Asperser's Syndrome Presentation

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Asperser's Syndrome Presentation

  1. 1. Asperger’s Syndrome Disease Module Presentation 717.03 – Developmental Disabilities Professor Helen Alexander, PT Abby Basbagill, Special Ed/Applied Behavior Analysis Daniel Gutkoski, Health Services Management & Policy Sally Hough, Nursing Matt Robison, Audiology November 10, 2008
  2. 2. Background Information – What is Asperger’s Syndrome (AS)? <ul><li>It is an autism spectrum disorder (ASD), one of a distinct group of neurological conditions characterized by a greater or lesser degree of: </li></ul><ul><ul><li>impairment in language and communication skills </li></ul></ul><ul><ul><li>repetitive or restrictive patterns of thought and behavior </li></ul></ul><ul><ul><li>qualitative impairment in reciprocal social interaction </li></ul></ul><ul><li>The most distinguishing symptom of AS is a child’s obsessive interest in a single object or topic to the exclusion of any other.  </li></ul><ul><ul><li>Children with AS want to know everything about their topic of interest and their conversations with others will be about little else.  </li></ul></ul><ul><li>Other characteristics of AS include: </li></ul><ul><ul><li>repetitive routines or rituals / peculiarities in speech and language </li></ul></ul><ul><ul><li>socially and emotionally inappropriate behavior </li></ul></ul><ul><ul><li>the inability to interact successfully with peers </li></ul></ul><ul><ul><li>problems with non-verbal communication </li></ul></ul><ul><ul><li>clumsy and uncoordinated motor movements. </li></ul></ul><ul><li>Children with AS are often isolated because of their poor social skills and narrow interests. </li></ul>Source: http:// www.ninds.nih.gov/disorders/asperger/asperger.htm
  3. 3. Etiology of Asperger's Syndrome <ul><li>A strong causal link like that of lung cancer and tobacco has yet to be established for Asperger’s Syndrome </li></ul><ul><li>Several Theoretical Perspectives exist - including: </li></ul><ul><ul><li>Familial history </li></ul></ul><ul><ul><ul><li>Age of parents </li></ul></ul></ul><ul><ul><ul><li>Psychological history of parents </li></ul></ul></ul><ul><ul><li>Genetic component (gene mutations) </li></ul></ul><ul><ul><li>Environmental factors </li></ul></ul><ul><ul><li>A combination of several underlying factors </li></ul></ul><ul><ul><li>Other factors not yet discovered </li></ul></ul>
  4. 4. Etiology of Asperger’s Syndrome (II) <ul><li>Resulting from MRI Study with AS Individuals: </li></ul><ul><ul><li>“ Functional impairment in the absence of structural abnormalities implies biochemical defects at the neurotransmitter level. Serotoninergic or dopaminergic disturbances” </li></ul></ul><ul><ul><li>That said, “The neurochemical correlation of our findings is unknown at present, and the role of neurotransmitters in the pathogenesis of Asperger's Syndrome is to be investigated further”. </li></ul></ul><ul><li>This study presents that there is a lack of anatomical change associated with AS, so that a portion of changes must be resulting from biochemical / endocrinology changes </li></ul>Source: Okten, et. al (2001)
  5. 5. Etiology of Asperger’s Syndrome (III) <ul><li>Arguments for genetic causal link </li></ul><ul><ul><li>The high prevalence in families – multiple children with varying placement on the Autism Spectrum </li></ul></ul><ul><ul><ul><li>One study “provides further evidence of the involvement of genetic factors in the etiology of autism based on the significant findings of very high relative risks of autism in the siblings of children with autism or the other PDDs studied compared to the other risk factors investigated” </li></ul></ul></ul><ul><ul><ul><li>This same study also found: relative risk of autism in siblings of children affected with autism is increased by about 22 times, and increased by about 13 times in siblings of children with the broader autism diagnoses. </li></ul></ul></ul>Source: Lauritsen, et. al. (2005)
  6. 6. Etiology of Asperger’s Syndrome (IV) <ul><li>Environmental Concerns: </li></ul><ul><ul><li>In addition to genetics and biochemical concerns, there are additional factors which may be associated with AS and the Autism Spectrum </li></ul></ul><ul><ul><li>Maternal Age at first birth and Paternal Age: </li></ul></ul><ul><ul><ul><li>Paternal Age: “Older fathers may, more often than older mothers, have children with new inheritable mutation disorders due to exposure to agents like ionizing radiation and chemical mutagens” </li></ul></ul></ul><ul><ul><ul><li>“ Older fathers might have increased risk of having a child with autism due to increasing frequency of mutant sperm as they grow older”. </li></ul></ul></ul>Source: Lauritsen, et. al. (2005)
  7. 7. Etiology of Asperger’s Syndrome (V) <ul><li>To Sum Up: </li></ul><ul><ul><li>The exact cause of Asperger’s Syndrome remains unknown </li></ul></ul><ul><ul><li>Many theoretical perspectives have been published: including </li></ul></ul><ul><ul><ul><li>1.) Biochemical Abnormalities during development </li></ul></ul></ul><ul><ul><ul><li>2.) Genetics </li></ul></ul></ul><ul><ul><ul><li>3.) Environmental / Parental Concerns </li></ul></ul></ul><ul><ul><ul><li>4.) A combination of many multi-causal factors </li></ul></ul></ul>
  8. 8. Autism Trend Among USA
  9. 9. Autism Prevalence in USA
  10. 10. Prevalence of Asperger Syndrome <ul><li>Much controversy exists over the 60-year history in determining prevalence and epidemiology data due to differing diagnostic criteria in early years & continuing debate between countries and researchers </li></ul><ul><li>Gillberg & Gillberg, (1989); Szatmari et al., (1989); ICD-10 (WHO,1993) and DSM-IV (2000) </li></ul><ul><li>1 per 1000 children with autism compared to 2.5 per 10,000 with Asperger Syndrome reported by British Medical Research Council, with higher rates reported in Japan, Sweden, and USA (Prior, 2001) </li></ul><ul><li>Current estimates indicate a rate of 2.5/10,000 for Asperger Syndrome compared to 60/10,000 for autism in USA (Toth & King, 2008). </li></ul><ul><li>Recent research establishes the prevalence of Asperger's Syndrome as approximately 1 in 300, affecting boys to girls ratio of 10:1 (Stokes, 2008) </li></ul>
  11. 11. Epidemiology and Prevalence Autism Asperger Syndrome Autism/AS Prevalence/10,000 N Prevalence/10,000 N Autism/AS ratio 1998 (Sponheim & Skieidal, 1998) 4.9 32 .3 2 16 1999 (Miller et al., 1999) 8.7 427 1.4 71 6 2000 (Baird, Charman, et al., 2000) 27.7 45 3.1 5 9 2001 (Fombonne, 2001) 16.8 26 8.4 13 2
  12. 12. DSM-IV Asperger Syndrome Definition <ul><li>Qualitative impairment in social interaction, as manifested by at least two of: </li></ul><ul><li>a. Impairment in use of nonverbal behaviors </li></ul><ul><li>b. Failure to develop peer relationships </li></ul><ul><li>c. Lack of spontaneous seeking to share enjoyment , </li></ul><ul><li> interests or achievements with other people </li></ul><ul><li>2. Repetitive or stereotyped patterns of behavior, interests, and </li></ul><ul><li> activities as manifested by at least one of: </li></ul><ul><li>a. Preoccupation with one or more interests that are abnormal in intensity or focus </li></ul><ul><li>b. Inflexible adherence to specific, nonfunctional routines </li></ul><ul><li>c. Stereotyped and repetitive motor mannerisms </li></ul><ul><li>d. Persistent preoccupation with parts of objects </li></ul>
  13. 13. DSM-IV Asperger Syndrome Definition <ul><li>Disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning </li></ul><ul><li>No clinically significant general delay in language </li></ul><ul><li>No clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior and curiosity about the environment in childhood </li></ul><ul><li>Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia </li></ul>
  14. 14. Qualitative Impairments in Reciprocal Social Interaction: Wishing “You’ve Got a Friend” <ul><li>Socially isolated, “loner” but often express </li></ul><ul><li>great interest in wanting to make friends </li></ul><ul><li>Desire to make friends thwarted </li></ul><ul><li> by their awkward approaches, </li></ul><ul><li> insensitivity to other’s feelings </li></ul><ul><li> and implied communication </li></ul><ul><li>Chronically frustrated by repeated </li></ul><ul><li> failure to engage others and peer </li></ul><ul><li> rejection, some develop depression </li></ul><ul><li>requiring treatment & medication </li></ul><ul><li>Impaired nonverbal communication </li></ul><ul><li>Inadequate friendships </li></ul><ul><li>Lack of empathy </li></ul><ul><li>Lack of sharing </li></ul>
  15. 15. “ Communication is a little different” <ul><li>Speech marked by constricted range of intonation patterns that do not match the communication, formal and pedantic language </li></ul><ul><li>Tangential, circumstantial speech which conveys looseness of associations and incoherence, but often does not reflect a thought disorder </li></ul><ul><li>One-sided egocentric conversation style </li></ul><ul><li>Idiosyncratic use of words </li></ul><ul><li>Abrupt changing of topics </li></ul><ul><li>Misinterpretations of literal/implied meanings </li></ul><ul><li>Failure to suppress the vocal output of their internal thoughts </li></ul><ul><li>Prominent characteristic of extreme verbosity, talking incessantly about their favorite subject </li></ul><ul><li>Long-winded monologue that never comes to point or conclusion </li></ul><ul><li>Lack of insight and awareness of other people’s expectations that these communication patterns are socially maladaptive </li></ul>
  16. 16. Repetitive, Restrictive, and Stereotyped Patterns of Behavior, Interests, and Activities <ul><li>Preoccupation with an unusual </li></ul><ul><li>topic with vast amounts of factual </li></ul><ul><li>knowledge are demonstrated </li></ul><ul><li>Topic may change every 1-2 years </li></ul><ul><li>Engages the energy of entire family </li></ul><ul><li>Difficult to see in preschool years, </li></ul><ul><li>but older interests shift to unusual </li></ul><ul><li>and narrow topics </li></ul>
  17. 17. Motor Clumsiness <ul><li>History of delayed motor skill development </li></ul><ul><li>Visibly awkward, rigid gait patterns, usually mild </li></ul><ul><li>Odd posture, poor manipulative skills </li></ul><ul><li>Significant deficits in visual-motor coordination </li></ul><ul><li>Contrasts with motor development in autism which is usually an area of strength. </li></ul><ul><li>Motor clumsiness may </li></ul><ul><li>result in teasing by peers </li></ul><ul><li>and rejection from sports </li></ul>
  18. 18. Treatment <ul><ul><li>Applied Behavior Analysis </li></ul></ul><ul><ul><ul><li>(a) Home based instruction programs generally consist of 10-40 hours a week of 1:1 direct instruction under the supervision of a Board Certified Behavior Analyst </li></ul></ul></ul><ul><ul><ul><li>(b) Clinic-based instruction with a qualified therapist under the supervision of a Board Certified Behavior Analyst </li></ul></ul></ul>
  19. 19. Treatment <ul><li>Verbal Behavior </li></ul><ul><ul><li>Focuses on research done by B.F. Skinner’s Analysis of Verbal Behavior and its effectiveness of teaching language skills. This research has improved ABA programs by emphasizing the important elements in language acquisition. </li></ul></ul>
  20. 20. Treatment <ul><li>Speech Therapy </li></ul><ul><ul><li>Non-behavioral Speech and Language Therapists (SLPs) have developed many treatments building upon a child’s natural interests and ability to learn language </li></ul></ul><ul><ul><li>1:1 instruction ranging from ½ hour to 3 hours per week </li></ul></ul>
  21. 21. Treatment <ul><li>Sensory Integration Therapy </li></ul><ul><ul><li>Provided by licensed Occupational Therapists (OTs) in public schools or private clinics </li></ul></ul><ul><ul><li>Therapy consists of stimulating a child’s skin and vestibular system with activities. </li></ul></ul><ul><ul><li>Also working to improve gross and fine motor skills as well as daily living skills. </li></ul></ul>
  22. 22. Treatment <ul><li>Auditory Integration Therapy </li></ul><ul><ul><li>Treatment begins with a hearing test to determine which frequencies are most sensitive </li></ul></ul><ul><ul><li>The child wears headphones playing music which filters out the predetermined frequencies </li></ul></ul><ul><ul><li>10 Hours a week spread out over 2 weeks </li></ul></ul>
  23. 23. Treatment <ul><li>Medications </li></ul><ul><ul><li>Limited use </li></ul></ul><ul><ul><li>Antidepressants, medicines for attention and hyperactivity </li></ul></ul><ul><ul><li>Melatonin to help a child sleep and regulate the sleep cycle </li></ul></ul>
  24. 24. Complementary/ Alternative Therapy <ul><li>Quite simply, this refers to treatment that is typically not accepted by conventional medical practice and may not have a scientific basis </li></ul><ul><li>Studies claiming benefit from this type of therapy often lack well-controlled, large, randomized trials </li></ul><ul><ul><li>Difficulty lies in differentiating slight improvements from actual therapy vs. normal variability </li></ul></ul><ul><li>As healthcare professionals, this is problematic since we espouse an evidence-based model when offering recommendations for treatment </li></ul><ul><li>But, parents want hope and are desperate to try things </li></ul><ul><li>If they pursue this route, then they need to confer with their family physician as AT can lead to adverse side effects </li></ul>
  25. 25. Alternative Therapy <ul><li>Studies suggest that roughly 40-65% of families with autism have sought AT, variability due to the actual definition of AT (Wong, 2008) </li></ul><ul><li>Wong found that about 40% of Hong Kong children with autism spectrum disorders (i.e. Asperger’s Syndrome) were treated with CAM </li></ul><ul><li>Popular treatments include acupuncture, sensory integration therapy, and Chinese herbs </li></ul><ul><li>Prevalence higher in US due to biological types of intervention used (i.e. diets) </li></ul>
  26. 26. Alternative Therapies <ul><li>There is a wide gamut of therapies out there (Brown and Percy, 2007) </li></ul><ul><ul><li>Acupuncture </li></ul></ul><ul><ul><li>Yoga/Meditation </li></ul></ul><ul><ul><li>Herbal Medicine </li></ul></ul><ul><ul><li>Energy Therapy </li></ul></ul><ul><ul><li>Hippo therapy </li></ul></ul><ul><ul><li>Music Therapy </li></ul></ul><ul><ul><li>Biofeedback </li></ul></ul><ul><li>Supplements </li></ul>
  27. 27. Alternative Therapies <ul><ul><li>Diet </li></ul></ul><ul><ul><ul><li>Foods containing preservatives and artificial colors are removed from the diet. </li></ul></ul></ul><ul><ul><ul><li>Casein-Free diet </li></ul></ul></ul><ul><ul><ul><ul><li>Foods with the milk protein casein (including all dairy products) are removed from the diet. </li></ul></ul></ul></ul><ul><ul><ul><li>Gluten-free diet </li></ul></ul></ul><ul><ul><ul><ul><li>Consist of removing foods containing gluten (e.g., barley, rye, oats, and wheat) </li></ul></ul></ul></ul>
  28. 28. Defeat Autism Now (DAN) <ul><li>Alternative approach to treating autism/AS </li></ul><ul><li>Aims at identifying dietary deficiencies and making dietary modifications to better regulate bodily functions </li></ul><ul><li>Several components to this approach </li></ul><ul><ul><li>Practitioners assess various aspects of diet and bodily functions: the intake ratio of vitamins, minerals, essential fatty acids, digestive function, liver detoxification, immune system </li></ul></ul><ul><ul><li>Aim at making dietary changes </li></ul></ul><ul><ul><ul><ul><ul><li>http://www.drpodell.org/autism_treatments.shtml </li></ul></ul></ul></ul></ul>
  29. 29. Prognosis <ul><li>At present there have been no long-term, well-designed, follow up studies tracking the outcome of individuals with Asperger’s syndrome </li></ul><ul><ul><li>Why? Newness in the diagnostic criteria, and co-morbidity of psychiatric disorders </li></ul></ul><ul><li>Thought that roughly 20% of individuals seem to outgrow AS, not meeting the diagnostic criteria as adults </li></ul><ul><ul><li>Adults with AS tend to be homebodies with many having difficulties maintaining work and relationships and difficulty maintaining high level jobs </li></ul></ul><ul><li>Given the social and behavioral issues associated with AS population, children with AS may need special education </li></ul>
  30. 30. Prognosis <ul><li>Good news is that it appears that the outcome is much better for people with AS than lower functioning forms of autism (Tsatsanis, 2003) </li></ul><ul><li>As true with other forms of developmental disabilities, research shows that the sooner intervention is applied the more beneficial </li></ul><ul><ul><ul><li>As discussed previously, management should be dealt with on an individual basis, based on the strengths and weaknesses of the child </li></ul></ul></ul><ul><li>This underscores the need for early intervention so that the child can thrive better in the social world </li></ul><ul><li>Tsatsanis (2003) stresses that intervention should aim at enhancing social communication and competence, and adaptive functioning </li></ul>
  31. 31. Prognosis <ul><li>Tsatsanis (2003) also found that intervention should incorporate transition planning to enhance prognosis </li></ul><ul><li>That is, long-term goals need to be established , including autonomy, employment, and fulfillment, with a focus on capitalizing on relative strengths and foster talents and interests </li></ul><ul><li>Further, specific training that focuses on the skills needed for self sufficiency (e.g., self-care, shopping, transportation use) and skills needed for college or employment </li></ul>
  32. 32. The Role of the Family <ul><li>Family involvement is crucial as autism spectral disorders (ASD) will affect family dynamics </li></ul><ul><li>Studies show that family advocacy can maximize outcomes (Tsatsanis, 2003) </li></ul><ul><li>This should include families recognizing and working with the child’s strengths and weaknesses as these are considerations for treatment </li></ul><ul><li>A nurturing family can promote development in a child with ASD, enhancing mental well-being </li></ul>
  33. 33. Where to Seek Resources <ul><li>Recall, that under IDEA/FERPA school-age kids are entitled to services that cater to their needs to help with educational development </li></ul><ul><li>As discussed in class, many sources of help available: Help Me Grow, Franklin County Board of Mental Retardation and Developmental Disabilities, etc </li></ul>
  34. 34. Additional Resources <ul><li>Many support networks available to family members and those afflicted with AS </li></ul><ul><li>Informative websites touching on a wide array of issues relating to Asperger’s Syndrome </li></ul><ul><ul><li>Asperger Syndrome Coalition of the US </li></ul></ul><ul><ul><li>Asperger Syndrome Education Network </li></ul></ul><ul><ul><li>Parent Support Network </li></ul></ul><ul><ul><li>Online Asperger's Syndrome Info and Support </li></ul></ul><ul><ul><li>http://aspirationsohio.org/index.html </li></ul></ul>
  35. 35. Social Support Groups in OH <ul><li>Aspirations, Columbus </li></ul><ul><li>A Different World, Mansfield </li></ul><ul><li>Dayton Asperger's Resource Network </li></ul><ul><li>Greater Cleveland Asperger's Support </li></ul><ul><li>Lawrence County Asperger's Syndrome & Autism Group </li></ul><ul><li>Additional supports found @ http://aspergers.meetup.com/all/ </li></ul>
  36. 36. Selected, Annotated Bibliography <ul><li>Please find on the following slide selected, annotated bibliographies for research articles that our group used in the completion of this presentation on Asperger Syndrome. </li></ul>
  37. 37. Toth, K., & King, B. (2008). Asperger’s Syndrome: Diagnosis and Treatment. American Journal of Psychiatry, 165:8, 958-963. <ul><li> Characteristics were first identified in 1944, but the diagnostic label of Asperger’s Syndrome did not emerge until 1980 when Wing proposed a spectrum of disorders with varying degrees of severity. Research that has attempted to support a distinction between AS and high-functioning autism have been mixed. In general, individuals with AS have higher comprehension and expressive language ability, more creative, and more varied interests compared to people with high-functioning autism. Early history variables appear to best distinguish between the two, with more impairments appearing in the preschool child with high-functioning autism. However, differences between high-functioning autism and AS tend to disappear by adolescence. The average age of diagnosis of AS is 11 years compared to 5.5 years for autism. </li></ul><ul><li>A core diagnostic assessment should include: detailed developmental history, Autism Diagnostic Interview-Revised, Autism Diagnostic Observation Schedule, screening for medical and psychiatric issues, intellectual testing and neuropsychological functioning, occupational therapy evaluation and family systems assessment. Specific AS assessments exist, but these have not been standardized or tested for validity and reliability including: Gilliam Asperger Disorder Scale, Asperger Syndrome Diagnostic Scale, and the Adult Asperger Assessment. Comorbid psychiatric disorders are very common with depression (41%), anxiety disorders (8%), bipolar disorder (9%), attempted suicide (7%), and hallucinations (6%). </li></ul>
  38. 38. Bouxsein, K., Fisher, W., & Tiger, J. (2007). Treating Excessively Slow Responding of a young Man with Asperger Syndrome Using Differential Reinforcement of Short Response Latencies. The Journal of Applied Behavior Analysis , pp. 559-563. <ul><li>The purpose of this study was to use differential reinforcement of short latencies to decrease a child’s latency to comply with instructions. A 19-yr old man named Joe, with Asperger syndrome, participated in the study. During baseline it was assessed that Joes took a long time to answer questions and tended to speak slowly. The experimenters added a differential reinforcement schedule to teach Joe to discriminate between math problem he could answer right away and math problems that required more time. The DR phase was effective to decrease the latency of Joe answering questions. </li></ul>
  39. 39. Lauritsen, M. B., Pedersen, C. B., & Mortensen, P. B. (2005). Effects of familial risk factors and place of birth on the risk of autism: a nationwide register-based study. Journal of Child Psychology and Psychiatry 46:9 , 963-971. <ul><li>Completed in Denmark, this article provides analyses pertaining to Asperger’s Syndrome and other forms of Autism that is the result of information kept through the Danish Civil Registration System via that country’s Personnummer. This information is typically very accurate and is often made available to individuals wishing to further the academic research community. This particular study was based upon a population cohort study formed of Swedish children born during a 14-year period starting in 1984. The study concluded that siblings born to parents who have other children with autism have a relative risk 22 times that of child born to a parent without other siblings with autism. Other interesting conclusions made from the data analyzed includes: the risk of autism was twice as high in children whose mother have a history of psychiatric disorders and admissions to psychiatric facilities, that children born to both older fathers and mothers have a higher risk of developing autism, and that country of origin may also effect a child’s relative risk of developing autism. </li></ul>
  40. 40. Tsatsanis, K.D. (2003). &quot; Outcome research in Asperger syndrome and autism &quot;. Child Adolescent Psychiatry Clinics of North America 12 (1): 47–63 <ul><li>Although there have been numerous small scale studies looking at functional abilities in individuals with autism spectral disorders (AS; there has not been well designed, large-scaled, studies establishing functional outcomes among the Asperger's Syndrome population.  Early studies have documented two factors suggestive of favorable outcomes: IQ and language development before six months of age.  Also, earlier studies have shown that the diagnosis of autism often remains stable with variability noted in functional outcomes.  In this article, the author explores recent literature in hopes of looking for consistent findings relating to functional outcomes among the population presenting with autism spectral disorders, particularly, Asperger's Syndrome. In exploring the previous studies, the author examined various outcome measures including school placement, employment, living arrangements as well as other outcome predictors (i.e. speech and language skills, verbal and nonverbal IQ scores, social adaptive behaviors, and academic achievements) across time.  </li></ul><ul><li>Findings from this study reveal that individuals with Asperger's syndrome have relatively good cognitive functioning, highly developed language skills, and often have specific areas of interests that may facilitate with developing friendships and obtaining satisfying jobs.  Collectively, these findings suggest that individuals with Asperger's Syndrome are less impaired than those with highly functioning autism.   While a minority of individuals with Asperger's Syndrome are able to live independently and maintain high level jobs, the majority tend to live at home, hold no job, and have few or no friends. These findings stress the need for future research into Asperger's Syndrome in terms of the functional impairment imposed on these individuals as well as in helping to design effective intervention plans so that the quality of life in these individuals is maximized.  </li></ul>
  41. 41. References <ul><li>American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders (4 th  edition Revision) </li></ul><ul><li>Baird, G., Charman, T., Baron-Cohen, S., et al. (2000) A screening instrument for autism at 18 months of age: A 6 year follow-up study. Journal of the American Academy of child and Adolescent Psychiatry, 39, 694-702. </li></ul><ul><li>Brown, I., & Percy, M. E. (2007). A comprehensive guide to intellectual and developmental disabilities . Baltimore, MD: P. H. Brookes. </li></ul><ul><li>Fombonne, E. (2001). What is the prevalence of Asperger disorder? Journal of Autism and Devleopmental Disorders, 31:3, 363-364. </li></ul><ul><li>Gillberg, I.C., & & Gillberg, C. (1989). Asperger syndrome- Some epidemiological considerations: A research note. J ournal of Child Psychological Psychiatry, 30, 631-638. </li></ul><ul><li>Lauritsen, M. P. (2005). Effects of familial risk factors and place of birth on the risk of autism: a nationwide register based study. Journal of Child Psychology and Psychiatry , 963-971. </li></ul><ul><li>Myers, S.M. & Johnson, C.P. (2007). &quot;Management of children with autism spectrum disorders&quot;. Pediatrics 120 (5): 1162–82. </li></ul>
  42. 42. References (II) <ul><li>National Institute of Neurological Disorders and Stroke, National Institutes on Health. (2008, October 17). Asperger Syndrome Information Page: National Institute of Neurological Disorders and Stroke (NINDS) . Retrieved November 8, 2008, from NINDS Asperger Syndrome Information Page: http://www.ninds.nih.gov/disorders/asperger/asperger.htm </li></ul><ul><li>Oktem, F. D. (2001). Functional magnetic resonance imaging in children with asperger's syndrome. Journal of Child Neurology , 253-258. </li></ul><ul><li>Prior, M. (2001). Is there an increase in the prevalence of autism spectrum disorders? Journal of Paediatric Child Health , 39, 81-82. </li></ul><ul><li>Sponheim, E., & Skjeidal, O. (1998). Autism and related disorders: Epidemiological findings in a Norwegian study using ICD-10 diagnostic criteria. Journal of Autism and Developmental Disorders, 28, 217-227. </li></ul><ul><li>South, M. O. (2005). Repetitive behavior profiles in asperger syndrome and high-functioning autism. Journal of Autism and Developmental Disorders , 145 - 260. </li></ul><ul><li>Stokes, S. (2008). Children with Asperger's Syndrome: Characteristics/Learning Styles and Intervention Strategies. Retrieved November 10, 2008, from www.specialed.us/autism/asper/asper11.html </li></ul>
  43. 43. References (III) <ul><li>Szatmari, P., Bremner, R., Nagy, J. (1989). Asperger’s syndrome: A review of clinical features. Canadian Journal of Psychiatry, 34; 554-560. </li></ul><ul><li>Taylor, B., Miller, E., Farrington, C., Petropoulos, M., Favot-Mayaud, I., Li, J., & Waight, P.A. (1999). Autism and measles, mumps, and rubella vaccine: No epidemiological evidence for a causal association. The Lancet, 353, 2026-2029. </li></ul><ul><li>Toth, K., & King, B. (2008). Asperger’s sydrome: diagnosis and treatment. American Journal of Psychiatry, 165:8, 958-963. </li></ul><ul><li>Tsatsanis, K.D. (2003). &quot;Outcome research in Asperger syndrome and autism&quot;. Child Adolescent Psychiatry Clinics of North America 12 (1): 47–63 </li></ul><ul><li>World Health Organization (1993). The ICD-10 Classification of Mental and Behavioral Disorders. Diagnostic Criteria for Research, Geneva: World Health Organization. </li></ul><ul><li>Wong, V.C (2008). &quot;Use of complementary and alternative medicine (CAM) in autism spectrum disorder (ASD): Comparison of Chinese and western culture (part A)&quot;. Journal Autism Developmental Disorders. </li></ul>

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