Asperger syndrome


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Asperger syndrome

  1. 1. ASPERGER ’ s syndrome MILEN SANTIAGO RAMOS Practitioner in Clinical Psychology and Neuroscience
  2. 2. <ul><li>Is it a high functioning autism ? </li></ul><ul><ul><li>or just a milder form of autism? </li></ul></ul><ul><ul><li>is it really part of the whole autism spectrum disorder? </li></ul></ul>
  3. 4. Asperger's disorder is named for a Viennese physician, Hans Asperger , who published a paper describing it in 1944. Dr. Asperger called the condition “autistic psychopathy” and described it as a personality disorder primarily marked by social isolation
  4. 5. <ul><li>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 .  </li></ul><ul><li>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 Disease s (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.  </li></ul>
  5. 6. <ul><li>In the context of the Nazi eugenics policy of sterilizing and killing social deviants and the mentally handicapped, Asperger passionately defended the value of autistic individuals , writing &quot;We are convinced, then, that autistic people have their place in the organism of the social community. They fulfil their role well, perhaps better than anyone else could, and we are talking of people who as children had the greatest difficulties and caused untold worries to their care-givers.&quot;Asperger also called his young patients &quot;little professors&quot;,and believed some would be capable of exceptional achievement and original thought later in life His paper was published during wartime and in German, so it was not widely read elsewhere. </li></ul>Uta Frith translated Asperger's paper to English in 1991
  6. 7. <ul><li>Hans Asperger observed four children in his practice who had difficulty integrating socially.  </li></ul><ul><li>Although their intelligence appeared normal , the children lacked nonverbal communication skills , failed to demonstrate empathy with their peers , and were physically cl umsy .  Their way of speaking was either disjointed or overly formal, and their all-absorbing interest in a single topic dominated their conversations. </li></ul>
  7. 9. Asperger syndrome (AS) is a developmental disorder that is characterized by: limited interests or an unusual preoccupation with a particular subject to the exclusion of other activities repetitive routines or rituals peculiarities in speech and language, such as speaking in an overly formal manner or in a monotone, or taking figures of speech literally socially and emotionally inappropriate behavior and the inability to interact successfully with peers problems with non-verbal communication, including the restricted use of gestures, limited or inappropriate facial expressions, or a peculiar, stiff gaze clumsy and uncoordinated motor movements
  8. 10. <ul><li>Parents usually sense there is something unusual about a child with AS by the time of his or her third birthday, and some children may exhibit symptoms as early as infancy.  </li></ul><ul><li>Unlike children with autism, children with AS retain their early language skills .  </li></ul><ul><li>Motor development delays – crawling or walking late, clumsiness – are sometimes the first indicator of the disorder.  </li></ul>
  9. 11. AS is an autism spectrum disorder (ASD), one of a distinct group of neurological conditions characterized by a greater or lesser degree of impairment in language and communication skills , as well as repetitive or restrictive patterns of thought and behavior.   Other ASDs include:  classic autism, Rett syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (usually referred to as PDD-NOS).
  10. 13. six basic symptom s <ul><li>1. Severe impairment in reciprocal social interaction. </li></ul><ul><li>2. All-absorbing narrow interest </li></ul><ul><li>3. Unlike classic Autism, there is no significant delay in language development, yet speech and language anomalies are seen. </li></ul><ul><li>4. Unlike classic Autism, there is no clinically significant delay in cognitive development or age-appropriate self-help skills. However, socially the child does not &quot;fit in.“ </li></ul><ul><li>5. Motor Clumsiness. </li></ul><ul><li>6. Imposes routines and interests on others. </li></ul>
  11. 14. diagnosis 1   <ul><li>The first stage begins with developmental screening during a “well-child” check-up with a family doctor or pediatrician.   </li></ul>
  12. 15. diagnosis 2   <ul><li>The second stage is a comprehensive team evaluation to either rule in or rule out AS.    This team generally includes a psychologist, neurologist, psychiatrist, speech therapist, and additional professionals who have expertise in diagnosing children with AS.  </li></ul>
  13. 16. <ul><li>The comprehensive evaluation includes </li></ul><ul><ul><li>neurologic and genetic assessment, with </li></ul></ul><ul><ul><li>in-depth cognitive and language testing to establish IQ and </li></ul></ul><ul><ul><li>evaluate psychomotor function, </li></ul></ul><ul><ul><li>verbal and non-verbal strengths and weaknesses, style of learning, and </li></ul></ul><ul><ul><li>independent living skills .    </li></ul></ul>
  14. 17. <ul><li>An assessment of communication strengths and weaknesses includes </li></ul><ul><li>evaluating non-verbal forms of communication (gaze and gestures); </li></ul><ul><li>the use of non-literal language (metaphor, irony, absurdities, and humor) </li></ul><ul><li>patterns of inflection, stress and volume modulation; pragmatics (turn-taking and sensitivity to verbal cues) </li></ul><ul><li>and the content, clarity, and coherence of conversation.  </li></ul><ul><li>The physician will look at the testing results and combine them with the child’s developmental history and current symptoms to make a diagnosis </li></ul>
  15. 18. <ul><li>Autism Spectrum Disorder is a collection of disorders related to autism. Clinicians use two references that describe ASD/PDD and its subtypes. The two references are: </li></ul><ul><li>The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, (DSM-IV ) is published by the American Psychiatric Association. </li></ul><ul><li>The World Health Organisation publishes the International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10 ). </li></ul><ul><li>The following table shows relationships between clinical terms and their sources. </li></ul>
  16. 19. Diagnostic Criteria For 299.80 Asperger's Disorder – DSM IV TR (1) <ul><li>A. Qualitative impairment in social interaction, as manifested by at least two of the following: marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction failure to develop peer relationships appropriate to developmental level a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g. by a lack of showing, bringing, or pointing out objects of interest to other people) lack of social or emotional reciprocity </li></ul>
  17. 20. Diagnostic Criteria For 299.80 Asperger's Disorder DSM IV RT (2) <ul><li>B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus apparently inflexible adherence to specific, nonfunctional routines or rituals stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements) persistent preoccupation with parts of objects </li></ul>
  18. 21. Diagnostic Criteria For 299.80 Asperger's Disorder (3) <ul><li>C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning </li></ul><ul><li>D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years) </li></ul><ul><li>E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than social interaction), and curiosity about the environment in childhood </li></ul>
  19. 22. Diagnostic Criteria- ICD 10 <ul><li>F84.5 Asperger's syndrome </li></ul><ul><li>A disorder of uncertain nosological validity, characterized by the same kind of qualitative abnormalities of reciprocal social interaction that typify autism, together with a restricted, stereotyped, repetitive repertoire of interests and activities. </li></ul><ul><li>The disorder differs from autism primarily in that there is no general delay or retardation in language or in cognitive development. </li></ul><ul><li>Most individuals are of normal general intelligence but it is common for them to be markedly clumsy; the condition occurs predominantly in boys (in a ratio of about eight boys to one girl). </li></ul><ul><li>It seems highly likely that at least some cases represent mild varieties of autism, but it is uncertain whether or not that is so for all. </li></ul><ul><li>There is a strong tendency for the abnormalities to persist into adolescence and adult life and it seems that they represent individual characteristics that are not greatly affected by environmental influence. Psychotic episodes occasionally occur in early adult life. </li></ul>
  20. 23. <ul><li>Diagnostic guidelines </li></ul><ul><li>Diagnosis is based on the combination of a lack of any clinically significant general delay in language or cognitive development plus, as with autism, the presence of qualitative deficiencies in reciprocal social interaction and restricted, repetitive, stereotyped patterns of behaviour, interests, and activities. There may or may not be problems in communication similar to those associated with autism, but significant language retardation would rule out the diagnosis . </li></ul><ul><li>Includes: </li></ul><ul><li>autistic psychopathy </li></ul><ul><li>schizoid disorder of childhood </li></ul><ul><li>Excludes: </li></ul><ul><li>anankastic personality disorder (F60.5) </li></ul><ul><li>attachment disorders of childhood (F94.1, F94.2) </li></ul><ul><li>obsessive-compulsive disorder (F42.-) </li></ul><ul><li>schizotypal disorder (F21) </li></ul><ul><li>simple schizophrenia (F20.6) </li></ul><ul><li>F84.8 Other pervasive developmental disorders </li></ul>
  21. 24. Pervasive Developmental Disorders F84.9 Pervasive developmental disorders, unspecified 299.80 Pervasive Developmental Disorder not otherwise specified (PDD-NOS) (including Atypical Autism) F84.8 Other pervasive developmental disorders F84.5 Asperger’s Syndrome 299.80 Asperger’s Disorder F84.4 Overactive disorder associated with mental retardation and stereotyped movements F84.3 Childhood Disintegrative Disorder 299.10 Childhood Disintegrative Disorder F84.2 Rett’s Syndrome 299.80 Rett’s Disorder F84.1 Atypical Autism F84.0 Childhood Autism 299.00 Autistic Disorder ICD-10 DSM-IV
  22. 26. <ul><li>PDD-NOS in the DSM-IV includes F84.1, F84.8 and F84.9 from the ICD-10 </li></ul><ul><li>The conditions labelled F84.2, F84.3 and F84.4 are considered rare. There is debate as to whether they are part of the Autism Spectrum. </li></ul><ul><li>“ High-functioning Autism” (HFA) appears to mean Autistic Disorder (F84.0) with an IQ>70 . It is not a formal category in either of these classifications. </li></ul>
  23. 28. <ul><li>Lars Christopher Gillberg </li></ul>
  24. 29. <ul><li>Lars Christopher Gillberg </li></ul><ul><li>(born 19 April 1950 ) </li></ul><ul><li>is a professor of child and adolescent psychiatry at Gothenburg University in Gothenburg , Sweden , and </li></ul><ul><li>an honorary professor at the Institute of Child Health (ICH), University College London . [1] </li></ul><ul><li>He has also been a visiting professor at the universities of Bergen , New York , Odense , St George's (University of London) , San Francisco , and Strathclyde . </li></ul>
  25. 30. <ul><li>Gillberg is known for his research of autism in children, Asperger syndrome , Tourettes syndrome , Fragile X syndrome , Autism Spectrum Disorder (ASD), ADHD , and anorexia nervosa . </li></ul><ul><li>He is the founding editor of the journal European Child & Adolescent Psychiatry , and is the author and editor of many scientific and educational books. </li></ul><ul><li>He is the recipient of several scientific awards including the Philips Nordic Prize 2004 for neurological research, and he has more than 300 scientific papers listed in Medline . </li></ul><ul><li>Additionally, Gillberg has become known internationally for his contributions to pioneering research projects into the genetics of autism. </li></ul>
  26. 31. <ul><li>In 2003, a French and Swedish research team at the Institut Pasteur and the psychiatric departments at Gothenburg University and University of Paris , led by Thomas Bourgeron , Marion Leboyer and Gillberg, discovered the first precisely identified genetic mutations in individuals with autism </li></ul><ul><li>The team identified mutations altering two genes on the X chromosome which seem to be implicated in the formation of synapses (communication spaces between neurons ), in two families where several members are affected. </li></ul><ul><li>Previous studies, such as the Paris Autism Research International Sib-Pair Study (PARIS), coordinated by Gillberg and Marion Leboyer, have more generally associated the X-chromosome regions with autism. </li></ul>
  27. 32. <ul><li>The 2003 breakthrough indicated the location of the mutation to be on the NLGN4 gene and the NGLN3 gene . The mutation prevents a complete protein from forming and is inherited from the mother </li></ul>
  28. 33. <ul><li>In 1989, Gillberg became instrumental in the publication of the first diagnostic criteria for Asperger syndrome </li></ul><ul><li>Gillberg's criteria most closely resemble the original description of Hans Asperger , and for this reason, some clinicians consider them the first choice in clinical practice. </li></ul><ul><li>All of the following six criteria must be met for confirmation of diagnosis </li></ul>
  29. 35. Gillberg's criteria for Asperger syndrome
  30. 36. <ul><li>Severe impairment in reciprocal social interaction (at least two of the following) </li></ul><ul><ul><li>inability to interact with peers </li></ul></ul><ul><ul><li>lack of desire to interact with peers </li></ul></ul><ul><ul><li>lack of appreciation of social cues </li></ul></ul><ul><ul><li>socially and emotionally inappropriate behavior </li></ul></ul><ul><li>All-absorbing narrow interest (at least one of the following) </li></ul><ul><ul><li>exclusion of other activities </li></ul></ul><ul><ul><li>repetitive adherence </li></ul></ul><ul><ul><li>more rote than meaning </li></ul></ul><ul><li>Imposition of routines and interests (at least one of the following) </li></ul><ul><ul><li>on self, in aspects of life </li></ul></ul><ul><ul><li>on others </li></ul></ul>
  31. 37. <ul><li>Speech and language problems (at least three of the following) </li></ul><ul><ul><li>delayed development </li></ul></ul><ul><ul><li>superficially perfect expressive language </li></ul></ul><ul><ul><li>formal, pedantic language </li></ul></ul><ul><ul><li>odd prosody , peculiar voice characteristics </li></ul></ul><ul><ul><li>impairment of comprehension including misinterpretations of literal/implied meanings </li></ul></ul><ul><li>Non-verbal communication problems (at least one of the following) </li></ul><ul><ul><li>limited use of gestures </li></ul></ul><ul><ul><li>clumsy/gauche body language </li></ul></ul><ul><ul><li>limited facial expression </li></ul></ul><ul><ul><li>inappropriate expression </li></ul></ul><ul><ul><li>peculiar, stiff gaze </li></ul></ul><ul><li>Motor clumsiness: poor performance on neurodevelopmental examination </li></ul>
  32. 38. DAMP, MBD, and ADHD
  33. 39. In the 1970 s, Gillberg played a leading role in developing the concept Deficits in Attention, Motor control and Perception (DAMP), a concept primarily used in Scandinavia . The DAMP concept as used in more recent publications, refers to Attention-deficit hyperactivity disorder (ADHD) in combination with Developmental Coordination Disorder (DCD).
  34. 40. According to Gillberg, it constitutes a &quot;subgroup of the diagnostic category of ADHD, conceptually similar - but not clinically identical - to the WHO concept of HKD (hyperkinetic disorder)&quot; and is diagnosed on the basis of &quot;concomitant attention deficit/hyperactivity disorder and developmental coordination disorder in children who do not have severe learning disability or cerebral palsy
  35. 41. Some scholars disagree with the lumping of ADHD and DCD, with the argument that they are unrelated. Gillberg stated in 2003 that, although he feels that there is a &quot;very real issue of how to deal with the conflict between splitting (ADHD plus developmental coordination disorder (DCD)) and lumping (DAMP),&quot; he nevertheless feels that &quot;the DAMP construct has been helpful in identifying a group of children with ADHD and multiple needs that will not be self evident if the diagnosis is just ADHD or just DCD.&quot;
  36. 42. Before the Scandinavian studies, recognition that individuals with attention problems may also have difficulties with movement, perception, and memory had received little attention in studiesAccording to various studies, half of the children with ADHD also have DCD
  37. 43. With the development of the ADHD concept , the previous, less precise, category of Minimal Brain Dysfunction (MBD ), &quot;a term almost universally employed in child psychiatry and developmental paediatrics from the 1950s to the early 1980s was replaced
  38. 44. Gillberg began to study DAMP in the late 1970s, when ADHD was still called MBD and the DAMP concept has been adjusted as the term ADHD was introduced and became internationally used
  39. 45. Around 1990, DAMP had become a generally accepted diagnostic concept in two Nordic countries but when the DSM-IV appeared in 1994, DAMP became considered a redundant term in many countries, since DAMP is essentially equivalent to ADHD in combination with DCD as defined by DSM-IV
  40. 46. Gillberg's four criteria for DAMP are: ADHD as defined in DSM-IV ; Developmental Coordination Disorder as defined in DSM-IV; Condition not better accounted for by cerebral palsy; IQ higher than about 50 [Gillberg , 2003:
  41. 47. According to Gillberg, clinically severe form DAMP (or ADHD+DCD) affects about 1.5% of the general population of school age children ; another few per cent are affected by more moderate variants. Boys are overrepresented ; girls are currently probably underdiagnosed.
  42. 48. There are many overlapping conditions, including conduct disorder, depression/anxiety, and academic failure. There is a strong link with autism spectrum disorders in severe DAMP
  43. 49. Familial factors and pre- and perinatal risk factors account for much of the variance.
  44. 50. Psychosocial risk factors appear to increase the risk of marked psychiatric abnormality in DAMP
  45. 51. Outcome in early adult age was psychosocially poor in one study in almost 60% of unmedicated cases .
  46. 52. About half of all cases with ADHD have DCD, and conversely, ADHD occurs in about half of all cases of DCD . Gillberg has published around 80 papers on DAMP, ADHD and related conditions
  47. 54. psychologist’s tools <ul><li>Asperger Syndrome Diagnostic Scale (ASDS) </li></ul><ul><li>Autism Spectrum Screening Questionnaire (ASSQ) </li></ul><ul><li>Childhood Asperger Syndrome Test (CAST) Gilliam Asperger's Disorder Scale (GADS) </li></ul><ul><li>Krug Asperger's Disorder Index (KADI) </li></ul><ul><li>the Autism Spectrum Quotient (AQ; with versions for children,] adolescents and adults </li></ul>
  48. 56. prognosis <ul><li>as many as 20% of children with AS &quot;grow out&quot; of it </li></ul><ul><li>Individuals with AS appear to have normal life expectancy but have an increased prevalence of comorbid psychiatric conditions such as major depressive disorder and anxiety disorder that may significant affect prognosis . </li></ul><ul><li>Although social impairment is lifelong, outcome is generally more positive than with individuals with lower functioning autism spectrum disord </li></ul><ul><li>Although most students with AS/HFA have average mathematical ability and test slightly worse in mathematics than in general intelligence, some are gifted in mathematics and AS has not prevented some adults from major accomplishments such as winning the Nobel Prize . </li></ul><ul><li>Prognosis may be improved by diagnosis at a younger age that allows for early interventions, while interventions in adulthood are valuable but less beneficial. </li></ul>
  49. 58. management <ul><li>A typical program generally includes </li></ul><ul><li>the training of social skills for more effective interpersonal interactions cognitive behavioral therapy to improve stress management relating to anxiety or explosive emotionsand to cut back on obsessive interests and repetitive routines, </li></ul><ul><li>medication , for coexisting conditions such as major depressive disorder and anxiety disorder , occupational or physical therapy to assist with poor sensory integration and motor coordination , </li></ul><ul><li>social communication intervention, which is specialized speech therapy to help with the pragmatics of the give and take of normal conversation </li></ul><ul><li>the training and support of parents, particularly in behavioral techniques to use in the home. </li></ul>
  50. 60. treatment <ul><li>The ideal treatment for AS coordinates therapies that address the three core symptoms of the disorder :  </li></ul><ul><ul><ul><li>poor communication skills, </li></ul></ul></ul><ul><ul><ul><li>obsessive or repetitive routines, </li></ul></ul></ul><ul><ul><ul><li>and physical clumsiness.  </li></ul></ul></ul><ul><li>There is no single best treatment package for all children with AS, but most professionals agree that the earlier the intervention, the better.  </li></ul>
  51. 61. <ul><li>An effective treatment program builds on the child’s interests, offers a predictable schedule, teaches tasks as a series of simple steps, actively engages the child’s attention in highly structured activities, and provides regular reinforcement of behavior.  </li></ul>
  52. 62. <ul><li>This kind of program generally includes: </li></ul><ul><ul><li>social skills training, a form of group therapy that teaches children with AS the skills they need to interact more successfully with other children </li></ul></ul><ul><ul><li>cognitive behavioral therapy, a type of “talk” therapy that can help the more explosive or anxious children to manage their emotions better and cut back on obsessive interests and repetitive routines </li></ul></ul><ul><ul><li>medication, for co-existing conditions such as depression and anxiety </li></ul></ul><ul><ul><li>occupational or physical therapy, for children with sensory integration problems or poor motor coordination </li></ul></ul><ul><ul><li>specialized speech/language therapy, to help children who have trouble with the pragmatics of speech – the give and take of normal conversation </li></ul></ul><ul><ul><li>parent training and support, to teach parents behavioral techniques to use at home </li></ul></ul>
  53. 64. <ul><li>Cultural aspects </li></ul><ul><li>People with Asperger syndrome may refer to themselves in casual conversation as aspies , coined by Liane Holliday Willey in 1999. The word neurotypical (abbreviated NT ) describes a person whose neurological development and state are typical, and is often used to refer to non-autistic people. The Internet has allowed individuals with AS to communicate and celebrate with each other in a way that was not previously possible because of their rarity and geographic dispersal. A subculture of aspies has formed. Internet sites like Wrong Planet have made it easier for individuals to connect </li></ul>
  54. 65. <ul><li>Autistic people have advocated a shift in perception of autism spectrum disorders as complex syndromes rather than diseases that must be cured. Proponents of this view reject the notion that there is an &quot;ideal&quot; brain configuration and that any deviation from the norm is pathological ; they promote tolerance for what they call neurodiversity These views are the basis for the autistic rights and autistic pride movementsThere is a contrast between the attitude of adults with self-identified AS, who typically do not want to be cured and are proud of their identity, and parents of children with AS, who typically seek assistance and a cure for their children </li></ul>
  55. 66. <ul><li>Some researchers have argued that AS can be viewed as a different cognitive style, not a disorder or a disability.In a 2002 paper, Simon Baron-Cohen wrote of those with AS, &quot;In the social world there is no great benefit to a precise eye for detail, but in the worlds of math, computing, cataloguing, music, linguistics, engineering, and science, such an eye for detail can lead to success rather than failure.&quot; </li></ul><ul><li>Baron-Cohen cited two reasons why it might still be useful to consider AS to be a disability: to ensure provision for legally required special support , and to recognize emotional difficulties from reduced empathy. It has been argued that the genes for Asperger's combination of abilities have operated throughout recent human evolution and have made remarkable contributions to human history </li></ul>
  57. 71. Gary McKinnon
  58. 73. <ul><li>Gary McKinnon (born 10 February 1966) is a alleged British hacker facing extradition to the United States to face charges of perpetrating what is described by one prosecutor as the &quot;biggest military computer hack of all time </li></ul>
  59. 74. <ul><li>As a teenager, Gary McKinnon was entranced by WarGames , a film about a computer whiz-kid who hacks into America’s military computers and triggers a national emergency </li></ul>
  60. 75. <ul><li>The Glasgow -born systems administrator , who attended Highgate Wood Secondary School in north London, is accused of hacking into 97 United States military and NASA computers in 2001 and 2002, using the name 'Solo'. The computer networks he is accused of hacking include networks owned by NASA, the US Army , US Navy , Department of Defense , and the US Air Force . </li></ul><ul><li>The US authorities claim he deleted critical files from operating systems, which shut down the US Army’s Military District of Washington network of 2,000 computers for 24 hours, as well as deleting US Navy Weapons logs, rendering a naval base's network of 300 computers inoperable after the September 11th terrorist attacks. They claim the cost of tracking and correcting the problems he caused was $ 700,000 </li></ul>
  61. 76. <ul><li>Accused of carrying out “the biggest military computer hack of all time”, he failed in his latest legal attempt to avoid extradition to the US, where he could face a sentence of up to 60 years in a high-security prison </li></ul>
  62. 77. <ul><li>McKinnon, who claims he was searching for UFO information when he allegedly wiped important US navy files, paralysed munitions supplies for the US Atlantic fleet, and shut down 2,000 army computers for 24 hours, is running out of lifelines </li></ul>
  63. 78. <ul><li>McKinnon’s mental condition was revealed by accident, when his appearance on ITV news prompted several viewers to ring in and point out that he was displaying the symptoms of Asperger’s syndrome , a form of autism characterised by obsessive behaviour and poor social skills. The diagnosis was confirmed by Simon Baron-Cohen , an expert in the field, who warned that if McKinnon were imprisoned in the US, there was “a risk that he would take his own life”. </li></ul>
  64. 79. <ul><li>Britain’s most notorious hacker does not strike interviewers as an evil genius. Described as a pale, dreamy eccentric, with wide-apart eyes and an elfin face, he is a pacifist vegetarian who writes moody songs. Yet the avowed “bumbling computer nerd” is well spoken and articulate. Confessing his fears, he has said he wakes every morning “feeling as though someone has taken a sledgehammer to my chest during the night”. </li></ul>
  65. 80. <ul><li>But claiming to be an eccentric in pursuit of alien technology has cut no ice with American prosecutors. They maintain he scanned more than 73,000 government computers, deleted files, caused the district of Washington’s network to shut down and copied top secret files onto his own computer. </li></ul><ul><li>A senior Pentagon official declared: “ All the evidence was that someone was staging a very serious attack on US computer systems .” </li></ul>
  66. 81. <ul><li>McKinnon’s biggest mistake was the timing of his two-year hacking spree — before and after the terrorist attacks on the twin towers on September 11, 2001 . Shortly before he was caught, he left a provocative note on a US army computer suggesting 9/11 was an inside job. Using the signature Solo , he added: “ I will continue to disrupt at the highest levels .” </li></ul>
  67. 82. <ul><li>McKinnon’s arrest in March 2002 was dramatic — he woke up in bed to find an agent from Britain’s national high-tech crime unit looking down at him. However, the Crown Prosecution Service decided not to press charges. Some have suggested that this was because a British trial would have made him immune to extradition since he could not be punished twice for the same crime . </li></ul>
  68. 83. <ul><li>The US waited — deliberately, McKinnon’s lawyers said — until October 2004 to request his extradition, thus exploiting the controversial Extradition Act that had come into operation earlier that year. </li></ul><ul><li>The treaty, signed by the home secretary at the time, David Blunkett, was never debated in parliament and many critics have argued it is unfair. </li></ul><ul><li>McKinnon, who enjoys the same “enemy combatant” status as Osama bin Laden, believes the US is determined to prosecute him “because they can get me and it’s hard for them to get their hands on Al-Qaeda ”. </li></ul>
  69. 84. <ul><li>Following legal hearings in the UK it was decided in July 2006 that he should be extradited to the US. </li></ul><ul><li>In February 2007 his lawyers argued against the ruling in an appeal to the High Court in London ,] which was turned down on 3 April. </li></ul><ul><li> On 30 July 2007 the House of Lords agreed to hear the appeal and on 17 June 2008 the Law Lords began hearing the case. </li></ul><ul><li>This Judgment was delivered on 30 July 2008 with the Law Lords judging that Gary McKinnon could be extradited to the United States. </li></ul><ul><li>He was given two weeks to appeal to the European Court of Human Rights before extradition, but the Court halted the extradition for an additional two weeks to allow time to hear his appeal on August 28, which was subsequently rejected </li></ul>
  70. 85. CASE 2
  72. 87. 1. August 29, 2006 8:38 AM » Aprilf00l1 - Can Asperger's have a negative affect on the male libido? I believe that Asperger's Syndrome is the cause of my husbands low libido. For years I have felt the problem was me. The recent diagnosis of Autism for our 4 year old has brought up the question of Asperger's. My husband and some of his immediate family fit the criteria or symptoms of Asperger's. I'm just looking for information or maybe someone who has had a similar experience.
  73. 88. 2.   September 22, 2006 10:56 AM » Rachel43 - Can Asperger's have a negative affect on the male libido? In response to Can Asperger's have a negative affect on the male libido? posted by Aprilf00l1 : Hi there. My partner has Aspergers (even though he won't admit it) and he, also, has an extremely low sex drive. Sex is 99 per cent of the time initiated by myself, and it is never what I would call exciting. He is never tender and loving with me during sex, he never caresses me, he just gets on with the job and as soon as he has finished he just gets off the bed and goes and makes a cup of tea and carries on with the conversation we were having earlier on. Absolutely NO intimacy, tenderness or loving here either!!! And if, by chance, I try to give him a kiss or cuddle any other time of the day, he practically runs away from me!! And by the way, I am an attractive woman with a good figure. I have just learned to accept it. Hope this helps you.
  74. 89. 3.   September 22, 2006 6:24 PM » tc6305 - Can Asperger's have a negative affect on the male libido? In response to Can Asperger's have a negative affect on the male libido? posted by Rachel43 : Great post! I think the same may apply to women with Asperger's. I could cut/paste your post regarding my partner: - She intiates about 1% - Never what I would call exciting - Never tender and loving - Never Caresses - Get the job done, efficiently - NO emotional intimacy - Practically runs from contact
  75. 90. 4.   October 1, 2006 11:53 PM » ginger30 - Can Asperger's have a negative affect on the male libido? In response to Can Asperger's have a negative affect on the male libido? posted by Rachel43 : I am the very same way. My husband is very sexaul and I would describe myself as asexual. I am also asperger. I don't kiss or hug him either. I have no interest in physical touch. I have come to realize that physical touch is a *NEED* for typical people. yet it has no meaning to me. It is hard on our relationship. It is hard on him. And it is hard on me being in a world where
  76. 91. 4.   October 1, 2006 11:53 PM » ginger30 - Can Asperger's have a negative affect on the male libido? In response to Can Asperger's have a negative affect on the male libido? posted by Rachel43 : I am the very same way. My husband is very sexaul and I would describe myself as asexual. I am also asperger. I don't kiss or hug him either. I have no interest in physical touch. I have come to realize that physical touch is a *NEED* for typical people. yet it has no meaning to me. It is hard on our relationship. It is hard on him. And it is hard on me being in a world where
  77. 92. Famous people with autistic traits <ul><li>Only a person's close friends or relatives, or doctors, are likely to be able to judge whether he or she can be diagnosed with autism or Asperger's syndrome (AS). But it is illuminating to learn of people with similar characteristics to ourselves, especially when those people are successful or well-known </li></ul><ul><li>[email_address] </li></ul>
  78. 93. <ul><li>Fictional characters </li></ul><ul><li>Television characters </li></ul><ul><li>Alex P Keaton , played by Michael J Fox in Family Ties , USA 1982-1989 </li></ul><ul><li>Basil Fawlty , played by John Cleese in Fawlty Towers , BBC 1975-1979 </li></ul><ul><li>Bert (voiced by Frank Oz) in Sesame Street , USA 1969- </li></ul><ul><li>Cliff Clavin, played by John Ratzenberger in Cheers , USA 1982-1993 </li></ul><ul><li>Daria Morgendorffer (voiced by Tracy Grandstaff) in Daria , MTV cartoon USA 1997- </li></ul><ul><li>Jim Dial , played by Charles Kimbrough in Murphy Brown , USA 1988-1998 </li></ul><ul><li>Lisa Simpson (voiced by Yeardley Smith) and Moe (Moe Szyslak of Moe's Tavern, voiced by Hank Azaria) in The Simpsons cartoon, USA 1989- </li></ul><ul><li>Martin Miller (&quot;Ben's little brother&quot;) played by Matthew Buckley in Grange Hill , Children's BBC UK 1978- </li></ul><ul><li>Mr Bean , played by Rowan Atkinson in the eponymous TV series UK 1989- and film Bean UK/USA 1997- </li></ul><ul><li>Taz Tasmanian Devil (voiced by Jim Cummings) in Taz -Mania , USA cartoon 1991-1993 </li></ul><ul><li>Steven Quincy &quot;Steve&quot; Urkel / Myrtle Urkel / Stephan Urquell, played by Jaleel White in Family Matters , USA 1989-1998 </li></ul><ul><li>Dr Victor Ehrlich and Dr Mark Craig , played by Ed Begley Jr and William Daniels, in Saint Elsewhere , USA 1982-1988 </li></ul>
  79. 94. <ul><li>TV Aliens/Extra-Terrestrials </li></ul><ul><li>Mr Spock , played by Leonard Nimoy in Star Trek , TV and films, USA 1966- </li></ul><ul><li>Data and Reginald Barclay , played by Brent Spiner and Dwight Schultz in Star Trek: The Next Generation , USA 1987-1994 </li></ul><ul><li>Seven of Nine and The Doctor , played by Jeri Ryan and Robert Picardo in Star Trek: Voyager , USA 1995- </li></ul><ul><li>The Doctor , The Daleks and The Cybermen , from Dr Who , BBC TV and films UK 1963-1989 </li></ul><ul><li>Mork , played by Robin Williams in Mork and Mindy , USA 1978-1982 </li></ul><ul><li>Dick , Sally , Harry and Tommy Solomon, played by John Lithgow, Kristen Johnston, French Stewart and Joseph Gordon-Levitt in 3rd Rock from the Sun , USA 1996- </li></ul>
  80. 95. <ul><li>Film characters </li></ul><ul><li>Andrew Martin the robot, played by Robin Williams in Bicentennial Man , USA 1999 from a story by Isaac Asimov ( see below ) </li></ul><ul><li>Barry , played by Jack Black in High Fidelity , USA 2000 (based on the book of the same name by Nick Hornby, whose son is autistic) </li></ul><ul><li>Benjie , played by Oliver Conant in Summer of '42 , USA 1971 </li></ul><ul><li>Chance the Gardener (&quot;Chauncy Gardener&quot;), played by Peter Sellers in Being There , USA 1979 </li></ul><ul><li>Charly Gordon , played by Cliff Robertson in Charly , USA 1968; also known as Charlie Gordon , played by Matthew Modine, in Flowers for Algernon , USA 2000; based on the novel by Daniel Keyes </li></ul><ul><li>Cody , played by Holliston Coleman in Bless the Child , USA 2000 </li></ul><ul><li>Edward Scissorhands , played by Johnny Depp in Edward Scissorhands , USA 1990 </li></ul><ul><li>Herbie Stempel , played by John Turturro in Quiz Show , USA 1994 </li></ul><ul><li>&quot; Joon &quot; (Juniper Pearl), played by Mary Stuart Masterson in Benny & Joon , USA 1993 </li></ul><ul><li>Malcolm Hughes , played by Colin Friels in Malcolm , Australia 1986 </li></ul><ul><li>Melvin Udall , obsessive-compulsive writer played by Jack Nicholson in As Good as it Gets , USA 1997 </li></ul><ul><li>Molly McKay , played by Elisabeth Shue in Molly , USA 1999 </li></ul><ul><li>&quot; Noodles &quot; (David Aaronson), played by Robert De Niro in Once Upon a Time in America , Italy/USA 1984 </li></ul><ul><li>&quot; Powder &quot; (Jeremy Reeves), played by Sean Patrick Flanery in Powder , USA 1995 </li></ul><ul><li>Raymond Babbitt , played by Dustin Hoffman in Rain Man , USA 1988 </li></ul><ul><li>Ricky Fitts , played by Wes Bentley in American Beauty , USA 1999 </li></ul><ul><li>Simon Lynch , &quot;nine-year-old autistic boy&quot;, played by Miko Hughes in Mercury Rising , USA 1998 </li></ul><ul><li>Thomas Newton , played by David Bowie in The Man Who Fell to Earth , UK 1976 </li></ul><ul><li>Victor , played by Jean-Pierre Cargol in L'Enfant Sauvage , directed by François Truffaut, France 1969 (based on the true story of &quot;the wild boy of Aveyron&quot;; see also Genie, below ) </li></ul><ul><li>William Forrester , played by Sean Connery in Finding Forrester , UK/USA 2000 </li></ul>
  81. 96. <ul><li>Cartoon characters </li></ul><ul><li>Calvin of Calvin and Hobbes , created by Bill Watterson , US </li></ul><ul><li>Dilbert , engineer, created by Scott Adams, US </li></ul><ul><li>Mr Logic , literalist character from the adult British comic Viz , inspired by Steve Donald (brother of the comic's creators) </li></ul><ul><li>Gerald McBoing-Boing , created by &quot; Dr Seuss &quot; (Theodore Seuss Geisel), US books, films and TV </li></ul><ul><li>Literary and stage characters </li></ul><ul><li>Alexandre Luzhin of The Luzhin Defence by Vladimir Nabokov , Russia/USA/Europe 1899-1977; played by John Turturro in the 2000 film </li></ul><ul><li>Bartleby of Bartleby, the Scrivener: A Story of Wall-Street , a short story by Herman Melville, USA 1819-1891 </li></ul><ul><li>Billy Bibbit of One Flew Over the Cuckoo's Nest by Ken Kesey , USA 1935-; played by Brad Dourif in the 1975 film </li></ul><ul><li>Frankenstein's Monster from Frankenstein , much-filmed book by Mary Wollstonecraft Shelley , England 1797-1851 </li></ul><ul><li>Geoffrey Firmin of Under the Volcano by Malcolm Lowry , played by Albert Finney in the subsequent film </li></ul><ul><li>Professor Henry Higgins , the linguist in Pygmalion , a play by George Bernard Shaw ( see below ), staged and filmed as the musical My Fair Lady </li></ul><ul><li>Monsieur Hercule Poirot , Belgian private detective, from the books of Agatha Christie , England 1890-1976 </li></ul><ul><li>Ignatius Reilly of A Confederacy of Dunces by John Kennedy Toole </li></ul><ul><li>Jeremy Clockson of Thief of Time by Terry Pratchett </li></ul><ul><li>Mary Bennet , Mr Bennet and Mr Collins from Pride and Prejudice by Jane Austen ( see below ) </li></ul><ul><li>Phileas Fogg from Around the World in Eighty Days by Jules Verne , France 1828-1905 </li></ul><ul><li>Sherlock Holmes of the detective stories by English-Scottish author Sir Arthur Conan Doyle, 1859-1930, who himself may have had some autistic traits </li></ul>
  82. 97. <ul><li>Characters from children's literature </li></ul><ul><li>Catweazle the wizard, from children's stories by Richard Carpenter, played by Geoffrey Bayldon in the UK TV series </li></ul><ul><li>Pippi Longstocking or Pippi Langstrump , from the children's stories written by Astrid Lindgren , Sweden 1907-2002 </li></ul><ul><li>Musical characters </li></ul><ul><li>Albert Herring from the 1947 comic opera of the same name by Benjamin Britten , England 1913-1976 </li></ul><ul><li>Petroushka or Petrushka, the puppet, from the 1911 ballet of the same name by Igor Stravinsky , 1882-1971 </li></ul><ul><li>Fabled characters </li></ul><ul><li>Domme Hans (&quot;Stupid Hans&quot;) from the Tales of the Brothers Grimm </li></ul><ul><li>Brother Juniper , disciple to Saint Francis of Assisi </li></ul>
  83. 98. <ul><li>Historical famous people </li></ul><ul><li>Jane Austen , 1775-1817, English novelist, author of Pride and Prejudice ( see above ) </li></ul><ul><li>Béla Bartók , 1881-1945, Hungarian composer </li></ul><ul><li>Ludwig van Beethoven , 1770-1827, German/Viennese composer </li></ul><ul><li>Alexander Graham Bell , 1847-1922, Scottish/Canadian/American inventor of the telephone </li></ul><ul><li>Anton Bruckner , 1824-1896, Austrian composer </li></ul><ul><li>Henry Cavendish , 1731-1810, English/French scientist, discovered the composition of air and water </li></ul><ul><li>Emily Dickinson , 1830-1886, US poet </li></ul><ul><li>Thomas Edison , 1847-1931, US inventor </li></ul><ul><li>Albert Einstein , 1879-1955, German/American theoretical physicist </li></ul><ul><li>Henry Ford , 1863-1947, US industrialist </li></ul><ul><li>Kaspar Hauser , c1812-1833, German foundling, portrayed in a film by Werner Herzog </li></ul><ul><li>Oliver Heaviside , 1850-1925, English physicist </li></ul><ul><li>Thomas Jefferson , 1743-1826, US politician </li></ul><ul><li>Carl Jung , 1875-1961, Swiss psychoanalyst </li></ul><ul><li>Franz Kafka , 1883-1924, Czech writer </li></ul><ul><li>Wasily Kandinsky , 1866-1944, Russian/French painter </li></ul><ul><li>H P Lovecraft , 1890-1937, US writer </li></ul><ul><li>Ludwig II , 1845-1886, King of Bavaria </li></ul><ul><li>Charles Rennie Mackintosh , 1868-1928, Scottish architect and designer </li></ul><ul><li>Gustav Mahler , 1860-1911, Czech/Austrian composer </li></ul><ul><li>Wolfgang Amadeus Mozart , 1756-1791, Austrian composer </li></ul><ul><li>Isaac Newton , 1642-1727, English mathematician and physicist </li></ul><ul><li>Friedrich Nietzsche , 1844-1900, German philosopher </li></ul><ul><li>Bertrand Russell , 1872-1970, British logician </li></ul><ul><li>George Bernard Shaw , 1856-1950, Irish playwright, writer of Pygmalion ( see above ), critic and Socialist </li></ul><ul><li>Richard Strauss , 1864-1949, German composer </li></ul><ul><li>Nikola Tesla , 1856-1943, Serbian/American scientist, engineer, inventor of electric motors </li></ul><ul><li>Henry Thoreau , 1817-1862, US writer </li></ul><ul><li>Alan Turing , 1912-1954, English mathematician, computer scientist and cryptographer </li></ul><ul><li>Mark Twain , 1835-1910, US humorist </li></ul><ul><li>Vincent Van Gogh , 1853-1890, Dutch painter </li></ul><ul><li>Ludwig Wittgenstein , 1889-1951, Viennese/English logician and philosoph </li></ul>
  84. 99. <ul><li>Historical people prominent in the late twentieth century (died after 1975) </li></ul><ul><li>Isaac Asimov , 1920-1992, Russian/US writer on science and of science fiction, author of Bicentennial Man ( see above ) </li></ul><ul><li>Hans Asperger , 1906-1980, Austrian paediatric doctor after whom Asperger's Syndrom is named </li></ul><ul><li>John Denver , 1943-1997, US musician </li></ul><ul><li>Glenn Gould , 1932-1982, Canadian pianist </li></ul><ul><li>Jim Henson , 1936-1990, creator of the Muppets, US puppeteer, writer, producer, director, composer </li></ul><ul><li>Alfred Hitchcock , 1899-1980, English/American film director </li></ul><ul><li>Howard Hughes , 1905-1976, US billionaire </li></ul><ul><li>Andy Kaufman , 1949-1984, US comedian, subject of the film Man on the Moon </li></ul><ul><li>L S Lowry , 1887-1976, English painter of &quot;matchstick men&quot; </li></ul><ul><li>Charles Schulz , 1922-2000, US cartoonist and creator of Peanuts and Charlie Brown </li></ul><ul><li>Andy Warhol , 1928-1987, US artist </li></ul>
  85. 100. <ul><li>Contemporary famous people </li></ul><ul><li>Woody Allen , 1935-, US comedian, actor, writer, director, producer, jazz clarinettist </li></ul><ul><li>Tony Benn , 1925-, English Labour politician </li></ul><ul><li>Bob Dylan , 1941-, US singer-songwriter </li></ul><ul><li>Joseph Erber , 1985-, young English composer/musician who has Asperger's Syndrome, subject of a BBC TV documentary </li></ul><ul><li>Bobby Fischer , 1943-, US chess champion </li></ul><ul><li>Bill Gates , 1955-, US global monopolist </li></ul><ul><li>Genie , 1957-?, US &quot; wild child &quot; (see also L'Enfant Sauvage , Victor, above ) </li></ul><ul><li>Crispin Glover , 1964-, US actor </li></ul><ul><li>Al Gore , 1948-, former US Vice President and presidential candidate </li></ul><ul><li>Jeff Greenfield , 1943-, US political analyst/speechwriter, a political wonk </li></ul><ul><li>David Helfgott , 1947-, Australian pianist, subject of the film Shine </li></ul><ul><li>Michael Jackson , 1958-, US singer </li></ul><ul><li>Garrison Keillor , 1942-, US writer, humorist and host of Prairie Home Companion </li></ul><ul><li>Kevin Mitnick , 1963-, US &quot;hacker&quot; </li></ul><ul><li>John Motson , 1945-, English sports commentator </li></ul><ul><li>John Nash , 1928-, US mathematician (portrayed by Russell Crowe in A Beautiful Mind , USA 2001) </li></ul><ul><li>Keith Olbermann , 1959-, US sportscaster </li></ul><ul><li>Michael Palin , 1943-, English comedian and presenter </li></ul><ul><li>Keanu Reeves , 1964-, Lebanese/Canadian/US actor </li></ul><ul><li>Oliver Sacks , 1933-, UK/US neurologist, author of The Man Who Mistook His Wife for a Hat and Awakenings </li></ul><ul><li>James Taylor , 1948-, US singer/songwriter </li></ul>
  86. 101. <ul><li>Writers on autism </li></ul><ul><li>Gunilla Gerland , 1963-, Swedish </li></ul><ul><li>Temple Grandin , 1947-, US </li></ul><ul><li>Wendy Lawson , 1952-, English/Australian </li></ul><ul><li>Edgar Schneider , 1932-, US </li></ul>
  87. 102. SALAMAT PO