AAA Section 04 Asperger's Disorder Ver 04 2013
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  • Retts: Development of several specific deficits following a period of normal functioning after birth. Typically associated with severe or profound mental retardation. Normal head circumference at birth Deceleration of head growth between ages 5 and 48 months. Loss of purposeful hand skills. CDD: Marked regression in multiple areas of functioning following a period of at least 2 years of apparently normal development. After the first 2 years of life (but before age 10 years), the child has a clinically significant loss of previously acquired skills in at least two of the following areas: Expressive or receptive language, social skills or adaptive behavior, bowel or bladder control, play, or motor skills.

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  • 1. Asperger’s Disorder UNDERGRADUATE 3 or 201 dat ed f Up Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 1 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077)Ver: 004 33
  • 2. Introduction to the Section.• What is Asperger’s Disorder?• Symptoms of Asperger’s. UNDERGRADUATE• How Asperger’s was first recognised.• Characteristics of Asperger’s Disorder.• Comorbidity.• How is Asperger’s different from Classic Autism.• Questions. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 2 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 3. Learning Outcomes of thisSection.On completion of the Section and with independent study you should be able to: UNDERGRADUATE1. Understand the main symptoms, variations and diagnostic criteria relating to Asperger’s disorder.2. Be able to describe Asperger’s disorder in detail. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 3 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 4. Autism Spectrum Disorder. In her 1981 paper ‘Aspergers syndrome: a clinical account’ Lorna Wing proposed Aspergers syndrome as a separate condition. UNDERGRADUATEA continuum that…“…ranges from the most profoundly physically and mentally retarded person ... to the most able, highly intelligent person with social impairment in its subtlest form as his only disability. It overlaps with learning disabilities and shades into eccentric normality.” The Autistic Spectrum (2003) Lorna Wing Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 4 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 5. Autism No single cause; no single cure. UNDERGRADUATE Hence: A spectrum, a continuum, a syndrome.Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 5Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 6. Terms.There is a confusing plethora of terms including autism, autistic disorder, UNDERGRADUATE Asperger syndrome or disorder, high- functioning, pervasive developmental disorder (PDD), semantic-pragmatic disorder, pathological demand avoidance, Nonverbal Learning Disability, PDD-NOS, atypical Asperger syndrome. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 6 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 7. Asperger’s Disorder is not in the DSM-VThe DSM-V will combine the currently separatediagnoses of Autistic Disorder, AspergersDisorder, Pervasive Developmental Disorder-nototherwise specified (PDD-NOS) and Childhood UNDERGRADUATEDisintegrative Disorder.The major change to the diagnosis of Asperger’sDisorder and Autism is the use of the umbrellaterm of ‘Autism Spectrum Disorder’. [from May 2013] The age of onset will be more flexible, allowing for older children and adults to be diagnosed. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 7 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 8. What Is Asperger’s Disorder (DSM-IV)?The DSM-IV includes five types of disorder under the term ‘Pervasive Developmental UNDERGRADUATE Disorder’ PDD. 1) Autistic Disorder*. 2) Rett’s Disorder. 3) Childhood Disintegrative Disorder. 4) Asperger’s Disorder*. 5) Pervasive Development Disorder Not Otherwise Specified*.* Mainly these form the Autistic spectrum ASD. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 8 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 9. What Is Asperger’s Disorder?• ASD is a spectrum of disorders. Ranges from low functioning – high functioning / Aspergers UNDERGRADUATE syndrome.• Milder / higher-functioning form of Autism characterised by impairments in the social domain, some impairment in the behaviour/interests domain.• No significant delays in cognitive or language skills. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 9 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 10. What Is Asperger’s Disorder? Wing and Gould’s triad of impairments Impairment in social interaction.Impairment in verbaland non verbalcommunication. Restricted, repetitive andPeculiarities in verbal stereotyped patterns ofand non verbal behaviour.communication. • The triad of impairment summarises the difficulties of the Autistic child but the actual manifestation of these can vary. Asperger’s may be a subtler form of ASD.
  • 11. Asperger’s Diagnosis (DSM-IV).A. Qualitative impairment in social interaction, as manifested by at least two of the following: • Marked impairment in the use of multiple UNDERGRADUATE 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. • Lack of social or emotional reciprocity. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 11 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 12. Asperger’s Diagnosis (DSM-IV).B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: UNDERGRADUATE • 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. • Persistent preoccupation with parts of objects. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 12 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 13. Asperger’s Diagnosis (DSM-IV).C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning. UNDERGRADUATED. 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).E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 13 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 14. How AS was First Recognised. UNDERGRADUATE• Leo Kanner and Hans Asperger who, independently of each other, published accounts of this disorder.• These publications, Kanners in 1943 and Asperger’s in 1944, contained detailed case descriptions and also offered the first theoretical attempts to explain the disorder. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 14 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 15. How AS was First Recognised.• Asperger’s paper, written in German, and published during the second world war, was UNDERGRADUATE largely ignored.• Asperger’s definition of autism or, as he called it, ‘autistic psychopathy’ is far wider than Kanners.• The belief has grown that Asperger described quite a different type of child, not to be confused with the one Kanner described. This is not the case. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 15 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 16. How AS was First Recognised.• 1944 - First identified in Austria by Hans Asperger.• 1981 - Reintroduced as Asperger’s Syndrome by Lorna Wing who reviewed Asperger’s paper. UNDERGRADUATE• Wing’s review provided a description of Asperger’s, as well as 34 case studies, and discussed classification and differential diagnosis.• 1994 - Recognised as a distinct disorder by the American Psychiatric Association in the DSM-IV.• United Kingdom, Australia, and Sweden lead in research on AS.• 2013 – DSM-V, new cases are ‘Autism Spectrum Disorder’, previously diagnosed are retained. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 16 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 17. Characteristics of Asperger’s.• It’s lifelong disorder of unknown origin that usually shows up around 18 months to 3 years. UNDERGRADUATE• Generally thought to be a form of Autism, it is characterised by: – Normal or above-normal intelligence. – Social awkwardness. – Verbal rigidity. – A fixation with an obscure topic that can be learned by rote (memory). Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 17 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 18. Characteristics of Asperger’s.• People with Aspergers have a hard time relating to other people. UNDERGRADUATE• Can and do go on for hours about their obsession. (Little Professors!).• Not interested in playing with other children but later often desire relationships.• Preoccupation with things that seem beyond their age level.• Little or no eye contact.• Fascinated with numbers and letters. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 18 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 19. Characteristics of Asperger’s.Qualitative impairment of social interaction:• Delays in nonverbal behaviors (gesturing, facial UNDERGRADUATE expression, body posture).• Impairments in establishing peer relationships.• Absence of spontaneous seeking to share enjoyment, interests, or achievements with others.• Theory of Mind - Some have described individuals with AS as having a low ‘EQ’ or Empathy Quotient or as having a ‘Learning Disability’ in social skills. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 19 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 20. Characteristics of Asperger’s.• Stereotyped Behaviors, Activities, and Interests. UNDERGRADUATE• Preoccupation with narrow area of interest.• Inflexibility or rigidity – often causes stress.• Sticking to a set, sometimes nonfunctional routine.• Repetitive motor movements.• Preoccupation with objects. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 20 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 21. Characteristics of Asperger’s.• Sensory differences - touch, taste, odours, textures, noise levels, lighting. UNDERGRADUATE• Motor clumsiness, especially in younger children.• Poor problem-solving and organisational skills. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 21 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 22. Characteristics of Asperger’s.• Talks in a flat affect. – Voice and tone modulation – failure to make voice interesting to listener UNDERGRADUATE because they lack the concept of the listener as interested. – May sound robotic.• Speech may be characterised by poor prosody, awkward intonation, and odd/inappropriate subject matter.• Echolaic speech. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 22 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 23. Characteristics of Asperger’s.• People with Aspergers Disorder are inclined to construe language very literally. UNDERGRADUATE – so they may not understand slang or informal speech.• People with Aspergers Disorder may also have difficulty decoding tone of voice and facial expressions. – Derisive statements such as, "Oh, that was great!" may inadvertently provide positive reinforcement of an inappropriate behaviour. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 23 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 24. Characteristics of Asperger’s.• Have unusual fear based or stress based reactions. – Tear up a room. UNDERGRADUATE – Tantrum. – Reactions are not proportionate to the situation. – Very easily upset.• Have a strong desire for routine or sameness.• Have limited ability to form friendships. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 24 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 25. Characteristics of Asperger’s.• Unlike Autistic individuals, who may seem aloof and disinterested in others, people with UNDERGRADUATE Asperger’s tend to desire to interact with others, but don’t know how to in an appropriate way.• Often self-described “loners”, “Geeks”.• May live very successful independent lives in appropriate job settings. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 25 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 26. Assessment & Diagnosis.• Similar to Autism (we’ll cover more on this in later sections).• It is easier to ‘spot’ Autism UNDERGRADUATE at the low-functioning end of the spectrum.• Not so easy to spot Asperger’s Disorder.• High functioning children do adapt . Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 26 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 27. Prevalence of Aspergers.• More common in males.• Prevalence estimates vary widely UNDERGRADUATE (36/1000 to 1/10,000) depending on what literature you read. We just don’t know accurately.• Incidence increasing greatly recently.• Increase due to better identification or true increase due to unknown factor? Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 27 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 28. Prognosis.• The factors associated with a good prognosis are a normal IQ, high-level social skills, better communication skills and later onset. UNDERGRADUATE• Prognosis depends on severity and services available.• Jobs often in area of their interest, which can also help with social integration. Web Search for ‘Temple Grandin’ http://www.templegrandin.com/ Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 28 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 29. Comorbid Disabilities.• In addition to Aspergers Disorder, many people with Aspergers will also exhibit: – Tics (blinking, sniffing, facial grimaces, throat clearing). – Obsessive Compulsive Disorder. – Executive Dysfunction. UNDERGRADUATE – ADHD. – Anxiety. – Sleep Disturbances. – Eccentric eating habits. – Self-injurious behaviors. – Depression – especially in adolescents.• Learning Disabilities.• …Even though they may not be formally diagnosed with those disorders. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 29 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 30. Comorbid Disabilities.• Tics – Are distinguished by sudden, repetitive movements (motor tics) or sounds (phonic tics). UNDERGRADUATE – Frequently preceded by a premonitory feeling of an urge, anxiety, distress, or other sensory phenomena.• Executive Dysfunction – planning for the future – the ability to inhibit or delay responding – initiating behavior – shifting between activities flexibly Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 30 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 31. Comorbid Disabilities.• Obsessive Compulsive Disorder – Repeated and unrelenting beliefs, impulses, or images cause marked anxiety or distress. UNDERGRADUATE The person endeavors to ignore or restrain such thoughts, impulses, or images, or to counterbalance them with some other thought or action that the person feels compelled to complete in response to an obsession, or concurrent to rules that must be applied inflexibly. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 31 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 32. Unique Difficulties of AS.• The very characteristics that make child higher functioning can produce its own difficulties. – Awareness of social difficulties. – Disabilities not always taken seriously. UNDERGRADUATE – Late/difficult diagnosis.• Until school, symptoms not always disruptive, child may seem simply extremely bright.• Easy to miss diagnose or misdiagnose.• Teachers’ Misunderstandings. (Disabilities not always taken seriously). – Compensates for lack of social insight with logic. – Verbal abilities appear intact. – Rote memory. – Logical thinking. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 32 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • 33. Differences in AS Presentation from Autism. Asperger’s Autism• Later onset • Early onset UNDERGRADUATE• Higher range of IQ • IQ tends to be lower• No language deficit • Often fail to develop• Non-verbal spoken language communication problems • Problems with non-verbal less severe communication• Clumsiness in basic • Tend to be adept at basic motor skills motor skills Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 33 Section: 4 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33