Asperger or High Function Autism?

Ruthie - posted on 03/21/2011

I have 2 boys and the way the doctoers explaned it when they were trying to decide between the two for my oldest son was that beacouse hes abilitys did on a mild to large scale effect his way of talking he was getting a diagnosis of autism. Aspergers is mainly with the social interactions.

Stephanie - posted on 03/07/2011

Lori I first sought help from the school guidance counselor. They did some testing and then we took him to see a therapist who had him tested by a psychologist. He seams to have a lot of the same issues my son has. I would lean towards AS. It is so hard since every kid is different. I have two sons ages 7-11 and they both have AS. My younger one carries more symptoms. He externalizes while my older son keeps everything inside. Don't lose hope with the help of good teachers, a good therapist and all your love and support he can get help and learn to cope. It can happen. Just keep seeking help and fight until you feel like you have the answers you need.

Stephanie - posted on 03/07/2011

Aspergers is a social disorder. It mocks the symptoms of autism however it is different. My 7 year old son has AS keep in mind that each AS kid is different. My son has sensory issues and melt downs. He is very smart but doesn't have a lot of the "typical" signs of AS and was diagnosed with ADD, ODD and OCD prior to his AS diagnosis. He has issues with clothes and obsessions with certain things, he is very particular and doesn't make eye contact. He doesn't however like to be alone, he is very social with a lot of friends and different interests. He swears a lot. He does well academically especially in math and reading. He attends a school where he is in a autistic cluster with 9 other kids with AS. We recently made that change and it has changed his world and school out look. The past 3 years of mainstream and resource have been hell. He is loving and funny and can be overwhemjngly hard but he is who he is and I love him. He takes medication and is in therapy. The best thing you can do is seek the help of a therapist and get the correct diagnosis.

Joanie - posted on 12/29/2009

My name is Joanie Bottoms and I have an Aspergers child, they usually only have trouble with speech when they are younger and then grow out of it so speech isn't really what determines the difference it is their social behavior and functions. Most Autistic children high functioning or otherwise still don't like to make eye contact or to be touched.. An Aspergers child can be, as my child is very affectionate and he will make eye contact if you remind him. Also most Aspergers children when tested, test into the genious level as they are extremely intelligent.

Denise - posted on 12/28/2009

Hi Lois,
I have a son who has what they call "High functioning Autism" and when he was given his diagnosis, we thought it would be Aspergers not Autism. The reason that they gave was the way in which the speech manifests itself. My son's speech was very disordered very early on and was very obvious to all those around him, whereas they said to be diagnosed Aspergers, the speech is not an obvious sign early on at all. They appear slightly aloof but no big alarm bells ringing! As you probably know, some children with Aspergers fall through the net until a much later age and I think it is these speech signs that are key. Hope this helps.

Heather - posted on 12/28/2009

I should probably add that along with the HFA, he also has SEVERE (exactly how it was diagnosed) ADHD, OCD (obsessive compulsive disorder), SID (sensory intergration disorder), ODD (oppositional defiant disorder) and i can't remember the other ones. He used to flap his arms among other "tics". He has emotional issues. He is very aggresive. He used to do the rain man thing as long as the objects were the same shape and color. that was freaky at first i must say. But, regarless of his "problems", I love him as he is and I thank God for him.

Heather - posted on 12/28/2009

My son was originally diagnosed Aspi. But, after further testing, it was changed to high-functioning autistic. Unfortunately I don't remember what they all are, but there are 3 things that determine between the 2 "titles". One of which, is the speech.

Paulette - posted on 12/27/2009

Post a reply Aspergers don" t have any social skills. They do not do good in a crowd of people they just shut down. My son is a 4.0 students in school, but can only interact with 1 or 2 people at a time before he shuts down.

Dawn - posted on 12/27/2009

Lori~ Call Easter Seals. They usually work with younger children, but they would be an excellent place to start and may know of programs that would suit your family. There really isn't any medication for Asbergers. It is based on behavior modification and social training. The earlier these things occur, the better. As for his anger, that also is going to be behavior modification. Look into BIOFEEDBACK. This is a non invasive thing... your son will sit in front of a computer and have some wires stuck to the scalp with an adhesive (like heart monitor wires). The wires measure brain wavelengths and puts those waves lengths into an easy-to-read graph on the computer. There are brainwaves that have to do with anger and self control, and that is what will be measured. When your son sees these bars, they will move according to the "brainwave' they produce. By watching the graph he can learn how to control his own brainwaves to keep them above a certain level or below, depending on if the waves are to high/low/fast/slow. this doesn't harm anything and it is not hypnotic. No drugs are needed. Its a matter of him mentally repairing his own wave pattern to help fix "short circuits and mis-firings within the brain. I had biofeedback after a severe head injury. I had qualified for a free study that was being done out of Philadelphia, PA. my head injury symptoms and my ADHD were significantly repaired by seeing my own brain and "thinking the wavelengths" into repairing themselves. After my head injury, I had major anger issues and did things and thought things that before the injury, were not even a part of me. Compare biofeedback to a video game. Gaining some control over anger issues is the reward. I hope this helps you.

Lori - posted on 12/27/2009

I have been raising my step-son full time since he was 3 1/2. When he came into my life he had been committed to a psychiatric ward at 3 without his father's consent. His father was working out of state at the time. His mother snydly remarked it was cheaper copays than daycare. Unfortunately it has taken years to unravel that mess. They diagnosed him as possible ADD, ADHD, PDD, ODD, but noted possible as he was too young to be diagnosed. Regardless they put him on extensive antipsychotic, antiseizure meds. We took him to see a psychologist and psychiatrist regularly to monitor his behaviours and medications. Finally in first grade (6 yrs old) they suggested a new medication (Ambilify) but had to slowly take him off all meds to change prescriptions. Once the medications were removed from his little body it was like a cloud was lifted and this bright light shined through. Even his teachers noted amazing changes showing this kid was very bright, etc. We took that information and we convinced his doctors to allow him to function without the medication. He still had to take speech therapy all through grade school. I cant help but blame the medications in delaying his speech, and his development. He is now in 7th grade, they took him out of special education this year, I was preparing for the worst honestly. He proved us all wrong and made the honor roll! I still feel he has been wrongly diagnosed and feel with his lack of social skills that he possibly does have Aspergers. My problem is now how do I go about getting him tested/diagnosed. He is having major meltdowns, extremely lacking in apathy and constant mood changes. We cant afford insurance for him, we make 100-200 too much to qualify for state aid. His mother was court ordered to pay child support and doesnt (another story) & court ordered to provide insurance but when I tried to get him into a mental health facility I found out that too was never completed. The child has major anger issues and it is like he has to blow up a big disruption wherever he goes, his moms for visits, or in our house. We are all sick of dealing with this, we have tried so many ways by experts and nothing seems to work. He needs help, any tips on how to get help when you cant afford it? Any ideas on how to get him tested for Aspergers? diagnosed? I called the state and they said we are the typical family that falls through the cracks. We have tapped out all resources we have and frankly have nothing else. Thanks for your feedback.

Darlene - posted on 12/27/2009

Thank you for the research. It was enlightening and I am sure it would have been more so were I more intelligent.:) I also wanted to add after reading a lot of the posts that some of the things change over time. My son had a hard time with loud noises, airplanes, busses,elevators, 4wheelers, boats, etc. We forced his to endure these things (at times I thought I was a horrible parent while we litterally wrestled with him to get him in a life jacket or on a plane) and now he loves them and is much more tolerant than many autistic children. He enjoys fishing, 4-wheeling, skating, bike riding, and can use any form of public transportation with comfort. So, even though we almost got thrown off the bus, (the first time while riding he screamed bloody murder) I didn't give up. I took him to the back of the bus, covered his mouth and sang very softly his favorite tune. Twinkle Little Star, until he quieted to hear me and for the rest of the journey, he was tense, but the screaming subsided. Now he is 14 and boards the bus everyday for school. I thank God that we went through that early on while he was small. There are so many challenges with children of special needs and some may not like what you do, you just have to think of their future and trust yourself. Now he wants his DRIVERS LICENSE! I told him when he can read well enough to pass the test... Unfortuneately, reading cuts into his X-box time. Sometimes, William is entirely to normal. LOL

Dawn - posted on 12/27/2009

http://getresponse.com/click.html?x=a62b...

Dawn - posted on 12/27/2009

I don't understand what things are like where you live, but the biggest things i can suggest would be 1) doing a lot of your own social skills training with him. 2) Let him be in situations where he can watch and do what other children his age are doing (mimicking). and 3) Find out what his interests are and promote his learning them. Having information accessible may be the challenge necessary to draw him into talking more and interacting.

I have ADD hyperactivity and when I was growing up i didn't sit still. i moved around a lot and had a hard time focusing for periods of time. One on one communication kept my attention longer and helped me build skills that being in a large class setting couldn't accomplish.

In the USA we have homeschool as an option... that is where the parent teaches the student at home using a curriculum that the parent has researched and feels comfortable teaching. The curriculum can be different for each student. I do this with my daughter because i do not like the local school systems in my area, and because i want my daughter to learn things that the government run schools will not teach (like creation and Bible). Is this an option where you live? For recreation, we have sports programs, church programs, other community programs. and my daughter is involved in music lessons, singing and dance class. Other homeschool friends take other classes like karate or art class.

You know your child best, so please do not let your government or doctors push you around and put you in a position to keep trying different medications on your son. Some children are late at having things come together in their minds, whether it is speech, coordination or learning basic skills. Be consistent and persistent in helping your son learn what is expected of him (speech and behaviors), and he will eventually surprise you by displaying more social skills and having a desire to learn and become more independent. His speech may all of a sudden take off as well. My daughter was seeing a specialist for Asbergers and she had stopped talking or making eye contact when she was 11 1/2 months old. i did exactly the advise i gave you, and she is now talking at 3 years old, and she sings songs and counts and says her alphabet. From the specialists we saw, and the books I've read, I learned that early intervention can stop certain things and promote the things we want our children to succeed in. The parents play the biggest role and have the most love and concern invested. Doctors don't have that privilege.

Lois - posted on 12/27/2009

sorry forgot to add that my son does have some form of early intervention 3 times 2 hourly at a early intervention centre runs by charity organisation that provided some subsidies. normal days he attends a regular childcare (I paid premium inorder to have low teacher student ratio, about 1:4). I feel that currently he's having ADD and Speech Delay (talk like 3 year old) but he has lesser issues in understanding speech (ie receiving end of verbal communication). He needs a shadow teacher during Sunday school to help him to 'blend' well in the class, but one of the teacher who happens to be a special needs teacher at a low function school told me that he's good to be at mainstream ( a confidence booster!) so I am counting my blessings too for all the help I received so far!

Lois - posted on 12/27/2009

hi all this is my first post and feels so good to see so many of you out there responding to me!!! Yes this is indeed like a ray of light into my search for help for my son. To answer a few questions :
I am in Singapore and if Clair said that Australia is behind US and UK, Singapore is consider an INFANT in this area, especially in High Function Autism. We have many establishments over the years for lower function needs and those with mild behaviour problems HFA will go mainstream schools and keep fingers crossed that they will survive well there. for those with 'problematic' behaviours will ended up with the same path as the low function attending to schools that only prepare them life skills. So that will spells the end of their prospect in life. In conclusion, ironically for parents then, if they send their children for 'help' based on what was available then, they are like sending their children to their 'doom'.
Things have improve in recent years and we have our first HFA school that caters for mainstream school programme in 2004 (i can imagine some mommies having their jaws drop by now) and they run like private school and so one can imagine what parents have to folk out inorder for their HFA children not to 'fall through the cracks and rejected by society'. I submit my son's application for their kindergarten2 programme to prepare him for his primary one (grade one) education (the only programme available with such objective in mind in Singapore) in April this year, but received a letter that informed me that he will be on wait list for God knows how long recently. It's so discouraging that despite the fact I've pushed my best to apply as early as possible (need to go through Weshler IQ test first as criteria for application and according to my doctor, Lucus speech delay will not help him to score well if he take this test too early so he only did the test in March09). => Moms in USA/US/Australia => count your blessings!!!
So that's why I have to do a lot of research on my own, reading books after books on how I can help my son on my own.
Lucus is diagnosed as PDD-NOS ( DSM-IV ) at about 3 years old and his eye contact then were rather poor and had speech delay but his social skills seems not that severe enough to get a tick on that form. (by the way the entire assessment was done by a 'stranger' aka therapist to lucus in a room that he only visited first time with my husband and I there observing and answering few questions and only 2.5 hours but I read that in US such assessment takes days and few locations including home, right?)
based on the Weshler IQ test, he scored 121 (superior) on performance IQ but only managed 55 for Verbal IQ.
So you can see now that my son needs SPEECH IMPROVEMENT desperately. He does have other 'minor' in comparison issues such as attention, but I've managed to somehow overcome them and slowly we see many milestones. e.g. Eye Contact, and no longer wondering around in class when the lesson is on, but still sits there distracted.
So mommies, any advice in this area? private ST is so so expensive and even if we are willing to pay, logistically hard to compromise because we are both working parents.
THANKS for all the REPLIES!!!!!!!!!!!!!

Evie - posted on 12/27/2009

My son was diagnosed with HFA they told me he was diagnosed as this because the tests used for AS required speech at an early age. My son, who is profoundly deaf never recived hearing until he was 22 months old, therefore he couldn't develop speech early.

Dawn - posted on 12/27/2009

My husband has Asbergers Syndrome. He was labeled later in life after being misdiagnosed, put on and taken off various drugs in his child hood years to see what worked, hooked up with a psychologist who couldn't figure out how to work with him, and put in a class for slow learners. Now he is 38 and life has been an eye opener.

We have learned together all kinds of stuff. Accidentally through life, and by reading up on the subject. He speaks very well and annunciates very well. He does not like to read aloud though. When he was in 3rd grade he was reading Beowulf and The Iliad and The Odyssey to himself while the other kids in his special ed class were reading Dick and Jane books. As far back as he can remember he has had an interest in history, war and the minute details of each... no glossing over! Everything is about 'If-this-than-that'. His mind acts like a running time-line and he fills in information mentally via that time line. He also likes metallurgy and can chronicle the types of metal used at various times in history, the techniques used to create the metals and the things made from the metals, and the heats etc necessary to melt and make things from metal. From that, he can time line any people from any time in any land and tell you how they lived and how advanced they were etc. he can take anything and relate it that way, like cotton use and how it was manufactured and when etc.

When I first met him, he was the king in his own world. He was given a job at his own station and he took pride in keeping his work area the neatest and most efficient it could be, Through the years, he has improved each work place by "accidentally" organizing and making it more efficiently run (It was done to accommodate his comfort zone, but accidentally made things better for everyone around him as well) . His motivation was really his OCD about everything being in it's place and easily utilized. As a matter of fact, he lived out of a duffel bag for the first year we were together. If it wasn't in his duffel bag, it was an unnecessary item. He also lived by the Cowboy creed about walk tall, shoot straight, and whatever else. The quote stuck with him and made sense so it became his motto.

For the first 5 years we were together it was very difficult to get him to ask me how my day was. My tears and my telling him how upset his lack of concern was did not phase him. I even called him an unfeeling robot. That hurt his feelings, but he either still did not respond, or gave me some matter-of-fact reason about already knowing how my day would go, so why ask. It wasn't until later that I realized that he didn't know how to respond.

In our early marriage, it was a difficult time. But some interesting things happened. One was that he got very tipsy one night and he loosened up during that time. We talked and he asked me questions and listened to my answers etc. he poured out his heart about how he wished he could fix the world because he knew how to, but no one took him seriously, and a bunch of other stuff. He even explained what went through his head when he couldn't talk to or respond to me at various times. It was as much a healing and understanding moment for him as it was for me. He even apologized for not appearing to be more supportive or caring! (I am not recommending getting your child drunk! LOL, but i am stating that getting into a state of having the pressure off, caused him to open up without inhibitions).

We are very open to treating his Asbergers like an interesting science project. I watch him more now to see how he interacts with me, the children and others. What I've learned is that his restraints and tolerances are low. He has a strong sense of right and wrong/black and white/etc, and he lives by that. he doesn't expect things from others that he wouldn't expect from himself... the problem is that his expectations of himself are very high and the reason he succeeds there is because of how he leads his life. Not everyone has the same standards or philosophies... he can't understand that and it can ruin his evening dwelling on the "mistakes of stupid people."

He figures out how things work and he has studied people for so long and so well throughout his life that he can start watching NCIS or CSI and after 5 minutes tell me what direction the show is going to head in, the dynamics of the characters with each other, and how it's going to end. I am constantly amazed because it's like he helped write the script!

We watched a video of Men are From mars and Women are from Venus one evening, and that further made lights go on for each of us. We laughed through the whole things and kept pointing fingers at each other. I learned that Bruce acts like a typical guy does anyway, but much much more intensely. I learned how to cope and how to more often talk in short sentences without going off on girly details. In so doing, I learned to keep his attention longer and to get a good response from him. (It was social skill training late in life!... the stuff mama never told you but should have). My husband learned that he has to listen more often and he needs to repeat back what i say in a way that gets me to realize he was listening... he began asking me how my day went!!!!

Now, things that others take for granted, we have too. it took years of practice and heart ache to get it right since social training didn't come until so late in life (late 20s) rather than in the elementary years when most people develop those skills.

We later went to an I STILL DO seminar, and that was reinforcement to the video we watched, and then it was a whole bunch more. God got us there and sat us down and made us listen and understand each other better. Our lives have improved from those social skill building events tremendously, and i swear by them as something that all Asberger children should get as soon as possible.... morals, values and spoon-feeding the proper words and actions/reactions, until they become ingrade habits and personality traits.

We still have issues as any marriage does. He happens to have issues with bright lights, jolts (like from having to break quickly in the car), piercing, repetitive and loud noises, anything wet, and other "odd" sensations. They can put him in a foul mood as quickly as turning on a light switch. When he is deep in thought, his hand waves almost like swing a hand gun made from his fingers. He wasn't aware of this tic until I pointed it out, but now if he notices he becomes self-conscious.

He often talks excessively about his favorite topics and does not get my body language that shows my disinterest or need for him to hurry and get to the point. But, If i verbalize that I am not interested, he will make his point if he has one, then stop talking about that topic. Oddly, he gets upset if I do not recognize his accomplishments, but is unaware of when he doesn't recognize mine. At one time this all bothered me, but now I am not so bothered. it is what it is.

Sometimes it is not easy being married to an Aspie. other times, there is no one else in the world I would want by my side. I have a head injury and some short term memory loss and word confusion. He is my walking encyclopedia, my champion, my helpmate and my personal organizer when I need it. He loves being needed and it drives him to succeed.

I hope this helps some of you mothers wondering what is in store for your children with Asbergers. Please remember to be consistent with teaching things that others take for granted~ In public if need be, and repeat as necessary. Even if you sound like a drill sargeant or a broken record. It will pay off. If the deed has a cause-and-affect or If-This-Than-That explanation to give support for the necessity of the action or words, explain it. It goes with the way they think-logically and precisely (at least as per my experience). I believe that the earlier the issues are examined and corrected through social training, the less Asberger-ish the person will appear as he gets older.

O.A.S.I.S. has several excellent articles (some written by Aspies) that explain how to teach social skills and what areas to concentrate on. They are full of useful info and resources!

He has an extremely high retention rate for things he reads and hears and can often repeat back word for word what was said. i asked him once to tell me what the second sentence in the third paragraph of a 2 page article about Teas of the World said. He gave it to me word for word!

Michelle - posted on 12/26/2009

thanks for all that information it hass confused me a little but i will use the web site you gave me My son i now 14 and hasnever done a whole a day at school but the more i learn the better for him , i too habe read many books each contradicting the last so i gues its back to counselling and trowellling thru the web thanks michelle

Dawn - posted on 12/26/2009

www.O.A.S.I.S.com (or .org?) is a fantastic resource for getting your questions answered and it is full of personal testimonies and links and help sections.

D. L. - posted on 12/26/2009

The USA and UK are far ahead of AU in diagnosis and recommended treatment of this condition, so look up on your search engine for those countries organizations. I have included Victoria Australia information for you to consider:
information from: http://www.autismvictoria.org.au/diagnos...
DIAGNOSIS & DEFINITIONS
Diagnosis
There is no specific diagnostic test for Autism Spectrum Disorder. The best way to get a diagnosis is via a multi disciplinary assessment. For children, this involves having your child tested by a number of professionals, who will provide you with the information you need to make decisions about program and treatment approaches. For adults, either a psychologist or psychiatrist experienced with Autism Spectrum Disorders can make a diagnosis.
The age of diagnosis these days ranges from approximately 18 months through to adulthood, depending on circumstances. A diagnosis of Autism Spectrum Disorder will only be made if the 'autistic like' pattern of behaviour is apparent before the age of three years. Sometimes a provisional diagnosis is made if the child is very young, and a reassessment at a later date is recommended.
Definitions
The way people think about autism has changed in recent years. It is best described as a group of disorders with a similar pattern of behaviour in three key areas - communication, social interaction and imaginative thought.
The currently favoured term is Autism Spectrum Disorder, with the word 'spectrum' used because no two people with an Autism Spectrum Disorder are exactly alike.
What is an Autism Spectrum Disorder?
As the term suggests, there is no one diagnosis or label. Rather there are several labels that place people at different points on the spectrum. At one end of the spectrum diagnostic labels such as "Asperger Syndrome", "High Functioning Autism" and "PDD-NOS" are used. At the other end of the spectrum you will find labels such as "Autism", "Classic Autism" and "Kanner Autism".
More information
What are the common everyday diagnostic terms or labels?
• Autism (or Autistic Disorder)
• Asperger Syndrome (or Asperger Disorder)
• Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)
• Atypical Autism
• High Functioning Autism
What are the international classification guides?
There are two international classification guides used to determine the diagnostic criteria for Autism Spectrum Disorders.
DSM IV - Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, 1994, published by the American Psychiatric Association
and/or the ICD 10 - International Statistical Classification of Diseases and Related Health Problems Tenth Edition, 1992, published by the World Health Organisation.
Terms Explained
The term Autism Spectrum Disorder is used because there is great variation from person to person depending on the severity and combination of each area of impairment. Autism Spectrum Disorder may also coexist with other conditions or disorders, including intellectual disability, speech and language disorders, anxiety and depression (especially in adolescents and adults), epilepsy, attention disorders, Tourette Syndrome and Down Syndrome. (See also "Why is Autism Spectrum Disorder so hard to understand?")
Autism
In Autism the impairments in the social and communication areas are severe and sustained and clearly present before the age of three years. The child is often anxious, has poor attention and motivation, responds unusually to many different stimuli and is observed as being 'different' from other children. Speech is delayed, or largely absent. A strong reliance on routine is apparent, and the child can have a range of ritualistic behaviours such as toe walking, hand flapping and finger gazing. The child/adult with autism may also be intellectually disabled. Sometimes, clinicians will refer to Classic Autism or Kanner Autism. This is because they believe the child or adult fits the early descriptions of Autism published by Dr Leo Kanner in the 1940's.
High Functioning Autism
High Functioning Autism is a loosely used term (not defined in the diagnostic criteria) to describe a child or adult who meets the criteria for a diagnosis of Autism, but is not as severely affected as the more classically autistic person.
Asperger Syndrome
In Asperger Syndrome there are severe and sustained social impairments, but impairments are not as severe in the language and communication area. Speech usually develops within the normal age range, but the ability to communicate effectively (known as language pragmatics) is impaired. The impairments seem more subtle in the very young child, and become more apparent as the child reaches pre school and school age. The Asperger person is usually in the normal intelligence range.
PDD-NOS
Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS) is the diagnosis given for children who present with some of the characteristics of either Autism or Asperger Syndrome, but not severe enough for a diagnosis of either of these conditions. In the ICD 10 and previous editions of the DSM this diagnosis was referred to as Atypical Autism.
Most important of all
Irrespective of the diagnosis or where they fit on the spectrum, each child or adult diagnosed with an Autism Spectrum Disorder is developmentally delayed, has significant difficulties participating in day-to-day life and requires sensitive understanding and specialist support and intervention.

AUTISM VICTORIA ABN: 15 600 724 949
Address: 24 Drummond Street, Carlton, VIC 3053, Australia Melway Ref: B2 G12
Postal Address: PO Box 374, Carlton South, VIC 3053, Australia
Phone: (03) 9657 1600 Fax: (03) 9639 4955
Contact: Contact Us Web: www.autismvictoria.org.au

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also use google/other search for some other pertinent articles:
• Victorian Autism State Plan gives a good overview – and plan for the future re those experiencing austism – also considers the need for greater understanding and support re employment – pertinent for those with Aspergers.
• Phetrasuwan – considers definitions and complexity thereof
• Crane – considers the practice of early detection/intervention
• Bellando – considers autism incl aspergers in classroom setting/school
• The Associated School Press is very interesting and parents are rightly fighting for service dogs to help moderate transitions/anxiety/unfamiliarity/frustration tantrums and safety in school with use of trained service dogs – huge discrimination remains here.
• Assistance Dogs Autism – Australia is just picking up on/training for the use of these dogs in Aust – and very interestingly, the Disability Discrimination Act was amended this year 2009 and includes an substantial section on Assistance Dogs (at last some foresight, before we see parents challenging schools in court).

All the best for you and your family! Kind regards, Denise L. Clair.

Michelle - posted on 12/26/2009

my son didnt have any language delays just his overall capacity seemed as though he was 2 or 3 years behind his peers both accademically and with his co-ordination, for example he never crawled but commandoed style across the room he didnt walk till 15 months.

Debbie - posted on 12/26/2009

There is no agreed upon difference. There are well respected experts who believe HFA is aspergers, and well respected experts who see them as different. In my own experience they are from the same origin but manifest differently in children, mostly due to language fluency. But the rule of thumb *seems* to be that aspergers kiddos have the autism deficits and strengths, minus language delay.

Michelle - posted on 12/26/2009

Quoting lois:

Asperger or High Function Autism 

my son was diagnosed with autism when he was 4
then at 6 hey told me it was aspergers apprently ADHDA ,ASPERGERS AND AUTISM are all  on the same continuim so basically it  they can got from hypo to being in there own world with a range of all in between many kids howdifferent signs when they are stressed or anxious i would go and find a professional who deals with the whole range of these issues books are far to confusing and everyone has a different point of view. find omeone you trust and go them

Laura - posted on 12/26/2009

Every child is a puzzle when they have either autism or aspergers. I have a child who is high functioing autistic. He has always been a puzzle to figure out. Our family has always tried to treat him just the same as our other two children in order to push him to achieve and fit into normal life. Our child is unique, and it seems that every child I meet with autism has their own issues they deal with.

Carolyn - posted on 12/26/2009

My daughter was dx with hfa and not as b/c she had a speech delay. Now that she is a teen, her more accurate dx is as. the doctor told me that because she had the speech delay, that took her out of the as dx. Other than that, she told us they are pretty much similar once the child gains language.

Donna - posted on 12/26/2009

My grandson has Aspergers Syndrome. He is highly intelligent and has no learning problems at all. However, his social skills are way behind. He doesn't seem to realize that other people have feelings. He has tremendous problems with anger management, and he only gets along with other kids one on one. His diagnosis hasn't changed how we feel about or interact with him. He is who he is and has strengths and weaknesses just like the rest of us. We try to challenge him, but not overwhelm him, and let him be himself. He is doing well.

Wintress - posted on 12/26/2009

Ok, well first of all. Every case is going to be different dependent upon the child. I have a son who was diagnosed with Aspergers or AS when he was 5 years old, he is now 11. Technically the difference between AS and HFA is all that medical jargon they give you when you are sitting in the doctor's office. However, according to my son's doctors and what they have admitted to me in the past, there really is no difference between the two. Aperger's Syndrome is a form of High Functioning Autism. With this being said, there are no medications, therapy, etc. for Asperger's Syndrome, therefore it is placed on the autism spectrum as HFA so that those individuals who have it or are being diagnosed with it can seek the medical attention for it. For example, my son has no issues with loud noise, touch, taste, or anything social. He has friends and hangs out with them all the time. He is great in school and at church. His only disability would be in Reading and Language arts. Everything for him is very concrete, he is learning to develop the abstract part of life. Meaning, he is currently reading on a high school level, but he can only summarize what he reads on maybe an elementary school level (he is in middle school). Or another example would be, in school he has a hard time writing "make believe" stories because his brain has not completely develped in that area that allows us to decern reality from fairy tale so that is hard for him to do. He is being taught that, whereas for the majority of us, we just know because we are born with it. But because he has very good eye contact, he has social skills, he tolerates loud sounds and bright lights, he would not be what is generally diagnosed as autistic. But because of his brains inability to discern certain things that the rest of us just know from birth he has been diagnosed with AS which is termed as a "FORM" of High Function Autism, so that he can receive the help in school that is necesary for him to progress. I think the major difference with High Functioning Autism and Autism in general, however, is that individuals who are High Functioning may not have all of the general characteristics that are associated with autism. So some individuals can tolerate loud noises but maybe they do not do well with bright lights or colors. Some individuals may be geniuses in school, but the do not socialize or make friends easily. It varies from child to child, person to person. I agree with Darlene Rea when she said that you should just focus and learn your child. The reason I say this is also because aside of having a child with AS, I also work at an elementary school with special needs children and their needs vary. All the definitions and explanations that you read in books or online are just generalizations. The best thing is to just learn what is necessary to love, teach, and communicate with your child. Doctors can help in giving guidlines or their opinions, but no one knows your child better than you. It is having an open mind and an open heart and through trial and error that you learn what works and what doesn't, because I will admit to you that in 11 years, the doctors were not always right. Maybe consult your family physician to get a better understanding if this doesn't help. Good luck to you and God bless.

Darlene - posted on 12/26/2009

Welcome to my world! My son was diagnosed with Autism and another doctor practically bit my head off for using the word. He wanted to call it something else. I decided then the name wasn't improtant, Just find out what can be done to help him be all he can be I do not know the difference and I drove myself batty trying to figure out what Autism is. The more I studied, the more confused I became with so many conflicting ideas. I just pray for guidance and study my son. If he has problems reading, we read. Just like any other child. He is a wonderful child and has came a long way. The main thing I noticed in studing different cases is that there is no typical or average case. The children with diseases like this run the gammet. Some have speech problems, some behavior, some repetitive movement, etc. If someone does answer this with the difference I would be interested in seeing it also. Good luck to you and God Bless you.

Elizabeth - posted on 12/26/2009

Hi Lois, my name is Liz Burt and I have a son with high function Austism plus other family members. Asperbergs is a part of the Autism spectrum. The main difference between the two is that Aspergers is mostly a social aspect of the disorder where as Autism is more of a learning disability. I don't know where you are but we have a great society in Edmonton, www.autismedmonton.org, there you will find a great amount of info and other links to all aspects of the ASD (Autism Spectrum Disorder)

Renee - posted on 12/26/2009

Do you have a diagnosis yet or you're just wondering what the difference is? Just curious. Both Aspergers and Autism are marked by a lack of social skills there are so many similarities and they are part of the same group of disorders. My son has high functioning Autism and is at the genius end of the intelligence chart, but the kid has a terrible time trying to play a board game or card game with others, it's hard for him to wait his turn or understand what the object of the game is. I would visit one of the major autism websites like www.autismspeaks.org to get some answers too.

D. L. - posted on 12/26/2009

Dear Lois: I found this research by Sally Bloch-Rosen, Ph.D. pretty comprehensive. I have included it in my post, as it has a reference listing all the sources she used in the research she did.

Asperger's Syndrome, High Functioning Autism,

and Disorders of the Autistic Continuum

Sally Bloch-Rosen, Ph.D.

8 April 1999



Please note that the Appendices referred to here were not available in digitized form and are not part of this page. We apologize for not being able to include them here.



Introduction

Asperger Syndrome (AS) is a pervasive developmental disorder characterized by deficits in social interaction and motor coordination, and unusual or restricted patterns of interest or behavior. Clinically, the distinction between autism and Asperger’s disorder is often made in terms of severity and in the qualitative expression of the criteria. Both syndromes are characterized by social interaction deficits, impaired communication skills, and unusual or bizarre behaviors. However, in AS, motor deficits are more pronounced, onset seems to be later, and social deficits are present without grossly impaired speech and language (Frith 1991). In DSM-IV (American Psychiatric Association, 1994) a diagnosis of AS requires the absence of any clinically significant delay in language acquisition, cognitive development, and adaptive behavior (with the exception of social interaction.) In this way, DSM-IV clearly distinguishes between the AS diagnosis and that of autism (which is characterized by more marked delays in these areas prior to three years of age). Since parameters for diagnosis have only recently been formulated such that a consensual definition can be drawn upon for research purposes, relatively little is known about AS.

Asperger’s Syndrome v. High Functioning Autism

Similarities have been noted between the definition of AS and that of autism without mental retardation, or High Functioning Autism (HFA). Mental retardation co-occurs with autism in about 75% of reported cases so the DSM-IV definition allows for children who do not demonstrate emasured intelligence in the mentally retarded range. Currently there are no widely accepted diagnostic guidelines specifically for High Functioning Autism (Gillberg, 1998). HFA may be most appropriately diagnosed when the criteria for autistic disorder are met (American Psychiatric Association, 1994) and Full Scale IQ exceeds the mentally retarded range. As compared to AS, HFAs generally have lower Full Scale IQs, with less apparent Verbal/Performance IQ discrepancies. In AS, Verbal IQ typically exceeds Performance IQ (Gillberg 1989, Ozonoff & Farham, 1994). There may be more of a family history in AS, especially in fathers of AS children, than in HFA (Gillberg, 1989). Motor clumsiness may be more characteristic of AS, whereas motor mannerisms may appear more in association with HFA (Gillberg, Steffenburg, & Schaumann, 1991).

Abnormalities and delays in language and communication may be more severe in HFA than in AS. Peculiarities of speech and language may nonetheless be present in children eventually identified as AS. Since most cases of AS are diagnosed at approximately age seven or later (Gillberg & Gillberg, 1989), data regarding early language development may depend largely on accurate recollections by parents, which may not be reliable (Hart, Bax, & Jenkins, 1978). The exclusionary criterion of the absence of language delays for the AS diagnosis remains controversial (Gillberg 1995) .

AS may also be distinguished from autism on the basis of early attachment patterns. In early childhood, AS is associated with adequate attachment to family members and with approaches to interact with peers (although inappropriate and awkward). In autism, attachment to family members is more atypical and broader social patterns are marked by withdrawal and aloofness (Klin & Volkmar, 1997).

AS may be most accurately identified through neuropsychological assessment (Lockyer & Rutter, 1970, Happe, 1994). Details of these patterns will be discussed later.

The ‘Autistic Continuum’

Some researchers (e.g., Schopler, 1985) have objected to the use of a distinct diagnostic category for a disorder the represents only one point on the “autistic continuum.” Frith (1991, p.5) agrees that, “Asperger syndrome is the first plausible variant to crystallise from the autism spectrum...no doubt other variants will follow.”

Wing (1991) concluded that both autism and AS are best regarded as falling within the continuum of social impairment which may differ in their clinical presentation due to the degree of deficit in the cognitive, language and motor realms. However, Frith asserts that, for the time being, the AS diagnostic category should be retained for clinical reasons. First, many parents of AS children will find the diagnosis more acceptable than the diagnosis of autism (which, among lay persons, may be associated with extreme withdrawal, unusual stereotypies, and self-injurious behaviors). Secondly, many children with milder forms of the disorder would be left without a diagnosis and hence, without the services and understanding they require (Frith, 1991).

In practice, children may fail to fit neatly into the diagnoses of AS or autism as sanctioned by the American Psychiatric Association (1994). When a child presents with pervasive and atypical development, the diagnosis of Pervasive Developmental Disorders- Not Otherwise Specified (PDD-NOS) may be most appropriate. Thus children who display some characteristics thought to fall on the autistic continuum, but who do not meet the criteria for AS, may receive the diagnosis of PDD-NOS. Whether a subset of PDD-NOS cases represent milder AS or autism is not known, in part because it is difficult to obtain funding for research for any disorder labeled “Not Otherwise Specified” (Klin, 1999).

History

Autism was first described by Kanner (1943, as cited in Frith, 1991). Kanner described a group of patients who, from an early age appeared aloof or indifferent to other people, resisted change, and engaged in repetitive activities. As these children grew, he observed a conspicuous absence of make-believe play, a fascination with objects which were often skillfully handled, mutism or language which seemed to lack communicative intent, and ‘islets of ability’ or special skills which were expressed in remarkable feats of rote memory, calculation, or other isolated skill. Shortly after the publication of Kanner’s paper in the United States, Hans Asperger, an Austrian physician, published a report, in German, in which he described four boys who, despite apparently adequate verbal and cognitive skills, displayed deficits in social interaction and milder autistic behaviors (Asperger, 1944, as sited in Frith, 1991). Mental retardation was not prominent in these patients and they demonstrated deficits which resembled a milder, higher functioning form of autism. Asperger’s work was published in German and his contribution went largely unrecognized until the 1980s when his work was translated by Lorna Wing (1981).

Although initially unaware of each other’s work, both Kanner and Asperger used the word “autistic” to characterize the disturbances that they observed. This term had been introduced by Eugen Bleuler in 1911 to describe the extreme withdrawal from the outside world into the self, which he identified as the basic disturbance in schizophrenia (Frith, 1991). Both Kanner and Asperger independently recognized that, in contrast to Bleuler’s schizophrenia, the difficulties in entering affective relationships with others seemed to be present from the beginning, among their patients. Unlike the “autism” of schizophrenia, typified by a progressive loss of contact with the external world, Kanner and Asperger’s patients exhibited this difficulty early in life and with a consistent and chronic, rather than progressive, course.

Early diagnostic schemes intertwined autism with childhood schizophrenia and both were so vaguely defined as to be of no research utility (Ciaranello & Ciaranello, 1995). Although Asperger firmly held that the disorder was rooted in neurobiological causes, initially, psychodynamic theories of etiology and approaches to treatment prevailed. These theories implicated parents, specifically “refrigerator mothers” as the underlying cause of the autistic child’s delayed and atypical development. Following this theoretical framework, treatment logically necessitated residential placement of such children for extended periods (Bettleheim, 1967).

A formal diagnostic criteria for autism was not developed until the 1970s (Ritvo & Freeman, 1978, Rutter & Hersov, 1977). Autism was first included in the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association in 1980 and is now a widely recognized diagnostic entity. AS was not included until DSM-IV was published in 1994.

Clinical Presentation

The autistic continuum ranges from the most severe mentally retarded individuals with social impairment as one of several severe impairments, to highly intelligent and able persons with subtle social impairments (Wing, 1991). The various clinical pictures of autism and related disorders depend upon the combinations of different impairments, which may vary in severity independent of one another, and interact to produce various overt behaviors.

Social Interaction

The criteria for AS and autism are identical in terms of social deficits. However, in AS there are generally fewer symptoms, as well as a distinct presentation. Individuals with AS are aware of other people and desire friendship. They are often (involuntarily) socially isolated because their approaches tend to be inappropriate and peculiar. Although the AS individual may be able to correctly describe other people’s intentions, emotions, and conventions, they are unable to execute this knowledge in a spontaneous and useful manner. The lack of spontaneous adaptation is associated with an over-reliance on formalistic rules of behavior.

Autistic individuals are more apt to be withdrawn and may seem disinterested in relating to others whereas those with AS are often quite eager to relate to others but lack the requisite skills to do so (Klin & Volkmar, 1995). Meisbov and Stephens (1990) studied HFA adults’ perception of popularity among peers and found that, like their age-mates, they valued humor, attractiveness, intelligence, and athletic ability. However, they did not always agree with their age-mates perceptions of these attributes.

Communication

Although severe deficits in communication would lead to a diagnosis of autism instead of AS, several unique qualitative aspects of communication in AS have been identified. First, speech is often marked by poor prosody. Inflection and intonation typically are not as rigid and monotone as in autism. A restricted range of intonation patterns may result in utterances in which tone of voice is inconsistent or unrelated to content and communicative intent. Second, speech may also seem tangential and circumstantial. Although this may sometimes be a manifestation of a thought disorder, among AS children it is more often a reflection of their egocentric conversational approach and failure to censor output which accompanies internal thoughts. This may be evident in monologues on the topic of consuming interest (e.g., geography, railway schedules), failure to integrate what the listener can be expected to know in terms of background information; difficulty implementing the rules of conservation, such as turn-taking and topic transitioning. A third characteristic of communication among individuals with AS is verbosity. The individual with AS may launch into monologues on their favorite topic with complete disregard of the listener’s interest, nonverbal signals, or background information

Restricted Range of Interests, Activities, or Behaviors

In autism, one of the most frequently observed and most pronounced symptom is an intense preoccupation with restricted patterns of interest. In AS, this is much less commonly reported, with the exception of a preoccupation with an unusual topic about which the AS individual amasses considerable factual knowledge. Given deficits in pragmatics of social interaction, the AS individual will readily share this information, at great length and in considerable detail. The area of special interest may dominate the social interactions and activities of the AS individual (and often their families, as well). The specific subject area may change every two years or so (Klin & Volkmar, 1995).

Motor Deficits

Gross and fine motor problems are often seen in association with AS but are not part of the required criteria for diagnosis. Motor milestones may be delayed, but more typically, there are delays in the acquisition of more complex motor skills such as riding a bike, catching a ball, and climbing. AS individuals often display odd gait, poor manipulative skills, and deficits in visual-motor coordination. In autism, gross motor skills are often a relative strength.

Autistic Spectrum Disorders Through the Lifespan

Autism is a developmental disorder and its behavioral manifestations vary with age and ability. Its defining features, impairments in socialization, communication, and imagination, (Frith, 1991) are present in different forms at all stages of development. One of the earliest signs thought to be specific to autism is a lack of pointing and looking to share interest and attention with another person. However, in children with global developmental delays, this behavior would also be expected to emerge later, and hence would lack specificity to autism. Losche (1990) reviewed early home movies of autistic and nonautistic subjects and concluded that the timing and sequence of developmental gains differs between normal and autistic children only from the second year of life. It may therefore be difficult to make the diagnosis of autism with confidence prior to ages two or three years (Frith, 1991).

During the preschool years a more recognizable pattern of behavior difficulties emerge. Language may be delayed, precocious, or otherwise highly idiosyncratic (Wing, 1991). Some AS children show an early fascination with numbers and letters. Hyperlexia may be evident in which the child is able decode words, but with little or no comprehension of meaning. Deafness is often suspected because these children seem unaware of what is going on around them. Social interaction is noticeably impaired. Make-believe play is absent and instead, the child may become fixated on simple repetitive activities or rituals. In young children deficits in ‘mentalising’ are common. Mentalising refers to the ability to attribute mental state (e.g., thoughts, feelings, motives) to others and to oneself. As they mature, AS and HFA children may pass mentalising tasks in formal test situations while continuing to show deficits in applying these abilities into real-life settings (Ozonoff, Rogers, & Pennington, 1991).

Among children diagnosed with autism, the grade school years bring divergent paths of development which may represent different subtypes of the disorder (Cohen, Paul, & Volkmar, 1987). With some exceptions, language and general intellectual ability go hand in hand (Frith, 1991). In AS, fluent speech is usually achieved by the age of five even though it may be noticeably odd in terms of pragmatics.

In adolescence, the AS individuals may vaguely realize that they are different from others and that they are excluded from many interpersonal relationships (Kanner, 1971). Although they amass many facts about the world, their knowledge remains fragmented and they continue to have difficulty in the meaningful, integrated execution of their knowledge (Frith, 1991). AS individuals, despite average measured intelligence and adequate academic abilities are often described as lacking in common sense.

In adulthood, the AS individual may become superficially well adapted but typically remain egocentric and isolated (Volkmar, 1987). Use of language and gestures remains stilted, and they seldom enter the natural flow of conversation. Difficulties often arise in living and working with other people and psychiatric intervention may be helpful (Frith, 1991).

Psychiatric Comorbidity

Studies of comorbid psychiatric disorders in AS subjects have been sparse. Most studies of comorbidity are limited by small sample size as well as problems in uniformly defining AS. Volkmar and Klin (1997) stated that some studies found an association between AS and Tourette’s Syndrome, a finding that they were unable to replicate when examining a larger pool of AS subjects. Other disorders which may co-occur with AS include obsessive-compulsive disorder (19%); depression (15%); and ADHD (28%). Comorbidity of certain conditions may vary according to developmental level. For example, ADHD appears to be more common in younger AS individuals while depression may be more apt to emerge in adolescence and adulthood (Volkmar & Klin, 1997).

Some researchers have proposed that at least some of the adults previously identified as Schizoid Personality Disorder may actually be displaying the manifestation of AS in adulthood. Schizoid Personality Disorder is an Axis II diagnosis (APA, 1994) from adult psychiatric nomenclature. Schizoid Personality Disorder may actually represent a form of autism in adults (Wolff & Barlow, 1979). In two studies (Wolff & Chick, 1980; Cull, Chick & Wolff, 1984) children diagnosed with Schizoid Personality Disorder and those diagnosed with AS were followed into adulthood. Both groups of researchers concluded that the these disorders were essentially identical. However, Wolff and Chick (1980) noted that the group identified as “Schizoid” demonstrated more distractibility and less perseveration on cognitive tasks than the subjects identified as AS. Other researchers object to the idea of collapsing these diagnostic categories (Tantum, 1988).

Etiology

Ciaranello and Ciaranello (1995) distinguish between nongenetic and genetic etiologies. Nongenetic causes are associated with disruption, usually prenatally, to the pattern of normal brain development. Genetic causes arise from mutations in genes controlling brain development. Clinically, there is no distinction between these classifications and it is assumed that both genetic and nongenetic etiologies cause damage to the same brain centers and regions (Ciaranello, VandenBerg, & Anders, 1982).

Nongenetic Causes

The most frequently sited nongenetic cause of autism is prenatal exposure to viral infection (Ciaranello & Ciaranello, 1995). Chess (1977) reported a significantly increased incidence in children born during the 1964 rubella pandemic. These children developed autism along with other birth defects characteristic of congenital rubella syndrome. Although other infectious agents have been associated with autism, these are mostly single cases (Lotspeich & Ciaranello, 1993). Varicella (Knobloch & Pasamanick, 1975), rubeola (Deykin & MacMahon, 1979), and prenatal toxoplasmosis and syphilis (Rutter & Bartak, 1971), have been linked to single cases of autism. Taken together, these and other case reports provide evidence of a possible link between prenatal infection and the disruption of brain development such that autism ensues.

There is inconsistent evidence regarding prenatal, perinatal, or neonatal trauma in association with autism. In a review of the literature, Nelson (1991) was unable to find any consistent link between maternal history, pregnancy, delivery, or neonatal events with autism. However, in a study of 46 children with HFA which used normally developing siblings as controls, it was reported that the HFA subjects had a higher frequency of reported complications during pregnancy, were more likely to have a gestation period over 42 weeks, and were more frequently first born or fourth-or-later born children (Lord, Mulloy, Weendelboe, and Schopler, 1991) . In a review of the literature, Ciaranello and Ciaranello (1995) concluded that pre- and perinatal factors seem to play a larger role in cases of autism associated with mental retardation than with HFA.

Other nongenetic factors associated with autism include hypothyroidism and other medical conditions in the mother. Gillberg, Gillberg & Kopp (1992) studied five children with autistic conditions and found that three of the five had congenital hypothyroidism and the remaining two had mothers who were likely to have been hypothyroid during pregnancy. Maternal antibody formation and rejection by embryonic lymphocytes was found in association with autism in a sample of eleven mothers of autistic children (Warren, Cole, & Odell, 1990).

Teratogens have also been studied. Davis, Fennoy, and Laraque (1992) studied 70 mothers who used cocaine or engaged in poly-drug abuse during pregnancy. In this sample, 11.4% of these women gave birth to autistic children and 94% of the children born showed a pattern of delayed language development. Environmental toxins have also been implicated as possible etiologic agents in autistic spectrum disorders (Rodier, 1998).

Genetic Causes

Evidence of a genetic etiology for autism has been provided by numerous epidemiological studies. Estimates for sibling frequency have ranged from 2-6 %, 50-150 times the frequency in the general population ( Rutter & Bartak, 1971). Ritvo (1989) in a study of a relatively large autistic sample, estimated the overall risk of recurrence to be 8.6%. In Ritvo’s sample, if the first autistic child was male, the recurrence risk was 7%; if the first autistic child was female, the recurrence rate was 14.5%. In an overview of these studies, Ciaranello & Ciaranello (1995) concluded that all of the studies may underestimate the recurrence rate due to a tendency to stop having children after the birth of an autistic child. However, the extent to which these stoppage rules apply among parents of autistic children is unknown.

Attempts to specify a mode of inheritance for autism has been complicated by factors including: sex-influenced inheritance; reduced penetrance; variable expression of the disorder; diagnostic ambiguities; and stoppage rules. Smalley et al (1988, 1991) have proposed that autism is the result of multifactorial inheritance and genetic heterogeneity.

Twin studies further support a genetic basis for autism. Studies completed by a number of researchers (e.g. Ritvo Freeman, Mason-Brothers, & Ritvo, 1985; Steffenburg, Gillberg, Hellgren, & Anderson, 1989) concur that there is a much greater degree of concordance in monozygotic than in dizygotic twins. Family studies provide further evidence of a genetic basis for autism.

Epidemiology

Autism occurs in 7-16 per 10,000 children (Wing, 1993; Baron-Cohen, 1995; Gillberg, 1995). HFA constitutes only a fraction (11-34%) of such cases. In contrast, AS may occur at a rate oft 3.6 to 7.1 per 1000 children ages 7-16 years (Ehlers & Gillberg, 1993). Gillberg and Gillberg (1989) found that AS was about five times as common as autism. If these figures can be replicated and, if it becomes accepted that autism refers to a spectrum or continuum disorder, the estimate that 75% of children with autism have concomitant mental retardation would drop to only about 15% (Gillberg 1998).

The excess of autistic boys over girls was noted by both Kanner and Asperger, and is now well established, although the incidence for females is higher than originally thought. In reviews of 16 population studies of autism Wing (1993) and Gillberg (1995) found that the male: female ratio was closer to 2-3:1. However, in HFA, the ratio is probably higher (Wing & Gould, 1979). The male:female ratio in autism tends to go down with decreasing IQ (Wing, 1981). At the lowest ability levels the ratio of boys to girls was only 2:1. At the highest ability levels, Wing’s sample showed a ratio of 15:1. However, Newson, Dawson, & Everard (1982) identified a sample of 93 very able autistic people who lived all over Britain and found that only nine of them were women.

Neuropathology of Autism, AS, and HFA

The literature on the neuropathology of autism spans four decades and has produced a large body of inconsistent and often contradictory results. Autistic children, as defined in various studies, may exhibit intellectual functioning ranging from mentally retarded to intellectually superior, they may be mute or have a highly developed language skills, and stereotypic rituals and social handicaps may range from mild to severe. Given the heterogeneity of subject populations, the inconsistency in results is not particularly surprising. Postmortem and neuroimaging studies have described neuroanatomical abnormalities in Autism but the extent to which their conclusions can be generalized to AS and HFA is not known.

Autism

Structural and cellular abnormalities have been found in the hippocampus, amygdala, and cerebellum (Bauman & Kemper, 1985). These deficits have been associated with difficulties in socioemotional functioning, sensory processing, and motor planning (Aronowitz, Decaria, Allen, Weiss, & Saunders, 1997).

Evidence for pathophysiology in the cerebellum was originally proposed on the basis of clinical and neurophysiologic deficits (Ornitz,1985). The role of the cerebellum was further investigated on an anatomic level, through autopsy studies by Bauman & Kemper (1985). The loss of granule and Purkinje cells may disrupt the developmental cytoarchitecture of the cerebellar circuitry. Immature neurons persist, and a nonfunctional fetal neuronal pattern of circuitry is retained. With maturation, the fetal neuronal pattern may be lost but it is not replaced by an adult pattern so the normal circuitry of the cerebellum does not develop.

Auditory and vestibular pathways in the brainstem were implicated in some studies (Ornitz, 1985; Ornitz & Ritvo, 1968) but these findings could not be replicated in subsequent research using a variety of anatomic, imaging, and neurophysiological methods. Although several neurophysiological abnormalities have been identified in autistic subjects, these have not been specific for autism and have also been found in non-autistic matched controls (Minshew, 1991).

Kemper and Bauman (1993) reported small, densely packed cells in the hippocampus and amygdala and suggested that this reflected an immature pattern of neuronal development in these structures. They observed neurons which appeared immature in the diagonal band of Broca, which projects cholinergic afferents to the hippocampus and amygdala (Ciaranello & Ciaranello, 1995).

Many studies have attempted to find neurochemical deficits in autism following the hypothesis that autism may be a metabolic disease which arises from a defect in some biochemical pathway. With the exception of the occasional association of autism with a known metabolic disorder, there have been no consistent findings implicating a biochemical basis for autism.

Although there is no consistent neuroanatomic defect in autism, there is evidence that implicates neuronal maturation defects, particularly in the cerebellum and limbic structures. These deficits do not appear to be reflected in the size or metabolic activity of these structures. Thus, the weight of neuroanatomic and neuropsychological evidence implicates the cerebellum and the limbic forebrain, at the cellular level, suggesting possible deficits in neuronal migration, maturation, or synaptic connectivity.

In a study which compared PET results of young men with AS and normal controls, both groups showed increased regional blood flow in the left frontal lobe in connection with mentalising tasks. However the specific area of activity differed between the two groups. These researchers suggested that difficulty in mentalising activity may be associated with dysfunctional activity in the medial portion of the left frontal lobe (Happe, Ehlers, & Frackowiak, 1996).

Unspecified abnormal electroencephalogram, auditory brainstem response, and oculomotor findings have been reported in AS and HFA, as well as in low-functioning autism (Gillberg, 1989). In a study which examined cerebrospinal fluid glial fibrillary acidic protein (GFA-p), a small group of AS children (n=4) had levels of this marker which fell in between the normal group (n=10) and an autism group, which included an HFA subsample (n=14) with high GFA-p levels equal to those of the low functioning subjects. This raises more questions regarding the etiology of AS, indicating a possible role of glial dysfunction or abnormal demyelination in the pathophysiology of this spectrum of disorders

Several case studies have documented specific medical disorders in association with AS and HFA symptomology including: tuberous sclerosis (Gillberg, Gillberg, & Ahlsen, 1994); Marfan-like syndromes (Tantam, Evered, & Hersov, 1990); Kleine-Levin syndrome (Berthier, Santamaria, & Encabo, 1992); fragile X syndrome (Hagerman, 1989); and other chromosomal anomalies (Anneren, Dahl, & Uddenfelt, 1995).

Assessment Issues

Assessment should begin with a comprehensive history. In addition to the typical practice of collecting data on early development, medical, educational, and family aspects, areas of particular relevance to the diagnosis of AS should also be explored. These include: an exploration of the onset of, or first recognition of problems; practical use of language; and special areas of interest. Emphasis should placed on problems in social interaction, patterns of attachment to family members, development of friendships, self-concept and self esteem, and mood presentation.

Neuropsychological Assessment

AS shares several characteristics with Rourke’s (1989) concept of Nonverbal Learning Disabilities. Within the NLD framework, AS corresponds to a type of neurological impairment in which virtually the entire spectrum of NLD assets and deficits are in evidence. Many areas of functioning present a mixed bag of strengths and weaknesses. Simple and repetitive motor skills tend to improve and normalize with increasing age, however, performance on tests of complex motor skills tend to deteriorate, relative to age-based norms. Psychomotor coordination difficulties are bilateral, although a greater degree of impairment may be apparent on the left side of the body.

Bilateral tactile-perceptual deficits may similarly be more apparent on the left side. Deficits may vary according to age, with tactile imperception and suppression subsiding over time while problems with complex tactile input persist. Simple visual discrimination, especially for material that can be translated into verbal input, usually approaches normal levels. However, complex visual-spatial-organizational skills, particularly when demanded in a novel situation, tend to worsen relative to age-based norms.

Assets are often evident in the areas of rote verbal learning, however, the NLD individual may tend to overly rely on this approach and experience extreme difficulty in adapting to novel and complex situations. Demonstrated memory skills in dealing with complex verbal material is usually deficient, perhaps due to difficulties in initial comprehension of complex material.

Auditory perceptual skills are usually intact, although sometimes later to emerge as compared to normals. In linguistics, assets are apparent in a well developed vocabulary and fund of verbal information. Although sometimes judged to have unusual linguistic prowess, deficits in this area are quite severe. Deficits are most apparent in the pragmatic use of language. Speech prosody is extremely limited.

Academic functioning usually reveals the NLD pattern of deficits in mechanical arithmetic as compared to relative intact word recognition and spelling skills. Comprehension of complex reading material tends to be poor and difficulties in dealing with scientific concepts and theories are often apparent by adolescence. Errors in spelling are primarily of the phonetically accurate type.

These deficits impact interpersonal functioning in problems appreciating incongruities and humor, difficulty in adapting to novel and complex situations, and an over-reliance on rote and rigid behaviors in a constantly changing social milieu. Overall, social perception and social judgment are impaired.

Speech and Language Assessment

A speech and language evaluation should include both qualitative as well as quantitative aspects of the child’s functioning. The typical test battery which focuses primarily on formal language (i.e., vocabulary, articulation, comprehension, and sentence construction) will tap only areas of strength in most AS individuals. language assessment should thus also incorporate measures of nonverbal communication, nonliteral language (e.g., absurdities, metaphor, and humor) speech prosody (melody, volume, and pitch), and pragmatics (i.e., turn-taking, sensitivity to cues, adherence to rules of conversation). This latter group of language skills are more apt to reveal areas of significant deficits for individuals with AS. A language assessment should also note perseveration on circumscribed topics and social reciprocity.

Intervention

Securing Services

Klin & Volkmar (1997) have noted a tendency for parents and professionals to underestimate the deficits which impact on AS individuals. This is, to an extent, understandable given the proficient verbal skills, average or higher psychometric intelligence, and solitary lifestyle which may serve to mask severe deficits that become evident primarily in novel and/or socially demanding situations. Some AS children have been identified as Learning Disabled which may be successful in securing some accommodations and support but fails to address some of the most debilitating aspects of AS (e.g. deficits in reciprocal social interaction). Other AS children have been classified as PDD-NOS or autistic which often leads to placement with children who are significantly lower functioning. Such a placement may fail to make use of their unique assets. A third and most inappropriate label is “Social-Emotional maladjustment”. This label is used in educational nomenclature for children with severe behavior or conduct problems who do not qualify for special education services as Emotionally Impaired. Klin (1995) describes this as, “the worst mismatch possible, namely of individuals with a very naive understanding of social situations in a mix with those who can and do manipulate social situations to their advantage without the benefit of self-restraint.”

Acceptance of AS and related diagnoses in educational settings has been limited. Children with milder autistic continuum disorders may be certified for special education services under a variety of labels. Due to the mismatch of the diagnostic category with education classifications, services may be difficult to obtain. By way of example, Appendix A shows the classifications under which an AS child is apt to receive special education services in the State of Michigan (Michigan State Board of Education,1997). An AS child, may qualify for special education services under the classification of “Specific Learning Disability” ( perhaps in reading comprehension and/or mathematics calculation), as “Speech and Language Impaired” (due to deficits in pragmatic use of language), or “Emotionally Impaired” (due to the inability to build or maintain satisfactory interpersonal relationships within the school environment). Ironically, by Michigan eligibility definitions, it appears unlikely that a child presenting with AS would be serviced under the definition of “Autism.” Some are also found ineligible for special education services because the “interdisciplinary team,” does not feel that the areas of deficit have a significant impact on the child’s academic functioning.

Services designed for accommodating and remediating specific learning disabilities may not address the range of problem areas in AS, especially when deficits are subtle, cause few problems for school officials, and do not directly and obviously impact on academic achievement.

To explain some of the basic concepts of AS/ NLD, the writer has developed a booklet which has enjoyed some limited, anecdotal success in enhancing awareness and understanding among a small sample of public school personnel. This is provided in Appendix B.

Although neuropsychological assessment is central to designing programs and interventions tailored to the needs of the individual, a label from the psychiatric nomenclature is essential for providing health care services and an educational classification will be needed to deem the child eligible for special education services.

Intervention Strategies

Volkmar and Klin (1997) suggest that skills and concepts be taught in an explicit and rote fashion where possible, employing a parts to whole verbal instructional approach. Learning strategies will be most effective when based on the specific pattern of strengths and deficits demonstrated in neuropsychological assessment. If motor and visual-motor deficits are identified, physical and occupational therapies are indicated.

Interventions designed to improve communication and social skills may have any or all of the following as its goals, depending on the specific needs of the individual: enhanced awareness of one’s own nonverbal behaviors (e.g., the use of verbal inflection, eye contact, and gaze in social interaction); verbal decoding strategies for more accurately interpreting the nonverbal behavior of others; more integrated processing of visual and auditory stimuli; improved social awareness and perspective taking. Techniques for teaching nonverbal communication skills have been described in the literature on learning disabilities (e.g., Minskoff, 1980).

Treatments for AS and HFA are primarily symptomatic and supportive. As lifelong disorders, treatment needs and approaches will change with the individual development.

Psychoactive medications may be used to target specific symptoms but are generally not indicated in AS and HFA. In high-functioning individuals with symptoms of obsessive-compulsive disorder, anxiety, or depression, pharmacotherapy may be helpful (Wing, 1991). Insight-oriented psychodynamic therapy has been extensively used to treat these disorders with little objective evidence of success (Campbell, Schopler, Cueva, & Hallin, 1996).

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I hope this helps to answer some of your questions. Kind regards, Denise L. Clair.