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Psychological and Physiological Trauma Research
Seize Your Journeys
_______________________ Traumatic stress is found in many competent, healthy, strong, good people. No one can completely protect themselves from traumatic experiences. Many people have long-lasting problems following exposure to trauma. Up to 8% of persons will have PTSD at some time in their lives. People who react to traumas are not going crazy. What is happening to them is part of a set of common symptoms and problems that are connected with being in a traumatic situation, and thus, is a normal reaction to abnormal events and experiences. Having symptoms after a traumatic event is NOT a sign of personal weakness. Given exposure to a trauma that is bad enough, probably all people would develop PTSD. By understanding trauma symptoms better, a person can become less fearful of them and better able to manage them. By recognizing the effects of trauma and knowing more about symptoms, a person will be better able to decide about getting treatment. _______________________
FUNCTIONAL NEUROANATOMY In order to best understand this atlas it is important to have a sense of the functional neuroanatomy of the brain. Over the next several pages there is a brief summary of the 5 major brain systems that relate to behavior, along with the general location seen on SPECT of these areas.
The Deep Limbic System
Functions
Problems
The Basal Ganglia System
Functions
Problems
The Prefrontal Cortex
Functions
Problems
The Cingulate Gyrus
Problems
The Temporal Lobes
Functions
Problems
Non-dominant Side (usually the right)
Secure Attachments as a Defense Against Trauma “All people mature and thrive in a social context that has profound effects on how they cope with life’s stresses. Particularly early in life, the social context plays a critical role in fuffering an individual against stressful situations, and in building the psychological and biological capacities to deal with further stresses. The primary function of parents can be thought of as helping children modulate their arousal by attuned and well-timed provision of playing, feeding, comforting, touching, looking, cleaning, and resting—in short, by teaching them skills that will gradually help them modulate their own arousal. Secure attachment bonds serve as primary defenses against trauma-induced psychopathology in both children and adults (Finkelhor & Browne, 1984). In children who have been exposed to severe stressors, the quality of the parental bond is probably the single most important determinant of long-term damage (McFarlane, 1988).” van der Kolk, Bessel, Alexander C. McFarlane, and Lars Weisaeth, eds. 1996. Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York and London: Guilford Press. .p. 185 _______________________
Sleep Disorders
“The sleep disorders are organized into four major sections according to presumed etiology. Primary Sleep Disorders are those in which none of the etiologies listed below (i.e., another mental disorder, a general medical condition, or a substance) is responsible. Primary Sleep Disorders are presumed to arise from endogenous abnormalities in sleep-wake generating or timing mechanisms, often complicated by conditioning factors. Primary Sleep Disorders in turn are divided into Dyssomnias (characterized by abnormalities in the amount, quality, or timing of sleep) and Parasomnias (characterized by abnormal behavioral or physiological events occurring in association with sleep, specific sleep stages, or sleep-awake transitions). Sleep Disorder Related to Another Mental Disorder involves a prominent complaint of sleep disturbance that results from a diagnosable mental disorder (often a Mood Disorder or Anxiety Disorder) but that is sufficiently severe to warrant independent clinical attention. Presumably, the pathophysiological mechanisms responsible for the mental disorder also affect sleep-awake regulation. Sleep Disorder Due to a General Medical Condition involves a prominent complaint of sleep disturbance that results from the direct physiological effects of a general medical condition on the sleep-wake system. Substance-Induced Sleep Disorder involves prominent complaints of sleep disturbance that result from the concurrent use, or recent discontinuation of use, of a substance (including medications). That systematic assessment in individuals who present with prominent complaints of sleep disturbance includes an evaluation of the specific type of sleep complaint and a consideration of concurrent mental disorders, general medical conditions, and substance (including medication) use that may be responsible for the sleep disturbance. Five distinct sleep stages can be measured by polysomnography: rapid eye movement (REM) sleep and four stages of non-rapid eye movement (NREM) sleep (stages 1, 2, 3, and 4). Stage 1 NREM sleep is a transition from wakefulness to sleep and occupies about 5% of time spent asleep in healthy adults. Stage 2 NREM sleep, which is characterized by specific EEG waveforms (sleep spindles and K complexes), occupies about 50% of time spent asleep. Stages 3 and 4 NREM sleep (also known collectively as slow-wave sleep) are the deepest levels of sleep and occupy about 10%-20% of sleep time. REM sleep, during which the majority of typical storylike dreams occur, occupies about 20%-25% of total sleep. These sleep stages have a characteristic temporal organization across the night. NREM stages 3 and 4 tend to occur in the first one-third to one-half of the night and increase in duration in response to sleep deprivation. REM sleep occurs cyclically throughout the night, alternating with NREM sleep about every 80-100 minutes. REM sleep periods increase in duration toward the morning. Human sleep also varies characteristically across the life span. After relative stability with large amounts of slow-wave sleep in childhood and early adolescence, sleep continuity and depth deteriorate across the adult age range. This deterioration is reflected by increased wakefulness and stage 1 sleep and decreased stages 3 and 4 sleep. Because of this, age must be considered in the diagnosis of a Sleep Disorder in any individual. Polysomnography is the monitoring of multiple electrophysiological parameters during sleep and generally includes measurement of EEG activity, electroculographic activity, and electromyographic activity. Additional polysomnographic measures may include oral or nasal airflow, respiratory effort, chest and abdominal wall movement, oxyhemoglobin saturation, or exhaled carbon dioxide concentration; these measures are used to monitor respiration during sleep and to detect the presence and severity of sleep apnea. Measurement of peripheral electromyographic activity may be used to detect abnormal movements during sleep. Most polysomnographic studies are conducted during the person’s usual sleeping hours—that is, at night. However, daytime polysomnographic studies also are used to quantify daytime sleepiness. The most common daytime procedure is the Multiple Sleep Latency Test (MSLT), in which the individual is instructed to lie down in a dark room and not resist falling asleep; this protocol is repeated fives times during the day. Sleep latency (the amount of time required to fall asleep) is measured on each trial and is used as an index of physiological sleepiness. The converse of the MSLT is also used: In the Repeated Test of Sustained Wakefulness (RTSW), the individual is placed in a quiet, dimly lit room and instructed to remain awake; this protocol is repeated several times during the day. Again, sleep latency is measured, but is it used here as an index of the individual’s ability to maintain wakefulness. Standard terminology for polysomnographic measures is used throughout the test in this section. Sleep continuity refers to the overall balance of sleep and wakefulness during a night of sleep. “Better” sleep continuity indicates consolidated sleep and wakefulness; “worse” sleep continuity indicates disrupted sleep with more wakefulness. Specific sleep continuity measures include sleep latency—the amount of time required to fall asleep (expressed in minutes); intermittent wakefulness—the amount of awake time after initial sleep onset (expressed in minutes); and sleep efficiency—the ratio of actual time spent asleep to time spent in bed (expressed as a percentage, with higher numbers indicating better sleep continuity). Sleep architecture refers to the amount and distribution of specific sleep stages. Sleep architecture measures include absolute amount of REM sleep and each NREM sleep stage (in minutes), relative amount of REM seep and NREM sleep stages (expressed as a percentage of total sleep time), and latency between sleep onset and the first REM period (REM latency). The text for each of the Sleep Disorders contains a section describing its relationship to corresponding disorders in The International Classification of Sleep Disorders: (ICSD) diagnostic and Coding Manual, published in 1990 by the American Sleep Disorders Association. _________________
Substance Dependence “Features The essential feature of Substance Dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. There is a pattern of repeated self-administration that can result in tolerance, withdrawal, and compulsive drug-taking behavior. A diagnosis of Substance Dependence can be applied to every class of substances except caffeine. The symptoms of Dependence are similar across the various categories of substances, but for certain classes some symptoms are less salient, and in a few instances not all symptoms apply (e.g., withdrawal symptoms are not specified for Hallucinogenic Dependence). Although not specifically listed as a criterion item, “craving” (a strong subjective drive to use the substance) is likely to be experienced by most (if not all) individuals with Substance Dependence. Dependence is defined as a cluster of three or more of the symptoms listed below occurring at any time in the same 12-month-period. Tolerance (Criterion 1) is the need for greatly increased amounts of the substance to achieve intoxication (or the desired effect) or a markedly diminished effect with continued use of the same amount of the substance. The degree to which tolerance develops varies greatly across substances. Furthermore, for a specific drug, varied degrees of tolerance may develop for its different central nervous system effects. For example, for opioids, tolerance to respiratory depression and tolerance to analgesia develop at different rates. Individuals with heavy use of opioids and stimulants can develop substantial (e.g., 10-f0ld) levels of tolerance, often to a dosage that would be lethal to a nonuser. Alcohol tolerance can also be pronounced, but is usually less extreme than for amphetamine. Many individuals who smoke cigarettes consume more than 20 cigarettes a day, an amount that would have produced symptoms of toxicity when they first started smoking. Individuals with heavy use of cannabis or phencyclidine (PCP) are generally not aware of having developed tolerance (although it has been demonstrated in animal studies and in some individuals). Tolerance may be difficult to determine by history alone when the substance used is illegal and perhaps mixed with various diluents or with other substances. In such situations, laboratory tests may be helpful (e.g., high blood levels of the substance coupled with little evidence of intoxication suggest that tolerance is likely). Tolerance must also be distinguished from individual variability in the initial sensitivity to the effects of particular substances. For example, some first-time drinkers show very little evidence of intoxication with three or four drink, whereas others of similar weight and drinking histories had slurred speech and incoordination. Withdrawal (Criterion 2a) is a maladaptive behavioral change, with physiological and cognitive concomitants, that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of the substance. After developing unpleasant withdrawal symptoms, the persons is likely to take the substance to relieve or to avoid those symptoms (Criterion 2b), typically using the substance throughout the day beginning soon after awakening. Withdrawal symptoms, which are generally the opposite of the acute effects of the substance, vary greatly across the calluses of substances, and separate criteria sets for Withdrawal are provided for most of the classes. Marked and generally easily measured physiological signs of withdrawal are common with alcohol, opioids, and sedatives, hypnotics, and anxiolytics. Withdrawal signs and symptoms are often present, but may be less apparent, with stimulants such as amphetamines and cocaine, as well as with nicotine and cannabis. No significant withdrawal is seen even after repeated use of hallucinogens. Withdrawal from phencyclidine and related substances has not yet been described in humans (although it has been demonstrated in animals). Neither tolerance nor withdrawal is necessary or sufficient for a diagnosis of Substance Dependence. However, for most classes of substances, a past history of tolerance or withdrawals is associated with a more severe clinical course (i.e., an earlier onset of Dependence, higher levels of substance intake, and a greater number of substance-related problems). Some individuals (e.g., those with Cannabis Dependence) show a pattern of compulsive use without obvious signs of tolerance or withdrawal. Conversely, some general medical and postsurgical patients without Opioid Dependence may develop a tolerance to prescribed opioids and experience withdrawal symptoms without showing any signs of compulsive use. The specifiers With Physiological Dependence and Without Physiological Dependence are provided to indicate the presence or absence of tolerance or withdrawal. The following items describe the pattern of compulsive substance use that is characteristic of Dependence. The individual may take the substance in larger amounts or over a longer period than was originally intended (e.g., continuing to drink until severely intoxicated despite having set a limit of only one drink) (Criterion 3). The individual may express a persistent desire to cut down or regulate substance use. Often, there have been many unsuccessful efforts to decrease or discontinue use (Criterion 4). The individual may spend a great deal of time obtaining the substance, using the substance, or recovering from its effects (Criterion 5). In some instances of Substance Dependence, virtually all of the person’s daily activities revolve around the substance. Important social, occupational, ore recreational activities may be given up or reduced because of substance use (Criterion 6). The individual may withdraw from family activities and hobbies in order to use the substance in private or to spend more time with substance-using friends. Despite recognizing the contributing role of the substance to a psychological or physical problem (e.g., sever depressive symptoms or damage to organ systems), the person continues to use the substance (Criterion 7). The key issue in evaluating this criterion is not eh existence of the problem, but rather the individual’s failure to abstain from using the substance despite having evidence of the difficulty it is causing.
Specifiers Tolerance and withdrawal may be associated with a higher risk for immediate general medical problems and a higher relapse rate. Specifiers are provided to note their presence or absence: With Physiological Dependence. This specifier should be used when Substance Dependence is accompanied by evidence of tolerance (Criterion 1) or withdrawal (Criterion 2). Without Physiological Dependence. This specifier should be used when there is no evidence of tolerance (Criterion 1) or withdrawal (Criterion 2). In these individuals, Substance Dependence is characterized by a pattern of compulsive use (at least three items from Criteria 3-7).”
Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. P. 193-195.
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PTSD, DID, and EMDR Posttraumatic Stress Disorder "The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
Dissociative Identity Disorder (DID) "The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play. Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations. Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities." Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. EMDR Eye Movement Desensitization and Reprocessing "Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. Eight Phases of Treatment The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com __________________ Major Depressive Disorder “Diagnostic Features The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C). Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B). The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent. It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes. For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months. During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission). The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance. If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission. If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder. However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted. Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369 “Course Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s. Epidemiological data suggest that the age at onset is decreasing for those born more recently. The course of Major Depressive Disorder, Recurrent, is variable. Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. Some evidence suggests that the periods of remission generally last longer early in the course of the disorder. The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode. At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode. Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth. About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder). Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases). For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery. The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value. A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode. Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state. Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder. The severity of the initial Major Depressive Episode appears to predict persistence. Chronic general medical conditions are also a risk factor for more persistent episodes. Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce. Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes. Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder. It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder. Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder. A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373
Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association.
________________ Major Depressive Disorder “Diagnostic Features The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C). Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B). The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent. It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes. For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months. During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission). The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance. If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission. If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder. However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted. Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369 “Course Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s. Epidemiological data suggest that the age at onset is decreasing for those born more recently. The course of Major Depressive Disorder, Recurrent, is variable. Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. Some evidence suggests that the periods of remission generally last longer early in the course of the disorder. The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode. At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode. Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth. About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder). Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases). For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery. The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value. A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode. Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state. Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder. The severity of the initial Major Depressive Episode appears to predict persistence. Chronic general medical conditions are also a risk factor for more persistent episodes. Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce. Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes. Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder. It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder. Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder. A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373 Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. ________________ DID-PTSD-EMDR Dissociative Identity Disorder (DID) "The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play. Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations. Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities." Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. PTSD, DID, and EMDR Posttraumatic Stress Disorder "The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
EMDR Eye Movement Desensitization and Reprocessing "Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. Eight Phases of Treatment The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com
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NeuroBiology of Trauma
Asperger’s Disorder and Childhood
Title: Childhood Autism Rating Scale Tokyo Version for screening pervasive developmental disorders. Author(s): Tachimori, Hisateru , National Ctr for Neurology & Psychiatry, National Inst of Mental Health, Dept of Mental Health Administration, Chiba, Japan, tachi@ncnp-k.go.jp; Osada, Hirokazu , U Tokyo, Graduate School of Medicine, Dept of Mental Health, Tokyo, Japan; Kurita, Hiroshi , U Tokyo, Graduate School of Medicine, Dept of Mental Health, Tokyo, Japan Address: Tachimori, Hisateru, Dept of Mental Health Administration, National Inst of Mental Health, National Ctr for Neurology & Psychiatry, 1-7-3 Konodai, Ichikawa, Chiba, Japan, 272-0827, tachi@ncnp-k.go.jp Source: Psychiatry & Clinical Neurosciences , Vol 57(1), Feb 2003. pp. 113-118. Publisher: United Kingdom: Blackwell Publishing Abstract: To assess the utility of the Childhood Autism Rating Scale Tokyo Version (CARS-TV), its total score was compared among 430 children per diagnosed subgroup (i.e. autistic disorder (AD), childhood disintegrative disorder (CDD), Asperger's disorder, and pervasive developmental disorders (PDD) not otherwise specified (PDDNOS)). Values of Cronbach's alpha were 0.91 for the PDD group and 0.89 for the non-PDD mental retardation (MR) group, and 0.93 for both groups combined. The total score was significantly higher in PDD than in non-PDD MR. The total score differed significantly among the 4 groups, with CDD and AD being significantly higher than both PDDNOS and Asperger's disorder, PDDNOS being significantly higher than Asperger's disorder and no significant difference between CDD and AD. It is concluded that CARS-TV seems to be a useful instrument for differentiating between PDD and non-PDD MR and between AD and PDDNOS, although further replication is needed. _____
Title: Asperger's disorder: A case report of repeated stealing and the collecting behaviours of an adolescent patient. Author(s): Chen, P. S. , National Cheng Kung U Medical Coll & Hosp, Dept of Psychiatry, Tainan, Taiwan, chenps@mail.nckw.edu.tw; Chen, S. J. , National Cheng Kung U Medical Coll & Hosp, Dept of Psychiatry, Tainan, Taiwan; Yang, Y. K. , National Cheng Kung U Medical Coll & Hosp, Dept ofPsychiatry, Tainan, Taiwan; Yeh, T. L. , National Cheng Kung U Medical Coll & Hosp, Dept of Psychiatry, Tainan, Taiwan; Chen, C. C. , National Cheng Kung U Medical Coll & Hosp, Dept of Psychiatry, Tainan, Taiwan; Lo, H. Y. , National Cheng Kung U Medical Coll & Hosp, Dept of Psychiatry, Tainan, Taiwan Address: Chen, P. S., Dept of Psychiatry, National Cheng Kung U & Hosp, Tainan, Taiwan, 704, chenps@mail.nckw.edu.tw Source: Acta Psychiatrica Scandinavica , Vol 107(1), Jan 2003. pp. 73-76. Publisher: United Kingdom: Blackwell Publishing Abstract: Discusses special behavioural problems shown by a 21-yr-old male patient with Asperger's disorder from adolescence onward. The subject developed obstinate stealing behaviours when he was 17 yrs old. He was regarded as a schizophrenic at first, and was suspected of kleptomania later. Asperger's disorder was diagnosed after we reconsidered the relationship between the schizoid psychopathology in childhood and the stealing behaviours which occurred in adolescence. A wide variety of bizarre behaviours and so-called borderline behaviours occur in late adolescence and adult life of patients with Asperger's disorder. But classic schizophrenia is very rare. Psychiatrists unacquainted with the clinical diagnosis/context may find it difficult to evaluate 'concrete', 'childish', or 'bizarre' symptoms in patients with Asperger's disorder, and thus are prone to misdiagnose them as having schizophrenia disorders or similar disorders. A brief comment to the article is appended. _____
Title: Sleep patterns of children with pervasive developmental disorders. Author(s): Honomichl, Ryan D. , U California, Dept of Human & Community Development, Davis, CA, US; Goodlin-Jones, Beth L. , U California, Dept of Psychiatry, Davis, CA, US; Burnham, Melissa , U California, Dept of Human & Community Development, Davis, CA, US; Gaylor, Erika , U California, Dept of Human & Community Development, Davis, CA, US; Anders, Thomas F. , U California, Dept of Psychiatry, Davis, CA, US Address: Anders, Thomas F., School of Medicine, UC Davis, Dean's Office, Davis, CA, US Source: Journal of Autism & Developmental Disorders , Vol 32(6), Dec 2002. pp. 553-561. Publisher: Netherlands: Kluwer Academic Publishers Abstract: Data on sleep behavior were gathered on 100 children with pervasive developmental disorders (PDD), ages 2-11 years, using sleep diaries, the Children's Sleep Habits Questionnaire (CSHQ), and the Parenting Events Questionnaire. Two time periods were sampled to assess short-term stability of sleep-wake patterns. Before data collection, slightly more than half of the parents, when queried, reported a sleep problem in their child. Subsequent diary and CSHQ reports confirmed more fragmented sleep in those children who were described by their parents as having a sleep problem compared to those without a designated problem. Interestingly, regardless of parental perception of problematic sleep, all children with PDD exhibited longer sleep onset times and greater fragmentation of sleep than that reported for age-matched community norms. The results demonstrate that sleep problems identified by the parent, as well as fragmentation of sleep patterns obtained from sleep diary and CSHQ data, exist in a significant proportion of children with PDD. _____
Title: The relationship between sensory processing and play in children with autistic spectrum disorders. Author(s): Gaines, Elizabeth Chilton , The Wright Inst., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 63(4-B), Oct 2002. pp. 2055. Publisher: US: Univ Microfilms International Abstract: Individuals with autism are significantly challenged by sensory processing disturbances that affect all areas of functioning. Little is known about the relationship between sensory processing dysfunction and other deficit areas for autistic individuals. This was a preliminary study into the relationship between functional sensory processing capacities and one area that distinguishes development of autistic children from nonautistic children: play. It was hypothesized that children with more disturbed sensory processing capabilities would show less developmental progression in their play, and greater degrees of autistic pathology. Twenty children ages 4-7 with varying degrees of autistic spectrum disorders including Autism, Pervasive Developmental Delay Not Otherwise Specified and Asperger's Disorder participated in the study. Information was gathered about the child's overall level of autistic pathology (the Child Autism Rating Scale), the child's functional sensory processing capabilities (the Sensory Profile), the child's receptive language functioning (the Peabody Picture Vocabulary Test-III), and how the child played (videotaped free play segment coded into highest level and most typical level of play in the following categories: not engaged, sensorimotor play, relational play, functional play, and representational play). Separate multiple regression analyses using highest level of play, typical level of play, and overall level of autistic pathology as dependent variables and sensory processing factors and sections as independent variables yielded nonsignificant results, with one exception. Multisensory processing significantly predicted highest level of play and degree of autistic pathology. This research suggests that there is a relationship between these children's trouble managing multiple incoming sensations and play. Difficulties with amodal or multisensory processing were discussed in light of Stern's model of interpersonal development (1985). The lack of relationship overall between other sensory processing variables and play was discussed, suggesting that there are other cognitive and social emotional functions at work in the play of children with autistic spectrum disorder, including metarepresentational or executive functioning deficits. _____
Title: Research, diagnosis, and treatment of mental health disorders of children and adolescents. Author(s): Campbell, A. Laura , Private Practice, Atlanta, GA, US, ALauraCampbell@msn.com; Bush, Carol , Georgia Dept of Human Services, Dekalb Regional Mental Health, Mental Retardation and Substance Abuse Board, Decatur, GA, US Address: Campbell, A. Laura, Psychotherapy Assoc, 25 A Lenox Pointe, Atlanta, GA, US, ALauraCampbell@msn.com Source: Issues in Mental Health Nursing , Vol 23(6), Sep 2002. Special issue: Child and adolescent mental health. pp. 535-536. Publisher: United Kingdom: Taylor & Francis Abstract: Provides a brief overview by the guest editors of the articles contained in the special issue of Issues in Mental Health Nursing, Vol 23(6), on child and adolescent mental health. A wide range of diagnostic categories are represented, including depression, attention deficit hyperactivity disorder, and Asperger's syndrome. Contributors and populations addressed represent diverse areas of the US. It is the authors' hope that the articles contribute to improving the knowledge base, research efforts, and treatment of children and adolescents that will foster comprehensive health and well-being of children and youth throughout the years ahead. _____
Title: Asperger's syndrome: Implications for nursing practice. Author(s): Marshall, Margaret Cole , U Texas Health Science Ctr--San Antonio, San Antonio, TX, US, PeggyMarshall@bigplanet.com Address: Marshall, Margaret Cole, 2702 Green Range Dr., San Antonio, TX, US, PeggyMarshall@bigplanet.com Source: Issues in Mental Health Nursing , Vol 23(6), Sep 2002. Special issue: Child and adolescent mental health. pp. 605-615. Publisher: United Kingdom: Taylor & Francis Abstract: The most common disorders within the category of Pervasive Developmental Disorders (PDD) are the Autistic Disorders. In the 1994 Diagnostic and Statistical Manual-IV, Asperger's Disorder became a distinct diagnosis within the Autistic category, as part of the disorders first diagnosed in childhood and adolescence. The terms Asperger's Disorder and Asperger's Syndrome are used interchangeably. Attention to and knowledge of Asperger's Syndrome (AS) are necessary to differentiate it from closely related disorders that have overlapping symptoms. There is much discussion about different definitions of Asperger's, different viewpoints of experts in the field, and the diagnostic dilemmas related thereto. Last, and most important, are the nursing implications. Nurses are in a position to identify children with Asperger's early. After identification, the necessary referrals, treatment options, support, and follow-up are essential for these children. Nurses need more knowledge about this disorder and need to be proactive in defining their role to help children with the disorder in the schools and the community. _____
Title: The autistic-spectrum disorders. Author(s): Rapin, Isabelle , Albert Eistein Coll of Medicine, Bronx, NY, US Source: New England Journal of Medicine , Vol 347(5), Aug 2002. pp. 302-303. Publisher: US: Massachusetts Medical Society Abstract: Notes that any person, talented or handicapped, whose social skills have been severely deficient since very early childhood, who started to talk late or whose communicative use of language is inadequate, and who perseverates and lacks cognitive and behavioral flexibility meets the diagnostic criteria for an autistic-spectrum disorder. The term "pervasive developmental disorder" is used to encompass the broad range spectrum of developmental disorders with these characteristics. Characteristics of autistic disorder which is classic autism, Asperger's disorder, pervasive developmental disorder not otherwise specified, disintegrative disorder and Rett's syndrome are discussed. The author also notes that pharmacologic agents can not cure autism because, in most cases, the brain has undergone atypical cellular development dating from the earliest embryonic stages. The goal is to alleviate troublesome symptoms that interfere with the most effective intervention--intensive targeted education. _____
Title: A neuropsychological investigation of the 'weak central coherence' anomaly in autism. Author(s): Buchanan, Cathleen Paige , The Herman M. Finch U Health Sciences - The Chicago Medical School, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 62(11-B), Jun 2002. pp. 5364. Publisher: US: Univ Microfilms International Abstract: Autistic Spectrum Disorders (ASD), including Asperger's Syndrome and Pervasive Developmental Disorder, are believed to be caused by abnormalities of brain development and function. One theory to account for the unusual processing style of children with ASD is called Weak Central Coherence (WCC; Frith,1989), a notion which purports that the ability to integrate visual stimuli is deficient, resulting in an unusually local, detail-oriented approach to perceptual tasks. Prior studies of autistic adults have supported WCC on the basis of superior performance on embedded figures, block design, visual illusions, homograph performance, and even savant skills. The purpose of the present study was (1) to contrast patterns of perceptual asymmetry (PA) in healthy control children and children with ASD. It was predicted that the groups would show different patterns on a chimeric task of happy facial affect. Specifically, a rightward bias of face chimeras was predicted for autistic children; (2) to examine the relationship between PA and performance on CC measures (Children's Embedded Figure, CEFT, and Block Design, BD). For autistics, children with a stronger rightward bias (greater degree of left PA) were expected to show better performance on the tests of CC; and (3) to examine the relationship between PA and clinical indices of autism severity (Childhood Autism Rating Scale, CARS) and social emotional behavior (Aberrant Behavior Checklist, ABC). It was predicted that autism symptoms would be significantly associated with degree of reversed PA. Twenty children with ASD were compared to 20 age-matched controls on Raven's Coloured Progressive Matrices, BD and LEFT, and a chimeric face paradigm. As predicted, the ASD group showed a preference for the right side of faces, implicating a reversed PA, or left hemisphere bias, which differed significantly from controls. Within groups, Asperger's children performed most like typical children on the chimeric task, demonstrating a right hemisphere bias. In contrast to study predictions, neither severity of autism (CARS, ABC) nor performance on the CC measures correlated significantly with PA. Chronological age showed a trend with PA for ASD children only. Results are described in terms of neurodevelopment and reorganization, face processing, functional neuroanatomy, CC, and associated difficulties in the social realm in ASD. Also discussed is the unexpected Asperger's group difference, and potential implication for heterogeneity within ASD. _____
Title: Editorial. Author(s): Verhulst, Frank C. Source: Journal of Child Psychology & Psychiatry & Allied Disciplines, Vol 43(4), May 2002. pp. 415. Publisher: United Kingdom: Blackwell Publishing Asperger's syndrome; failure to thrive; children; adolescents Abstract: Summarizes articles by A. Raine, S. L. Olson et al, M. Kasese-Hara et al, S. H. Spence et al , M. Happonen et al, J. R. Seguin et al, F. Vitaro et al , C. Hughes et al, N. Kaland et al, and A. Smith. The topics discussed include: biological correlates of antisocial and aggressive behavior in children; early developmental precursors of impulsive and inattentive behavior; energy compensation in young children who fail to thrive; early childhood predictors of anxiety and depressive symptoms in adolescence; the heritability of depressive symptoms; the role of underlying processes in response perseveration in adolescent boys with stable and unstable histories of physical aggression; antecedent and subsequent characteristics of reactively and proactively aggressive children; the SNAP observational paradigm for assessing young children's disruptive behavior in competitive play; theory of mind testing of children and adolescents with Asperger's syndrome; and time perception in children with attention deficit hyperactivity disorder (ADHD). _____
Title: Outcome of Asperger's syndrome. Author(s): Duggal, Harpreet S. ; Dutta, Siddhartha; Sinha, Vinod K. Source: American Journal of Psychiatry , Vol 159(2), Feb 2002. pp. 325-326. Publisher: US: American Psychiatric Assn Abstract: Comments on the study by P. Szatmari et al concerning the two-year outcome of preschool children with autism or Asperger's syndrome. The study confirms, in part, the original observation (L. Wing, 1981) emphasizing the stability of the clinical picture throughout childhood and adolescence and at least into early adult life, with maturation bringing about an increase in skill level. _____
Title: Social-cognitive processing in 6- to 12-year-old children with Asperger's disorder. Author(s): Carothers, Douglas Edward , Florida Atlantic U., US Source: Dissertation Abstracts International Section A: Humanities & Social Sciences , Vol 63(6-A), Jan 2002. pp. 2196. Publisher: US: Univ Microfilms International Abstract: Students with Asperger's disorder manifest social, behavioral and pragmatic language impairments that result in their lower social acceptance. However, peer rejection in childhood is correlated with both current and future maladjustment, so it is important to investigate the causes of social rejection for children with Asperger's disorder. The first purpose of this study was to determine the relative effectiveness with which students with Asperger's disorder and typically developing students were able to interpret the social intentions of their peers. The second purpose of the study was to determine whether, with a given interpretation of social intention, there were differences in the social interaction strategies chosen by these two groups of students. Twenty students with Asperger's disorder and 20 typically developing elementary school students participated in this study. They viewed videotapes depicting social conflict situations and were interviewed to determine if they perceived the cause of a conflict, how they interpreted an antagonist's actions, and how they would respond in a similar situation. An independent samples t-test indicated that the typically developing group performed significantly better on the encoding of conflicts and benign intention cues. Further, the Asperger's disorder group rejected benign intention cues that they had encoded at a higher rate than their typically developing peers. A mixed ANOVA revealed that there were significant differences between groups for the rating of a peer as "not mean" based on cue type, with the Asperger's disorder group most likely to rate a peer as "not mean" after watching ambiguous vignettes and the typically developing group most likely to give this rating after watching benign vignettes. Additionally, a mixed ANOVA demonstrated that the Asperger's disorder group was significantly more likely to cite the use of aggressive strategies both against peer entry and peer provocation conflict types and when they had attributed a peer to be "mean." _____
Title: Pervasive developmental disorder and parental adaptation: Previewing and reviewing atypical development with parents in child psychiatric consultation. Author(s): Schuntermann, Peter , Harvard Medical School, Dept of Psychiatry, Children's Hosp, Beth Israel Deaconess Medical Ctr, Boston, MA, US Address: Schuntermann, Peter, Developmental Consultation Services, Harvard Vanguard Medical Associates, Somerville Offices, 40 Holland St., Somerville, MA, US Source: Harvard Review of Psychiatry , Vol 10(1), Jan-Feb 2002. pp. 16-27. Publisher: United Kingdom: Oxford Univ Press Abstract: Parenting young children with pervasive developmental disorder engenders unique sustained stresses, which have been termed "burden of care." One specific source of stress for parents is the children's uneven developmental progress, in which delays and accelerations of adaptive functioning may exist side by side. This paper proposes a clinical method that may be incorporated into periodic child psychiatric consultations with parents of young children who have high-functioning autism or Asperger's disorder. Using a semistructured technique, the clinician reviews with the parents the details of the child's recent developmental course and attempts to identify emergent skills that may serve to preview upcoming developmental issues and gains. This method is aimed at enhancing parental abilities to track and anticipate developmental progress and the resultant shift in the parent-child relationship, in order to reduce one source of sustained parental stress. Case illustrations of children ages 2-8 yrs old are discussed in light of recent literature on adaptive issues in families of individuals with a chronic medical or psychiatric condition and, specifically, families of children with pervasive developmental disorder. _____
Title: Mood stabilizers in Asperger's syndrome. Author(s): Duggal, Harpreet S. , Central Inst of Psychiatry, Ranchi, India; Dutta, Siddhartha; Sinha, Vinod K. Source: Australian & New Zealand Journal of Psychiatry, Vol 35(3), Jun 2001. pp. 390-391. Publisher: United Kingdom: Blackwell Publishing Abstract: Reports a case of Asperger's syndrome (AS) whose comorbid mania responded to a combination of two mood stabilizers. A 22 yr old male is presented with a history of poor socialization, circumscribed areas of interest, oddities of speech, repetitive patterns of behavior and an awkward gait since early childhood. The authors highlight that chronic mania may be common in some subsets of patients with AS, which may be mistaken as a manifiestation of the behavioural dysregulation and mood swings associated with autistic syndromes. _____
Title: Functional magnetic resonance imaging in children with Asperger's syndrome. Author(s): Oektem, Ferhunde , Hacettepe U, Dept of Child Psychiatry, Ankara, Turkey; Diren, Baris; Karaagaoglu, Ergun; Anlar, Banu , banlar@gen.hun.edu.tr Address: Oektem, Ferhunde, Hacettepe University Faculty of Medicine, Department of Child Neurology, Ankara, Turkey, 06100, banlar@gen.hun.edu.tr Source: Journal of Child Neurology , Vol 16(4), Apr 2001. pp. 253-256. Publisher: Canada: BC Decker Abstract: Asperger's syndrome is a pervasive developmental disorder of unknown etiology. This report describes a study in which researchers evaluated 9 children with this syndrome (7-17 yrs old) and 8 control children by functional magnetic resonance imaging (MRI) during a task involving social judgment. All control and 5 of 9 Ss with Asperger's syndrome showed signal intensity changes in frontal regions. Four patients with Asperger's syndrome, including 1 case with right frontal dysplasia, had no signal intensity change during the task. In this first functional MRI study of childhood Asperger's syndrome, frontal activation patterns demonstrated some differences between patients and normal Ss. Further studies are warranted involving other functions frequently impaired in Asperger's syndrome. _____
Title: The role of medication in the management of autistic spectrum disorders. Series Title: Advances in special education; Vol. 14. Author(s): Hoover, Marlin , Hoover and Associates, Orland Park, IL, US Source: Autistic spectrum disorders: Educational and clinical interventions. Wahlberg, Tim (Ed); Obiakor, Festus (Ed); et al; pp. 255-267. Oxford, England: Elsevier Science Ltd, 2001. ix, 302 pp. Abstract: (from the chapter) In this chapter, the author discusses the current use of mental health medications in treating autistic spectrum disorders. He briefly reviews similarities and differences in featured behaviors and symptoms for autistic disorder, Asperger's disorder, Rett's disorder, childhood degenerative disorder, and atypical pervasive developmental disorder. He discusses the use of specific categories of medications to affect specific symptoms, and the benefits and hazards of mental health medications. It is noted that medications work best in conjunction with and coordinated with psychological, educational, and social interventions designed to enhance the individual's functioning. _____
Translated Title: Structural brain abnormalities in childhood autism. Author(s): Propper, Lukas , Detska psychiatricka klinika, Motol, Czech Republic, propper@lfmotol.cuni.cz; Hrdlicka, M.; Lisy, J.; Belsan, T. Address: Propper, Lukas, Detska psychiatricka klinika, LF UK a FN Motol, V Uvalu 84, 150 06 Praha 5, Prague, Czech Republic, lukas.propper@lfmotol.cuni.cz Source: Ceska a Slovenska Psychiatrie , Vol 97(6), 2001. pp. 269-275. Publisher: Czech Republic: Czech Medical Society JEv Purkyne Abstract: Presents original results of the Motol University Hospital Autistic Interdisciplinary Project, which evaluated structural brain findings in a sample of inpatient children with autistic spectrum disorder, 1998-2000. 25 3-26 yr old patients (21 boys, 4 girls) were examined. Childhood autism was diagnosed in 15 children, atypical autism in 5, Asperger's syndrome in 2, mental retardation with autistic symptoms in 2, and pervasive developmental disorder (unspecified) in 1 child. magnetic resonance imaging (MRI) scans were performed in 22 patients and CT scans in 3 patients. Brain abnormalities were detected in 8 patients and in all cases were non-specific. These included: structural cerebellar abnormalities detected in 3 children (vermal hypoplasia, mild cortical cerebellar atrophy); glial changes in 3 children (bilateral, occipital and frontal, periventricular and corticosubcortical); brain cysts in 3 children (arachnoid bitemporal cysts laterally from the trigonum of the lateral ventricle, pineal cyst) and megacisterna magna in 1 child. _____
Title: Pervasive developmental disorders. Author(s): Sabatino, David A., East Tennessee State U, Johnson City, TN, US; Vance, H. Booney; Fuller, Gerald Source: Clinical assessment of child and adolescent behavior. Vance, H. Booney (Ed); Pumariega, Andres (Ed); pp. 188-230. New York, NY, US: John Wiley & Sons, Inc, 2001. xvi, 557 pp. Abstract: (from the chapter) Pervasive Developmental Disorders (PDD) include a group of one broadband and 4 specific childhood mental disorders, each of which has recognizable and therefore diagnosable features. The characteristics associated with PDDs are frequently subtle. Topics include: Autism, Asperger's disorder, changes in conceptual considerations, current definitions of autism, autism-related disorders, specific scales for autism, differential diagnosis, interventions, controversial and unorthodox interventions. _____
Title: Gifted children with Asperger's syndrome. Author(s): Neihart, Maureen Source: Gifted Child Quarterly , Vol 44(4), Fal 2000. pp. 222-230. Publisher: US: National Assn for Gifted Children Abstract: Asperger's Syndrome is a pervasive developmental disorder characterized by deficits in social communication and by repetitive patterns of behaviors or interests. It is observed in some gifted children. The author proposes that gifted children with Asperger's Syndrome may not be identified because their unusual behaviors may be wrongly attributed to either their giftedness or to a learning disability. This article discusses ways in which Asperger's Syndrome might be missed in gifted children and proposes guidelines for differentiating characteristics of giftedness from characteristics of Asperger's Syndrome. _____
Title: The right hemisphere and psychopathology. Author(s): Wasserstein, Jeanette , CUNY School of Medicine, Clinical Neuroscience Div, New York, NY, US; Stefanatos, Gerry A. Source: Journal of the American Academy of Psychoanalysis & Dynamic Psychiatry , Vol 28(2), Sum 2000. Special issue: Neuroscience and Psychoanalysis. pp. 371-394. Publisher: US: Guilford Publications Abstract: Provides a selective review of the role of the right hemisphere in mediating component processes related to disorders of self-awareness and reciprocal socioemotional functioning. Only those diagnoses most consistently related to right hemisphere pathology are discussed. Neuropsychological deficits related to right hemisphere dysfunction can exist at all ages while their functional significance changes in the course of development. The right cerebral hemisphere plays a pivotal role in disorders of social processing, awareness, and emotional functioning. WWII reopened examination of right brain specialization, stimulated by results of psychological testing in survivors of discrete missile wounds to the brain. A dual consciousness line of thinking from the 1960s provided some of the initial theoretical links between the right hemisphere and psychopathology. There is a consensus that the right hemisphere is differentially capable in many nonverbal and verbal skills, which are key in socioeconomic functioning, attention distribution, and spatial understanding. Adult onset psychopathology concerns schizophrenia, and childhood onset psychopathology concerns attention deficit hyperactivity disorder, nonverbal learning disability, and Asperger's Syndrome. _____
Title: Comparison of ICD-10 and Gillberg's criteria for Asperger syndrome. Author(s): Leekam, Susan , U Durham, Dept of Psychology, Durham, England; Libby, Sarah; Wing, Lorna; Gould, Judith; Gillberg, Christopher Source: Autism , Vol 4(1), Mar 2000. Special issue: Asperger syndrome. pp. 11-28. Publisher: US: Sage Publications Abstract: Algorithms designed for the Diagnostic Interview for Social and Communication Disorders were used to compare the International Classification of Diseases-10 (ICD-10) criteria for Asperger syndrome with those suggested by C. Gillberg (e.g., S. Ehlers and C. Gillberg, see record 1994-13715-001). Ss were 200 children and adults (aged 32 mo to 38 yrs) who met the ICD-10 criteria for childhood autism or atypical autism. Only 3 met criteria for ICD-10 Asperger syndrome. In contrast, 91 met criteria for Asperger syndrome defined by Gillberg, which more closely resemble Asperger's own descriptions. Results showed that the discrepancy in diagnosis was due to the ICD-10 requirement for "normal" development of cognitive skills, language, curiosity, and self-help skills. When comparisons were based on Gillberg's criteria only, results showed that the Ss diagnosed as having Asperger syndrome differed significantly from the rest on all but 2 of Gillberg's criteria. However, all of these criteria could be found in some of those not diagnosed as having Asperger syndrome. The results emphasize the differences between the 2 diagnostic systems. They also question the value of defining a separate subgroup and suggest that a dimensional view of the autistic spectrum is more appropriate than a categorical approach. _____
Title: Portraits of three adolescent students with Asperger's syndrome: Personal stories and how they can inform practice. Author(s): Marks, Susan Unok , SRI International, Menlo Park, CA, US; Schrader, Carl; Longaker, Trish; Levine, Mark Source: Journal of the Association for Persons with Severe Handicaps , Vol 25(1), Spr 2000. pp. 3-17. Publisher: US: Assn for Persons with Severe Handicaps Abstract: Examined the personal experiences of 3 adolescent male students (aged 13-15 yrs) with Asperger's syndrome. The portraits included descriptive details about these students as young children, their schooling experiences, their interests, and their social life experiences. A series of focus groups with professionals who provide direct services to these students was performed. Interviews with the students and parents were also conducted. The purpose of these 3 portraits was to serve as a starting point for those in the field to further examine possible solutions for better meeting the needs of these students. The role of these portraits (or personal stories) in helping to inform critical areas of need and important directions for meeting the needs of adolescent students with Asperger's syndrome conclude the article. _____
Title: Pervasive developmental disorders: The spectrum of autism. Author(s): Harris, Sandra L. , Rutgers U, NJ, US Source: Advanced abnormal child psychology (2nd ed.). Hersen, Michel (Ed); Ammerman, Robert T. (Ed); pp. 357-370. Mahwah, NJ, US: Lawrence Erlbaum Associates, Publishers, 2000. x, 525 pp. Abstract: (from the chapter) Children with pervasive developmental disorders (PDDs) are relatively rare, but these are serious disorders that begin in infancy or early childhood and require early, intensive intervention for maximum treatment benefits. Symptoms of these disorders include pervasive problems of social behavior and emotional expression, communication deficits, and disruptive behaviors (e.g., stereotyped behaviors, self-injury, and resistance to change). Included as PDDs are autistic disorder, Rhett's disorder, childhood disintegrative disorder, Asperger's disorder, and pervasive developmental disorder not otherwise specified. This chapter provides a clinical and disease course description of, familial contributions to, physiological and genetic influences on, and current treatment for autistic disorder, the most common of the PDDs. _____
Title: What is autism? Author(s): Powers, Michael D. , Ctr for Children with Special Needs, Tolland, CT, US Source: Children with autism: A parents' guide (2nd ed.). Powers, Michael D. (Ed); pp. 1-44. Bethesda, MD, US: Woodbine House, 2000. xxvii, 427 pp. Abstract: (from the chapter) This chapter discusses the major symptoms of autism, including failure to develop normal socialization; disturbances in speech, language, and communication; abnormal relationships to objects and events; abnormal responses to sensory stimulation; developmental delays and differences; and the beginning of autism during infancy or childhood. The following types of autism, all of which fall under the broad diagnostic umbrella called pervasive developmental disorders, are discussed: autistic disorder, Asperger's disorder, Rett's disorder, childhood disintegrative disorder, and pervasive developmental disorder: not otherwise specified. The chapter provides information on the number of people with autism, gender differences, current trends, etiology, and what parents and professionals should consider to be progress or even a "cure." The chapter also discusses how professionals arrive at a diagnosis of autism and how parents participate in that diagnosis; provides a brief history of autism; and discusses the future of children with autism. _____
Title: El Sindrome de Asperger, una variante del espectro autista. Translated Title: Asperger's syndrome, a variant of the autistic spectrum. Author(s): Martinez Alonso, B. , Hosp Provincial de Pontevedra, Servicio de Psiquiatria, Pontevedra, Spain; Dominguez, M. D.; Mateos, R.; Alonso, M. J. Source: Revista de Psiquiatria Infanto-Juvenil , No 4, 2000. pp. 213-221. Publisher: Spain: Siglo Editorial Abstract: Studied the clinical features of school-age children and adolescents in Spain with 2 types of generalized developmental disorders: Asperger's syndrome (AS) and childhood autism. Ss were 5 9-14 yr olds with AS in regular schools and 5 8-15 yr olds with autism and mild mental retardation in special classes. The Ss with AS had been diagnosed previously with autism, schizoid disorder, and bipolar disorder. They had problems with relationships (usually with other children and adolescents). The autistic Ss manifested major symptomatology (e.g., psychosis). Ss were observed and were assessed with the Integrated Scale of Assessment of Childhood Autism (M. Trias et al, 1994). Functioning in the areas of (1) social integration, behavior, and psychomotor skills, (2) language, communication, and sensory functioning, and (3) affectivity was compared. The results indicate some similarities in the clinical profiles of the 2 groups of Ss. However, autistic Ss manifested greater disabilities than AS Ss did. The position of AS and childhood autism in the broader autistic spectrum is examined. _____
Title: Autistic spectrum disorders in childhood epilepsy surgery candidates. Author(s): Taylor, D. C. , Inst of Child Health, Neurosciences Unit, Great Ormond St. Hosp for Children NHS Trust, London, United Kingdom; Neville, B. G. R. , Inst of Child Health, Neurosciences Unit, Great Ormond St. Hosp for Children NHS Trust, London, United Kingdom; Cross, J. H. , Inst of Child Health, Neurosciences Unit, Great Ormond St. Hosp for Children NHS Trust, London, United Kingdom Address: Taylor, D. C., Great Ormond St. Hospital for Children, NHS Trust, Mecklenburgh Sq, London, United Kingdom, WC1 2AP Source: European Child & Adolescent Psychiatry , Vol 8(3), Sep 1999. pp. 189-192. Publisher: Germany: Dietrich Steinkopff Verlag Abstract: About one third of the children with autistic spectrum disorders enter that state by regression from a more normal prior development at the onset of epilepsy abnormality in the elecxtroencephalogram. In a very small proportion structural lesions of the temporal lobes are discovered. These form part of the sample of 98 children coming to a surgical treatment program. These children were seen by a neuropsychiatrist. Their psychiatric diagnoses were coded on %DSM IV% schedules. Other variables of interest were the age at onset of epilepsy: the nature, the side, and the time of acquisition of the lesion; intelligence and sex. Results show that there were 19 children with autistic spectrum disorders including 8 with Asperger's syndrome. 10 of the children in the autistic group had right brain lesions; six were dysembryoplastic neuroepithelial tumors (DNETs); two were cortical dysplasias; 1 tuberous sclerosis; 1 hemi-cortical defect; and 1 mesial temporal sclerosis. Nine started epilepsy in their first year; 9 had IQs in the retarded range; 9 of the 11 were male. Six of the 8 Asperger's children had right brain lesions; 2 DNETS; 4 mesial temporal sclerosis; 1 Rasmussen encephalitis. Four started epilepsy in their first year; 1 was retarded; 5 were female. _____
Title: Autism spectrum disorders at 20 and 42 months of age: Stability of clinical and ADI-R diagnosis. Author(s): Cox, Antony , Guy's, King's Coll & St Thomas' Medical School, Bloomfield Clinic & Newcomen Ctr, London, England; Klein, Kate; Charman, Tony; Baird, Gillian; Baron-Cohen, Simon; Swettenham, John; Drew, Auriol; Wheelwright, Sally Source: Journal of Child Psychology & Psychiatry & Allied Disciplines, Vol 40(5), Jul 1999. pp. 719-732. Publisher: United Kingdom: Blackwell Publishing Abstract: Examined the association between, and stability of, clinical diagnosis and diagnosis derived from the Autism Diagnostic Interview-Revised (ADI-R) in a sample of prospectively identified children with childhood autism (CA) and other pervasive developmental disorders (PDDs) assessed at the age of 20 mo and 42 mo. Clinical diagnosis of autism was stable, with all children diagnosed with CA at age 20 mo receiving a diagnosis of CA or a related PDD at age 42 mo. Clinical diagnosis of CA was also reasonably sensitive, with all children who went on to receive a clinical diagnosis of CA at 42 mo being identified as having autism or PDD at 20 mo. However, clinical diagnosis for PDD and Asperger's syndrome lacked sensitivity at 20 mo, with several children who subsequently received these diagnoses at 42 mo receiving diagnoses of language disorder or general developmental delay, as well as in 2 cases being considered clinically normal, at the earlier timepoint. The ADI-R was found to have good specificity but poor sensitivity at detecting CA at 20 mo; however, the stability of diagnosis from 20 to 42 mo was good. In addition, the ADI-R at age 20 mo was not sensitive to the detection of related PDDs or Asperger's syndrome. _____
Title: Neuropsychology of childhood mental disorders: Integration of phenomenological, neurobiological, and neuropsychological findings. Author(s): DeCaria, Concetta M. , Mt Sinai School of Medicine, New York, NY, US; Aronowitz, Bonnie R.; Twersky-Kengmana, Rebecca; Hollander, Eric Source: Assessment of neuropsychological functions in psychiatric disorders. Calev, Avraham (Ed); pp. 135-231. Washington, DC, US: American Psychiatric Association, 1999. xiii, 508 pp. Abstract: (from the chapter) In this chapter, the authors provide an overview of prominent childhood mental disorders described within a neuropsychological framework. This perspective suggests that development is linked to genetic and environmental factors that may interfere with normal brain development. Neuropsychological function and child development may be viewed within the context of cognitive functions and associated neural representations. Vulnerability of a particular cognitive or functional system depends on brain location as well as the phylogenic and ontogenic development of that particular area. Disturbances in the normal development of these brain areas may contribute to compromised cognitive function in 1) learning disorders (reading, mathematics, and writing disorders), 2) pervasive developmental disorders (autism and Asperger's disorder), and 3) attention deficit hyperactivity disorder (ADHD). Neuropsychiatric, neuropsychological, and neuroanatomical abnormalities are also found in children and adolescents with obsessive-compulsive disorder. The chapter highlights diagnostic, phenomenological, neurobiological, and neuropsychological characteristics of each of these disorders and summarizes assessment and treatment issues. _____
Title: Pervasive developmental disorders. Series Title: Oxford textbooks in clinical psychology Author(s): Treffert, Darold A. , Associated Psychiatric Consultants, SC, US Source: Child & adolescent psychological disorders: A comprehensive textbook. Netherton, Sandra D. (Ed); Holmes, Deborah (Ed); et al; pp. 76-97. London,: Oxford University Press, 1999. xvii, 604 pp. Abstract: Discusses history, prevalence, diagnostic description, etiology, assessment, treatment, course and prognosis of autistic disorders in children as described by DSM and International Classification of Diseases (ICD). Specifically, educational, behavioral therapies, psychotherapy, pharmacotherapy, and facilitated communication are described within the treatment discussion. Savant syndrome and autistic disorder, Williams syndrome and autistic disorder, Rett's disorder, childhood disintegration disorder, Asperger's disorder, and pervasive developmental disorder not otherwise specified are also examined. _____
Title: Pervasive developmental disorders. Author(s): Durand, V. Mark , U Albany, Dept of Psychology, Albany, NY, US; Mapstone, Eileen Source: Developmental issues in the clinical treatment of children. Silverman, Wendy K. (Ed); Ollendick, Thomas H. (Ed); pp. 307-317. Needham Heights, MA, US: Allyn & Bacon, 1999. xviii, 510 pp. Abstract: (from the book) After describing the 4 disorders that are subsumed under the pervasive developmental disorder category (i.e., autistic disorder, Rett's disorder, Asperger's disorder, and childhood disintegrative disorder), the chapter focuses on developmental theory and treatment with respect to autistic disorder. The chapter shows how work in the areas of language, behavior problems, and early intervention have been found to be useful for helping children who suffer from autism. It underscores how progress in this area will require an integration of the biological aspects of this disorder with the psychological (e.g., cognitive, social, behavioral) factors. _____
Title: Psychosocial characteristics of children with pervasive developmental disorders. Series Title: Plenum series on human exceptionality Author(s): Zwaigenbaum, Lonnie , Chedoke McMaster Hosp, Ctr for Studies of Children at Risk, Hamiton, ON, Canada; Szatmari, Peter Source: Handbook of psychosocial characteristics of exceptional children. Schwean, Vicki L. (Ed); Saklofske, Donald H. (Ed); pp. 275-298. Dordrecht, Netherlands: Kluwer Academic Publishers, 1999. xxiii, 622 pp. Abstract: (from the chapter) Focuses on the diagnostic criteria, characteristics, differentiation, and treatment considerations of nonautism pervasive developmental disorders, including Asperger's syndrome, Rett syndrome, childhood disintegrative disorder, pervasive developmental disorder not otherwise specified/atypical autism. _____
Title: A case of Asperger's syndrome first diagnosed in adulthood. Author(s): Bankier, Bettina , Vienna U, Dept of Psychiatry, Div of Social Psychiatry, Vienna, Austria; Lenz, Gerhard; Gutierrez, Karin; Bach, Michael; Katschnig, Heinz Source: Psychopathology , Vol 32(1), Jan-Feb 1999. pp. 43-46. Publisher: Switzerland: Karger Abstract: A 25-year-old White male patient was admitted to the Department of Psychiatry, Division of Social Psychiatry, of the University of Vienna, Austria, for severe social withdrawal, selective mutism and outbursts of violence with attacks on his mother. Careful examination revealed the presence of all the typical symptoms of Asperger's syndrome. The diagnosis had never been made before, although the patient had a history of a difficult childhood with several admissions to a child psychiatric inpatient unit for 'obsessional neurosis' and an institutional career. It is stressed that, in view of the availability of treatments and the deleterious effect of the untreated condition in the sensitive years of personality development, early recognition and diagnosis of Asperger's syndrome are of utmost importance. _____
Title: Discovering my autism: Apologia pro vita sua (with apologies to Cardinal Newman). Author(s): Schneider, Edgar Source: Philadelphia, PA, US: Jessica Kingsley Publishers, Ltd., 1999. 125 pp. Abstract: (from the cover) In 1978, E. Schneider suffered a nervous breakdown, and was eventually misdiagnosed as schizophrenic. 16 yrs later, the chance reading of an article on autistic savants alerted him to the possibility that he had been misdiagnosed. This proved to be the case: He is believed to be a high-functioning autistic, with attention deficit disorder (ADD). Schneider attributes his autism to brain damage caused by infectious diseases in early childhood. In this book, he reflects on his experiences and his memories of his childhood and teenage years as a clever and artistic loner. He explains how, in order to experience emotions such as grief, sympathy, or desire, he must intellectualize or aestheticize them. He examines his difficulties with relationships, his high pain threshold, his lack of concentration, and his highly absorbant intelligence, all of which are related to his autism. Schneider also describes the pleasure he derives from art, music, and literature; the importance to him of his religious beliefs; and his work with parent support groups. As an account of how it feels to be a high-functioning autistic, this book should be read by parents of autistic children; professionals working with them; and people with autism, Asperger's Syndrome, or ADD themselves. _____
Title: Diagnoses commonly missed in childhood: Long-term outcome and implications for treatment. Author(s): Burger, Frances L. , U Utah, School of Medicine, Dept of Psychiatry, Salt Lake City, UT, US; Lang, Christopher M. Source: Psychiatric Clinics of North America , Vol 21(4), Dec 1998. pp. 927-940. Publisher: United Kingdom: Elsevier Science Abstract: The authors discuss psychiatric and developmental disorders with onset in early childhood that are often missed and commonly overlooked by adult psychiatrists. These disorders include mild autism and Asperger's Syndrome, developmental speech and language disorders, learning disabilities, mood disorders, posttraumatic stress disorder (PTSD), and tic disorders. They have important continuities into adulthood and are powerful predictors of chronicity, comorbidity, and severity. It is essential that they are recognized and taken into account in the assessment and treatment of the adult patient. _____
Title: Schizoid personality in childhood: The links with Asperger syndrome, schizophrenia spectrum disorders, and elective mutism. Series Title: Current issues in autism Author(s): Wolff, Sula Source: Asperger syndrome or high-functioning autism? Schopler, Eric (Ed); Mesibov, Gary B. (Ed); et al; pp. 123-142. New York, NY, US: Plenum Press, 1998. xviii, 409 pp. Abstract: (from the chapter) The aim of this chapter is to draw attention to a group of patients, not uncommonly seen in child psychiatric practice, who were diagnosed as having a schizoid personality disorder. They appear to be quite similar to the patients Asperger described, but do not entirely fulfill current diagnostic criteria for Asperger syndrome. The chapter starts with an account of the main features of the condition and of a prognostic validation study. The multiple diagnostic labels that have been applied to affected children is mentioned, and the similarity of the syndrome to Asperger's original description of autistic psychopathy pointed out. Next, the link between schizoid personality of childhood and the schizophrenia spectrum is described. The relationship between schizoid personality and childhood autism is clarified in terms of the similarities and differences of symptoms and of psychological functioning, and in terms of a possible common genetic factor. Current concepts of AS as defined in International Classification of Diseases and Related Health Problems (ICD—10) and Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) are reviewed in relation to our own outcome studies of schizoid children. Treatment needs are then discussed. A note on the association with developmental language disorders and elective mutism follows. _____
Title: Psychopharmacology. Series Title: Cambridge monographs in child and adolescent psychiatry Author(s): McDougle, Christopher J. , Yale U School of Medicine, Dept of Psychiatry, New Haven, CT, US Source: Autism and pervasive developmental disorders. Volkmar, Fred R. (Ed); pp. 169-194. New York, NY, US: Cambridge University Press, 1998. xvi, 278 pp. Abstract: (from the chapter) This chapter reviews psychopharmacology research in pervasive developmental disorders (PDDs) from the perspective of specific neurochemical systems. When relevant, differences in drug treatment response between the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) of the American Psychiatric Association (1994) subtypes of PDD, including autistic disorder, Rett's syndrome, childhood disintegrative disorder, Asperger's syndrome, and PDD not otherwise specified will be highlighted. _____
Title: Pervasive developmental disorders and learning disorders. Author(s): Ghuman, Harinder S. , U Maryland, School of Medicine, Dept of Psychiatry, Walter P. Carter Ctr, Child & Adolescent Outpatient Services, Baltimore, MD, US; Ghuman, Jaswinder K.; Ford, Laurence W. Source: Handbook of child and adolescent outpatient, day treatment and community psychiatry. Ghuman, Harinder S. (Ed); Sarles, Richard M. (Ed); pp. 197-212. Philadelphia, PA, US: Brunner/Mazel, Inc, 1998. xvii, 393 pp. Abstract: (from the chapter) In 1994, the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) categorized pervasive developmental disorders into autistic disorder, Rett's disorder, childhood disintegrative disorder, Asperger's disorder, and pervasive developmental disorder, NOS (not otherwise specified). This chapter discusses the clinical presentation, differential diagnosis, epidemiology, diagnostic assessment, etiology, prognosis, management, and pharmacotherapy of pervasive developmental disorders, as well as the basic definitions, diagnostic criteria, and protocols used in the identification of development disabilities, with a focus on learning disorders. _____
Title: Low body weight in male children and adolescents with schizoid personality disorder or Asperger's disorder. Author(s): Hebebrand, Johannes , U Marburg, Dept of Child & Adolescent Psychiatry, Clinical Research Group, Marburg, Germany; Hennighausen, K.; Nau, S.; Himmelmann, G. W.; Schulz, E.; Schaefer, H.; Remschmidt, H. Source: Acta Psychiatrica Scandinavica , Vol 96(1), Jul 1997. pp. 64-67. Publisher: United Kingdom: Blackwell Publishing Abstract: Explored the hypothesis that body weight is reduced in male children and adolescents with schizoid personality disorder or Asperger's disorder. The body weights of 33 consecutively admitted male Ss (aged 7.7-20.4 yrs) with one of these disorders were retrospectively assessed with percentiles for the body mass index (BMI). The mean percentile (+-SD) for the BMI was 31.6+-27.6 and differed significantly from the expected value of 50 (P < 0.001). Ten Ss had a BMI of <=10th age percentile. Post hoc comparisons revealed that BMI percentiles were (a) reduced to a similar extent in patients with schizoid personality disorder and Asperger's disorder, and (b) reduced to a greater extent in patients with abnormal eating behavior. During childhood and adolescence both diagnoses are associated with an increased risk of being underweight. Population-based BMI percentiles are useful for detecting associations between specific psychopathological syndromes and body weight. _____
Title: Risperidone treatment of children and adolescents with pervasive developmental disorders: A prospective, open-label study. Author(s): McDougle, Christopher J. , Yale U, School of Medicine, Dept of Psychiatry, Child Study Ctr, Clinical Neuroscience Research Unit, New Haven, CT, US; Holmes, Janice P.; Bronson, Mary R.; Anderson, George M.; et al. Source: Journal of the American Academy of Child & Adolescent Psychiatry, Vol 36(5), May 1997. pp. 685-693. Publisher: US: Lippincott Williams & Wilkins Abstract: Investigated the short-term safety and efficacy of risperidone in a 12-wk, prospective, systematic, open-label trial that included 18 Ss (aged 5-18 yrs). The sample included 11 Ss with autistic disorder, 3 with Asperger's disorder, 1 with childhood disintegrative disorder, and 3 with pervasive developmental disorder not otherwise specified. 14 Ss had comorbid mental retardation. Behavioral ratings were obtained during 2 baseline visits and again after 12 wks of risperidone treatment. The optimal dose of risperidone for the 18 Ss was 1.8 +- 1.0 mg/day. On the basis of the global improvement item of the Clinical Global Impression Scale, 12 Ss were considered responders. Significant improvement was seen in measures of interfering repetitive behavior, aggression, and impulsivity, and some elements of impaired social relatedness. The most common side effect was weight gain. _____
Title: Asperger syndrome, autism and attention disorders: A comparative study of the cognitive profiles of 120 children. Author(s): Ehlers, Stephan , U Goeteborg, Dept of Clinical Neuroscience, Section of Child & Asolescent Psychiatry, Goteborg, Sweden; Nyden, Agneta; Gillberg, Christopher; Dahlgren Sandberg, Annika; et al. Source: Journal of Child Psychology & Psychiatry & Allied Disciplines, Vol 38(2), Feb 1997. pp. 207-217. Publisher: United Kingdom: Blackwell Publishing Abstract: Applied the Swedish version of the Wechsler Intelligence Scale for Children--Revised (WISC--R) to 40 children with Asperger syndrome, 40 children with autistic disorder/childhood autism, and 40 children with deficits in attention, motor control, and perception (all Ss aged 5-15 yrs). Using stepwise logistic regression analysis, the WISC--R's discriminating ability was investigated. The overall rate of correct diagnostic classification was 63%. Further, WISC--R profiles were analyzed within each group. The group with autistic disorder was characterized by a peak in Block Design. The Asperger syndrome group had good verbal ability and troughs on Object Assembly and Coding. The group with attention disorders had troughs on Coding and Arithmetic. Results suggest that Kaufman's Verbal Comprehension, Perceptual Organization and Freedom from Distractibility factors rather than verbal or performance IQ account for the variance on the WISC--R. Furthermore, the Asperger syndrome and autistic disorder groups differed in respect of "fluid" and "crystallized" cognitive ability. _____
Title: Pervasive developmental disorders. Author(s): Kusch, Michael , U Bonn, Zentrum fur Kinderheilkunde, Bonn, Germany; Petermann, Franz Source: Developmental psychopathology: Epidemiology, diagnostics and treatment. Essau, Cecilia Ahmoi (Ed); Petermann, Franz (Ed); pp. 177-218. Amsterdam, Netherlands: Harwood Academic Publishers, 1997. xvii, 478 pp. Abstract: Examines risk factors (including family and genetic factors, brain mechanisms, frontal lobe, executive, and cerebellar dysfunction, and neurological theories), comorbidity, course outcome, and psychosocial impairment of pervasive developmental disorders in children. Specifically, autistic disorder, Asperger's disorder, Rett's disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified are discussed. Pharmacotherapy (megavitamins, fenfluramine, therapy with opiatantagonist, and neuroleptic therapy), psychological intervention, and educational programs are presented. _____
Title: Autism, pervasive developmental disorders, and Asperger. Series Title: The Jossey-Bass library of current clinical technique Author(s): Lotspeich, Linda J. , Stanford U, School of Medicine, Div of Child Psychiatry & Child Development, Stanford, CA, US Source: Treating preschool children. Steiner, Hans (Ed); pp. 27-59. San Francisco, CA, US: Jossey-Bass, 1997. xix, 232 pp. Abstract: The author first reviews the diagnostic criteria for autism and then refers back to some of these criteria when discussing the diagnosis of other pervasive developmental disorders (PDDs), i.e., PDDs not otherwise specified, Asperger's disorder, Rett's disorder, and childhood disintegrative disorder. The diagnostic criteria are: qualitative impairments in reciprocal social interaction; qualitative impairments in communication; and restricted, repetitive, and stereotyped patterns of behavior, interests, and activities. Next, the author reviews associated disorders and problematic symptoms and differential diagnosis. The epidemiology and etiology of the disorders are briefly discussed. In addition, the author discusses issues surrounding the initial assessment and treatment of children with PDD. The author notes that to be an effective advocate for children with PDD, she has found it imperative to be well versed in community institutions that are gatekeepers of services. The author concludes with a general discussion of the prognosis for children with PDDs. _____
Title: Asperger's syndrome: A case diagnosed in late adolescence. Author(s): Gilmore, Linda , U Queensland, Fred & Eleanor Schonell Educational Research Ctr, Brisbane, QLD, Australia; Hayes, Alan Source: Clinical Child Psychology & Psychiatry , Vol 1(3), Jul 1996. pp. 431-439. Publisher: US: Sage Publications Abstract: The case is presented of a 17 yr old boy with a recent diagnosis of Asperger's syndrome. Despite displaying a characteristic pattern of deficits in cognitive, social and behavioral functioning, isolated cognitive skills and a remarkable ability for calendar calculation, this boy was not diagnosed during childhood. Coexisting skills and impairments were explored through a description of developmental history and current functioning. The article considers the reasons for the disorder not being identified during childhood and discusses the case-study findings in relation to current issues about the prevalence of Asperger's syndrome, the difficulties of diagnosis and essential diagnostic criteria. _____
Title: Early detection of autism: Diagnostic instruments for clinicians. Author(s): Gillberg, C. , U Goeteborg, Dept of Child & Adolescent Psychiatry, Sweden; Nordin, V.; Ehlers, S. Source: European Child & Adolescent Psychiatry, Vol 5(2), Jun 1996. pp. 67-74. Publisher: Germany: Dietrich Steinkopff Verlag Abstract: Reviews screening and diagnostic instruments for autism and Asperger syndrome. These instruments are grouped according to the age of the child for which they are appropriate. While no instrument can diagnose autism in the first 12 mo of life, clues to an eventual diagnosis include minor physical anomalies, muscular hypotonia, developmental delay, and epileptic syndrome. Parental interview and behavioral observation can aid in detection at 18-24 mo. Eight instruments are described that can be used with children of preschool age and older, including the Childhood Autism Rating Scale. It is concluded that autism may be screened around age 18 mo and a diagnosis reliably be made around age 30 mo, whereas a diagnosis of Asperger syndrome is not usually suspected, screened, or made until into the child's school age. _____
Title: Disorders usually first diagnosed in infancy, childhood, or adolescence. Author(s): Popper, Charles W. , Harvard Medical School, Boston, MA, US; Steingard, Ronald J. Source: American Psychiatric Press synopsis of psychiatry. Hales, Robert E. (Ed); Yudofsky, Stuart C. (Ed); pp. 681-774. Washington, DC, US: American Psychiatric Association, 1996. xxvi, 1449 pp. ISBN: 0-88048-889-1 (paperback) Language: English Key Concepts: diagnosis & etiology & epidemiology & other clinical features of disorders usually 1st diagnosed in infancy or childhood or adolescence Abstract: Discusses the epidemiology, etiology, course, and prognosis of disorders that are usually first diagnosed in infancy, childhood, or adolescence.
(from the chapter) disruptive behavior and attention-deficit disorders [attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder] / learning, motor skills, and communication disorders [learning disorders, motor skills disorder (developmental coordination disorder), communication disorder] / mental retardation / pervasive developmental disorders [childhood disintegrative disorder, Rett's disorder, Asperger's disorder] / tic disorders [Tourette's disorder] / feeding and eating disorders of infancy or early childhood [pica, rumination disorder, feeding disorder of infancy or early childhood] / elimination disorders [functional encopresis, functional enuresis] / other disorders of infancy, childhood, or adolescence [separation anxiety disorder, reactive attachment disorder of infancy and early childhood, stereotypic movement disorder] _____
Title: Autismo y otros desordenes extensos y permanentes del desarrollo. Translated Title: Autism and other pervasive developmental disorders. Author(s): Giraldo, Benjamin , Fundacion Universitaria Konnrad Lorenz, Colombia Source: Avances en Psicologia Clinica Latinoamericana , Vol 14, 1996. pp. 83-101. Publisher: Colombia: Fundacion para el Avance de la Psicologia Abstract: Reviews recent research on the etiology, differential diagnosis, assessment and treatment of autism and other extensive and permanent developmental disorders. Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for diagnosis and etiological theories based on neurobiological research are considered. The differential diagnosis of autism, mental retardation, schizophrenia, developmental language/speech disorders, Asperger's disorder, Rett's disorder, childhood disintegrative disorder, atypical autism and other disorders and issues in pharmacological and behavioral treatment are also discussed. (English abstract) _____
Title: Autism and pervasive developmental disorders. Author(s): Campbell, Magda , New York U, Medical Ctr, Dept of Psychiatry, New York, NY, US; Cueva, Jeanette E.; Hallin, Alejandra Source: Diagnosis and psychopharmacology of childhood and adolescent disorders (2nd ed.). Wiener, Jerry M. (Ed); pp. 151-192. Oxford, England: John Wiley & Sons, 1996. xxiv, 519 pp. Abstract: Discusses diagnostic criteria and pharmacological interventions for pervasive developmental disorders and autism in children. (from the chapter) classification of pervasive developmental disorders (PDD) and definition of autistic disorder / Rett's disorder / childhood disintegrative disorder / Asperger's disorder / indications for pharmacotherapy / methodological issues: patients, design, and assessments / review of the literature / drugs of choice and clinical usage / side effects / neuroleptic-related tardive and withdrawal dyskinesias _____
Title: Pervasive developmental, psychotic, and allied disorders. Author(s): Werry, John Scott , U Auckland, Auckland, New Zealand Source: Do they grow out of it? Long-term outcomes of childhood disorders. Hechtman, Lily Trokenberg (Ed); pp. 195-223. Washington, DC, US: American Psychiatric Association, 1996. xv, 287 pp. Abstract: (from the preface) outlines Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) definitions and characteristics of autism, Asperger's disorder, and pervasive developmental disorder / the problems of outcome studies of these disorders are described and the various types of outcome are summarized / the effect of treatment on outcome is addressed as well as other factors that may influence outcome, such as severity of the disorder, IQ, language development, and the presence of other physical disorders / addresses schizophrenia in children and adolescents / explores the issues of bipolar mood disorder in children and adolescents _____
Title: Pervasive developmental disorders. Series Title: The Hatherleigh guides series, #1 Author(s): Goldstein, Sam , U Utah, School of Medicine, Dept of Psychiatry, Developmental Disabilities & Mental Retardation Clinic, Salt Lake City, UT, US Source: Hatherleigh guide to psychiatric disorders. ; pp. 171-189. New York, NY, US: Hatherleigh Press, 1996. xiv, 290 pp. Abstract: (from the chapter) the term pervasive developmental disorder refers to a group of disorders that appear to exert a significant negative impact on children's general development, communication, behavior, and interpersonal relations / included in this group are autism, Rett's disorder, childhood disintegrative disorder, Asperger's disorder, and atypical patterns of pervasive developmental disorder / despite recent research and clinical advances in distinguishing these different types of pervasive developmental disorders, all of them continue to be referred to colloquially as autism early descriptions / common characteristics / Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria / epidemiology / etiology / evaluation / treatment _____
Title: Asperger's disorder and atypical pervasive developmental disorder. Author(s): Szatmari, Peter , McMaster U, Dept of Psychiatry, Hamilton, ON, Canada Source: Psychoses and pervasive developmental disorders in childhood and adolescence. Volkmar, Fred R. (Ed); pp. 191-221. Washington, DC, US: American Psychiatric Association, 1996. xx, 306 pp. Abstract: (from the chapter) review the available data on Asperger's disorder and [atypical pervasive developmental disorder] APDD [in children], two nonautistic forms of PDD Asperger's disorder [overview, definition, prevalence and epidemiology, clinical features, differences from autism, course and prognosis, etiology and pathogenesis, assessment, differential diagnosis] / APDD [overview, prevalence and epidemiology, clinical features, course and prognosis, etiology and pathogenesis, assessment, differential diagnosis] / directions for research _____
Title: Pervasive developmental disorders: Distinguishing among subtypes. Author(s): Harris, Sandra L. , Rutgers U, Graduate School of Applied & Professional Psychology, Piscataway, NJ, US; Glasberg, Beth; Ricca, Donna Source: School Psychology Review , Vol 25(3), 1996. pp. 308-315. Publisher: US: National Assn of School Psychologists Abstract: Reviews and distinguishes the various diagnoses of pervasive developmental disorders (PDDs) in the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) and considers their value for school psychologists. PDDs are severe and pervasive conditions that begin in early life and influence multiple areas of development. In addition to the more commonly known autistic disorder and PDDs not otherwise specified, the DSM-IV expands the list of PDDS to include Asperger's disorder, Rett's disorder, and childhood disintegrative disorder. Intensive behavioral intervention at an early age has been documented to improve the developmental trajectory of many of these children, and this treatment is therefore essential from the preschool years on. The school psychologist has a vital role to play in diagnosis, assessment, and classroom consultation for children with PDDs. _____
Title: Schizoid personality in girls: A follow-up study: What are the links with Asperger's syndrome Author(s): Wolff, Sula , U Edinburgh Dept of Psychiatry, Royal Edinburgh Hosp, Scotland; McGuire, Ralph J. Source: Journal of Child Psychology & Psychiatry & Allied Disciplines , Vol 36(5), Jul 1995. pp. 793-817. Publisher: United Kingdom: Blackwell Publishing Abstract: Child psychiatric records of 33 girls (aged 42-197 mo) given a diagnosis of schizoid personality in childhood were compared with the records of a control group of 33 other referred girls and with those of 32 pairs of schizoid and control boys. 17 schizoid girls were seen again in adult life and compared with 32 schizoid boys previously followed at the same age. The features of schizoid girls in childhood and adult life were similar to those of the boys. There was a high rate of antisocial conduct in schizoid girls, both in childhood and adult life. It is concluded that although the presence of the precise boundaries of the syndrome of schizoid personality and of Asperger"s syndrome must await clarification through clinical genetic studies, it is important to recognize the similarities between the groups of children to whom these labels have been applied. The case histories of 3 girls misdiagnosed in childhood are appended. _____
Title: Hypomania following bereavement in Asperger's syndrome: A case study. Author(s): Berthier, Marcelo , Hospital Universitario Virgen de la Victoria, Servicio de Neurologia, Malaga, Spain Source: Neuropsychiatry, Neuropsychology, & Behavioral Neurology, Vol 8(3), Jul 1995. pp. 222-228. Publisher: US: Lippincott Williams & Wilkins Abstract: Reports the development of hypomania following bereavement in a depressed 24-yr-old woman with Asperger's syndrome (AS), which is a subclass of pervasive developmental disorder closely related to childhood autism. The S was seen regularly as an outpatient because of seizures, unipolar depression, and suicide attempts. Neuropsychological assessment uncovered specific deficits in social cognition, executive function, and affective recognition domains suggestive of a combined frontal and right hemisphere dysfunction. These neuropsychological deficits probably contributed to the emergence of hypomania following bereavement and to a limited ability to conceptualize the loss. Affective recognition and social-cognitive functions were assessed in 4 other patients with AS and in 5 controls. The bereaved S showed test results similar to those of the other AS patients. _____
Title: Disorders usually first diagnosed in infancy, childhood, or adolescence. Author(s): Popper, Charles W. , Harvard Medical School, Boston, MA, US; Steingard, Ronald J. Source: American Psychiatric Press textbook of psychiatry (2nd ed.). Hales, Robert E. (Ed); Yudofsky, Stuart C. (Ed); et al; pp. 729-832. Washington, DC, US: American Psychiatric Association, 1994. xxiii, 1694 pp. Abstract: (from the chapter) the discrete psychopathological entities that are "usually first diagnosed" in youth are discussed / [focus is on] the flux and change that these abstracted entities exert on the lives of children and of the adults they become. disruptive behavior and attention-deficit disorders [conduct disorder, oppositional defiant disorder] / learning, motor skills, and communcation disorders / mental retardation / pervasive developmental disorders [autistic disorder, childhood disintegrative disorder, Rett's disorder, Asperger's disorder] / tic disorders [transient tic disorder, chronic motor or vocal tic disorder, Tourette's disorder] / feeding and eating disorders of infancy or early childhood [pica, rumination disorder] / elimination disorders [functional encopresis, functional enuresis] / other disorders of infancy, childhood, or adolescence [separation anxiety disorder, selective mutism, reactive attachment disorder of infancy and early childhood, stereotypic movement disorder] / standardized assessment instruments for children and adolescents _____
Title: Asperger's syndrome or schizophrenia: Is differential diagnosis necessary for adult patients? Author(s): Taiminen, Tero , Turku U Central Hosp, Dept of Psychiatry, Finland Source: Nordic Journal of Psychiatry , Vol 48(5), 1994. pp. 325-328. Publisher: Norway: Scandinavian Univ Press Abstract: Patients with Asperger's syndrome use pedantic, literate, concrete or repetitive language, and their facial expression is either absent or inappropriately exaggerated. Those who also exhibit poor motor coordination and mild mental retardation are often diagnosed in childhood, but patients who have normal intelligence may not come to psychiatric treatment until their peculiar social interaction becomes apparent. Features of typical social interaction associated with Asperger's syndrome include tendency to suddenly change, lack of social relevance, repetition, and inclination to classification. A clinical vignette describing a 28-yr-old man illustrates the difficulty of making a differential diagnosis between Asperger's syndrome and schizophrenia. _____
Title: Autism: An introduction to psychological theory. Author(s): Happe, Francesca , Medical Research Council, Cognitive Development Unit, London, England Source: Cambridge, MA, US: Harvard University Press, 1994. viii, 152 pp. Abstract: (from the jacket) Autism is a fascinating yet perplexing disorder that continues to intrigue researchers and clinicians studying brain and behavior. In this . . . book, Francesca Happe provides a concise overview of current psychological theory and research that synthesizes the established work on the biological foundations, cognitive consequences, and behavioral manifestations of this disorder. She focuses her discussion on the cognitive approaches that deal with both thought and feeling--those hypotheses of mind that link brain to action, deepen our understanding of the autistic person's apprehension of the world, and offer better approaches to effectively managing the behavior of autistics in the world. The book reviews the latest research into the communication, socialization, and imaginative potential of autistics and further distinguishes the levels of severity in autism. [The author] also includes a discussion of the talented few--high-functioning autistics with Asperger's syndrome--and of the many nonrelated autistic behaviors of early childhood. [This book] will prove useful to parents and teachers of autistic children as well as to students and researchers interested in disorders of language and communication. _____
Title: Do some cases of anorexia nervosa reflect underlying autistic-like conditions? Author(s): Gillberg, C. , Annedals Clinics Child Neuropsychiatry Ctr, Dept of Pediatrics & Child Psychiatry, Goeteborg, Sweden; Rastam, M. Source: Behavioural Neurology , Vol 5(1), Mar 1992. pp. 27-32. Publisher: Netherlands: IOS Press Abstract: In 51 adolescents (aged 10-17 yrs) with anorexia nervosa (AN), several had shown social, communicative and behavior patterns suggestive of autistic-like conditions as children, long before the onset of AN. One of the 3 boys in the AN group had Asperger syndrome. Three of the 48 girls had histories suggesting high functioning autism and continued to show many features typical of autism. Two other girls had Tourette syndrome (TS), obsessive-compulsive traits, and social interaction problems. 18 other girls met criteria for obsessive-compulsive personality disorder (OCPD) and 13 also had had childhood social interaction problems. Comparison of this group with a sex- and age-matched group suggest that an underlying trait might be common to Asperger syndrome, autistic-like conditions, TS, OCPD, and some cases of AN. _____
Title: Autism. Series Title: Wiley series on personality processes Author(s): Dawson, Geraldine , U Washington, Dept of Psychology, Seattle, WA, US; Castelloe, Paul Source: Handbook of clinical child psychology (2nd ed.). Walker, Clarence Eugene (Ed); Roberts, Michael C. (Ed); pp. 375-397. Oxford, England: John Wiley & Sons, 1992. xx, 1145 pp. Abstract: Reviews findings on the diagnosis, etiology, and treatment of childhood autism. (from the chapter) diagnostic considerations [distinction between autism and childhood schizophrenia, Asperger's syndrome, diagnostic criteria and related characteristics and conditions, epidemiological findings, autism and mental retardation, autism and developmental language disorder] / etiology [early psychogenic theories, neurological findings, neuropsychological hypotheses, genetic contribution, biochemical studies, social, cognitive, and language development in children with autism, orienting responses and arousal regulation, object concepts, symbolic play, and imitation, knowledge of self and others, attachment, affective recognition and expression, language development] / treatment [biological interventions, behavioral interventions, psychoeducational programs, promoting early communication and social development, vocational skills and residential living programs] _____
Title: "Schizoid" personality in childhood and adult life. I: The vagaries of diagnostic labelling. Author(s): Wolff, Sula , U Edinburgh, Dept of Psychiatry, Edinburgh, Scotland Source: British Journal of Psychiatry , Vol 159, Nov 1991. pp. 615-620. Publisher: United Kingdom: Royal College of Psychiatrists Abstract: The literature is reviewed on children variously described as having "schizoid" personality disorders, Asperger's syndrome, and schizotypal personality disorders. The aim of this review is to clarify the nature of these clinical syndromes, and in particular the features of those children whose follow-up characteristics are described in two papers. _____
Title: Psycho Educational Profile. Beskrivelse og vurdering af en test for born med gennemgribende udviklingsforstyrrelser samt psykisk udviklingshaemmede born og smaborn. Translated Title: Psychoeducational Profile: Description and evaluation of a test for children with serious developmental disturbances and for children with psychological developmental problems. Author(s): Hvolbaek, Hanne; Lind, Ditte Source: Psykologisk Paedagogisk Radgivning , Vol 28(1), 1991. pp. 46-51. Publisher: Denmark: Dansk Psykologisk Forlag Abstract: Discusses the use of the Psychoeducational Profile developed by E. Schopler and R. J. Reichler to assess the development and behavior of children with serious developmental disturbances (e.g., infantile autism, children's psychoses, Asperger's syndrome). The background, structure, scoring, and use of the test are described. The results of the test on a group of Danish children are considered. (English abstract) (0 ref) _____
Title: Do children with autism have March birthdays? Author(s): Gillberg, Christopher , U Gothenburg, Child Neuropsychiatry Ctr, Sweden Source: Acta Psychiatrica Scandinavica , Vol 82(2), Aug 1990. pp. 152-156. Publisher: United Kingdom: Blackwell Publishing Abstract: Examined the possible connection between autism and month of birth in 100 children and young adults with autism (aged 4-26 yrs), 48 Ss with autistic-like disorders, 20 Ss with Asperger syndrome, and 6 male Ss with childhood disintegrative disorder. The general population of Sweden born from 1962 to 1984 was used as a control group. Findings support the possibility of seasonal variation in the frequency of typical autistic disorder. The high frequency of March births in the autistic Ss is consistent with previous studies (e.g., M. M. Konstantaneras et al). The March effect may be attributable to the males in the study. _____
Title: Left temporal lobe damage in Asperger's syndrome. Author(s): Jones, P. B. , U London Inst of Psychiatry, Genetics Section, England; Kerwin, R. W. Source: British Journal of Psychiatry , Vol 156, Apr 1990. pp. 570-572. Publisher: United Kingdom: Royal College of Psychiatrists Abstract: Presents a case of Asperger's syndrome in an otherwise physically healthy adult male (34 yrs old), who evidenced left temporal lobe damage on computerized tomography (CT). The S's continuous illness since childhood and his disturbance of social interaction and nonverbal communication are described. This case supports the notion of autism as a temporal lobe disorder. _____
Title: Schizophrenia in childhood. Series Title: Pergamon general psychology series; 161 Author(s): Kolvin, Israel , Royal Free Hosp, Professor of Child & Family Mental Health, London, England; Berney, T. P.; Yoeli, Joel Source: Handbook of child and adult psychopathology: A longitudinal perspective. Hersen, Michel (Ed); Last, Cynthia G. (Ed); pp. 99-113. Elmsford, NY, US: Pergamon Press, Inc, 1990. x, 459 pp. Abstract: (from the chapter) description of the disorder [spectrum disorders versus multiple categories, developmental perspective, subclassification of autistiform disorders, disintegrative psychosis, descriptive account of childhood schizophrenia, "borderlands" and spectrum disorders, multiaxial approaches] / epidemiology [autism, disintegrative psychosis, schizoid personality disorder and Asperger's syndrome, childhood schizophrenia] / natural history [autism, childhood schizophrenia] / impairment and complications [autism, childhood schizophrenia] / differential diagnosis [autism, childhood schizophrenia, the borderlands of childhood psychoses, Asperger's syndrome and schizoid personality disorder in childhood, other borderline states] / continuity and discontinuity with adult presentation [autism, Asperger's syndrome, childhood schizophrenia] concerned with a developmental perspective in relation to the classification and diagnosis of the psychoses and allied disorders of childhood and adolescence / provides evidence of wide differences in psychopathology, epidemiology, natural history, impairments, and complications of autism and childhood schizophrenia and their associated spectrum disorders _____
Title: Taxonomy of major disorders in childhood. Series Title: Perspectives in developmental psychology Author(s): Howlin, Patricia , U London, Dept of Psychology, London, England; Yule, William Source: Handbook of developmental psychopathology. Lewis, Michael (Ed); Miller, Suzanne M. (Ed); pp. 371-383. New York, NY, US: Plenum Press, 1990. xxvi, 529 pp. Abstract: (from the chapter) early childhood autism / characteristics of autism / impaired social relationships / language deficits / abnormal play patterns / obsessional interests and attachments / cognitive abnormalities age of onset / prevalence of early infantile autism / the causes of autism / later outcome the classification of autism the differential diagnosis between autism and other childhood disorders / autism of childhood schizophrenia / autism as a form of mental retardation / autism and severe developmental language disorders / autism and Asperger's syndrome / disintegrative disorders _____
Title: Theory and therapy of psychosis in childhood: Experience in England. Author(s): Gath, Ann , Bethlem Royal Hosp, Hilda Lewis House, London, England Source: Italian Journal of Intellective Impairment , Vol 2(2), Dec 1989. pp. 123-130. Publisher: Italy: GISSTIMMAI Editore Abstract: Describes 3 groups of childhood conditions to which the term psychosis has been applied that are distinguished by age of onset. Children with early onset (before age 30 mo) are now classified with pervasive developmental disorders including infantile autism and subtle disorders of language and social development (e.g., Asperger's syndrome). The 2nd group features onset after 30 mo but usually before age 6 yrs. The disorder may follow a period of normal development as in disintegrative disorders such as Rett's syndrome and Heller's disorder. In later childhood, rarely until after the onset of puberty, adult types of functional disorders may occur, such as schizophrenia. Treatment for each group of disorders is discussed. _____
Title: Constitutional aspects of personality beginning in childhood: Schizoid personality disorder (Asperger's Syndrome). Series Title: NATO Advanced Science Institutes series. Series A: Life sciences; Vol. 160. Author(s): Wolff, Sula , U Edinburgh, Dept of Psychiatry, Honorary Fellow, Edinburgh, Scotland Source: Early influences shaping the individual. Doxiadis, Spyros (Ed); Stewart, Susie (Ed); pp. 283-297. New York, NY, US: Plenum Press, 1989. x, 338 pp. Abstract: (from the chapter) clinical features of schizoid personality disorder in childhood (Asperger's syndrome) are described, as well as a series of studies designed to validate this syndrome / reference is made to its important associations with childhood conduct disorders and adult sociopathy, and to a possible link with early infantile autism. preliminary results of an ongoing study show that a majority of boys with this childhood syndrome have the features of shizotypal personality disorder in adult life / this means that the syndrome is likely to form part of the schizophrenic spectrum / implications of this are discussed _____
Title: Diagnosis of pervasive developmental disorders. Author(s): Volkmar, Fred R. , Yale U, Child Study Ctr, New Haven, CT, US; Cohen, Donald J. Source: Advances in clinical child psychology, Vol. 11. Lahey, Benjamin B. (Ed); Kazdin, Alan E. (Ed); pp. 249-284. New York, NY, US: Plenum Press, 1988. xviii, 396 pp. Abstract: (from the chapter) issues in classification historical background infantile autism/autistic disorder categorical approaches to the diagnosis of autism alternative approaches to the diagnosis of autism subtypes of autism nonautistic PDD [Pervasive Developmental Disorders] / autistic psychopathy (Asperger's syndrome) / schizoid disorder / disintegrative psychosis/childhood onset PDD / childhood schizophrenia epidemiology and natural history areas for future research _____
Title: "Schizoid" personality and antisocial conduct: A retrospective case note study. Author(s): Wolff, Sula , Royal Edinburgh Hosp, Scotland; Cull, Ann Source: Psychological Medicine , Vol 16(3), Aug 1986. pp. 677-687. Publisher: US: Cambridge Univ Press Abstract: A retrospective case note analysis for 30 boys diagnosed as having a schizoid personality disorder (Asperger's syndrome) in childhood and for 30 matched clinic attenders (with systematic follow-up data for 19 matched pairs) showed the incidence of antisocial conduct to be the same in the 2 groups. However, the schizoid Ss stole less often and had fewer alcohol problems. In this group, antisocial conduct was less related to family disruption and social disadvantage, and more to an unusual fantasy life. Clinical descriptions of a series of schizoid boys and girls with conspicuous antisocial conduct suggest that characteristic patterns of antisocial conduct in such children are persistent expressions of hostility and, especially in girls, pathological lying, for which environmental circumstances provide no explanation. _____
Title: Chromosome abnormalities in infantile autism and other childhood psychoses: A population study of 66 cases. Author(s): Gillberg, Christopher , Goeteborgs U, BUP-Kliniken, Sweden; Wahlstroem, Jan Source: Developmental Medicine & Child Neurology, Vol 27(3), Jun 1985. pp. 293-304. Publisher: US: Cambridge Univ Press Abstract: 66 psychotic children (aged 2-20 yrs) who were diagnosed according to strict criteria as having infantile autism, other psychoses, or Asperger's syndrome were examined with chromosomal cultures in folic-acid deficit medium. 47% of the Ss showed major or minor chromosomal aberrations. Results are discussed and correlated with clinical characteristics of these disorders. (French, German & Spanish abstracts) (2 p ref) _____
Title: A consensual validation of schizoid personality in childhood and adult life. Author(s): Cull, Ann , Western General Hosp, Dept of Psychiatry, Edinburgh, Scotland; Chick, Jonathan; Wolff, Sula Source: British Journal of Psychiatry , Vol 144, Jun 1984. pp. 646-648. Publisher: United Kingdom: Royal College of Psychiatrists Abstract: Life histories and interview descriptions of 23 young men diagnosed as schizoid in middle childhood and adult life and of 20 control Ss not given this diagnosis were presented for diagnostic rating to 2 independent general psychiatrists. Agreement about the presence or absence of schizoid personality was good. It is concluded that, in the case of boys, the syndrome of schizoid personality in childhood (Asperger's syndrome) corresponds to or is subsumed by the more general clinical picture psychiatrists have of schizoid personality in adult life and that the original use of this diagnostic label was not idiosyncratic. (14 ref) _____
Title: Identical triplets with Asperger's syndrome. Author(s): Burgoine, Eyrena , U London, London Hosp Medical Coll, England; Wing, Lorna Source: British Journal of Psychiatry , Vol 143, Sep 1983. pp. 261-265. Publisher: United Kingdom: Royal College of Psychiatrists Abstract: Presents the case history of 3 17-yr-old identical male triplets with Asperger's syndrome. Ss displayed the impairments affecting social interaction, nonverbal communication and imagination, motor clumsiness, and the circumscribed interests characteristic of that condition. They also had features in their history and present behavior more typical of childhood autism. Ss showed a lack of empathy, little ability to form friendships, repetitive behaviors, and great discrepancies between their intelligence and the application of their intellectual skills. Despite marked overall similarities, the 3 differed in the severity with which their problems were manifested. A relationship was found between the amount of peri- and postnatal trauma, degree of intellectual impairment, and number of autistic features. Findings support the hypothesis that autism and Asperger's syndrome are on the same continuum of pathology. (15 ref) _____
Title: Asperger's syndrome: A clinical account. Author(s): Wing, Lorna , MRC Social Psychiatry Unit, U London Inst of Psychiatry, England Source: Psychological Medicine , Vol 11(1), Feb 1981. pp. 115-129. Publisher: US: Cambridge Univ Press Abstract: Describes the clinical features, course, etiology, epidemiology, differential diagnosis, and management of Asperger's syndrome. Classification is discussed, and reasons are given for including the syndrome, together with early childhood autism, in a wider group of conditions that have in common the impairment of development of social interaction, communication, and imagination. (34 ref) _____
Title: Schizoid personality in childhood: A comparative study of schizoid, autistic and normal children. Author(s): Wolff, Sula; Barlow, Anne Source: Annual Progress in Child Psychiatry & Child Development, 1980. pp. 396-417. Publisher: US: Brunner/Mazel Abstract: (The following abstract of this reprinted article originally appeared in PA, Vol 64:5840.) Eight schizoid children (clinically resembling H. Asperger's [1944] autistic psychopaths), 8 high-grade speaking autistic children, and 8 normal children individually matched for age, sex, and intelligence were compared on a battery of tests, including the WISC and the Illinois Test of Psycholinguistic Abilities. Results suggest that Ss with schizoid personality disorders are distinct from autistic children on the one hand and from normal children on the other. In all cognitive, language, and memory tests the schizoid Ss were more distractible than the normal group. In language function, they showed disabilities similar to the autistic group, though to a lesser extent. Unlike autistic children, they were not perseverative. On 2 tests of affect, the schizoid group used even fewer emotional constructs when describing people than did the autistics. (41 ref) _____
Title: Schizoid personality in childhood: A comparative study of schizoid, autistic and normal children. Author(s): Wolff, Sula , Royal Hosp for Sick Children, Edinburgh, Scotland; Barlow, Anne Source: Journal of Child P |
