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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 Development
Title: Frontal lobe dysfunction and everyday problem-solving: Social and non-social contributions. Author(s): Channon, Shelley, Subdepartment of Clinical Health, Department of Psychology, University College London, UCL, London, United Kingdom, s.channon@ucl.ac.uk Address: Channon, Shelley, Subdepartment of Clinical Health, Department of Psychology, University College London, UCL, Gower Street, London, United Kingdom, WC1E 6BT, s.channon@ucl.ac.uk Source: Acta Psychologica, Vol 115(2-3), Feb-Mar 2004. pp. 235-254. Publisher: United Kingdom: Elsevier Science Abstract: Everyday problem-solving involves both non-social executive processes, social and emotional processes, and draws upon social and practical knowledge. A series of studies including both adult-acquired lesions and neurodevelopmental disorders is reviewed examining problem-solving on a real-life-type task that involves generating a range of solutions to brief problem scenarios and selecting preferred solutions to solve the problems. Impairments in problem-solving are described in groups of participants with left anterior frontal lobe lesions, Tourette's syndrome and Asperger's syndrome. By contrast, healthy older people did not show problem-solving deficits on the same task. The possible contributions of non-social executive skills, social and emotional skills, and knowledge acquired from experience are each considered in relation to everyday performance. Multiple cognitive/emotional routes to the development of everyday life difficulties pose a complex challenge both in understanding the nature of the relevant processes and in developing adequate methods for management and rehabilitation. _____
Title: Mind-reading difficulties in the siblings of people with Asperger's syndrome: evidence for a genetic influence in the abnormal development of a specific cognitive domain. Author(s): Dorris, L., University of Glasgow, Glasgow, United Kingdom, l.dorris@clinmed.gla.ac.uk; Espie, C. A. E., University of Glasgow, Glasgow, United Kingdom; Knott, F., University of Glasgow, Glasgow, United Kingdom; Salt, J., University of Glasgow, Glasgow, United Kingdom Address: Dorris, L., Department of Psychological Medicine, University of Glasgow, Academic Centre, Gartnavel Royal Hospital, Glasgow, United Kingdom, G12 0XH, l.dorris@clinmed.gla.ac.uk Source: Journal of Child Psychology & Psychiatry & Allied Disciplines, Vol 45(2), Feb 2004. pp. 412-418. Publisher: United Kingdom: Blackwell Publishing Abstract: Background: Previous research suggests that the phenotype associated with Asperger's syndrome (AS) includes difficulties in understanding the mental states of others, leading to difficulties in social communication and social relationships. It has also been suggested that the first-degree relatives of those with AS can demonstrate similar difficulties, albeit to a lesser extent. This study examined 'theory of mind' (ToM) abilities in the siblings of children with AS relative to a matched control group. Method: 27 children who had a sibling with AS were administered the children's version of the 'Eyes Test' (Baron-Cohen, Wheelwright, Stone, & Rutherford, 1999). The control group consisted of 27 children matched for age, sex, and a measure of verbal comprehension, and who did not have a family history of AS/ autism. Results: A significant difference was found between the groups on the Eyes Test, the 'siblings' group showing a poorer performance on this measure of social cognition. The difference was more pronounced among female siblings. Discussion: These results are discussed in terms of the familial distribution of a neuro-cognitive profile associated with AS, which confers varying degrees of social handicap amongst first-degree relatives... _____
Title: Parental reports of the development of autism in their children: The relevance of regression, comorbidity, and genetics in the detection of early characteristics. Author(s): Goin, Robin Page, Virginia Commonwealth U., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 64(7-B), 2004. pp. 3558. Publisher: US: Univ Microfilms International Abstract: Early detection of autism plays an important role in enhancing developmental outcomes for affected children. Identifying potential characteristics of the disorder evident during infancy and toddlerhood aids efforts to screen for such symptoms, which may lead to earlier and more accurate diagnoses; however, it is unclear to what extent certain factors encourage or impede early detection. Because parents are responsible for making decisions on behalf of their children based upon their perceptions of children's developmental progression, caregivers were queried in terms of their beliefs about the development of autism characteristics in their children. Participants included 393 caregivers of children with autism, Asperger's syndrome, and PDD-NOS from the U.S. and 5 other English-speaking countries who completed an online questionnaire containing both closed- and open-ended questions. Rich, descriptive information on children was provided in terms of demographic variables, comorbid diagnoses outside of the autism spectrum, the type of autism onset (congenital or regressive) children experienced, the presence of a family history of autism or other mental-health disorders, and the ages at which behavioral difference were detected for 11 early symptoms indicative of autism. Analyses were conducted with the last 4 variables within this list and with an additional variable reflecting parents' beliefs about the etiology of autism (genetic versus some external mechanism). Significant relationships existed between a variety of these variables with the exception of a family history of autism or other mental-health disorders. About half of the sample reported that their children developed autism in a congenital fashion while the remaining half, a regressive fashion. Those indicating a congenital onset reported noticing all 11 early characteristics at younger ages relative to those indicating a regressive onset; however, significant differences between groups existed for only 4 of these 11 early symptoms. Parents who indicated a congenital onset were also more likely to espouse a genetic etiology for autism relative to parents indicating a regressive onset who were more likely to attribute the disorder to some external mechanism. Type of autism onset and presence versus absence of child comorbidity independently predicted the ages at which parents detected anomalies in 7 of the 11 early characteristics. Interpretations of the findings are discussed in detail, followed by suggestions for future directions of research in this area. _____
Title: Autism spectrum disorder is not as certain as implied. Author(s): Simpson, David, Tavistock Clinic, London, United Kingdom, dsimpson@tavi-port.nhs.uk Address: Simpson, David, Tavistock Clinic, London, United Kingdom, NW3 5BA, dsimpson@tavi-port.nhs.uk Source: BMJ: British Medical Journal, Vol 326(7396), May 2003. pp. 986. Publisher: United Kingdom: BMJ Publishing Group Abstract: Comments on an editorial by P. Szatmari regarding the causes and understanding of autism and autism spectrum disorders. Szatmari's editorial implies more certainty about the existence of an autism spectrum and causes of autism than is warranted. Debate remains about the validity and usefulness of a broad definition of autism. Autism and Asperger's syndrome are distinct, and although they share common difficulties in social relatedness and obsessiveness, they can be distinguished in these. Also problematic is Szatmari's statement that autism is a neuropsychiatric disorder--neurological problems have a bearing on autism but the relation remains obscure and the implied claim that autism results from a primary neurological disorder is based on slim evidence. A genetic link does not necessarily imply neurological damage. Szmatari acknowledges environmental factors but omits social and emotional factors, although the importance of these for psychological and brain development is well established. _____
Title: Developmental coordination disorder in Swedish 7-year-old children. Author(s): Kadesjo, Bjorn; Gillberg, Christopher Source: Annual progress in child psychiatry and child development: 2000-2001. Hertzig, Margaret E. (Ed); Farber, Ellen A. (Ed); pp. 317-334. New York, NY, US: Brunner-Routledge, 2003. xvii, 632 pp. Abstract: (from the chapter) This reprinted article originally appeared in Journal of the American Academy of Child & Adolescent Psychiatry, 1999(Jul), Vol 38(7), 820-828. Examined the prevalence, comorbidity, and outcome in developmental coordination disorder (DCD). Ss consisted of 818 7-yr-olds undergoing individual examination plus teacher and parent interviews, children were followed up at ages 8, 9, and 10 yrs. Severe DCD occurred in 4.9% and moderate DCD in another 8.6% of Ss. Boy-girl ratios ranged from 4:1 to 7:1. Children with severe and moderate DCD did not differ from each other on any measure, but both groups were clearly separated from children without DCD with respect to associated attention deficit symptoms, Asperger's disorder symptoms, school dysfunction scores, and outcome. Approximately half of all children with DCD had moderate to severe symptoms of ADHD. It is concluded that DCD is a common problem, and it is strongly associated with ADHD symptoms. A diagnosis of DCD at age 7 yrs predicted DCD at age 8 yrs and restricted reading comprehension at age 10 yrs.... _____
Title: Correspondence of DSM-IV Criteria for Autistic Spectrum Disorders with standardized measures of intelligence and language. Author(s): Huckabee, Helena C. Grant , U Houston, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 64(5-B), 2003. pp. 2390. Publisher: US: Univ Microfilms International Abstract: The study investigated whether differences in communication and cognitive development as specified in the DSM-IV for Autistic spectrum disorders correspond to empirical differences in IQ and language scores on standardized measures. Comprehensive review of patient records between 1989 and 2002 from a university clinic identified 272 children diagnosed with Autistic Disorder (AD), Asperger's Disorder (ASP), Pervasive Developmental Disorder NOS (PDDNOS) or Developmental Disorder NOS (DDNOS, DSM-III-R). IQ, receptive and expressive language, and Vineland Socialization scores from the children's youngest evaluation (mean age = 3 years, 9 months) were evaluated using profile analysis and pairwise comparisons. Results supported hypotheses that children with ASP have the highest IQ and language scores, children with PDDNOS are intermediate in IQ and language while children with AD have the weakest IQ and language skills (F(3,173) = 10.49, p < .0001). An exception was that receptive language skills were not found to be different in children with AD versus PDDNOS. Children with PDDNOS were found to have better social skills than children with AD (F(1,133) = 3.87, p < .05, d = 0.45) but differences were not found between ASP and PDDNOS or between ASP and AD. A comparatively large percentage of the sample was diagnosed with PDDNOS (58%) suggesting problems with diagnostic reliability in this population. _____
Title: Mind reading and social functioning in children with autistic disorder and Asperger's disorder. Series Title: Macquarie monographs in cognitive science Author(s): Dissanayake, Cheryl , School of Psychological Science, LaTrobe U, Australia; Macintosh, Kathleen , School of Psychological Science, LaTrobe U, Australia; Source: Individual differences in theory of mind: Implications for typical and atypical development. Repacholi, Betty (Ed); Slaughter, Virginia (Ed); pp. 213-239. New York, NY, US: Psychology Press, 2003. xi, 366 pp. Abstract: (from the chapter) The first aim in the study reported was to investigate the purported link between theory of mind (ToM) and social functioning in children with autism. Thus, in addition to the parent interview version of the Vineland Adaptive Behavior Scales, naturalistic observations were conducted to assess children's spontaneous social interactions with their peers in the schoolyard. Furthermore, children's social skills were rated by both their parents and teachers using Gresham and Elliot's (1990) Social Skill Rating System. In light of the evidence for superior ToM abilities among individuals with Asperger's disorder, in comparison to those with autism, it was of interest to investigate the association between these abilities in children with Asperger's disorder. The third aim of the research was to compare children with high-functioning autism to those with Asperger's disorder on their social understanding and behavior. It was hypothesized that Ss with Asperger's disorder would generally show less severe impairments in comparison to those with high-functioning autism, and that Ss with autism would show greater ToM deficits as compared to those with Asperger's disorder and the typically developing children. _____
Title: Synthesis: Psychological understanding and social skills. Series Title: Macquarie monographs in cognitive science Author(s): Davies, Martin , Research School of Social Sciences, Australian National U, Australia Stone, Tony , Dept of Psychology, South Bank U, London, United Kingdom Source: Individual differences in theory of mind: Implications for typical and atypical development. Repacholi, Betty (Ed); Slaughter, Virginia (Ed); pp. 305-352. New York, NY, US: Psychology Press, 2003. xi, 366 pp. Abstract: (from the chapter) This chapter attempts to synthesize information on psychological understanding and social skills. Perspectives are drawn on issues including normal development, autism, and Asperger's sydrome; the role of language; understanding, empathy, and antisocial behavior; developmental cognitive neuropsychology; theory of mind and other distal causes of disorders like autism and schizophrenia. _____
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: 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: Brain anatomy and sensorimotor gating in Asperger's syndrome. Author(s): McAlonan, Grainne M., Kings Coll, Inst of Psychiatry, Dept of Psychological Medicine, London, United Kingdom; Daly, Eileen , Kings Coll, Inst of Psychiatry, Dept of Psychological Medicine, London, United Kingdom; Kumari, Veena, Kings Coll, Inst of Psychiatry, Dept of Psychological Medicine, London, United Kingdom Critchley, Hugo D., Kings Coll, Inst of Psychiatry, Dept of Psychological Medicine, London, United Kingdom; van Amelsvoort, Therese, Kings Coll, Inst of Psychiatry, Dept of Psychological Medicine, London, United Kingdom; Suckling, John, Kings Coll, Inst of Psychiatry, Dept of Neuroimaging, London, United Kingdom; Simmons, Andrew, Kings Coll, Inst of Psychiatry, Dept of Neuroimaging, London, United Kingdom; Sigmundsson, Thordur, Kings Coll, Inst of Psychiatry, Dept of Psychological Medicine, London, United Kingdom; Greenwood, Kathyrn, Kings Coll, Inst of Psychiatry, Dept of Psychological Medicine, London, United Kingdom; Russell, Ailsa, Kings Coll, Inst of Psychiatry, Dept of Psychological Medicine, London, United Kingdom; Schmitz, Nicole, Kings Coll, Inst of Psychiatry, Dept of Psychological Medicine, London, United Kingdom; Happe, Francesca, Kings Coll, Inst of Psychiatry, Dept of Neuroimaging, London, United Kingdom; Howlin, Patricia, St George's Hosp Medical School, Dept of Psychology, London, United Kingdom; Murphy, Declan G. M., Kings Coll, Inst of Psychiatry, Dept of Psychological Medicine, London, United Kingdom Address: Murphy, Declan G. M., Div of Psychological Medicine, Inst of Psychiatry, Room M216,, London, United Kingdom, SE5 8AF Source: Brain, Vol 125(7), Jul 2002. pp. 1594-1606. Publisher: United Kingdom: Oxford Univ Press Abstract: Compared brain anatomy and sensorimotor gating in healthy people with Asperger's syndrome (AS) and controls. The study included 21 adults with AS and 24 controls (aged 18-49 yrs). The authors studied brain anatomy using quantitative MRI, and sensorimotor gating using prepulse inhibition of startle in a subset of 12 individuals with AS and 14 controls. The authors found significant age-related differences in volume of cerebral hemispheres and caudate nuclei (controls, but not people with AS, had age-related reductions in volume). Also, people with AS had significantly less grey matter in fronto-striatal and cerebellar regions than controls, and widespread differences in white matter. Moreover, sensorimotor gating was significantly impaired in AS. People with AS most likely have generalized alterations in brain development, but this is associated with significant differences from controls in the anatomy and function of specific brain regions implicated in behaviors characterizing the disorder. It is hypothesized that AS is associated with abnormalities in fronto-striatal pathways resulting in defective sensorimotor gating, and consequently characteristic difficulties inhibiting repetitive thoughts, speech and actions. _____
Title: A comprehensive treatment program for elementary students with Asperger's syndrome. Author(s): Barsky, Steven Joshua, Carlos Albizu U., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 63(1-B), Jul 2002. pp. 515. Publisher: US: Univ Microfilms International Abstract: Asperger's Syndrome (also called Asperger disorder) is a relatively new category of developmental disorders. Attempts to identify this disorder and treat it have proven to be circular and uncertain. Much of this is due to the quasi nature of the disorder itself and its confusing etiology. Because of its vague diagnostic dynamics, securing and implementing service has been elusive. This treatment program was designed with the goal of identifying AS children and treating them at the elementary school level. The thrust of this program is to treat specific symptoms that the young AS child presents, utilizing a comprehensive approach. The comprehensive approach includes a speech therapist, an occupational therapist and a psychologist. In addition, utilizing group therapy as a model to treat the AS child is unique in its application. A specific rating scale would be used to identify the disorder as well as to serve as an on-going pre and post-measure for treatment planning and program efficacy. A literature review was conducted regarding the historical aspect of AS as well as current knowledge of AS and its treatment, from a psychological, neuropsychiatric and psycho-educational perspective. From this review the design of the program was established. The treatment program utilizes a comprehensive, and integrated intervention rooted in cognitive behavioral principles, group therapy and milieu theory, and developmental perspectives. The program would treat 15 AS children for ten weeks, two hours a day, five days a week. Specific "core symptoms" would be addressed by staff while the AS student undergoes a therapeutic group and milieu process. It is believed that early detection and early treatment would help reduce the core symptoms of AS and prevent future poor self-esteem related feelings and behaviors. Ultimately, the program serves as a bridge between parents, teachers, and clinicians. Parents and teachers complete the rating scale on the AS child as well as the clinician. This rating scale is used as: (a) screening device, (b) an objective assessment for all parties involved with the AS child, (c) a treatment plan, goals, objectives, a baseline and, (d) as pre and post measures. In service training regarding the utilization of the A.S.A.S. rating scale for teachers and parents is included. Finally, the program allows for future feedback and reassessment. Inherently, close cooperation and dialogue between teachers, parents, and the clinicians is built into this program which will aid in a working alliance for future AS children. _____
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: Asperger's syndrome and nonverbal learning disabilities: Developmental social disabilities in adolescent women. Author(s): Veatch, Margaret Louise, Widener U, Inst For Graduate Clinical Psychology, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 62(11-B), Jun 2002. pp. 5397. Publisher: US: Univ Microfilms International Abstract: Asperger's Syndrome is presented as a nonverbal learning disability. Asperger's Syndrome and nonverbal learning disabilities are described and compared. Special emphasis is placed on the impact of Asperger's Syndrome (AS) and nonverbal learning disabilities (NLD) on intrapsychic development and object relations. Concepts from self psychology, attachment theory, and psychodynamic theory are applied to adverse effects of AS and NLD on psychological development, from infancy through adolescence. AS and NLD are portrayed as social perception disabilities. Differences between boys and girls with NLD and consequent delay in diagnosing girls are suggested. Two case studies are presented as representative of adolescent girls with Asperger's Syndrome. The clinical pictures for the two girls are compared and contrasted with current descriptions of AS, and with each other. Contemporary options for assessment and treatment of AS and NLD are explored. Consequences of misdiagnosing AS are included as well. _____
Title: Clinical problem solving: The case of Matthew, part III. Author(s): Nurcombe, Barry Drell, Martin J., LSU Health Sciences Ctr, New Orleans, LA, US; Leonard, Henrietta L., Brown U, School of Medicine, Child & Adolscent Psychiatry, Providence, RI, US; McDermott, John F. Source: Journal of the American Academy of Child & Adolescent Psychiatry, Vol 41(3), Mar 2002. pp. 344-353. Publisher: US: Lippincott Williams & Wilkins Abstract: Presents case material from a 9-yr-old male subject (S) diagnosed with a mixed anxiety disorder, reflecting long-standing and increasing conflict between his parents. Each of the current authors presents an analysis of the case. B. Nurcombe describes an interview with the S including the child mental status examination. Nurcombe concludes that the S has normal development in most areas, but manifests abnormal thought content and magical thinking, particularly centering around the themes of anxiety, fear, loss, abandonment, helplessness, and physical injury. M. J. Drell agrees with these conclusions, but adds that the S appears to have anxiety caused by girls and sexual images. Drell's analysis focuses on the S's coping styles and defenses, as well as ways in which these are elicited by his parents and ways to involve the parents in the S's therapy. H. L. Leonard raises the possibility of nonverbal learning disability, socioemotional disorder, or high functioning Asperger's spectrum disorder. Leonard concludes that the S is in the midst of family discord and psychosocial stressors, and suggests evaluation of both the S and family. J. F. McDermott uses a fictional sleuth and forensic pathologist to discuss diagnosis, etiology, and treatment plans. Nurcombe discusses follow-up. _____
Title: A study of the nonverbal learning disabilities subtype and its impact on peer interaction and peer acceptance. Author(s): Marchman, Krista Michiels, The Union Inst., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 62(7-B), Feb 2002. pp. 3401. Publisher: US: Univ Microfilms International Abstract: The purpose of this study was to examine the impact of the nonverbal learning disabilities subtype (NVLD) on peer interaction and peer acceptance. Data were collected by means of key informant interviews, observation and review of clinical history. Specific inquiry was made to (1) identify what peer interaction skills individuals with NVLD exhibit that contribute to rejection or acceptance, (2) determine whether or not others perception's of the individual with a NVLD peer interaction skills are positive, negative or nonexistent, and (3) to determine if there are varying degrees of impairment in nonverbal communication that dictate positive or negative outcomes of peer interaction. In this sample (n = 4), the children diagnosed with NVLD engaged in limited interaction, prefer one-to-one interaction, avoided larger groups, preferred younger peers and were immature. In addition several factors were identified as reinforcing these characteristics. Identified factors included emotional functioning, verbal communication, egocentric orientation and perception. Furthermore, results from the study suggested that the parents interviewed believe their children are well accepted by their preferred peer group but that as the peers get older and enter into adolescence peer rejection increases. A difference was indicated in the degree of impairment between males who were also diagnosed as having Asperger's syndrome and the female participants who were only diagnosed as NVLD. The suggestion was made that NVLD and similar conditions such as Asperger's Syndrome, Right Hemispheric Dysfunction and Semantic-Pragmatic Disorders more than likely represent the same phenomenon occurring on a continuum of common social disorders known as Autistic Spectrum Disorders. Information about social interaction that is believed to be of significant value to curriculum development for social skill training was discussed. _____
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. Conference: 14th International Congress of the International Association for Child and Adolescent Psychiatry and Allied Professions, Aug, 1998, Stockholm, Sweden _____
Title: Diagnosis of autistic disorder: Problems and new directions. Author(s): Young, Robyn, Flinders U, School of Psychology, Adelaide, SA, Australia, robyn.young@flinders.edu.au Brewer, Neil, Flinders U, School of Psychology, Adelaide, SA, Australia Address: Young, Robyn, Flinders U, School of Psychology, GPO box 2100, Adelaide, SA, Australia, 5001, robyn.young@flinders.edu.au Source: International review of research in mental retardation, Vol. 25. Glidden, Laraine Masters (Ed); pp. 107-134. San Diego, CA, US: Academic Press, 2002. xiii, 298 pp. Abstract: (from the chapter) The chapter begins with a discussion of the early identification of autistic disorder, followed by a discussion of the ontogeny of development. The chapter then discusses the difficulty in differentially diagnosing autistic disorder from other pervasive developmental disorders (PDDs). The relevant exclusion criteria and the comorbidity of these disorders with other mental disorders are discussed. Particular attention is given to the differential diagnosis of 2 PDDs; autistic disorder and Asperger's disorder. It is argued that the differential diagnosis of these and other PDDs is based on diagnostic criteria that lack empirical support, are not mutually exclusive, and do not have separate etiology. The methodological limitations of the studies that have tried to identify differences in these disorders are also discussed. It is suggested that, because Asperger's disorder shares many common features with autistic disorder, classification of Asperger's disorder should be reevaluated and not used until it can be empirically validated. The limitations of current assessment tools are discussed. The ideal is to develop a more accurate clinical impression of how autistic disorder presents in the 1st 2 yrs of life and to develop appropriate tests to reflect these behaviors. _____
Title: Lost in translation: A primer for understanding autism. Author(s): Mong, Shannon Carter, The Wright Inst., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 62(5-B), Dec 2001. pp. 2494. Publisher: US: Univ Microfilms International Abstract: The purpose of this dissertation is to provide a comprehensive overview of the literature regarding Autistic Disorder which can be of use to clinicians who are beginning their work with, or expanding their knowledge of, children with autism. Given the documented rise in the prevalence of Autistic Disorder in the last decade, there is an increased likelihood autistic children will be seen by psychologists who are unfamiliar with the complexities of the disorder (Cohen, 1998; Peeters, 1997). This dissertation aims to provide a relevant introduction to areas of particular concern to service providers who find themselves working with such a child. A description of autism is presented, within the context of the DSM-IV criteria; symptoms are elaborated via a comparison of normative and autistic deficits. Developmental issues are addressed across multiple domains, including social-emotional, symbolic, communication, sensory, motor, and attachment development. The primer reviews how Autistic Disorder (and variations of autism, such as Asperger's Disorder) was initially defined by Leo Kanner in 1943 and has subsequently been reconceptualized. Over the past five decades these theoretical perspectives have ranged from early psychoanalytic theories that emphasized an environmental etiology of autism, through a later understanding of the disorder as being caused by biological factors inherent to the individual, to a more recent understanding of the complex genetic and neurobiological deficits that produce a myriad of symptoms. The dissertation also contains recommendations regarding the psychological evaluation of Autistic Disorder, a review of current tests and measures used to diagnose autism, and a description of the challenges faced by a provider in constructing a comprehensive intervention program. Personal memoirs are prominent throughout the work in an effort to bring to light the social and psychological challenges of autism on the autistic individual, his parents, and other family members. Finally, a discussion is provided which emphasizes the author's understanding of Autistic Disorder via an integrative neurodevelopmental model. The implications this multi-causal model may have for assessment and intervention, as well as for understanding the autistic individual, are elaborated. _____
Title: Do individuals with autism and Asperger's syndrome utilize prior knowledge when pairing stimuli. Author(s): Ropar, Danielle, U Nottingham, School of Psychology, Nottingham, United Kingdom, lpxdr@psychology.nottingham-ac.uk; Mitchell, Peter Address: Ropar, Danielle, U Nottingham, School of Psychology, University Park, NG7 2RD, Nottingham, United Kingdom, lpxdr@psychology.nottingham-ac.uk Source: Developmental Science, Vol 4(4), Nov 2001. pp. 433-441. Publisher: United Kingdom: Blackwell Publishing Abstract: While several studies suggest that individuals with autism use prior knowledge appropriately, others have found that this may be a particular area of weakness. This study investigated whether individuals with autism (n = 8; aged 9-39 yrs) and Asperger's syndrome (n = 10; aged 9-29 yrs) utilize prior knowledge when pairing objects with colors. Participants were presented with cards illustrating common objects and asked to pair them with 1 of 2 color patches. Some target objects were colored inappropriately (e.g., blue banana), allowing a participant to pair it either with blue or yellow. Results indicated that a majority of participants chose the associated in preference to the surface color. This suggests that prior knowledge governed pairing in many individuals with autism and Asperger's syndrome as it did in comparison groups, except in typically developing children aged 5 yrs. However, those with autism and moderate learning difficulties were less affected by prior knowledge than some of the other groups. _____
Title: Cognitive and linguistic profiles of specific language impairment and semantic-pragmatic disorder in bilinguals. Author(s): Jordaan, Heila, U Witwatersrand, Dept of Speech Pathology & Audioloty, Johannesburg, South Africa; Shaw-Ridley, Gill; Serfontein, Jean; Orelwitz, Kerry; Monaghan, Nicole Source: Folia Phoniatrica et Logopaedica , Vol 53(3), May-Jun 2001. pp. 153-165. Publisher: Switzerland: Karger Abstract: This study explored the notion that the extent to which language-impaired children can become bilingual depends on the type of language impairment. Single-case studies were conducted on 2 7-yr-old bilingual children, who had both been exposed to English and Afrikaans consistently and regularly from an early age. The aim of the study is to describe language proficiency in each language and to relate the linguistic profiles to the cognitive processing profiles of each S. The 1st S (a girl) presented with specific language impairment (SLI) and the 2nd S (a male diagnosed with Asperger's syndrome) presented with semantic-pragmatic disorder (SPD). They were assessed on a battery of cognitive and linguistic tests in both languages. Results indicate that the SLI S, who presented with a deficit in successive processing on the Cognitive Assessment System, had difficulty in acquiring the surface features of both languages. She developed much better proficiency in English than in Afrikaans, despite substantial exposure to the latter. The SPD S, whose cognitive profile was characterized by planning and attention deficits, but a strength in successive processing, presented with equal proficiency in both languages. The theoretical and clinical implications of this research are discussed. _____
Title: John Howard and Asperger's Syndrome: Psychopathology and philanthropy. Author(s): Lucas, Philip, philipalucas@yahoo.co.uk Source: History of Psychiatry, Vol 12(45,Pt1), Mar 2001. pp. 73-101. Publisher: United Kingdom: Alpha Academic Abstract: Provides a description of John Howard's life and possible explanations of his development as a prison reformer. Howard's (1726-1790) motives as a prison reformer appear obscure and a sense of his personality remains elusive. Biographies and contemporary texts suggest this is not merely the effect of historical distance: John Howard was considered eccentric by many of his contemporaries. It is suggested that Howard suffered from Asperger's Syndrome (AS), a disorder allied to autism. Sufferers may have high intelligence but characteristically manifest impairments in social, communicative and imaginative functioning with inflexible thinking and an often fanatical preoccupation with a narrow special interest. The hypothesis may help explain enigmatic aspects of Howard's career and personal life, as well as our difficulty forming a sense of his identity. The correspondence between Howard's idiosyncratic perspective, putatively related to AS, and the direction of the profound 'disciplinary' transformation of eighteenth-century society is highlighted. _____
Title: Dissociation between "theory of mind" and executive functions in a patient with early left amygdala damage. Author(s): Fine, C., U Coll London, Inst of Cognitive Neuroscience, London, England; Lumsden, J.; Blair, R. J. R. Source: Brain, Vol 124(2), Feb 2001. pp. 287-298. Publisher: United Kingdom: Oxford Univ Press Abstract: Reports on a 32-yr-old male patient with early or congenital left amygdala damage who, by adulthood had received the psychiatric diagnoses of schizophrenia and Asperger's syndrome. A series of experimental investigations were conducted to determine the S's cognitive functioning. Data show that the S was severely impaired in his ability to represent mental states. No indication of executive function impairment was found. The findings are discussed with reference to models regarding the role of the amygdala in the development of theory of mind and the degree of dissociation between theory of mind and executive functioning. It is concluded that the amygdala may play some role in the development of the circuitry mediating theory of mind. An appendix of an example of an advanced theory of mind and non-literal speech comprehension story is provided. _____
Title: Sprachentwicklung und Intelligenzniveau beim Autismus: Wie eigenstandig ist das Asperger-syndrom? Translated Title: Language development and level of intelligence in autism: Does Asperger's syndrome represent a different disorder? Author(s): Ruhl, D., Klinikum der J.-W. Goethe U, Frankfurt, Germany, d.ruehl@em-uni-frankfurt.de; Bolte, S.; Poustka, F. Address: Ruhl, D., Klinikum der J.-W.-Goethe-U, Klinik fur Psychiatrie & Psychotherapie des Kindes- & Jugendalters, Deutschordenstrasse 50, 60528, Frankfurt, Germany, d.ruehl@em.uni-frankfurt.de Source: Nervenarzt , Vol 72(7), 2001. pp. 535-540. Publisher: Germany: Springer Verlag Abstract: Since the introduction of a separate diagnosis for Asperger's syndrome in the ICD-10 and Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) classification systems, a controversial debate has continued on whether Asperger's syndrome is a specific, clearly distinguishable disorder within the autistic spectrum or whether it represents a milder phenotypical variation of autism. The effect on the amount of autistic symptoms of the variables language delay and level of intelligence was analyzed within a sample of individuals exhibiting autism diagnosed by standardized methods. Both variables showed a significant effect on the degree of autistic symptoms in that impairments in social interaction were less noticeable. In addition, a subsample of individuals exhibited symptoms assumed to be characteristic for Asperger's syndrome. The findings support the assumption that autism and Asperger's syndrome represent "extreme points" on a scale of severity, which leads to the suggestion that the classification of different subtypes of autism could be abandoned in favor of a dimensional (multiaxial) approach. _____
Title: Eriskin Bir Asperger Bozuklugu Olgusunun Klinik ve Noropsikolojik Degerlendirmesi. Translated Title: 1 Author(s): Ozguven, Halise Devrimci; Oner, Ozgur; Olmez, Senay Source: Turk Psikiyatri Dergisi, Vol 12(3), 2001. pp. 233-240. Publisher: Turkey: Turk Psikiyatri Dergisi Abstract: In this case report, we summarized an adult Asperger's disorder (AD) case. The patient's most prominent symptom was his inability to find a friend, despite his efforts. His developmental history revealed that he had social interaction problems beginning in his preschool period. He had some specific, inflexible routines. Although his voice was monotonous, his language development was clinically normal. His family applied to many psychiatrists for his treatment and he had many different diagnoses, including mental retardation and schizophrenia and antipsychotic drugs were prescribed. His new psychological testing revealed that he has an average verbal IQ but his performance IQ was disproportionately low. He had difficulty at information processing, and coordination he lacked empathy. Psychiatrists must consider schizoid and schizotypal personality disorders and other types of pervasive developmental disorders for the differential diagnosis of AD Obtaining a complete developmental history is crucial for the right diagnosis. The difference between AD and autistic disorder is the lack of qualitative impairments in communication at the latter. These patients require specific treatments for their accompanying problems and social skills training for improving their social interactions. _____
Title: Autistic spectrum disorders: Educational and clinical interventions. Series Title: Advances in special education; Vol. 14 Author(s): Wahlberg, Tim, (Ed), Northern Illinois U, De Kalb, IL, US; Obiakor, Festus, (Ed), U Wisconsin, Dept of Exceptional Children, Milwaukee, WI, US; Burkhardt, Sandra, (Ed), Saint Xavier U, Dept of Psychology, US; Rotatori, Anthony F., (Ed), Saint Xavier U, Dept of Psychology, US Source: Oxford, England: Elsevier Science Ltd, 2001. ix, 302 pp. Abstract: (from the preface) This book provides theoretical, educational and clinical perspectives on the study of children and adults with autistic spectrum disorders (ASD), which encompass the classic autistic disorder and mild variants such as Asperger syndrome and pervasive developmental disorder not otherwise specified. The perspectives are based on past and present theories of autism, educational practices over the past 30 years, and recent clinical innovations. The book provides information on theoretical aspects of ASD including chapters on cognitive symptomology of autism, neurological implications and the aging practices. Educational best practices are described including chapters on preservice and inservice training considerations, curriculum innovations, language development and text comprehension and multicultural concerns. Current clinical practices are also described including chapters on assessment, counseling parents of children with ASD, psychotropic management, and a clinical synopsis of a comprehensive interview of a high functioning adult with autism. Unique to the book is a new theoretical model to ASD called The Control Theory of Autism and a discussion related to multicultural issues for students with autism. _____
Title: Learning disorders & disorders of the self in children and adolescents. Author(s): Palombo, Joseph, Inst for Clinical Social Work, Chicago, IL, US Source: New York, NY, US: W. W. Norton & Co, Inc, 2001. xv, 332 pp. Abstract: (from the jacket) The relationship between learning disorders (LDs) and the development of the self is complex. However, clinicians who work with children with LDs must have a way to think about this relationship if they are to be of help. This book presents an integrated conceptual framework, based on psychoanalytic self psychology, to understand and treat children and adolescents whose development has been derailed by LDs. It addresses the concerns of 2 audiences: psychotherapists who treat children and adolescents with LD, and professionals, such as neuropsychologists, clinical and school psychologists, and learning-disability specialists, who are involved in the assessment and remediation of children's LDs. Using the idea that all psychopathology must be understood from a developmental perspective, Palombo conceptualizes disorders of the self as occurring at the intersection between the context within which the child is raised and the neuropsychological strengths and weaknesses he or she brings to that context. He illustrates his ideas using 5 common LDs: dyslexia, attention deficit disorder, executive dysfunction disorder, nonverbal learning disability, and Asperger's disorder. The probable effects of each disorder on development of the self are described, and case illustrations are included. _____
Title: The classification of autism, Asperger's syndrome, and pervasive developmental disorder. Author(s): Szatmari, Peter, Hamilton Health Sciences Corp, Hamilton, ON, Canada Source: Canadian Journal of Psychiatry, Vol 45(8), Oct 2000. pp. 731-738. Publisher: Canada: Canadian Psychiatric Assn Abstract: The current classification of the pervasive developmental disorders (PDDs) as conceptualized in both the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) and International Classification of Diseases (ICD), 10th revision, is deeply unsatisfying to many parents, front-line clinicians, and academic researchers. Is the diagnostic validity of the various disorders simply lacking empirical data for full substantiation, or does the overall conceptualization of the category have more fundamental problems, not reflecting the "true" nature of the phenomena? This paper argues the latter hypothesis. The author reviews the historical development of the classification of PDD, summarizes recent empirical data on issues of reliability and validity, and suggests a new approach to classification and understanding. _____
Title: Asperger's syndrome, X-linked mental retardation (MRX23), and chronic vocal tic disorder. Author(s): Searcy, Eileen, Child Evaluation & Treatment Program, Grand Forks, ND, US; Burd, Larry; Kerbeshian, Jacob; Stenehjem, Amy; Franceschini, Lisa A. Source: Journal of Child Neurology, Vol 15(10), Oct 2000. pp. 699-702. Publisher: Canada: BC Decker Abstract: Pervasive developmental disorders are severe disorders of development with no consistent neurobiologic etiology and most often an idiopathic etiology. The authors report a 12-yr-old male who met criteria for a pervasive developmental disorder (Asperger's syndrome) and a chronic tic disorder. The child also has an X-linked cognitive impairment (MRX23). The presence of tic symptomatology, pervasive developmental disorder, and fragile X syndrome has previously been reported. Since no singular etiology for Asperger's syndrome has been found, the possibility of other cases of Asperger's syndrome occurring with concurrent abnormalities on the X chromosome should be considered by clinicians, especially if tic symptomatology is present. _____
Title: Asperger syndrome: A study of the cognitive profiles of 37 children and adolescents. Author(s): Barnhill, Gena, U Kansas Medical Ctr, Autism/Asperger Syndrome Resource Ctr, Kansas City, KS, US; Hagiwara, Taku; Myles, Brenda Smith; Simpson, Richard L. Source: Focus on Autism & Other Developmental Disabilities , Vol 15(3), Fal 2000. pp. 146-153. Publisher: US: PRO-ED Abstract: Examined the cognitive profiles of individuals with Asperger's syndrome to determine if there is a characteristic profile that might aid diagnosis and the development of interventions. 37 patients (aged 3-14 yrs) diagnosed with Asperger's syndrome completed one of the Wechsler intelligence scales, including verbal (VIQ) and performance (PIQ) subtests. Results show no statistically significant differences between the verbal and performance intelligence scores among Ss. 23 Ss scored higher on VIQ while 12 Ss scored higher on PIQ. Results suggest that salient factors associated with the diagnosis of Asperger syndrome may not be found in the cognitive profile but in other behavioral or academic characteristics. _____
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: Occurrence of tics in Asperger's syndrome and autistic disorder. Author(s): Ringman, John M., U California, Irvine School of Medicine, Dept of Neurology, Irvine, CA, US; Jankovic, Joseph Source: Journal of Child Neurology, Vol 15(6), Jun 2000. pp. 394-400. Publisher: Canada: BC Decker Abstract: Presents the cases of 12 patients (aged 3-32 yrs) with autistic spectrum disorders who were referred to a Movement Disorders Clinic for evaluation of tics. Eight of the 12 had normal language development and therefore met criteria for Asperger's syndrome. All patients exhibited stereotypic movements; in addition, 7 had tics and 6 of these met diagnostic criteria for Tourette syndrome. Of the 6 patients with clinical features of both Asperger's syndrome and Tourette syndrome, 3 had severe congenital sensory deficits. The autistic patients were clinically heterogeneous and though tics were clearly present, other aberrant movements demonstrated by them were harder to classify. The authors conclude that this confirms the wide range of clinical manifestations in Asperger's syndrome and autism, including tics and other features of Tourette syndrome. Furthermore, it suggests that sensory deprivation contributes to the development of adventitious movements in this population. _____
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: 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: Diagnostic issues in Asperger syndrome. Author(s): Volkmar, Fred R., Yale U, School of Medicine, Yale Child Study Ctr, New Haven, CT, US; Klin, Ami Source: Asperger syndrome. Klin, Ami (Ed); Volkmar, Fred R. (Ed); et al; pp. 25-71. New York, NY, US: Guilford Press, 2000. xvii, 489 pp. Abstract: (from the introduction) This chapter traces the development of the concept of Asperger syndrome (AS) from Asperger's original work to the inclusion of AS in current official diagnostic systems. A comparison of different approaches to the diagnosis of AS is made, including a critique of the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) and International Classification of Diseases-10 (ICD-10) definitions. The authors also review the issues involved in validation of AS as a diagnostic concept as well as the validation data currently available, concluding with a set of guideline for future research that will expand promising leads while avoiding methodological pitfalls from the past. _____
Title: I.Q. scores and social behavioral ratings of preschoolers in special education and cornerstone: Differential treatment efficacy. Author(s): Diaz Hope, Miquela , The Wright Inst., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 60(12-B), 2000. pp. 6358. Publisher: US: Univ Microfilms International Abstract: This pilot study tests whether three different psychoeducational treatments (Psychoanalytic Cornerstone, Supportive-Expressive Cornerstone, and a Comparison Special Education Group) affect cognitive and social behavioral scores of seriously emotionally disturbed (SED) preschoolers. The major hypotheses of this study are: (1)(a) children who completed Cornerstone treatment will have greater cognitive gains than a comparison group, (b) children who completed Cornerstone treatment will have lower parental ratings of total problem scores than a comparison group, (c) children who completed Cornerstone treatment will have lower investigator ratings of total problem scores and higher total on task scores than a comparison group, (d) children who completed Cornerstone treatment will have higher psychologist ratings of overall functioning than a comparison group, (e) children who completed Cornerstone treatment at an earlier age will show post-treatment maintenance of cognitive and social behavioral gains, and (2) children with the diagnoses of Autistic Disorder, Pervasive Developmental Disorder (PDD), Attention Deficit Disorder (ADD), Attention Deficit with Hyperactivity Disorder (ADHD) or Asperger's Disorder will show more improvement cognitively and social behaviorally with Cornerstone treatment than with a comparison group. Additional minor hypotheses concerning a child's personality characteristics and the levels of child and parent participation were also explored. Psychoanalytic Cornerstone showed significant cognitive gains at the p < .01 level as measured by WPPSI-R Full Scale IQ scores. Furthermore, Psychoanalytic Cornerstone was more cognitively effective (p = .0073) and social behaviorally effective (p = .0115) for children who had at least one major psychiatric diagnosis. These findings of measurable Cornerstone treatment benefits deserve intensive investigation and support continued development and widespread use of Cornerstone treatment with SED populations. _____
Title: Autism's home in the brain. Author(s): Simon, Nicole Source: Neurology, Vol 54(1), Jan 2000. pp. 269. Publisher: US: Lippincott Williams & Wilkins Abstract: Comments on articles on autism by I. Rapin, G. R. DeLong, N. J. Minshew et al, E. Courchesne et al. The present author discusses the possibility that dysgenesis of temporal and frontal lobes, abnornalities of the cerebellar vermis, oculomotor signs, and a disorder of serotonergic neurotransmission could result from perinatal disruption of aerobic metabilism. Anoxia, infections, or exposure to toxic subsntamces during gestation or early postnatal development may impair brainstem neclei of high metabilic rate in a Wernicke encephalopathy-type symmetric bilateral pattern, whether visible damage is apparent. Simon suggest that it might be worth considering whether autism spectrum disorders including Asperger's syndrome and antioscial persoanitly disorder could be caused by maldevelopment due to loss of trophic influences from caudal to rostral brain centers. _____
Title: Are individuals with autism and Asperger's syndrome susceptible to visual illusions? Author(s): Ropar, Danielle, U Nottingham, School of Psychology, Nottingham, England; Mitchell, Peter Source: Journal of Child Psychology & Psychiatry & Allied Disciplines, Vol 40(8), Nov 1999. pp. 1283-1293. Publisher: United Kingdom: Blackwell Publishing Abstract: A recent finding that individuals with autism are not susceptible to illusions has been explained by F. G. Happe as a sign of "weak central coherence" at lower levels of processing. We investigated the phenomenon with a more sophisticated measure. In Exp 1, 23 males with autism, 13 with Asperger's syndrome, 17 with moderate learning difficulties, and 3 groups with typical development (all aged 7-18 yrs) adjusted certain comparison lines and circles to make them appear to be the same in four visual illusions. With a minor exception, the participants with autism and Asperger's syndrome evidenced a systematic bias in their judgements in the illusion condition. The extent of this was no different from control participants. In a second experiment, a similar finding was obtained in a task where Ss made verbal judgements about the stimuli. The results suggest that lower-level coherence in visual processing in autism is intact. _____
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: The suffering of Asperger children and the challenge they present to psychoanalytic thinking. Author(s): Shuttleworth, Judy Source: Journal of Child Psychotherapy, Vol 25(2), Aug 1999. pp. 239-265. Publisher: United Kingdom: Taylor & Francis Abstract: Describes a lengthy period of psychotherapy with a 10 yr old male. This treatment began only after a prolonged contact with other child and adolescent mental health services during which the child's difficulties, which had initially seemed to be ordinary behavioral problems, had proved puzzlingly intractable to a variety of interventions. Subsequent psychotherapy revealed a profound disorder of development which lay beneath the surface presentation. In a climate where Asperger's syndrome is often felt to be untreatable, this paper argues that some children, at least, can benefit from psychotherapy and can be helped towards real mental growth. Asperger's syndrome in children bears some striking similarities to narcissistic personality disorder as described in the adult psychoanalytic literature and this paper discusses some of the theoretical and clinical implications of the innate origins of Asperger's syndrome. _____
Title: Theory of mind and self-consciousness: What is it like to be autistic? Author(s): Frith, Uta, U London, University Coll London, Inst of Cognitive Neuroscience, London, England; Happe, Francesca Source: Mind & Language, Vol 14(1), Mar 1999. pp. 1-22. Publisher: United Kingdom: Blackwell Publishing Abstract: Autism provides a model for exploring the nature of self-consciousness (SFC). Experimental studies of normal and abnormal development suggest that abilities to attribute mental states to self and to others are closely related. Inability to pass standard theory of mind (ToM) tests, which refer to others' false beliefs, may imply lack of SFC. Individuals who persistently fail ToM tests may, in the extreme, be unable to reflect on their intentions or to anticipate their own actions. In contrast, individuals with high-functioning autism or Asperger's syndrome often possess a late-acquired, explicit ToM that appears to result from effortful learning. An experiment with 3 people with Asperger's syndrome indicates that level of performance on standard ToM tasks was strongly related to ability to engage in introspection. Qualitative differences in introspections of high-functioning people with autism are reflected in autobiographical accounts. _____
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: Matthew: From numbers to numeracy: From knowledge to knowing in a ten year-old boy with Asperger's Syndrome. Author(s): Youell, Biddy, Tavistock Clinic, London, England Source: Autism and personality: Findings from the Tavistock Autism Workshop. Alvarez, Anne (Ed); Reid, Susan (Ed); pp. 186-202. Florence, KY, US: Taylor & Frances/Routledge, 1999. xv, 264 pp. Abstract: (from the chapter) This chapter is an account of the way a 10-yr-old autistic boy used numbers, words and definitions to sustain his autism and to mislead himself and others into believing him to be good at math. An attempt is made to describe how, in psychotherapeutic treatment, he began to allow this system to be challenged. The hypothesis is that the containing experience of a firm setting and a lively, thinking other (therapist) slowly enabled him to take the risk of allowing space in his mind in which his own symbolic thinking might ultimately develop. The chapter charts the S's progress through the 1st 2 yrs of therapy. For some time the S and author (therapist) both were troubled under the tyranny of his autism. The S became increasingly able to articulate his own experience and to recognize his compulsive listing, counting, and questioning as ways of trying to avoid what felt to him to be a catastrophic anxiety. _____
Title: Treatment of a boy with atypical ego development. Author(s): Olesker, Wendy, New York Psychoanalytic Inst, New York, NY, US Source: Psychoanalytic Study of the Child, Vol 54, 1999. pp. 25-46. Publisher: US: Yale Univ Press Abstract: A multifaceted mode of therapeutic action is delineated as the complex neuropsychological and psychogenic factors in the development and functioning of an unusual 4-yr-old boy, with a diagnostic impression of Asperger's Syndrome, became elucidated. In addition to standard technique, the author developed a variety of psychoanalytically informed ways to facilitate the boy's growth and ameliorate deviational aspects, especially his difficulties in appreciating and responding to the social-emotional world and establishing stable, integrated mental representations of self and other. The evolving treatment process is presented as well as attempts to coordinate and harmonize analytic and developmental goals. _____
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: 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. 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: Cyproterone acetate and striae. Author(s): Mohan, Damian, Broadmoor Hosp, Richard Dadd Ctr, Professorial Unit, Crowthorne, England; Taylor, Richard; Mackeith, James A. Source: International Journal of Psychiatry in Clinical Practice, Vol 2(2), Jun 1998. pp. 147-148. Publisher: United Kingdom: Martin Dunitz Abstract: Reports the development of multiple disfiguring striae in a 22-yr-old man with Asperger's syndrome, who was given the antilibidinal drug cyproterone acetate. The patient became distressed by the striae, and the medication was discontinued. ____
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: Language and communication in developmental disorders. Author(s): Denes, Gianfranco, U Padova, Dept of Neurological & Psychiatric Sciences, Padova, Italy; Sarkari, Shirin; Tan, Arlene A.; Molfese, Dennis L.; Happe, Francesca Source: Handbook of neurolinguistics. Stemmer, Brigitte (Ed); Whitaker, Harry A. (Ed); pp. 507-534. San Diego, CA, US: Academic Press, Inc, 1998. xxvi, 788 pp. Abstract: (from the book) "Landau-Kleffner Syndrome: Clinical and Linguistic Aspects" / Gianfranco Denes / discusses clinical neuropsychological and linguistic aspects of Landau-Kleffner syndrome and alternative hypotheses underlying comprehension disorders "The Development of Language in Some Neurological Diseases" / Shirin Sarkari, Arlene A. Tan and Dennis L. Molfese / discusses clinical and neuroanatomical features of various neurological diseases and deficits in language development and visuospatial skills specific to each disorder "Language and Communication Disorders in Autism and Asperger's Syndrome" / Francesca Happe / reviews current work on language and communication in autism, and explores what this disorder can tell us about the cognitive capacities that underlie normal communicative functioning and language acquisition. _____
Title: The pervasive developmental disorders: Nosology and profiles of development. Author(s): Klin, Ami, Yale U, School of Medicine, Child Study Ctr, New Haven, CT, US; Volkmar, Fred R. Source: Developmental psychopathology: Perspectives on adjustment, risk, and disorder. Luthar, Suniya S. (Ed); Burack, Jacob A. (Ed); et al; pp. 208-226. New York, NY, US: Cambridge University Press, 1997. xxi, 618 pp. Abstract: (from the chapter) This chapter illustrates the syndrome-specific approach through a review of the new nosology of the pervasive developmental disorders: broad and amorphous categories are slowly evolving into empirically derived and more homogeneous subgroups, with increasingly greater importance ascribed to processes and pathways of development. The "individual as a whole person" approach will be illustrated through a discussion of recent investigations that have delineated 2 profiles of adjustment observed in individuals with "higher-functioning' autism (FHA) and in individuals with Asperger's syndrome (AS). Although the profiles of individuals with FHA and AS resemble, they appear to evolve out of different constitutional endowment and to follow different adaptation pathways. _____
Title: Nonverbal learning disabilities, Asperger's syndrome, pervasive developmental disorder--should we care? Author(s): Brumback, Roger A., OUHSC-BMSB, Oklahoma City, OK, US; Harper, Caryn R.; Weinberg, Warren A. Source: Journal of Child Neurology, Vol 11(6), Nov 1996. pp. 427-429. Publisher: Canada: BC Decker Abstract: Discusses how effective human communication and interaction requires more than simply words. Facial expression, posture, gaze, and body movement (gesture) are as important as words in communicating correct information to another individual. Much of nonverbal communication appears to be a normal function of the right cerebral hemisphere. Selected right cerebral hemisphere functions and specific nonverbal learning disability syndromes are discussed. _____
Title: Comparison of clinical symptoms in autism and Asperger's disorder. Author(s): Eisenmajer, Richard, La Trobe U, School of Psychology, Bundoora, Victoria, Australia; Prior, Margot; Leekam, Susan; Wing, Lorna; et al. Source: Journal of the American Academy of Child & Adolescent Psychiatry, Vol 35(11), Nov 1996. pp. 1523-1531. Publisher: US: Lippincott Williams & Wilkins Abstract: Determined what clinical symptoms clinicians are using to distinguish between Asperger's disorder (AsD) and autistic disorder (AuD). Parents of 48 patients with high-functioning AuD and 69 patients with AsD (all Ss aged 2.7-21.3 yrs) were given a structured interview based on Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) and International Classification of Diseases (ICD) 10th edition diagnostic criteria. Data regarding early and current symptom presentation, family, developmental, and verbal mental age information were collected. Logistic regression analyses were conducted to determine which variables best predicted clinician's diagnosis. A number of clinical variables predicted diagnosis. Delayed language onset was the only variable of the family and developmental variables that predicted diagnosis. The AsD Ss were also significantly higher than the AuD Ss in verbal mental age. Clinicians appear to be diagnosing AsD and AuD on the basis of published research and case study accounts. The findings question whether DSM-IV and ICD-10 criteria adequately describe the AsD individual, particularly in the communication domain. _____
Title: Disembedding performance and recognition memory in autism/PDD. Author(s): Brian, Jessica A., York U, Dept of Psychology, North York, ON, Canada; Bryson, Susan E. Source: Journal of Child Psychology & Psychiatry & Allied Disciplines, Vol 37(7), Oct 1996. pp. 865-872. Publisher: United Kingdom: Blackwell Publishing Abstract: Explored the claim that superior disembedding performance in autism reflects "less capture by meaning" and/or reduced "central coherence" (A. Shah and U. Frith). Meaningless and meaningful disembedding contexts were used, and memory for contextual information was examined. 18 Ss (aged 10.6-27.4 yrs) diagnosed with autism or pervasive developmental disorder (PDD), and 2 comparison groups of Ss (aged 6.6-18.7 yrs) participated in the study. Neither qualitative (search strategy) nor quantitative (reaction time or accuracy) data indicated that autism/PDD Ss were superior to younger, developmentally matched Ss. All Ss found disembedding was slowest from meaningful contexts. No evidence was provided for less capture by meaning or reduced central coherence in autism/PDD, raising the possibility that earlier findings reflect a developmental, rather than a stable autism-specific, phenomenon. (Japanese abstract). _____
Title: Validity and neuropsychological characterization of Asperger Syndrome: Convergence with Nonverbal Learning Disabilities syndrome. Author(s): Klin, A., Yale U, School of Medicine, New Haven, CT, US; Volkmar, F. R.; Sparrow, S. S.; Cicchetti, D. V.; et al. Source: Annual Progress in Child Psychiatry & Child Development, 1996. pp. 241-259. Publisher: US: Brunner/Mazel Abstract: (This reprinted article originally appeared in Journal of Child Psychology & Psychiatry & Allied Disciplines, 1995, Vol 36 [7], 1127-1140.) Examined the validity of Asperger Syndrome (AS) by comparing the neuropsychological profiles in this condition and Higher-Functioning Autism (HFA) for 73 potential Ss. 21 Ss (mean age 16.1 yrs) were diagnosed with AS and 19 Ss (mean age 15.4 yrs) were diagnosed with HFA. The groups had comparable age and Full Scale IQ distributions. The groups differed significantly in 11 neuropsychological areas (e.g., fine motor skills, visual spatial perception, visual memory, and verbal memory). The profile obtained for Ss with AS coincided closely with a cluster of neuropsychological assets and deficits captured by the term nonverbal learning disabilities, suggesting an empirical distinction from HFA. _____
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: 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: Children with autism: Diagnosis and interventions to meet their needs. Author(s): Trevarthen, Colwyn, U Edinburgh, Edinburgh, Scotland; Aitken, Kenneth; Papoudi, Despina; Robarts, Jacqueline Source: Philadelphia, PA, US: Jessica Kingsley Publishers, Ltd., 1996. xii, 228 pp. Abstract: (from the cover) In this comprehensive study of autism the authors, balancing theory with practice, present a clear picture of what it means to be autistic and what can be done to improve the capabilities of the autistic child. They consider: the historical descriptions, explanations and recognition of the condition; the symptoms and probable causes; the classification of autism and related conditions such as Asperger's syndrome, including details of the latest diagnostic systems and they examine methods of communicating with autistic children [and] helping them to communicate as fully as possible. Calling on recent developmental research, new data on the communication and emotions of autistic children, and new findings on brain development, they examine the results of recent intervention trials to provide a wealth of information for parents, caregivers, students, researchers, and all those working with autistic children. _____
Title: Asperger's syndrome and autism: Differences in behavior, cognition, and adaptive functioning. Author(s): Szatmari, Peter, Chedoke-McMaster Hosps, Dept of Psychiatry, Chedoke Div, Hamilton, ON, Canada; Archer, Lynda; Fisman, Sandra; Streiner, David L.; et al. Source: Journal of the American Academy of Child & Adolescent Psychiatry, Vol 34(12), Dec 1995. pp. 1662-1671. Publisher: US: Lippincott Williams & Wilkins Abstract: Examined differences in behavior, cognition, and adaptive functioning in 47 children with autism and 21 with Asperger's syndrome (all Ss aged 4-6 yrs), differentiated from pervasive developmental disorder (PDD) on the basis of delayed and deviant language development. Ss completed the Autism Diagnostic Interview, Vineland Adaptive Behavior Scales, Leiter International Performance Scale, Stanford Binet Intelligence Scale, Reynell Developmental Language Scales, and the Beery Developmental Test of Visual-Motor Integration. Significant differences between the groups existed on many PDD symptoms, adaptive behaviors, and cognitive measures of language competence, but not on aspects of nonverbal communication, nonverbal cognition, or motor development. Results indicate that subtypes of children with PDD can be identified that differ on variables relatively independent of defining characteristics. _____
Title: Autism and its spectrum disorders: Epidemiology and neurobiology. Author(s): Gillberg, Christopher, U Goeteborg, Sweden Source: Japanese Journal of Child & Adolescent Psychiatry, Vol 36(5), Sep-Nov 1995. pp. 342-369. Publisher: Japan: Japanese Society for Child & Adolescent Psychiatry Abstract: Presents an overview of recent developments in the diagnosis, prevalence, associated neurobiological factors, and outcome in autistic disorder/infantile autism, autisticlike conditions, Asperger syndrome, and "other" autism spectrum disorders. Other issues discussed include the sex ratio of infantile autism, epilepsy in autism, and cognitive deficits associated with autism. Evidence converge to produce a concept of autism as a non-specific behavioral syndrome shading into other disorders of empathy that show continuity with poorly developed empathy skills in the general population. The autism spectrum includes a number of triad conditions. Autisticlike conditions, autistic traits, and Asperger syndrome seem to be related to autism, genetically and with respect to social functioning and outcome. _____
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: Asperger's syndrome or schizophrenia? Author(s): Bejerot, Susanne, Danderyds Hosp, Dept of Psychiatry, Sweden; Duvner, Tove Source: Nordic Journal of Psychiatry, Vol 49(2), 1995. pp. 145. Publisher: Norway: Scandinavian Univ Press Abstract: Comments on T. Taiminen's article on Asperger's syndrome, suggesting that Asperger's syndrome Ss have no clinically significant delay in language or cognitive development and that the case example cited exhibited delusion, not schizophrenia. It is suggested that Asperger's syndrome patients be excluded from schizophrenia research and that they are not helped by neuroleptics. _____
Title: Asperger syndrome: A label worth having? Author(s): Gross, Jean, Psychology Service, Bath, England Source: AEP (Association of Educational Psychologists) Journal, Vol 10(2), Jul 1994. pp. 104-110. Publisher: United Kingdom: Pitman Publishing Abstract: Explains why the Asperger syndrome (AS) label can be useful in helping to plan for the curricular and social needs of a small but often misunderstood group of children. AS, also called high-level autism or semantic-pragmatic disorder, is characterized by abnormal language and social development and by the presence of fixed interests and a limited range of imaginative activities. Because it is easy to miss children with AS, the author suggests that educational psychologists (EPs) routinely ask teachers structured questions to elicit information indicative of AS whenever the child's behavior indicates that AS is a possibility. The author describes the types of classroom context, academic curriculum, and social curriculum that are appropriate for students with AS, and concludes that EPs are uniquely placed to help implement effective special education support packages for students with AS. _____
Title: Three siblings with Asperger syndrome: A family case study. Author(s): Ghaziuddin, N., U Michigan Hosp, Dept of Child Psychiatry, Ann Arbor, US; Metler, L.; Ghaziuddin, Mohammad; Tsai, Luke; et al. Source: European Child & Adolescent Psychiatry, Vol 2(1), Jan 1993. pp. 44-49. Publisher: Germany: Dietrich Steinkopff Verlag Abstract: Describes 3 brothers (ages 15, 13, and 9 yrs) with Asperger syndrome based on criteria from the International Classification of Diseases (ICD), 10th edition. The oldest S had symptoms of persistent hand-washing and irritability. All 3 Ss were preoccupied with number counting and were socially withdrawn. None of the Ss met the Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) or ICD-10 criteria for autism. Their scores fell below the autistic range on the Autism Behavior Checklist. They all showed the social impairment of autism with normal intelligence and a normal history of language development. They all suffered from a significant degree of clumsiness. The Ss' 7-yr-old sister showed no signs of the syndrome. It is proposed that, in some families, Asperger syndrome may occur as a distinct clinical entity and show no overlap with autism. (French & German abstracts) _____
Title: Recurrent hypersomnia in two adolescent males with Asperger's syndrome. Author(s): Berthier, Marcelo L., Hosp Universitario Virgen de la Victoria, Servicio de Neurologia, Malaga, Spain; Santamaria, Juan; Encabo, Horacio; Tolosa, Eduardo S. Source: Journal of the American Academy of Child & Adolescent Psychiatry, Vol 31(4), Jul 1992. pp. 735-738 Publisher: US: Lippincott Williams & Wilkins Key Concepts: development of hypersomnia & Kleine-Levin syndrome, male 17 yr olds with Asperger's syndrome Abstract: Presents the case reports of 2 male patients (aged 17 yrs) with Asperger's syndrome, a rare pervasive developmental disorder (PDD) who developed recurrent episodes of hypersomnia and abnormal behavior (Kleine-Levin syndrome) during adolescence. The possible etiological role of developmental structural brain anomalies and the differential diagnosis of recurrent hypersomnia and abnormal behavior in patients with PDDs are discussed. _____
Title: Hypothyroidism and autism spectrum disorders. Author(s): Gillberg, I. Carina, Annedal Clinics, Goeteborg, Sweden; Gillberg, Christopher; Kopp, Svenny Source: Journal of Child Psychology & Psychiatry & Allied Disciplines, Vol 33(3), Mar 1992. pp. 531-542. Publisher: United Kingdom: Blackwell Publishing Abstract: Presents case reports of 5 individuals (aged 4-24 yrs) with autism or autistic-like conditions. Three had congenital hypothyroidism, and 2 had mothers who had probably been hypothyroid in pregnancy. It is suggested that hypothyroid hormone deficiency in early development might cause central nervous system (CNS) damage such that autistic symptoms are likely to ensue. An alternative explanation might be autoimmune factors linking hypothyroidism and autism. _____
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: Brief report: Biological factors associated with Asperger syndrome. Author(s): Rickarby, Geoff A., Gosford & District Hosp, NSW, Australia; Carruthers, Anne; Mitchell, Margery Source: Journal of Autism & Developmental Disorders, Vol 21(3), Sep 1991. pp. 341-348. Publisher: Netherlands: Kluwer Academic Publishers Abstract: Reviewed various diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), DSM-III--Revised (DSM-III--R), and International Classification for Diseases, 10th edition related to Asperger syndrome and autism. 10 families with a son (aged 5 yrs to late teens) with Asperger syndrome were administered the Peabody Picture Vocabulary Test (PPVT) and Wechsler Intelligence Scale for Children--Revised (WISC--R). Family history, medical, neonatal, and obstetrical data reveal that of the various parameters of fetal damage (anoxia, trauma, hypoglycemia) not a single factor was solely responsible. The issue with Asperger syndrome, and possibly with autism itself, may be a question of the vulnerability of a structure within the central nervous system (CNS), a specific tract or tracts, or a neurophysiological system that utilizes a vulnerable type of synapse. The various structures themselves may be vulnerable according to their stage of development. _____
Title: Asperger's syndrome: Diagnosis, treatment, and outcome. Author(s): Szatmari, Peter, Chedoke-McMaster Hosps, Dept of Psychiatry, Hamilton, ON, Canada Source: Psychiatric Clinics of North America, Vol 14(1), Mar 1991. pp. 81-93. Publisher: United Kingdom: Elsevier Science Abstract: Asperger's syndrome (AS) represents a subtype of pervasive developmental disorder that differs from autism in a number of important ways. The essential differences between AS and autism lie in the greater degree of social unresponsiveness, the higher frequency of deviant language development, and the lack of symbolic play in autistic children. Data on AS are reviewed with respect to clinical features, associated handicaps, etiology, treatment, and outcome. _____
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: Asperger's syndrome and ligamentous laxity. Author(s): Tantam, Digby, University Hosp of South Manchester, England; Evered, Christopher; Hersov, Lionel Source: Journal of the American Academy of Child & Adolescent Psychiatry, Vol 29(6), Nov 1990. pp. 892-896. Publisher: US: Lippincott Williams & Wilkins Abstract: Describes 2 autistic girls (aged 12 and 14 yrs) and 1 autistic man (aged 24 yrs) in whom Asperger's syndrome coexisted with lifelong ligamentous laxity and muscular incoordination. Two Ss had cranial circumferences at or above the 90th percentile as children, 2 had complex partial epilepsy, 1 had a colloid cyst of the 3rd ventricle, and 1 had evidence of Sotos syndrome. Echocardiography was performed in the 2 girls and both had evidence of increased aortic compliance. These Ss may suffer from a Marfan-like disorder of connective tissue that may have led to anomalous development of midline brain structures, with consequent social handicaps characteristic of Asperger's syndrome. _____
Title: Tourette-like disorder in Asperger's syndrome. Author(s): Littlejohns, Carl S., North Wales Hosp, Denbigh, Wales; Clarke, David J.; Corbett, John A. Source: British Journal of Psychiatry , Vol 156, Mar 1990. Special issue: Cross-cultural psychiatry. pp. 430-433. Publisher: United Kingdom: Royal College of Psychiatrists Abstract: An 8-yr-old boy with Asperger's syndrome was given haloperidol to control agitation and aggressive outbursts. Withdrawal of the drug after 2 yrs was followed by Tourette-like symptoms. Subsequently, neither haloperidol nor a second antipsychotic drug altered the core features of Asperger's syndrome, despite suppressing the movement disorder. His first exposure to neuroleptics was in utero when his mother received fluphenazine decanoate throughout pregnancy for schizophrenia. _____
Title: Developmental cortical anomalies in Asperger's syndrome: Neuroradiological findings in two patients. Author(s): Berthier, Marcelo L., Inst de Investigaciones Neurologicas "Dr. Raul Carrea," Buenos Aires, Argentina; Starkstein, Sergio E.; Leiguarda, Ramon Source: Journal of Neuropsychiatry & Clinical Neurosciences, Vol 2(2), Spr 1990. pp. 197-201. Publisher: US: American Psychiatric Assn Abstract: Reports neuroradiological findings of developmental cortical anomalies in 2 right-handed 17-yr-old male patients with Asperger's syndrome (AS), a less severe variant of infantile autism. Ss exhibited major behavioral symptoms of AS, including impaired social interaction and lack of empathy; left-sided neurological signs (e.g., hemihypotrophy, motor incoordination); and cognitive impairments compatible with right-hemisphere dysfunction. In both Ss, magnetic resonance imaging and computerized tomography (CT) scans showed areas of abnormal gyration bilaterally. Neuroimaging techniques may identify organic factors in a subgroup of patients with idiopathic psychiatric 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: Autism, Asperger's syndrome and semantic-pragmatic disorder: Where are the boundaries? Author(s): Bishop, D. V., Victoria U of Manchester, England Source: British Journal of Disorders of Communication, Vol 24(2), Aug 1989. Special issue: Autism. pp. 107-121. Publisher: United Kingdom: Taylor & Francis Abstract: The diagnostic criteria for autism have been refined and made more objective since L. Kanner (1943) first described the syndrome, so there is now reasonable consistency in how this diagnosis is applied. However, many children do not meet these criteria, yet show some of the features of autism. Where language development is impaired, such children tend to be classed as cases of developmental dysphasia (or specific language impairment) whereas those who learn to talk at the normal age may be diagnosed as having Asperger's syndrome. Rather than being a rigid diagnostic category, the core syndrome of autism shades into other milder forms of disorder in which language or non-verbal behavior may be disproportionately impaired. _____
Title: Asperger syndrome in 23 Swedish children. Author(s): Gillberg, Christopher, Goeteborgs U, Sweden Source: Developmental Medicine & Child Neurology, Vol 31(4), Aug 1989. pp. 520-531 Publisher: US: Cambridge Univ Press Abstract: 23 Swedish children (aged 5-18 yrs) who fulfilled specific criteria for Asperger syndrome (i.e., impaired social interaction, a single all-absorbing interest, stereotyped routines, language and communication problems) were examined and compared with an age- and IQ-matched group with infantile autism. The boy to girl ratio was 10:1. Less than 10% of Ss were mentally retarded and 17% were of above-average intelligence. Apart from motor clumsiness (very common in the Asperger group) and reduced optimality in the prenatal and perinatal periods (more common in the autistic group), there was very little in the clinical or neurobiological backgrounds to suggest a clear distinction between Asperger syndrome and infantile autism. _____
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: Lifelong eccentricity and social isolation: II. Asperger's syndrome or schizoid personality disorder? Author(s): Tantam, Digby, University Hosp of South Manchester, England Source: British Journal of Psychiatry, Vol 153, Dec 1988. pp. 783-791. Publisher: United Kingdom: Royal College of Psychiatrists Abstract: Describes several scales for measuring aspects of eccentricity and social isolation, in particular, for assessing schizoid and schizotypal personality and for rating abnormal nonverbal expression. Among 60 socially isolated and eccentric psychiatric patients, there was an association between schizoid personality traits and abnormalities of speech and nonverbal expression. Abnormal nonverbal expression was associated with other characteristic features of Asperger's syndrome. It is suggested that Asperger's syndrome is a distinct syndrome from either schizoid or schizotypal personality disorder, but may be a risk factor for the development of schizoid personality disorder. _____
Title: Neuropsychological profile of an Asperger's syndrome case with exceptional calculating ability. Author(s): Stevens, Denise E.; Moffitt, Terrie E. Source: Clinical Neuropsychologist, Vol 2(3), Jul 1988. pp. 228-238. Publisher: Netherlands: Swets & Zeitlinger Abstract: Presents a neuropsychological case study of a 34-yr-old socially and emotionally disabled male patient with Asperger's syndrome, who had remarkable mathematical abilities. Within a framework proposed by B. P. Rourke, it is hypothesized that the social deficits associated with Asperger's syndrome may arise from longstanding difficulty with processing of information in novel situations, including decoding of visual information such as interpersonal cues and facial expressions. Relatively intact verbal skills may prevent these individuals from leading severely autistic lives and, in some cases, superior auditory verbal memory capacity may support development of extraordinary isolated "savant" skills that utilize routinized processing. _____
Title: A possible case of Asperger's syndrome. Author(s): Munro, Alistair, Dalhousie U, Halifax, NS, Canada Source: Canadian Journal of Psychiatry, Vol 32(6), Aug 1987. pp. 465-466. Publisher: Canada: Canadian Psychiatric Assn Abstract: Defines Asperger's syndrome as an autistic-like disorder, that fits with Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria for Atypical Pervasive Development Disorder. It is asserted that the syndrome may be misdiagnosed as personality disorder in the adolescent. An illustrative case of an 18-yr-old male is presented. (French abstract) _____
Title: A vote for Asperger's syndrome. Author(s): Szatmari, Peter, McMaster U, Hamilton, Canada; Bartolucci, Giampiero; Finlayson, Alan; Krames, Lester Source: Journal of Autism & Developmental Disorders, Vol 16(4), Dec 1986. pp. 515-517. Publisher: Netherlands: Kluwer Academic Publishers Abstract: In contrast to reports by F. R. Volkmar et al and C. Gillberg, the present author argues that at least some cases of Asperger's syndrome represent an entity distinct from autism. The case is presented of an adolescent female who presented initially with Asperger's syndrome--including poor social development and impaired verbal and nonverbal communication--and then later developed schizophrenic symptoms. _____
Title: Asperger's syndrome and Tourette syndrome: The case of the pinball wizard. Author(s): Kerbeshian, Jacob, U North Dakota School of Medicine, Grand Forks Clinic; Burd, Larry Source: British Journal of Psychiatry, Vol 148, Jun 1986. pp. 731-736. Publisher: United Kingdom: Royal College of Psychiatrists Abstract: Discusses Asperger's syndrome, with particular reference to diagnostic criteria and differentiation from infantile autism and personality disorder. The cases of 6 patients (aged 8-21 yrs) are described. All met Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria for atypical pervasive developmental disorder. Three also developed Tourette syndrome. The cooccurrence of the 2 disorders and methods of intervention are discussed. _____
Translated Title: A variant of psychic dysontogenesis with early development of abstract thinking. Author(s): Bulakhova, L. A. Source: Zhurnal Nevropatologii i Psikhiatrii imeni S.S. Korsakova, Vol 82(3), 1982. pp. 47-51. Publisher: Russia: Izdatel'stvo "Medicina" Abstract: Presents data from 4-25 yr long observations of a group of boys distinguished since early age by a pronounced disproportionality of psychic development: an accelerated development of abstract-logical thinking with gross defects of sensuous perception, emotions, psychomotor functions, and adaptive behavior as a whole. Despite the evolutional course of the state, most Ss appeared to be unable to attain independent social adaptation. The degree and structure of this disharmonic underdevelopment allows one to regard this pathology as a variant of nervous system disontogenesis differing from, but bordering on, such forms as Kanner's autism, Asperger's psychopathy, or mental retardation with partial giftedness. (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)
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