Psychiatry. 1989 Jul;30(4):631-8. PMID 2670981
  • Haddon, Mark. "The Curious Incident of the Dog in the Night-Time". Vintage, 2004. ISBN 978-0-385-51210-7 (fiction).
  • Kennedy, Diane M., with Rebecca Banks. "The ADHD-Autism Connection : A Step Toward More Accurate Diagnoses and Effective Treatments". Waterbrook Press, Colorado Springs, 2002. ISBN 1578564980
  • Myles, Brenda Smith; and Southwick, Jack (2005). Asperger Syndrome and Difficult Moments. Shawnee Mission, Kansas: Autism Asperger Publishing Co.. ISBN 1931282706
  • Sainsbury, Clare. "Martian in the Playground: Understanding the Schoolchild with Asperger's Syndrome". Lucky Duck Publishing, 2000. ISBN 1873942087
  • Silver M, Oakes P. Evaluation of a new computer intervention to teach people with autism or Asperger syndrome to recognize and predict emotions in others. Autism. 2001 Sep;5(3):299-316. PMID 11708589
  • Stoddart, Kevin P. (Editor) (2005). Children, Youth and Adults with Asperger Syndrome: Integrating Multiple Perspectives. London: Jessica Kingsley Publishers. ISBN 1-84310-268-4.
  • Szatmari, Peter. "A Mind Apart. Understanding Children with Autism and Asperger Syndrome." Guilford Press, New York City 2004. ISBN 1572305444
  • Tani P, Lindberg N, et al. Childhood inattention and hyperactivity symptoms self-reported by adults with Asperger syndrome. Psychopathology. 2006;39(1):49-54. Epub 2005 Nov 18. PMID 16299413

See also

General

Advocacy groups

Lists

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