Diagnostic criteria of autism and Asperger's syndrome: similarities and differences

The American Psychiatric Association's last version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; APA, 1994) identifies within pervasive developmental disorders five subgroups: (a) autistic disorder; (b) Rett's disorder; (c) childhood disintegrative disorder; (d) Asperger's disorder's and (e) pervasive developmental disorder not otherwise specified. However, the diagnosis of the different sub-groups is difficult to establish, particularly between autistic disorder and Asperger's disorder. This article exposes the diagnostic criteria of autism and Asperger's syndrome in order to illustrate the similarities and differences between the two disorders.     

Life begins on an ant farm for two patients with Asperger's syndrome.

Asperger's syndrome, a pervasive developmental disorder first diagnosed in childhood, is characterized by severe impairment in social interactions, communication, and stereotypic behavior. In this paper, the authors expand a prevailing emphasis on behavioral-educational treatments, by presenting an approach that focuses on psychodynamic factors, nonverbal communication, and animal assisted psychotherapy. The authors describe interactions between patients and therapists on a procedural, verbal and nonverbal level that further the therapeutic process with increasing affect. The treatments of an adult and a child both presenting Asperger's syndrome illustrate the bridging from their nonhuman world to the world of feelings and people. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Asperger's syndrome--a separate nosologic entity or part of the spectrum of autism

This paper describes Asperger's syndrome, a disease similar to the autistic disorder, delineated for the first time by Asperger in 1944, just a few months after L. Kanner described infantile autism. Although, according to the epidemiological data, it occurs far more frequently than infantile autism, in practice this diagnosis is rarely established. Asperger's syndrome is defined as autistic syndrome among children with relatively high degree of intellectual functions, with marked disorder of speech and motoricity and interest confined to a very specified area. Learning is mechanical and routine and games uninventive. Children lack the need for age peer company. Boys are affected ten times more frequently than girls.     

Pharmacotherapy in Autism and Related Disorders.

Autistic disorder is characterized by qualitative impairment in the areas of social interaction and communication, as well as stereotypic, repetitive patterns of behavior. In addition to the core features of autism, many individuals display a range of behavioral concerns including anxiety, aggression, agitation, overactivity, self-injury, and stereotypic behavior. Recent prevalence estimates indicate that over 45% of individuals with autism are prescribed psychotropic medications for management of associated behavioral disorders. Yet, there remain considerable gaps in our knowledge of medication efficacy and safety in this population. This article provides an overview of the research in this area, including efficacy and potential side effects of the most commonly prescribed psychotropic medications for children and adolescents with autism. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Phenotype of the tomato high pigment-2 mutant is caused by a mutation in the tomato homolog of DEETIOLATED1

Autism is a poorly understood developmental disorder characterized by social impairment, communication deficits, and compulsive behavior. The authors review evidence from animal studies demonstrating that the nonapeptides, oxytocin and vasopressin, have unique effects on the normal expression of species-typical social behavior, communication, and rituals. Based on this evidence, they hypothesize that an abnormality in oxytocin or vasopressin neurotransmission may account for several features of autism. As autism appears to be a genetic disorder, mutations in the various peptide, peptide receptor, or lineage-specific developmental genes could lead to altered oxytocin or vasopressin neurotransmission. Many of these genes have been cloned and sequenced, and several polymorphisms have been identified. Recent gene targeting studies that alter expression of either the peptides or their receptors in the rodent brain partially support the autism hypothesis. While previous experience suggests caution in hypothesizing a cause or suggesting a treatment for autism, the available preclinical evidence with oxytocin and vasopressin recommends the need for clinical studies using gene scanning, pharmacological and neurobiological approaches.     

Inhibition of triazolam clearance by macrolide antimicrobial agents: in vitro correlates and dynamic consequences

OBJECTIVE: To evaluate the ability of the DSM-IV criteria for the pervasive developmental disorders (PDD) to reliably and accurately differentiate PDD subtypes. METHOD: The sample consisted of 143 children with various types of developmental disabilities. A diagnosis of PDD and PDD subtype was made by one clinician using information obtained from the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule. The raw data from the Autism Diagnostic Interview-Revised, clinical notes (excluding diagnostic opinion), Autism Diagnostic Observation Schedule, IQ, and other available data were independently assessed by three experienced raters, each of whom then made a separate, blind diagnosis. If there was any disagreement, a consensus best-estimate (CBE) diagnosis was made after discussion. To assess reliability, the agreement between the three raters was calculated using k. Accuracy was assessed by calculating the agreement between the clinician's diagnosis and the CBE and by calculating the error rates associated with the three raters using latent class analysis. RESULTS: The current DSM-IV criteria show good to excellent reliability for the diagnosis of PDD, Asperger's disorder (AsD), and autism, but they show poor reliability for the diagnosis of atypical autism. The clinician (compared to the CBE) had little difficulty differentiating PDD from non-PDD children and autism from AsD but had more difficulty identifying children with atypical autism. The latent class analysis also showed that the average error rates of the three raters for a differentiation of atypical autism from autism were unacceptably high. CONCLUSIONS: Although the psychometric properties of the current DSM-IV criteria for autism and AsD appear quite acceptable, there is likely to be a high rate of misclassification of children given a diagnosis of atypical autism.     

Fragile X syndrome.

This article provides an overview of current research on Fragile X Syndrome, and how that knowledge can be used to guide successful intervention. The genetic etiology of Fragile X is reviewed and the physical, cognitive, adaptive, behavioral, and emotional phenotypes of children with the disorder are described, highlighting the differences in presentation among males and females. Comorbidity with autism is addressed. Typical strengths and weaknesses of children with Fragile X are delineated as a basis for educational assessment and intervention. A multidisciplinary approach to treatment is advocated, including medical management, educational accommodations, and speech-language and occupational therapy. The social and emotional challenges of those with the syndrome are considered in recommended interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intact implicit learning of spatial context and temporal sequences in childhood autism spectrum disorder.

Autism spectrum disorder (ASD) is defined by atypicalities in domains that are posited to rely on implicit learning processes such as social communication, language, and motor behavior. The authors examined 2 forms of implicit learning in 14 children with high-functioning ASD (10 of whom were diagnosed with Asperger's syndrome) and 14 control children, learning of spatial context known to be mediated by the medial temporal lobes (using the contextual cueing task) and of sequences known to be mediated by frontal-striatal and frontal-cerebellar circuits (using the alternating serial reaction time task). Both forms of learning were unimpaired in ASD. Spatial contextual implicit learning was spared in ASD despite slower visual search of spatial displays. The present findings provide evidence for the integrity of learning processes dependent on integration of spatial and sequential contextual information in high-functioning children with ASD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacité d'un programme d'entra?nement aux habiletés sociales pour enfants présentant des diagnostics psychiatriques hétérogènes.

The purpose of this study was to evaluate the effectiveness of a 12-session social skills group intervention for 9 to 14 years old children with mental health problems and poor peer relationships. The program (implemented in an outpatient clinic) combines social learning and cognitive-behavioural techniques to build children's social skills and relationships with peers. Participants (51 children; M age = 10.8 years, range = 9 to 14) presented one of the following primary diagnoses: ADHD, anxiety disorder, Asperger's syndrome, pervasive development disorder or adjustment disorder. They were matched on age, gender, diagnosis, and then randomly assigned to either the treatment or control/waiting list condition. Measures of children's social skills (SSRS; F. W. Gresham & S. N. Elliot, 1990) and anxiety (Multidimensional Anxiety Scale for Children; March, J. S., Parker, J. D. A., Sullivan, K., Stallings, P., & Conners, K., 1997) were collected pre- and post treatment. Results indicated that the social skills training program increased parent/children ratings of social skills, as well as decreased ratings of anxiety as compared to similar children on a waiting list for treatment. Implications for practise and research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Otolaryngologic management of dizziness in the older patient

Studies report that dizziness is the most common presenting symptom in older patients who seek primary care. To understand the causes of dizziness, which is one of the major risk factors in causing falls in the older population, basic anatomy and physiology are reviewed in this article. Age-specific histopathologic changes occur in the labyrinth of the inner ear. To display evidence of the patient's symptoms, evaluation must include a comprehensive history, neurotologic examination, and diagnostic testing. There are common disorders associated with dizziness; thus, management depends on the cause. Once a diagnosis is secured, treatment is instituted based on sound medical principles.     

Language in autism and specific language impairment: Where are the links?

It has been suggested that language impairment in autism is behaviorally, neurobiologically, and etiologically related to specific language impairment (SLI). In this article, the authors review evidence at each level and argue that the vast majority of data does not support the view that language impairment in autism can be explained in terms of comorbid SLI. The authors make recommendations for how this debate might be resolved and suggest a shift in research focus. They recommend that researchers concentrate on those aspects of language impairment that predominate in each disorder rather than on those comparatively small areas of potential overlap. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Memory illusions: False recall and recognition in adults with Asperger's syndrome": Correction to Bowler et al. (2000).

Reports an error in "Memory illusions: False recall and recognition in adults with Asperger's syndrome" by Dermot M. Bowler, John M. Gardiner, Sarah Grice and Pia Saavalainen (Journal of Abnormal Psychology, 2000[Nov], Vol 109[4], 663-672). On page 665, Figure 1, the figure caption incorrectly reads, "Serial position effects for the Asperger and control groups of participants. Gray boxes = Asperger; black boxes = controls." The correct Figure 1 caption appears in the correction. (The following abstract of the original article appeared in record 2000-12687-011.) As persons on the autistic spectrum are known not to use semantic features of word lists to aid recall, they might show diminished susceptibility to illusory memories that typically occur with lists of associated items. Alternatively, since such individuals also have poor source monitoring, they might show greater susceptibility. The authors found that adults with Asperger's syndrome (n?=?10) recalled similar proportions of a nonpresented strong associate of the study list items, compared with controls (n?=?15). In Exp 2, rates of true and false recognition of study list associates did not differ significantly between Asperger (n?=?10) and control (n?=?10) participants. Moreover, the Asperger participants made fewer remember and more know judgments than controls for veridical but not for false recognitions. Thus, deficits found in some aspects of memory in people with Asperger's syndrome do not affect their susceptibility to memory illusions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social phobia: an update

The literature on social phobia is reviewed in this article. Social phobia has undergone considerable diagnostic evolution to reach its present form in DSM-IV. Its differential diagnosis includes panic disorder with agoraphobia, avoidant personality disorder, depression, and "shyness." Cross-cultural issues are important to consider because the disorder may manifest differently in different cultures and social settings. It is common, with a lifetime prevalence of 13.3% in the United States according to recent epidemiological studies. Underrecognition of social phobia remains an issue of concern. Comorbidity with other psychiatric disorders, including other anxiety disorders, depression, alcohol abuse, and personality disorders, frequently occurs. Current conceptualizations of the etiology of social phobia reflect psychodynamic theories and evidence from family and genetic studies, neurobiological research, and neuroimaging. Drugs such as monoamine oxidase inhibitors, selective serotonin-reuptake inhibitors, benzodiazepines, and beta3-adrenergic blockers have proven to be efficacious, as has cognitive-behavioral treatment, including group approaches.     

Rett syndrome. An update and review for the primary pediatrician

Rett syndrome is a common developmental-neurologic disorder that has been reported almost exclusively in females. Recent work has improved recognition of this condition and helped to clarify the management of this disorder for affected individuals. The primary-care physician can become a major source of support and advocacy for the family of a girl with Rett syndrome. Many other resources are available to the primary care giver and the families of children with Rett syndrome; these may help to provide early diagnosis, psychological support, and preventive medical care for these individuals. The current state of knowledge regarding Rett syndrome is reviewed and a framework is provided for medical and developmental interventions.     

Social behavior phenotypes in fragile X syndrome, autism, and the Fmr1 knockout mouse: Theoretical comment on McNaughton et al. (2008).

Comments on the article by C. H. McNaughton et al. ((see record 2008-03769-005). Individuals with fragile X syndrome (FXS) show varying degrees of social behavior disturbances, from social anxiety to autism. This variability of social behavior phenotypes in FXS is likely to be due to interactions of Fmr1 with other gene variants and environmental factors during brain development, although very little is known about the specific genetic and neural mechanisms involved. The Fmr1 knockout mouse is an important experimental resource for elucidating the neural mechanisms of social anxiety, social reward, and social cognition. However, studies of social behavior phenotypes in the Fmr1 knockout mouse are still in early stages. McNaughton et al provide important new information on these phenotypes in the Fmr1 knockout mouse through their use of novel, detailed behavioral analysis to identify signs of increased social anxiety and social cognition deficits. Their significant refinements in measurement of social behavior phenotypes will help to advance future efforts to elucidate the genetic and neural mechanisms underlying social behavior disturbances in FXS and autism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is it migraine?

BACKGROUND: Migraine is a common disorder affecting 8-10% of the population. It results in significant morbidity and has social and economic consequences. Vascular and neurogenic mechanisms are involved in the genesis of migraine. Serotonin plays an important part. Attacks are brought on by internal (not identified) and external (identified) trigger factors in people predisposed to the condition, often on an hereditary basis. OBJECTIVE: The diagnosis of migraine depends on the recognition of the features specific to the condition. This article aims to define these features. DISCUSSION: There are diagnostic criteria which define the two main types of migraine--migraine with aura and migraine without aura. The variants of migraine need to be recognised and migraine needs to be distinguished from cluster headache. It is also important to recognise and exclude sinister causes of headache. Treatment is not discussed.     

Fibromyalgia. A critical review

Fibromyalgia is a chronic pain syndrome, more common in women. Its prevalence is estimated around 2% in the general population, and up to 20% among rheumatology outpatients. Besides musculoskeletal pain, symptoms as fatigue and sleep disturbance are considered characteristic. Research criteria have been set up, but their seemingly preciseness is unable to distinguish clearly between fibromyalgia and other functional somatic syndromes (chronic fatigue syndrome, irritable bowel syndrome) and psychiatric disorders (depression, anxiety), with which a striking comorbidity is documented. The diagnosis of fibromyalgia does not theoretically require the exclusion of muscle, joint, or metabolic diseases, but in clinical practice this problem proves to be of crucial importance. There are numbers of pathophysiological hypothesis for fibromyalgia, but none of them is fully satisfying: muscle is probably innocent; sleep disturbance, although sometimes considered a landmark of the syndrome, is unspecific; stress response studies show subtle anomaly; psychiatric disorders may represent factors of vulnerability and perpetuation rather than causes. We propose to include some of these etiological contributors in vicious circles leading to a "final common pathway" characterized by generalized hyperalgesia. Treatments of fibromyalgia, whether pharmacological (antidepressants) or psychological (cognitive-behavioral therapies) are of little efficacy, and the global prognosis of fibromyalgia is poor. However, the outcome might prove better outside the specialized clinics in which studies of chronic sufferers with severe abnormal illness behaviors are done. The social consequences of the popularization of the diagnosis of fibromyalgia should not be neglected.     

Transcriptional regulation of metabolic processes: implications for cardiac metabolism

Developmental delay is frequently used to identify children with delay in meeting developmental milestones in one or more streams of development. There is no consensus on the specific definition. Developmental delay is best viewed generically as a chief complaint rather than a diagnosis. A child suspected to have delays should always be assessed in each of the major streams of development: expressive and receptive language, including social communication; visual problem solving (nonverbal cognition); motor development; neurobehavioral development; and social-emotional development. A model developed by the National Center for Medical Rehabilitation Research is used to compare existing classifications of developmental delays. This model defines the five domains in the disability process: pathophysiology, impairment, functional limitation, disability, and societal limitation. An etiology domain is added. This model is used to illustrate how existing classification systems of cerebral palsy, mental retardation, autism, and language delay draw on information from one or more domains. The model illustrates some of the conflicts between different systems. For example, most classification systems for cerebral palsy emphasize only impairment (spasticity, dyskinesias, and topography). The current definition and classification system for mental retardation focuses on functional limitations (IQ), disability, and societal limitations, ignoring pathophysiology and details of impairment. Given the complexity of neurodevelopmental disabilities, it is unlikely that a single classification system will fit all needs.