Understanding Asperger's Syndrome

Understanding Asperger’s Syndrome

Publish Date : 3/16/2005 2:47:00 AM Source : Health Section ExpressNewsline.com

Diagnosis of Asperger’s Syndrome is made in terms of one or both of two main sets of diagnostic criteria: the DSM-IV criteria, and Gillberg’s criteria (published by Swedish psychiatrist Christopher Gillberg).

THE DSM-IV DIAGNOSTIC CRITERIA FOR ASPERGER’S SYNDROME

(A) Qualitative impairment in social interaction, as manifested by at least two of the following:

1. marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

2. failure to develop peer relationships appropriate to developmental level

3. 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)

4. lack of social or emotional reciprocity.

(B) Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

2. apparently inflexible adherence to specific, non-functional routines or rituals

3. stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

4. persistent preoccupation with parts of objects

(C) The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

(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)

(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.

GILLBERG’S CRITERIA FOR ASPERGER’S SYNDROME

1. Severe impairment in reciprocal social interaction

(at least two of the following)

(a) inability to interact with peers

(b) lack of desire to interact with peers

(c) lack of appreciation of social cues

(d) socially and emotionally inappropriate behavior

2. All-absorbing narrow interest

(at least one of the following)

(a) exclusion of other activities

(b) repetitive adherence

(c) more rote than meaning

3. Imposition of routines and interests

(at least one of the following)

(a) on self, in aspects of life

(b) on others

4. Speech and language problems

(at least three of the following)

(a) delayed development

(b) superficially perfect expressive language

(c) formal, pedantic language

(d) odd prosody, peculiar voice characteristics

(e) impairment of comprehension including misinterpretations of literal/implied meanings

5. Non-verbal communication problems

(at least one of the following)

(a) limited use of gestures

(b) clumsy/gauche body language

(c) limited facial expression

(d) inappropriate expression

(e) peculiar, stiff gaze

6. Motor clumsiness: poor performance on neurodevelopmental examination

(All six criteria must be met for confirmation of diagnosis.)

There is no specific treatment or cure for any of the PDDs, including Asperger’s Syndrome. However, early diagnosis is essential, for the earlier intervention is initiated, the more promising the outcome. Treatment is individualized, based on specific symptoms and rehabilitative requirements. Appropriate educational programs will emphasize improving communication skills and social interaction, enhancing academic development, modifying maladaptive behaviors, encouraging adaptive behaviors, improving physical coordination, and developing daily living skills.

Social skills are more effectively developed through interaction with normal peers, who then can also serve as models of appropriate behavior and use of language. But the educational environment must also be structured and consistent, and information should be presented visually as well as verbally. In order to help the child with Asperger’s to generalize behaviors and skills learned at school, they need also to be reinforced at home. Thus parental involvement is absolutely essential to an integrated developmental program for an Asperger's child.

Intervention may also require medication, including psychostimulants, tricyclic antidepressants, and beta-blockers. As the individual with Asperger’s enters adulthood, he or she may also need specialized adult support services in order to locate and maintain employment and living arrangements.

This is not to suggest that there is any cognitive impairment in the Asperger’s individual. On the contrary, those with Asperger’s have no clinically significant delay in language development or in cognitive abilities. Many with Asperger’s are of average intelligence, but many are actually highly gifted and even brilliant. People with Asperger’s often obtain one or more college degrees, and they may become mathematicians, philosophers, scientists, university professors, etc. But adult functioning usually requires some degree of communication skill and social adaptability, and these are notably lacking in Asperger’s Syndrome, which is why adult support services are often helpful or even necessary.

What else is often lacking is comprehension of the nonliteral aspects of language, especially spoken language. Just as they miss nonverbal signals when interacting with others, people with Asperger’s usually are stymied by humor, irony, metaphor, or any other use of language that goes beyond literal meaning. This makes normal interaction with coworkers or acquaintances difficult.

Of all the pervasive developmental disorders, Asperger’s Syndrome has the most positive prognosis, and children with Asperger’s more often than not become independently functioning adults. However, their social impairments often lead to psychological difficulties, including poor self-image and depression, and as adults their social interactions will continue to be marked by typical Asperger’s disturbances, though usually in more subtle form if intervention has been initiated early and successfully.
Understanding Asperger�s Syndrome : Health Section ExpressNewsline.com- ExpressNewsline.com

Facts about autism

Facts about autism
Tuesday, March 15, 2005
The Grand Rapids Press

What is autism?

Not a disease, autism is a developmental disorder that includes a broad range of symptoms and conditions -- from a high functioning form called Asperger's Syndrome to more severe forms. Grouped with other developmental conditions called Autism Spectrum Disorders, the disability is a lifelong condition that usually appears in children before age 3. There is no cure.

Those with autism are bombarded with sensations from everything they touch, see, feel, hear and taste, all at the same time, to the point of overload. Many cannot deal with change and end up retreating into a world of their own.

Autism facts

Autism Spectrum Disorders occur in 1-2 or more of every 500 births; 3 to 4 times more often in boys.

The developmental disability is thought by some scientists to be genetic in origin.

It is the third most common developmental disability following mental retardation and cerebral palsy. It's the fastest-growing developmental disability.

75-80 per cent of people with autism have mental impairment

What are the signs?

Many children with autism may seem normal in their development until they're toddlers, when delays or regression in language, social interaction and play become more apparent. Possible signs include:

Slow or no language development, a short attention span, difficulty in answering questions or comprehending what they hear and read. They often interpret words literally, and have difficulty understanding humor, sarcasm, or figures of speech.

Unusual speech and language. Words, phrases or sentences may seem out of context.

Preference to being alone; difficultly joining others in make-believe play.

Repetitive or unusual mannerisms such as rocking, flapping a hand, banging his or her head and flicking fingers in front of the eyes. Possible physical awkwardness or seemingly lack of coordination.

Aversion to social touch.

Has difficulty making direct eye contact with others.

Has trouble understanding inferred meanings behind spoken words. Takes the meaning of words literally.

Violent reactions to objects, people and situations

Incredibly accurate memory of details such as dates, phone numbers, facts, quotes, etc., but trouble remembering where they left their shoes.

(Sources: The Gray Center for Social Learning and Understanding, and www.autismeducation.net.)

Behaviors to Watch

The criteria used to diagnose autism are designed for 3-year-olds. Recent research shows certain behaviors in younger children may indicate a higher risk for developing the disorder. No single factor indicates a child may have autism; the presence of several symptoms could be cause for concern.

Possible symptoms at 6 months

Not making eye contact with parents during interaction

Not cooing or babbling

Not smiling when parents smile

Not participating in vocal turn-taking (baby makes a sound, adult makes a sound, and so forth)

Not responding to peekaboo game

At 14 months

No attempts to speak

Not pointing, waving or grasping

No response when name is called

Indifferent to others

Repetitive body motions such as rocking or hand flapping

Fixation on a single object

Oversensitivity to textures, smells, sounds

Strong resistance to change in routine

Any loss of language

At 24 months

Does not initiate two-word phrases (that is, doesn't just echo words)

Any loss of words or developmental skill

(Source: Rebecca Landa, Center for Autism and Related Disorders at the Kennedy Krieger Institute, Baltimore)

Behaviors by age group

No single factor indicates autism; the presence of several could be cause for concern.

At 6 months:

Not making eye contact with parents during interaction

Not cooing or babbling

Not smiling when parents smile

Not participating in vocal turn taking (baby makes a sound, adult makes a sound, and so forth)

Not responding to peekaboo game

At 14 months:

No attempts to speak

Not pointing, waving or grasping

No response when name is called

Indifferent to others

Repetitive body motions

Fixation on a single object

Oversensitivity to textures, smells, sounds

Strong resistance to change in routine

Any loss of language

At 24 months

Does not initiate two-word phrases

Any loss of words or developmental skill

(Sources: Signs -- The Gray Center for Social Learning and Understanding,

and www.autismeducation.net. Behaviors -- Rebecca Landa, Center

for Autism and Related Disorders at the Kennedy Krieger Institute,

Baltimore, Md.)

Treatment questions

When deciding on an autism strategy, Kristen Priem suggests parents become "careful consumers" and look at every strategy and evaluate it based on their child, their family, and the time and energy they have to devote to it. She advises asking these questions:

How practical is it? Will it require special equipment, trained therapists or special materials? Can I continue it long term?

How much does it cost, and could the benefits justify the expense?

Does it fit with my family's other needs, lifestyle and beliefs? Consider the location where therapy is provided, your other children's needs, and other areas of stress in your life.

Assess your expectations about what your want the strategy to do for your child, how long it may take for improvement in specific areas and what happens when there's no improvement in a reasonable amount of time.

Statistics

In Kent County, students with autism numbered 493 in 2003; 555 in 2004.

In Ottawa County, students with autism numbered 220 in 2003; 271 in 2004.

In Michigan, students with autism numbered 7,525 in 2003; 8,650 in 2004.

In the U.S., 1 child in 166 has autism.

1 million to to 1.5 million Americans have the disorder.

Autism is the fastest growing developmental disability with a 10 to 17 percent annual growth rate which could reach 4 million Americans in the next decade. It's increased 10 times in the last 20 years.

During the 1990s, the increase of those diagnosed with autism was 172 per cent.

(Sources: www.autism-society.org and www.autisticsociety.org; Michigan Department of Education)

Resources

The Gray Center for Social Learning and Understanding, 4123 Embassy Drive SE, Kentwood, MI 49546. Contact them at 954-9747 or visit their website at www.thegraycenter.org.

Autism Asperger Associates of Michigan, 7027 10 Mile Road NE, Rockford, MI 49341. Contact them at 874-2090 or visit their website at www.autism-asperger-associates.com.

Autism Society of Michigan, 6035 Executive Dr., Ste 109, Lansing, MI 48911; www.autism-mi.org.

Autistic Society: www.autisticsociety.org.

www.autismspeaks.org.

Autism Coalition: autismcoalition.org.

CDC: cdc.gov/ncbddd/autism/actearly.

National Alliance for Autism Research: naar.org.

Autism Society of America, Inc.; www.autism-society.org.
Facts about autism

About Asperger's syndrome

Asperger’s Syndrome is a neurobiological disorder in the autism spectrum. The name Asperger’s syndrome comes from the psychiatrist Hans Asperger’s paper written in 1944. The term is used to describe certain patients who have never been easy to classify but who seem to constitute a recognizable type of autistic individual. The discovery of autism was credited to Leo Kanner in 1943. Kanner was an Austrian who immigrated to the United States in 1924. Asperger, also an Austrian, remained in Vienna. They both worked independently and by coincidence described the same type of disturbed child and used the term autism.

There is a great deal of overlap between Asperger’s and Kanner’s views of autism, they are mostly in agreement on all the major features. The features described first by Asperger were oddities of non-verbal communication; eye gaze, gestures, posture, voice quality, prosody and word choice. He also highlighted lack of humor and pedantry.

There is much to be learnt about Asperger’s Syndrome, our knowledge is still patchy. However, a consistent picture is beginning to emerge. Following are the six diagnostic criteria based on Asperger’s paper in 1944.

1) Speech- no delay, odd content, pedantic, stereotyped.

2) Non-verbal communication- little facial expression, monotone voice, inappropriate gestures.

3) Social Interactions-not reciprocal, lacking in empathy

4) Resistance to change-enjoys repetitive activities

5) Motor co-ordination- gait and posture odd, gross movements, clumsy, sometimes stereotypes

6) Skills and interests- good rote memory, circumscribed special interests.

Children with Asperger’s Syndrome show impairments in cognition. This has an affect on the child’s play, language, sociability and academic achievement. The have difficulties in extracting a meaningful whole from what they see and hear.

Cognitive Difficulties.

The more complex the environment the more difficulty they have in extracting vital information.

Sociability.

They usually want to be sociable but often go about this the wrong way. They often appear rude, shy or overfriendly. They can be distressed when hurt or ignored but have little idea about how they are sending out the wrong signals for friendships to develop. Also, they can behave appropriate when left on their own but become overwhelmed by large groups.

Language.

Children with Asperger’s make literal interpretations of other peoples’ conversations and can over react to comments. Other people’s teasing and sarcasm can distress them, although they may learn to use it themselves. They rarely make the connection between the harm they inflict on others and that directed towards them. They are often impulsive saying things that others only dare think. This can make them sound arrogant, rude or hurtful. They acquire language through memory rather than meaning and tend to convey messages obliquely.

Play.

Asperger’s children understand that toys represent real objects but often have problems with more abstract substitutions or omissions. They often have a poor imagination and find it difficult to role-play.

Identifying problematic conditions helps to ensure that specialist provision can be made for all those involved. There is a case to be made against the use of labels. The term ‘diagnosogenesis’ has been used to describe a process of labeling where a person given the label creates or exacerbates the disorder. However, an equally powerful plea for the diagnosis of autistic spectrum disorders is that knowing someone has the disorder will tell you how to treat and teach that person. Needs that are not recognized or met can lead to a lifetime of misery.

Not so long ago, autistic spectrum disorders were blamed on the mother. It was claimed that children became withdrawn and autistic because of a lack of maternal attention when very young. The term ‘refrigerator mother’ was coined. Fortunately, it is now known that this accusation was false. The actual cause of autism is still uncertain but it is believed to be of genetic source. Often members of the same family will have the syndrome. It is also found to be more common in males than females and is rarely recognized before the child is three years old. More recent therapies have included a gluten-free diet, although it has not been proved to be affective.

It takes time and understanding to improve the quality of life for an autistic spectrum disorder child. There are many useful resources for information both in books and on the internet. It is often helpful to join groups and associations who can offer support and advice. Many children with Asperger’s Syndrome find school difficult, although it is often possible for them to attend mainstream school. They concentrate better in smaller groups and may need extra explanation of what work is expected of them. Routine and structure is important to them and anxiety can occur if this is disrupted. Unstructured moments of the day, such as playtime, can cause the most problems. They will need extra supervision as they are often teased or bullied by other children. The best strategy to avoid problems seems to be protection rather than exposure.

Unwanted behaviors at home may be diminished by the use of a behavior chart. Recording behaviors, when they occur, what triggered them and what happened afterwards, can give cares a greater understanding of why the behaviors occurred. A strategy can then be worked out on how to prevent the unwanted behaviors re-occurring. A clearly presented behavior chart is also a useful tool to explain to the child which behaviors are acceptable and which are not.
About Asperger's syndrome : Health Section ExpressNewsline.com- ExpressNewsline.com

Coming to terms with autism

Coming to terms with autism
By THERESA WINSLOW, Staff Writer

"Hi. My name's Eric and I'm playing with some blocks."

After that announcement -- made to no one in particular -- Eric LeBow hurried from the living room of his Mayo home to the basement to resume building.

The bright-eyed 6-year-old was back upstairs a few minutes later with his favorite stuffed animal, proclaiming, "That's my teddy."

Eric smiles and laughs a lot, is unfailingly polite and has a fantastic memory. He's also been diagnosed as high-functioning autistic, a finding his parents, Bert and Tammy LeBow, are just beginning to come to terms with.

They got the devastating news from a psychologist just before Christmas, even though they suspected for a long time that something was different about their son.

"It threw us for a loop," said Mrs. LeBow, a district manager for Hair Cuttery. "I wondered, should I quit my job? I left in tears. It's heartbreaking, We just had a big time pity party in December."

After some more crying and a few "down" days, the LeBows resolved to do whatever they could to help Eric. "We need to focus on his abilities - not his disability," Mrs. LeBow said.

The LeBows, who've been married 13 years, decided to share their story to help other parents who might be wondering why their child behaves certain ways. They'd also like to meet families who have children Eric's age with the same diagnosis for support.

"It's what it is," said Mr. LeBow, who works in the security department for Prince George's County schools. "What are you going to do? Sit around and complain? The best you can do is take it head on. We're not looking for him to get by in life. We're looking for him to succeed."

Still, the LeBows are uncertain about what the future holds for Eric. "All this is new. We're still figuring stuff out," Mr. LeBow said.

Initially, the LeBows were told Eric might have Attention Deficit Disorder. Others suggested he'd just grow out of his behavior, that he was "just a boy" or that it was unfair to compare his growth and progress with that of his older sister. But Mrs. LeBow suspected more was wrong.

Eric had language delays, conducted one-sided conversations "at" people instead of with them, handled change with difficulty, had a penchant for putting things in order and repeated behaviors, she said.

Over the summer, Mrs. LeBow spent a lot of time on the Internet and eventually figured Eric might have Asperger's Syndrome, a developmental disorder that's included in an umbrella category known as the autistic spectrum disorders.

Asperger's is primarily characterized by difficulty with social skills. Some experts consider the difference between it and high-functioning autism to be merely a matter of semantics.

Eve Band, the Owings Mills psychologist who began seeing Eric last fall and presented her findings to the LeBows in December, said he tends to fixate on his own, narrow interests and doesn't engage in two-way conversations.

Despite these problems, she was hopeful he could make a lot of progress. "He's young enough that there's a lot we can do," she said.

Linda Jacobs, executive director of The Harbour School in Cape St. Claire, said a lot of the students there with Asperger's end up going on to college. "With careful planing, they do quite well," she said.

Ms. Jacobs said 50 to 60 percent of their referrals are for students with Asperger's or high-functioning autism. In the county school system, there are 506 students, ages 3 to 21, with autism, according to officials.

At Eric's school, Mayo Elementary, he has an aide who helps him twice a day and a kindergarten teacher whose commitment has garnered praise from his parents.

Teacher Donna Kachura, who stays in constant contact with the LeBows, said she's learned a lot about autism because she wants to do the best she can for Eric.

"He's challenging, but there are many challenges in every class," she said. "He is special, but every child is special."

Besides his teacher, the school and his parents, support for Eric also has come from his sister, Amber, 8

"He's a good brother," she said with a wide smile.

Amber wrote a poem about Eric recently that pleads for tolerance. She often sticks up for Eric when other children tease him. "I tell them he can't help it," she said.

Eric is too young to know he's autistic, and does interact with his family - just a little differently than other children. The LeBows wish they had learned about their son's diagnosis when he was younger so they could have started assisting him sooner. But they've come to terms with the past and want to move on.

"If we had the opportunity to trade him for (another) kid, I'd say, 'No way,' " Mrs. LeBow said. "We're happy with the package we got. (We're) hell-bent to help him do whatever he wants to do."

The LeBows want to contact other local families with children Eric's age with the same diagnosis. If you would like to contact them, send an email to bertamlebow@comcast.net.

twinslow@capitalgazette.com

This is a poem Amber LeBow recently penned about life with her brother:

Kids with autism can't help it. Did you know that is true? Kids with autism are not like you. Kids with autism don't understand the rules, that's why they have challenges at school.

When kids make fun of him it makes me sad. And when they're mean to him it makes me mad.

But kids with autism are special too. They can draw pictures that really amaze you! He can memorize lots of cool things. He can memorize all the things that he sees!

He can make the whole world laugh, just by telling about his favorite things. He can be annoying, but he's a fun friend. When we play games he has fun til the end.

Every time I read to him, he slowly walks away. But surprisingly he remembers every thing I say!

So give him a chance, by trying to understand, I really love him. He'll always be my brother and he'll always be my best friend.
HometownAnnapolis.com, Lifestyle - Coming to terms with autism

Study links mercury from power plants to autism

March 17, 2005, 6:24AM

Study links mercury from power plants to autism
By TODD ACKERMAN
Copyright 2005 Houston Chronicle

After years of debate about whether a nationwide explosion in autism is related to a mercury-based preservative used in vaccines, Texas researchers have found a new suspect: mercury from coal-burning power plants.

In a new study, scientists at the University of Texas Health Science Center at San Antonio are reporting a strong correlation between higher mercury release levels and the developmental disorder marked by communication and social interaction problems.

"This is a preliminary study that needs further study but suggests there is a link," said Raymond F. Palmer, an associate professor in the UT-San Antonio's department of family and community medicine and the study's lead author. "If corroborated, it would have pretty severe implications for policy."

Palmer called the study the first to examine the relationship between potentially chronic, low-dose exposure to mercury and developmental disorders such as autism. He stressed it does not prove causation.

The study, to be published in an upcoming edition of the journal Health and Place and already online, looked at 254 counties and 1,200 school districts in Texas, comparing 2001 mercury emission levels with rates of autism and special education services.

Using statistical modeling, Palmer's team found a 17 percent increase in autism rates for every 1,000 pounds of mercury released.

About 48 tons of mercury are released in the air annually in the United States from hundreds of coal-burning plants. Texas plants release more than those in any other state.

The study was undertaken amid uncertainty about a dramatic increase in autism. Once thought to occur in 1 of every 10,000 children, today it is estimated to afflict as many as 1 in 250.

The still poorly understood disorder has a strong genetic component, but the increase in cases has fueled theories the environment is playing a role. To some, mercury, a neurotoxin that affects the brain, spinal cord, kidneys and liver, made logical sense .

Suspicion initially fell upon vaccines, many of which use thimerosal, a mercury-based preservative. During the period reported autism rates grew, U.S. health authorities expanded the shots given to children, causing many parents to suspect the vaccine. But no proof was ever found; and last year, a controversial Institute of Medicine report concluded there is no causal link.

Dr. Sarah Spence, medical director of the UCLA Autism Evaluation Clinic, called the UT-San Antonio study "very interesting." She noted that the mercury released by power plants has known toxic effects on humans, whereas that's still speculative in the kind of mercury used in vaccines.

"If the statistical modeling in the study is accurate, it's an important first step," said Spence. "Proving causation would provide important information to both researchers and clinicians, who know people receiving treatment to remove mercury."

Susan West Marmagas, director of the Washington, D.C.-based Physicians for Social Responsibility's environment and health program, called the study "the kind of research the scientific community needs to better evaluate the potential links between mercury and autism," but said she would need to confer with experts before commenting further.

Palmer said his next step will be to look at associations between mercury emissions and autism rates over time, about 15 years. He will start with Texas data, then compare that to national numbers.

"If this study is corroborated, I would hope it leads to reductions, just as studies led to reductions in lead," said Palmer.

The Bush administration Tuesday ordered power plants to cut mercury pollution from smokestacks by nearly half within 15 years. Environmentalists complained that the order fell short of what was needed.
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RESOURCES
A NEW CULPRIT

Texas researchers are reporting an alternative to the theory that the mercury in vaccines is related to the explosion of autism — mercury released by coal-burning power plants.
• The increase: Once thought to occur in 1 of every 10,000 children, autism today is estimated to afflict 1 in 250.
• Suspected cause: Mercury is a neurotoxin that affects the brain, spinal cord, kidneys and liver. It is released by coal-burning power plants.
• The study numbers: A University of Texas Houston Health Science Center at San Antonio study found a 17 percent increase in the autism rate for every 1,000 pounds of mercury released into the environment.

HoustonChronicle.com - Study links mercury from power plants to autism

Learn the signs of autism, act early (printable child development chart)

It's time to change how we view a child's growth.