Asperger Syndrome

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Asperger syndrome 1 Asperger syndrome Asperger syndrome Classification and external resources People with Asperger syndrome often display intense interests, such as this boy's fascination with molecular structure. ICD-10 F84.5 [1] ICD-9 299.80 OMIM 608638 [2] DiseasesDB 31268 [3] MedlinePlus 001549 [4] eMedicine ped/147 [5] MeSH F03.550.325.100 [6] Asperger syndrome (AS), also known as Asperger's syndrome or Asperger disorder, is an autism spectrum disorder (ASD) that is characterized by significant difficulties in social interaction, alongside restricted and repetitive patterns of behavior and interests. It differs from other autism spectrum disorders by its relative preservation of linguistic and cognitive development. Although not required for diagnosis, physical clumsiness and atypical use of language are frequently reported. [7][8] The syndrome is named after the Austrian pediatrician Hans Asperger who, in 1944, studied and described children in his practice who lacked nonverbal communication skills, demonstrated limited empathy with their peers, and were physically clumsy. [9] The modern conception of Asperger syndrome came into existence in 1981 [10] and went through a period of popularization, [11][12] becoming standardized as a diagnosis in the early 1990s. Many questions remain about aspects of the disorder. [13] For example, there is doubt about whether it is distinct from high-functioning autism (HFA); [14] partly because of this, its prevalence is not firmly established. [7] It has been proposed that the diagnosis of Asperger's be eliminated, to be replaced by a diagnosis of autism spectrum disorder on a severity scale. [15] The exact cause is unknown. Although research suggests the likelihood of a genetic basis, [7] there is no known genetic etiology [16][17] and brain imaging techniques have not identified a clear common pathology. [7] There is no single treatment, and the effectiveness of particular interventions is supported by only limited data. [7] Intervention is aimed at improving symptoms and function. The mainstay of management is behavioral therapy, focusing on specific deficits to address poor communication skills, obsessive or repetitive routines, and physical clumsiness. [18] Most children improve as they mature to adulthood, but social and communication difficulties may persist. [13] Some researchers and people with Asperger's have advocated a shift in attitudes toward the view that it is a difference,

Transcript of Asperger Syndrome

Asperger syndrome 1

Asperger syndrome

Asperger syndromeClassification and external resources

People with Asperger syndrome often display intense interests, such as this boy's fascination with molecular structure.

ICD-10 F84.5 [1]

ICD-9 299.80

OMIM 608638 [2]

DiseasesDB 31268 [3]

MedlinePlus 001549 [4]

eMedicine ped/147 [5]

MeSH F03.550.325.100 [6]

Asperger syndrome (AS), also known as Asperger's syndrome or Asperger disorder, is an autism spectrumdisorder (ASD) that is characterized by significant difficulties in social interaction, alongside restricted and repetitivepatterns of behavior and interests. It differs from other autism spectrum disorders by its relative preservation oflinguistic and cognitive development. Although not required for diagnosis, physical clumsiness and atypical use oflanguage are frequently reported.[7][8]

The syndrome is named after the Austrian pediatrician Hans Asperger who, in 1944, studied and described childrenin his practice who lacked nonverbal communication skills, demonstrated limited empathy with their peers, and werephysically clumsy.[9] The modern conception of Asperger syndrome came into existence in 1981[10] and wentthrough a period of popularization,[11][12] becoming standardized as a diagnosis in the early 1990s. Many questionsremain about aspects of the disorder.[13] For example, there is doubt about whether it is distinct fromhigh-functioning autism (HFA);[14] partly because of this, its prevalence is not firmly established.[7] It has beenproposed that the diagnosis of Asperger's be eliminated, to be replaced by a diagnosis of autism spectrum disorder ona severity scale.[15]

The exact cause is unknown. Although research suggests the likelihood of a genetic basis,[7] there is no known genetic etiology[16][17] and brain imaging techniques have not identified a clear common pathology.[7] There is no single treatment, and the effectiveness of particular interventions is supported by only limited data.[7] Intervention is aimed at improving symptoms and function. The mainstay of management is behavioral therapy, focusing on specific deficits to address poor communication skills, obsessive or repetitive routines, and physical clumsiness.[18]

Most children improve as they mature to adulthood, but social and communication difficulties may persist.[13] Some researchers and people with Asperger's have advocated a shift in attitudes toward the view that it is a difference,

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rather than a disability that must be treated or cured.[19][20]

ClassificationAsperger syndrome (AS) is one of the autism spectrum disorders (ASD) or pervasive developmental disorders(PDD), which are a spectrum of psychological conditions that are characterized by abnormalities of social interactionand communication that pervade the individual's functioning, and by restricted and repetitive interests and behavior.Like other psychological development disorders, ASD begins in infancy or childhood, has a steady course withoutremission or relapse, and has impairments that result from maturation-related changes in various systems of thebrain.[21] ASD, in turn, is a subset of the broader autism phenotype, which describes individuals who may not haveASD but do have autistic-like traits, such as social deficits.[22] Of the other four ASD forms, autism is the mostsimilar to AS in signs and likely causes, but its diagnosis requires impaired communication and allows delay incognitive development; Rett syndrome and childhood disintegrative disorder share several signs with autism but mayhave unrelated causes; and pervasive developmental disorder not otherwise specified (PDD-NOS) is diagnosed whenthe criteria for a more specific disorder are unmet.[23]

The extent of the overlap between AS and high-functioning autism (HFA—autism unaccompanied by mentalretardation) is unclear.[14][24][25] The current ASD classification is to some extent an artifact of how autism wasdiscovered,[26] and may not reflect the true nature of the spectrum;[27] methodological problems have beset Aspergersyndrome as a valid diagnosis from the outset.[28][29] One of the proposed changes to the fifth edition of theDiagnostic and Statistical Manual of Mental Disorders (DSM-5), to be published in May 2013,[30] would eliminateAsperger syndrome as a separate diagnosis, and fold it under autistic disorder (autism spectrum disorder), whichwould be rated on a severity scale.[15] Like the diagnosis of Asperger syndrome,[31] the proposed change iscontroversial,[32] and it has been argued that the syndrome's diagnostic criteria should be broadened.[31]

Asperger syndrome is also called Asperger's syndrome (AS),[7] Asperger (or Asperger's) disorder (AD),[24][33] orjust Asperger's.[34] There is little consensus among clinical researchers about whether the condition's name shouldend in "syndrome" or "disorder".[14]

CharacteristicsA pervasive developmental disorder, Asperger syndrome is distinguished by a pattern of symptoms rather than asingle symptom. It is characterized by qualitative impairment in social interaction, by stereotyped and restrictedpatterns of behavior, activities and interests, and by no clinically significant delay in cognitive development orgeneral delay in language.[33] Intense preoccupation with a narrow subject, one-sided verbosity, restricted prosody,and physical clumsiness are typical of the condition, but are not required for diagnosis.[14]

Social interactionFurther information: Asperger syndrome and interpersonal relationshipsThe lack of demonstrated empathy is possibly the most dysfunctional aspect of Asperger syndrome.[8] Individualswith AS experience difficulties in basic elements of social interaction, which may include a failure to developfriendships or to seek shared enjoyments or achievements with others (for example, showing others objects ofinterest), a lack of social or emotional reciprocity, and impaired nonverbal behaviors in areas such as eye contact,facial expression, posture, and gesture.[7]

People with AS may not be as withdrawn around others as those with other, more debilitating, forms of autism; they approach others, even if awkwardly. For example, a person with AS may engage in a one-sided, long-winded speech about a favorite topic, while misunderstanding or not recognizing the listener's feelings or reactions, such as a need for privacy or haste to leave.[14] This social awkwardness has been called "active but odd".[7] This failure to react appropriately to social interaction may appear as disregard for other people's feelings, and may come across as

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insensitive.[14] However, not all individuals with AS will approach others. Some of them may even display selectivemutism, speaking not at all to most people and excessively to specific people. Some may choose to talk only topeople they like.[35]

The cognitive ability of children with AS often allows them to articulate social norms in a laboratory context,[7]

where they may be able to show a theoretical understanding of other people's emotions; however, they typically havedifficulty acting on this knowledge in fluid, real-life situations.[14] People with AS may analyze and distill theirobservations of social interaction into rigid behavioral guidelines, and apply these rules in awkward ways, such asforced eye contact, resulting in a demeanor that appears rigid or socially naive. Childhood desire for companionshipcan become numbed through a history of failed social encounters.[7]

The hypothesis that individuals with AS are predisposed to violent or criminal behavior has been investigated but isnot supported by data.[7][36] More evidence suggests children with AS are victims rather than victimizers.[37] A 2008review found that an overwhelming number of reported violent criminals with AS had coexisting psychiatricdisorders such as schizoaffective disorder.[38]

Restricted and repetitive interests and behaviorPeople with Asperger syndrome often display behavior, interests, and activities that are restricted and repetitive andare sometimes abnormally intense or focused. They may stick to inflexible routines, move in stereotyped andrepetitive ways, or preoccupy themselves with parts of objects.[33]

Pursuit of specific and narrow areas of interest is one of the most striking features of AS.[7] Individuals with AS maycollect volumes of detailed information on a relatively narrow topic such as weather data or star names, withoutnecessarily having a genuine understanding of the broader topic.[7][14] For example, a child might memorize cameramodel numbers while caring little about photography.[7] This behavior is usually apparent by grade school, typicallyage 5 or 6 in the United States.[7] Although these special interests may change from time to time, they typicallybecome more unusual and narrowly focused, and often dominate social interaction so much that the entire familymay become immersed. Because narrow topics often capture the interest of children, this symptom may gounrecognized.[14]

Stereotyped and repetitive motor behaviors are a core part of the diagnosis of AS and other ASDs.[39] They includehand movements such as flapping or twisting, and complex whole-body movements.[33] These are typically repeatedin longer bursts and look more voluntary or ritualistic than tics, which are usually faster, less rhythmical and lessoften symmetrical.[40]

According to the Adult Asperger Assessment (AAA) diagnostic test, a lack of interest in fiction and the positivepreference towards non-fiction is common among adults with AS.[41]

Speech and languageAlthough individuals with Asperger syndrome acquire language skills without significant general delay and theirspeech typically lacks significant abnormalities, language acquisition and use is often atypical.[14] Abnormalitiesinclude verbosity, abrupt transitions, literal interpretations and miscomprehension of nuance, use of metaphormeaningful only to the speaker, auditory perception deficits, unusually pedantic, formal or idiosyncratic speech, andoddities in loudness, pitch, intonation, prosody, and rhythm.[7] Echolalia has also been observed in individuals withAS.[42]

Three aspects of communication patterns are of clinical interest: poor prosody, tangential and circumstantial speech, and marked verbosity. Although inflection and intonation may be less rigid or monotonic than in autism, people with AS often have a limited range of intonation: speech may be unusually fast, jerky or loud. Speech may convey a sense of incoherence; the conversational style often includes monologues about topics that bore the listener, fails to provide context for comments, or fails to suppress internal thoughts. Individuals with AS may fail to monitor whether the listener is interested or engaged in the conversation. The speaker's conclusion or point may never be

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made, and attempts by the listener to elaborate on the speech's content or logic, or to shift to related topics, are oftenunsuccessful.[14]

Children with AS may have an unusually sophisticated vocabulary at a young age and have been colloquially called"little professors", but have difficulty understanding figurative language and tend to use language literally.[7]

Children with AS appear to have particular weaknesses in areas of nonliteral language that include humor, irony, andteasing. Although individuals with AS usually understand the cognitive basis of humor, they seem to lackunderstanding of the intent of humor to share enjoyment with others.[24] Despite strong evidence of impaired humorappreciation, anecdotal reports of humor in individuals with AS seem to challenge some psychological theories ofAS and autism.[43]

OtherIndividuals with Asperger syndrome may have signs or symptoms that are independent of the diagnosis, but canaffect the individual or the family.[44] These include differences in perception and problems with motor skills, sleep,and emotions.Individuals with AS often have excellent auditory and visual perception.[45] Children with ASD often demonstrateenhanced perception of small changes in patterns such as arrangements of objects or well-known images; typicallythis is domain-specific and involves processing of fine-grained features.[46] Conversely, compared to individualswith high-functioning autism, individuals with AS have deficits in some tasks involving visual-spatial perception,auditory perception, or visual memory.[7] Many accounts of individuals with AS and ASD report other unusualsensory and perceptual skills and experiences. They may be unusually sensitive or insensitive to sound, light, andother stimuli;[47] these sensory responses are found in other developmental disorders and are not specific to AS or toASD. There is little support for increased fight-or-flight response or failure of habituation in autism; there is moreevidence of decreased responsiveness to sensory stimuli, although several studies show no differences.[48]

Hans Asperger's initial accounts[7] and other diagnostic schemes[49] include descriptions of physical clumsiness.Children with AS may be delayed in acquiring skills requiring motor dexterity, such as riding a bicycle or opening ajar, and may seem to move awkwardly or feel "uncomfortable in their own skin". They may be poorly coordinated,or have an odd or bouncy gait or posture, poor handwriting, or problems with visual-motor integration.[7][14] Theymay show problems with proprioception (sensation of body position) on measures of apraxia (motor planningdisorder), balance, tandem gait, and finger-thumb apposition. There is no evidence that these motor skills problemsdifferentiate AS from other high-functioning ASDs.[7]

Children with AS are more likely to have sleep problems, including difficulty in falling asleep, frequent nocturnalawakenings, and early morning awakenings.[50][51] AS is also associated with high levels of alexithymia, which isdifficulty in identifying and describing one's emotions.[52] Although AS, lower sleep quality, and alexithymia areassociated, their causal relationship is unclear.[51]

As with other forms of ASD, parents of children with AS have higher levels of stress.[53]

CausesFurther information: Causes of autismHans Asperger described common symptoms among his patients' family members, especially fathers, and research supports this observation and suggests a genetic contribution to Asperger syndrome. Although no specific gene has yet been identified, multiple factors are believed to play a role in the expression of autism, given the phenotypic variability seen in children with AS.[7][54] Evidence for a genetic link is the tendency for AS to run in families and an observed higher incidence of family members who have behavioral symptoms similar to AS but in a more limited form (for example, slight difficulties with social interaction, language, or reading).[18] Most research suggests that all autism spectrum disorders have shared genetic mechanisms, but AS may have a stronger genetic component than

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autism.[7] There is probably a common group of genes where particular alleles render an individual vulnerable todeveloping AS; if this is the case, the particular combination of alleles would determine the severity and symptomsfor each individual with AS.[18]

A few ASD cases have been linked to exposure to teratogens (agents that cause birth defects) during the first eightweeks from conception. Although this does not exclude the possibility that ASD can be initiated or affected later, itis strong evidence that it arises very early in development.[55] Many environmental factors have been hypothesized toact after birth, but none has been confirmed by scientific investigation.[56]

MechanismFurther information: Mechanism of autismAsperger syndrome appears to result from developmental factors that affect many or all functional brain systems, asopposed to localized effects.[57] Although the specific underpinnings of AS or factors that distinguish it from otherASDs are unknown, and no clear pathology common to individuals with AS has emerged,[7] it is still possible thatAS's mechanism is separate from other ASDs.[58] Neuroanatomical studies and the associations with teratogensstrongly suggest that the mechanism includes alteration of brain development soon after conception.[55] Abnormalmigration of embryonic cells during fetal development may affect the final structure and connectivity of the brain,resulting in alterations in the neural circuits that control thought and behavior.[59] Several theories of mechanism areavailable; none are likely to provide a complete explanation.[60]

Functional magnetic resonance imaging providessome evidence for both underconnectivity and

mirror neuron theories.[61][62]

The underconnectivity theory hypothesizes underfunctioninghigh-level neural connections and synchronization, along with anexcess of low-level processes.[61] It maps well to general-processingtheories such as weak central coherence theory, which hypothesizesthat a limited ability to see the big picture underlies the centraldisturbance in ASD.[63] A related theory—enhanced perceptualfunctioning—focuses more on the superiority of locally oriented andperceptual operations in autistic individuals.[64]

The mirror neuron system (MNS) theory hypothesizes that alterationsto the development of the MNS interfere with imitation and lead toAsperger's core feature of social impairment.[62][65] For example, onestudy found that activation is delayed in the core circuit for imitation inindividuals with AS.[66] This theory maps well to social cognitiontheories like the theory of mind, which hypothesizes that autistic behavior arises from impairments in ascribingmental states to oneself and others,[67] or hyper-systemizing, which hypothesizes that autistic individuals cansystematize internal operation to handle internal events but are less effective at empathizing by handling eventsgenerated by other agents.[68]

Other possible mechanisms include serotonin dysfunction[69] and cerebellar dysfunction.[70]

ScreeningParents of children with Asperger syndrome can typically trace differences in their children's development to as early as 30 months of age.[54] Developmental screening during a routine check-up by a general practitioner or pediatrician may identify signs that warrant further investigation.[7][18] The diagnosis of AS is complicated by the use of several different screening instruments,[18][49] including the Asperger Syndrome Diagnostic Scale (ASDS), Autism Spectrum Screening Questionnaire (ASSQ), Childhood Asperger Syndrome Test (CAST), Gilliam Asperger's Disorder Scale (GADS), Krug Asperger's Disorder Index (KADI),[71] and the Autism Spectrum Quotient (AQ; with versions for children,[72] adolescents[73] and adults[74]). None have been shown to reliably differentiate between AS

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and other ASDs.[7]

DiagnosisStandard diagnostic criteria require impairment in social interaction and repetitive and stereotyped patterns ofbehavior, activities and interests, without significant delay in language or cognitive development. Unlike theinternational standard,[21] U.S. criteria also require significant impairment in day-to-day functioning.[33] Other sets ofdiagnostic criteria have been proposed by Szatmari et al.[75] and by Gillberg and Gillberg.[76]

Diagnosis is most commonly made between the ages of four and eleven.[7] A comprehensive assessment involves amultidisciplinary team[8][18][77] that observes across multiple settings,[7] and includes neurological and geneticassessment as well as tests for cognition, psychomotor function, verbal and nonverbal strengths and weaknesses,style of learning, and skills for independent living.[18] The "gold standard" in diagnosing ASDs combines clinicaljudgment with the Autism Diagnostic Interview-Revised (ADI-R)—a semistructured parent interview—and theAutism Diagnostic Observation Schedule (ADOS)—a conversation and play-based interview with the child.[13]

Delayed or mistaken diagnosis can be traumatic for individuals and families; for example, misdiagnosis can lead tomedications that worsen behavior.[77][78] Many children with AS are initially misdiagnosed with attention-deficithyperactivity disorder (ADHD).[7] Diagnosing adults is more challenging, as standard diagnostic criteria aredesigned for children and the expression of AS changes with age;[79] adult diagnosis requires painstaking clinicalexamination and thorough medical history gained from both the individual and other people who know the person,focusing on childhood behavior.[41] Conditions that must be considered in a differential diagnosis include otherASDs, the schizophrenia spectrum, ADHD, obsessive compulsive disorder, major depressive disorder, semanticpragmatic disorder, nonverbal learning disorder,[77] Tourette syndrome,[40] stereotypic movement disorder, andbipolar disorder.[54]

Underdiagnosis and overdiagnosis are problems in marginal cases. The cost and difficulty of screening andassessment can delay diagnosis. Conversely, the increasing popularity of drug treatment options and the expansion ofbenefits has motivated providers to overdiagnose ASD.[80] There are indications AS has been diagnosed morefrequently in recent years, partly as a residual diagnosis for children of normal intelligence who do not have autismbut have social difficulties.[14] In 2006, it was reported to be the fastest-growing psychiatric diagnosis in SiliconValley children; also, there is a predilection for adults to self-diagnose it.[81] There are questions about the externalvalidity of the AS diagnosis. That is, it is unclear whether there is a practical benefit in distinguishing AS from HFAand from PDD-NOS;[14] the same child can receive different diagnoses depending on the screening tool.[18] Thedebate about distinguishing AS from HFA is partly due to a tautological dilemma where disorders are defined basedon severity of impairment, so that studies that appear to confirm differences based on severity are to be expected.[82]

ManagementFurther information: Autism therapiesAsperger syndrome treatment attempts to manage distressing symptoms and to teach age-appropriate social,communication and vocational skills that are not naturally acquired during development,[7] with intervention tailoredto the needs of the individual based on multidisciplinary assessment.[83] Although progress has been made, datasupporting the efficacy of particular interventions are limited.[7][84]

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TherapiesThe ideal treatment for AS coordinates therapies that address core symptoms of the disorder, including poorcommunication skills and obsessive or repetitive routines. While most professionals agree that the earlier theintervention, the better, there is no single best treatment package.[18] AS treatment resembles that of otherhigh-functioning ASDs, except that it takes into account the linguistic capabilities, verbal strengths, and nonverbalvulnerabilities of individuals with AS.[7] A typical program generally includes:[18]

• Social skills training for more effective interpersonal interactions.[85]

• Cognitive behavioral therapy to improve stress management relating to anxiety or explosive emotions[86] and tocut back on obsessive interests and repetitive routines.

• Medication, for coexisting conditions such as major depressive disorder and anxiety disorder.[87]

• Occupational or physical therapy to assist with poor sensory integration and motor coordination.• Social communication intervention, which is specialized speech therapy to help with the pragmatics of the give

and take of normal conversation.[88]

•• Training and support of parents, particularly in behavioral techniques to use in the home.Of the many studies on behavior-based early intervention programs, most are case studies of up to five participants,and typically examine a few problem behaviors such as self-injury, aggression, noncompliance, stereotypies, orspontaneous language; unintended side effects are largely ignored.[89] Despite the popularity of social skills training,its effectiveness is not firmly established.[90] A randomized controlled study of a model for training parents inproblem behaviors in their children with AS showed that parents attending a one-day workshop or six individuallessons reported fewer behavioral problems, while parents receiving the individual lessons reported less intensebehavioral problems in their AS children.[91] Vocational training is important to teach job interview etiquette andworkplace behavior to older children and adults with AS, and organization software and personal data assistants canimprove the work and life management of people with AS.[7]

MedicationsNo medications directly treat the core symptoms of AS.[87] Although research into the efficacy of pharmaceuticalintervention for AS is limited,[7] it is essential to diagnose and treat comorbid conditions.[8] Deficits inself-identifying emotions or in observing effects of one's behavior on others can make it difficult for individuals withAS to see why medication may be appropriate.[87] Medication can be effective in combination with behavioralinterventions and environmental accommodations in treating comorbid symptoms such as anxiety disorder, majordepressive disorder, inattention and aggression.[7] The atypical antipsychotic medications risperidone and olanzapinehave been shown to reduce the associated symptoms of AS;[7] risperidone can reduce repetitive and self-injuriousbehaviors, aggressive outbursts and impulsivity, and improve stereotypical patterns of behavior and socialrelatedness. The selective serotonin reuptake inhibitors (SSRIs) fluoxetine, fluvoxamine, and sertraline have beeneffective in treating restricted and repetitive interests and behaviors.[7][8][54]

Care must be taken with medications, as side effects may be more common and harder to evaluate in individualswith AS, and tests of drugs' effectiveness against comorbid conditions routinely exclude individuals from the autismspectrum.[87] Abnormalities in metabolism, cardiac conduction times, and an increased risk of type 2 diabetes havebeen raised as concerns with these medications,[92][93] along with serious long-term neurological side effects.[89]

SSRIs can lead to manifestations of behavioral activation such as increased impulsivity, aggression, and sleepdisturbance.[54] Weight gain and fatigue are commonly reported side effects of risperidone, which may also lead toincreased risk for extrapyramidal symptoms such as restlessness and dystonia[54] and increased serum prolactinlevels.[94] Sedation and weight gain are more common with olanzapine,[93] which has also been linked withdiabetes.[92] Sedative side-effects in school-age children[95] have ramifications for classroom learning. Individualswith AS may be unable to identify and communicate their internal moods and emotions or to tolerate side effects thatfor most people would not be problematic.[96]

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PrognosisThere is some evidence that children with AS may see a lessening of symptoms; up to 20% of children may nolonger meet the diagnostic criteria as adults, although social and communication difficulties may persist.[13] As of2006, no studies addressing the long-term outcome of individuals with Asperger syndrome are available and thereare no systematic long-term follow-up studies of children with AS.[14] Individuals with AS appear to have normallife expectancy, but have an increased prevalence of comorbid psychiatric conditions, such as major depressivedisorder and anxiety disorder that may significantly affect prognosis.[7][13] Although social impairment is lifelong,the outcome is generally more positive than with individuals with lower functioning autism spectrum disorders;[7] forexample, ASD symptoms are more likely to diminish with time in children with AS or HFA.[97] Although moststudents with AS/HFA have average mathematical ability and test slightly worse in mathematics than in generalintelligence, some are gifted in mathematics[98] and AS has not prevented some adults from major accomplishmentssuch as winning the Nobel Prize.[99]

Although many attend regular education classes, some children with AS may utilize special education servicesbecause of their social and behavioral difficulties.[14] Adolescents with AS may exhibit ongoing difficulty with selfcare or organization, and disturbances in social and romantic relationships. Despite high cognitive potential, mostyoung adults with AS remain at home, although some do marry and work independently.[7] The "different-ness"adolescents experience can be traumatic.[100] Anxiety may stem from preoccupation over possible violations ofroutines and rituals, from being placed in a situation without a clear schedule or expectations, or from concern withfailing in social encounters;[7] the resulting stress may manifest as inattention, withdrawal, reliance on obsessions,hyperactivity, or aggressive or oppositional behavior.[86] Depression is often the result of chronic frustration fromrepeated failure to engage others socially, and mood disorders requiring treatment may develop.[7] Clinicalexperience suggests the rate of suicide may be higher among those with AS, but this has not been confirmed bysystematic empirical studies.[101]

Education of families is critical in developing strategies for understanding strengths and weaknesses;[8] helping thefamily to cope improves outcomes in children.[37] Prognosis may be improved by diagnosis at a younger age thatallows for early interventions, while interventions in adulthood are valuable but less beneficial.[8] There are legalimplications for individuals with AS as they run the risk of exploitation by others and may be unable to comprehendthe societal implications of their actions.[8]

EpidemiologyFurther information: Conditions comorbid to autism spectrum disordersPrevalence estimates vary enormously. A 2003 review of epidemiological studies of children found autismprevalence rates ranging from 0.03 to 4.84 per 1,000, with the ratio of autism to Asperger syndrome ranging from1.5:1 to 16:1;[102] combining the geometric mean ratio of 5:1 with a conservative prevalence estimate for autism of1.3 per 1,000 suggests indirectly that the prevalence of AS might be around 0.26 per 1,000.[103] Part of the variancein estimates arises from differences in diagnostic criteria. For example, a relatively small 2007 study of 5,484eight-year-old children in Finland found 2.9 children per 1,000 met the ICD-10 criteria for an AS diagnosis, 2.7 per1,000 for Gillberg and Gillberg criteria, 2.5 for DSM-IV, 1.6 for Szatmari et al., and 4.3 per 1,000 for the union ofthe four criteria. Boys seem to be more likely to have AS than girls; estimates of the sex ratio range from 1.6:1 to4:1, using the Gillberg and Gillberg criteria.[104]

Anxiety disorder and major depressive disorder are the most common conditions seen at the same time; comorbidity of these in persons with AS is estimated at 65%.[7] Depression is common in adolescents and adults; children are likely to present with ADHD.[31] Reports have associated AS with medical conditions such as aminoaciduria and ligamentous laxity, but these have been case reports or small studies and no factors have been associated with AS across studies.[7] One study of males with AS found an increased rate of epilepsy and a high rate (51%) of nonverbal

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learning disorder.[105] AS is associated with tics, Tourette syndrome, and bipolar disorder, and the repetitivebehaviors of AS have many similarities with the symptoms of obsessive-compulsive disorder andobsessive-compulsive personality disorder.[106] However many of these studies are based on clinical samples or lackstandardized measures; nonetheless, comorbid conditions are relatively common.[13]

HistoryNamed after the Austrian pediatrician Hans Asperger (1906–1980), Asperger syndrome is a relatively new diagnosisin the field of autism.[107] As a child, Asperger appears to have exhibited some features of the very condition namedafter him, such as remoteness and talent in language.[108][109] In 1944, Asperger described four children in hispractice[8] who had difficulty in integrating themselves socially. The children lacked nonverbal communicationskills, failed to demonstrate empathy with their peers, and were physically clumsy. Asperger called the condition"autistic psychopathy" and described it as primarily marked by social isolation.[18] Fifty years later, severalstandardizations of AS as a diagnosis were tentatively proposed, many of which diverge significantly fromAsperger's original work.[110]

Unlike today's AS, autistic psychopathy could be found in people of all levels of intelligence, including those withmental retardation.[111] In the context of the Nazi eugenics policy of sterilizing and killing social deviants and thementally handicapped, Asperger passionately defended the value of autistic individuals, writing "We are convinced,then, that autistic people have their place in the organism of the social community. They fulfill their role well,perhaps better than anyone else could, and we are talking of people who as children had the greatest difficulties andcaused untold worries to their care-givers."[9] Asperger also called his young patients "little professors",[9] andbelieved some would be capable of exceptional achievement and original thought later in life.[8] His paper waspublished during wartime and in German, so it was not widely read elsewhere.Lorna Wing popularized the term Asperger syndrome in the English-speaking medical community in her 1981publication[112] of a series of case studies of children showing similar symptoms,[107] and Uta Frith translatedAsperger's paper to English in 1991.[9] Sets of diagnostic criteria were outlined by Gillberg and Gillberg in 1989 andby Szatmari et al. in the same year.[104] AS became a standard diagnosis in 1992, when it was included in the tenthedition of the World Health Organization's diagnostic manual, International Classification of Diseases (ICD-10); in1994, it was added to the fourth edition of the American Psychiatric Association's diagnostic reference, Diagnosticand Statistical Manual of Mental Disorders (DSM-IV).[18]

Hundreds of books, articles and websites now describe AS, and prevalence estimates have increased dramatically forASD, with AS recognized as an important subgroup.[107] Whether it should be seen as distinct from high-functioningautism is a fundamental issue requiring further study,[8] and there are questions about the empirical validation of theDSM-IV and ICD-10 criteria.[14]

Cultural aspectsFurther information: Sociological and cultural aspects of autismPeople identifying with Asperger syndrome may refer to themselves in casual conversation as aspies (a term firstused in print by Liane Holliday Willey in 1999).[113] The word neurotypical (abbreviated NT) describes a personwhose neurological development and state are typical, and is often used to refer to non-autistic people. The Internethas allowed individuals with AS to communicate and celebrate diversity with each other in a way that was notpreviously possible because of their rarity and geographic dispersal. A subculture of aspies has formed. Internet siteslike Wrong Planet have made it easier for individuals to connect.[19]

Autistic people have advocated a shift in perception of autism spectrum disorders as complex syndromes rather than diseases that must be cured. Proponents of this view reject the notion that there is an "ideal" brain configuration and that any deviation from the norm is pathological; they promote tolerance for what they call neurodiversity.[114] These

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views are the basis for the autistic rights and autistic pride movements.[115] There is a contrast between the attitudeof adults with self-identified AS, who typically do not want to be cured and are proud of their identity, and parents ofchildren with AS, who typically seek assistance and a cure for their children.[116]

Some researchers have argued that AS can be viewed as a different cognitive style, not a disorder or a disability,[19]

and that it should be removed from the standard Diagnostic and Statistical Manual, much as homosexuality wasremoved.[117] In a 2002 paper, Simon Baron-Cohen wrote of those with AS, "In the social world, there is no greatbenefit to a precise eye for detail, but in the worlds of maths, computing, cataloguing, music, linguistics,engineering, and science, such an eye for detail can lead to success rather than failure." Baron-Cohen cited tworeasons why it might still be useful to consider AS to be a disability: to ensure provision for legally required specialsupport, and to recognize emotional difficulties from reduced empathy.[20] It has been argued that the genes forAsperger's combination of abilities have operated throughout recent human evolution and have made remarkablecontributions to human history.[118]

References[1] http:/ / apps. who. int/ classifications/ icd10/ browse/ 2010/ en#/ F84. 5[2] http:/ / omim. org/ entry/ 608638[3] http:/ / www. diseasesdatabase. com/ ddb31268. htm[4] http:/ / www. nlm. nih. gov/ medlineplus/ ency/ article/ 001549. htm[5] http:/ / www. emedicine. com/ ped/ topic147. htm[6] http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2011/ MB_cgi?mode=& term=Asperger+ syndrome& field=entry#TreeF03. 550. 325. 100[7] McPartland J, Klin A (2006). "Asperger's syndrome". Adolesc Med Clin 17 (3): 771–88. doi:10.1016/j.admecli.2006.06.010.

PMID 17030291.[8] Baskin JH, Sperber M, Price BH (2006). "Asperger syndrome revisited". Rev Neurol Dis 3 (1): 1–7. PMID 16596080.[9] Asperger H; tr. and annot. Frith U (1991) [1944]. "'Autistic psychopathy' in childhood". In Frith U. Autism and Asperger syndrome.

Cambridge University Press. pp. 37–92. ISBN 0-521-38608-X.[10] Klin A, Pauls D, Schultz R, Volkmar F (2005). "Three diagnostic approaches to Asperger syndrome: Implications for research". J of Autism

and Dev Dis 35 (2): 221–34. doi:10.1007/s10803-004-2002-y. PMID 15909408.[11] Wing L (1998). "The history of Asperger syndrome" (http:/ / books. google. com/ ?id=jz_xbeWgG9AC& printsec=frontcover&

dq=Asperger+ syndrome+ or+ high-functioning+ autism#v=onepage& q=Asperger syndrome or high-functioning autism?& f=false). InSchopler E, Mesibov GB, Kunce LJ. Asperger syndrome or high-functioning autism?. New York: Plenum press. pp. 11–25.ISBN 0-306-45746-6. .

[12] Woodbury-Smith M, Klin A, Volkmar F (2005). "Asperger's Syndrome: A Comparison of Clinical Diagnoses and Those Made According tothe ICD-10 and DSM-IV". J of Autism and Dev Disord. 35 (2): 235–240. doi:10.1007/s10803-004-2002-x. PMID 15909409.

[13] Woodbury-Smith MR, Volkmar FR (January 2009). "Asperger syndrome". Eur Child Adolesc Psychiatry 18 (1): 2–11.doi:10.1007/s00787-008-0701-0. PMID 18563474.

[14] Klin A (2006). "Autism and Asperger syndrome: an overview" (http:/ / www. scielo. br/ scielo. php?script=sci_arttext&pid=S1516-44462006000500002& lng=en& nrm=iso& tlng=en). Rev Bras Psiquiatr 28 (suppl 1): S3–S11.doi:10.1590/S1516-44462006000500002. PMID 16791390. .

[15] "299.80 Asperger's Disorder" (http:/ / www. dsm5. org/ ProposedRevisions/ Pages/ proposedrevision. aspx?rid=97#). DSM-5 Development.American Psychiatric Association. . Retrieved 2010-12-21.

[16] Matson JL, Minshawi NF (2006). "Etiology and prevalence" (http:/ / books. google. com/ ?id=XonQy12xCgEC& pg=PP2& dq=Early+intervention+ for+ autism+ spectrum+ disorders:+ a+ critical+ analysis#v=onepage& q=Early intervention for autism spectrum disorders: acritical analysis& f=false). Early intervention for autism spectrum disorders: a critical analysis. Amsterdam: Elsevier Science. p. 33.ISBN 0-08-044675-2. .

[17] Klauck SM (2006). "Genetics of autism spectrum disorder" (http:/ / www. nature. com/ ejhg/ journal/ v14/ n6/ pdf/ 5201610a. pdf) (PDF).Eur J of Hum Genet 14 (6): 714–720. doi:10.1038/sj.ejhg.5201610. .

[18] National Institute of Neurological Disorders and Stroke (NINDS) (2007-07-31). "Asperger syndrome fact sheet" (http:/ / www. ninds. nih.gov/ disorders/ asperger/ detail_asperger. htm). . Retrieved 2007-08-24. NIH Publication No. 05-5624.

[19] Clarke J, van Amerom G (2007). "'Surplus suffering': differences between organizational understandings of Asperger's syndrome and thosepeople who claim the 'disorder'". Disabil Soc 22 (7): 761–76. doi:10.1080/09687590701659618.

[20] Baron-Cohen S (2002). "Is Asperger syndrome necessarily viewed as a disability?". Focus Autism Other Dev Disabl 17 (3): 186–91.doi:10.1177/10883576020170030801. A preliminary, freely readable draft, with slightly different wording in the quoted text, is in:Baron-Cohen S (2002). "Is Asperger's syndrome necessarily a disability?" (http:/ / autismresearchcentre. com/ docs/ papers/2002_BC_ASDisability. pdf) (PDF). Cambridge: Autism Research Centre. . Retrieved 2008-12-02.

Asperger syndrome 11

[21] World Health Organization (2006). "F84. Pervasive developmental disorders" (http:/ / apps. who. int/ classifications/ apps/ icd/ icd10online/?gf80. htm+ f840). International Statistical Classification of Diseases and Related Health Problems (10th (ICD-10) ed.).ISBN 92-4-154419-8. . Retrieved 2007-06-25.

[22] Piven J, Palmer P, Jacobi D, Childress D, Arndt S (1997). "Broader autism phenotype: evidence from a family history study ofmultiple-incidence autism families" (http:/ / ajp. psychiatryonline. org/ cgi/ reprint/ 154/ 2/ 185. pdf) (PDF). Am J Psychiatry 154 (2): 185–90.PMID 9016266. .

[23] Lord C, Cook EH, Leventhal BL, Amaral DG (2000). "Autism spectrum disorders". Neuron 28 (2): 355–63.doi:10.1016/S0896-6273(00)00115-X. PMID 11144346.

[24] Kasari C, Rotheram-Fuller E (2005). "Current trends in psychological research on children with high-functioning autism and Aspergerdisorder". Curr Opin Psychiatry 18 (5): 497–501. doi:10.1097/01.yco.0000179486.47144.61. PMID 16639107.

[25] Witwer AN, Lecavalier L (2008). "Examining the validity of autism spectrum disorder subtypes". J Autism Dev Disord 38 (9): 1611–24.doi:10.1007/s10803-008-0541-2. PMID 18327636.

[26] Sanders JL (2009). "Qualitative or quantitative differences between Asperger's Disorder and autism? historical considerations". J AutismDev Disord 39 (11): 1560–7. doi:10.1007/s10803-009-0798-0. PMID 19548078.

[27] Szatmari P (2000). "The classification of autism, Asperger's syndrome, and pervasive developmental disorder" (http:/ / ww1. cpa-apc.org:8080/ Publications/ Archives/ CJP/ 2000/ Oct/ Classification. asp). Can J Psychiatry 45 (8): 731–38. PMID 11086556. .

[28] Matson JL, Minshawi NF (2006). "History and development of autism spectrum disorders" (http:/ / books. google. com/?id=XonQy12xCgEC& pg=PP2& dq=Early+ intervention+ for+ autism+ spectrum+ disorders:+ a+ critical+ analysis#v=onepage& q=Earlyintervention for autism spectrum disorders: a critical analysis& f=false). Early intervention for autism spectrum disorders: a critical analysis.Amsterdam: Elsevier Science. p. 21. ISBN 0-08-044675-2. .

[29] Schopler E (1998). "Premature popularization of Asperger syndrome" (http:/ / books. google. com/ ?id=jz_xbeWgG9AC&printsec=frontcover& dq=Asperger+ syndrome+ or+ high-functioning+ autism#v=onepage& q=Asperger syndrome or high-functioningautism?& f=false). In Schopler E, Mesibov GB, Kunce LJ. Asperger syndrome or high-functioning autism?. New York: Plenum press.pp. 388–90. ISBN 0-306-45746-6. .

[30] "DSM-5 development" (http:/ / dsm5. org/ Pages/ Default. aspx). American Psychiatric Association. 2010. . Retrieved 2010-02-20.[31] Ghaziuddin M (2010). "Should the DSM V drop Asperger syndrome?". J Autism Dev Disord 40 (9): 1146–8.

doi:10.1007/s10803-010-0969-z. PMID 20151184.[32] Faras H, Al Ateeqi N, Tidmarsh L (2010). "Autism spectrum disorders". Ann Saudi Med 30 (4): 295–300. doi:10.4103/0256-4947.65261.

PMC 2931781. PMID 20622347.[33] American Psychiatric Association (2000). "Diagnostic criteria for 299.80 Asperger's Disorder (AD)" (http:/ / www. behavenet. com/

capsules/ disorders/ asperger. htm). Diagnostic and Statistical Manual of Mental Disorders (4th, text revision (DSM-IV-TR) ed.).ISBN 0-89042-025-4. . Retrieved 2007-06-28.

[34] Rausch JL, Johnson ME (2008). "Diagnosis of Asperger's disorder". In Rausch JL, Johnson ME, Casanova MF (eds.). Asperger's Disorder.Informa Healthcare. pp. 19–62. ISBN 0-8493-8360-9.

[35] Brasic JR (2010-07-07). "Asperger's Syndrome" (http:/ / emedicine. medscape. com/ article/ 912296-overview). Medscape eMedicine. .Retrieved 2010-11-25.

[36] Allen D, Evans C, Hider A, Hawkins S, Peckett H, Morgan H (2008). "Offending behaviour in adults with Asperger syndrome". J AutismDev Disord 38 (4): 748–58. doi:10.1007/s10803-007-0442-9. PMID 17805955.

[37] Tsatsanis KD (2003). "Outcome research in Asperger syndrome and autism" (http:/ / www. childpsych. theclinics. com/ article/PIIS1056499302000561/ fulltext). Child Adolesc Psychiatr Clin N Am 12 (1): 47–63. doi:10.1016/S1056-4993(02)00056-1. PMID 12512398..

[38] Newman SS, Ghaziuddin M (2008). "Violent crime in Asperger syndrome: the role of psychiatric comorbidity". J Autism Dev Disord 38(10): 1848–52. doi:10.1007/s10803-008-0580-8. PMID 18449633.

[39] South M, Ozonoff S, McMahon WM (2005). "Repetitive behavior profiles in Asperger syndrome and high-functioning autism". J AutismDev Disord 35 (2): 145–58. doi:10.1007/s10803-004-1992-8. PMID 15909401.

[40] Rapin I (2001). "Autism spectrum disorders: relevance to Tourette syndrome". Adv Neurol 85: 89–101. PMID 11530449.[41] Roy M, Dillo W, Emrich HM, Ohlmeier MD (2009). "Asperger's syndrome in adulthood". Dtsch Arztebl Int 106 (5): 59–64.

doi:10.3238/arztebl.2009.0059. PMC 2695286. PMID 19562011.[42] Frith U (January 1996). "Social communication and its disorder in autism and Asperger syndrome". J. Psychopharmacol. (Oxford) 10 (1):

48–53. doi:10.1177/026988119601000108. PMID 22302727.[43] Lyons V, Fitzgerald M (2004). "Humor in autism and Asperger syndrome". J Autism Dev Disord 34 (5): 521–31.

doi:10.1007/s10803-004-2547-8. PMID 15628606.[44] Filipek PA, Accardo PJ, Baranek GT et al (1999). "The screening and diagnosis of autistic spectrum disorders". J Autism Dev Disord 29 (6):

439–84. doi:10.1023/A:1021943802493. PMID 10638459.[45] Frith U (2004). "Emanuel Miller lecture: confusions and controversies about Asperger syndrome". J Child Psychol Psychiatry 45 (4):

672–86. doi:10.1111/j.1469-7610.2004.00262.x. PMID 15056300.[46] Prior M, Ozonoff S (2007). "Psychological factors in autism". In Volkmar FR. Autism and Pervasive Developmental Disorders (2nd ed.).

Cambridge University Press. pp. 69–128. ISBN 0-521-54957-4.

Asperger syndrome 12

[47] Bogdashina O (2003). Sensory Perceptional Issues in Autism and Asperger Syndrome: Different Sensory Experiences, Different PerceptualWorlds. Jessica Kingsley. ISBN 1-84310-166-1.

[48] Rogers SJ, Ozonoff S (2005). "Annotation: what do we know about sensory dysfunction in autism? A critical review of the empiricalevidence". J Child Psychol Psychiatry 46 (12): 1255–68. doi:10.1111/j.1469-7610.2005.01431.x. PMID 16313426.

[49] Ehlers S, Gillberg C (1993). "The epidemiology of Asperger's syndrome. A total population study". J Child Psychol Psychiat 34 (8):1327–50. doi:10.1111/j.1469-7610.1993.tb02094.x. PMID 8294522.

[50] Polimeni MA, Richdale AL, Francis AJ (2005). "A survey of sleep problems in autism, Asperger's disorder and typically developingchildren". J Intellect Disabil Res 49 (4): 260–8. doi:10.1111/j.1365-2788.2005.00642.x. PMID 15816813.

[51] Tani P, Lindberg N, Joukamaa M et al (2004). "Asperger syndrome, alexithymia and perception of sleep". Neuropsychobiology 49 (2):64–70. doi:10.1159/000076412. PMID 14981336.

[52][52] Alexithymia and AS:

• Fitzgerald M, Bellgrove MA (2006). "The overlap between alexithymia and Asperger's syndrome". J Autism Dev Disord 36 (4): 573–6.doi:10.1007/s10803-006-0096-z. PMC 2092499. PMID 16755385.

• Hill E, Berthoz S (2006). "Response". J Autism Dev Disord 36 (8): 1143–5. doi:10.1007/s10803-006-0287-7. PMID 17080269.• Lombardo MV, Barnes JL, Wheelwright SJ, Baron-Cohen S (2007). Zak, Paul. ed. "Self-referential cognition and empathy in autism"

(http:/ / www. plosone. org/ article/ fetchArticle. action?articleURI=info:doi/ 10. 1371/ journal. pone. 0000883). PLoS ONE 2 (9): e883.doi:10.1371/journal.pone.0000883. PMC 1964804. PMID 17849012. .

[53] Epstein T, Saltzman-Benaiah J, O'Hare A, Goll JC, Tuck S (2008). "Associated features of Asperger Syndrome and their relationship toparenting stress". Child Care Health Dev 34 (4): 503–11. doi:10.1111/j.1365-2214.2008.00834.x. PMID 19154552.

[54] Foster B, King BH (2003). "Asperger syndrome: to be or not to be?". Curr Opin Pediatr 15 (5): 491–4.doi:10.1097/00008480-200310000-00008. PMID 14508298.

[55] Arndt TL, Stodgell CJ, Rodier PM (2005). "The teratology of autism". Int J Dev Neurosci 23 (2–3): 189–99.doi:10.1016/j.ijdevneu.2004.11.001. PMID 15749245.

[56] Rutter M (2005). "Incidence of autism spectrum disorders: changes over time and their meaning". Acta Paediatr 94 (1): 2–15.doi:10.1111/j.1651-2227.2005.tb01779.x. PMID 15858952.

[57] Müller RA (2007). "The study of autism as a distributed disorder". Ment Retard Dev Disabil Res Rev 13 (1): 85–95.doi:10.1002/mrdd.20141. PMC 3315379. PMID 17326118.

[58] Rinehart NJ, Bradshaw JL, Brereton AV, Tonge BJ (2002). "A clinical and neurobehavioural review of high-functioning autism andAsperger's disorder". Aust N Z J Psychiatry 36 (6): 762–70. doi:10.1046/j.1440-1614.2002.01097.x. PMID 12406118.

[59] Berthier ML, Starkstein SE, Leiguarda R (1990). "Developmental cortical anomalies in Asperger's syndrome: neuroradiological findings intwo patients". J Neuropsychiatry Clin Neurosci 2 (2): 197–201. PMID 2136076.

[60] Happé F, Ronald A, Plomin R (2006). "Time to give up on a single explanation for autism". Nat Neurosci 9 (10): 1218–20.doi:10.1038/nn1770. PMID 17001340.

[61] Just MA, Cherkassky VL, Keller TA, Kana RK, Minshew NJ (2007). "Functional and anatomical cortical underconnectivity in autism:evidence from an FMRI study of an executive function task and corpus callosum morphometry" (http:/ / cercor. oxfordjournals. org/ cgi/content/ full/ 17/ 4/ 951). Cereb Cortex 17 (4): 951–61. doi:10.1093/cercor/bhl006. PMID 16772313. .

[62] Iacoboni M, Dapretto M (2006). "The mirror neuron system and the consequences of its dysfunction". Nat Rev Neurosci 7 (12): 942–51.doi:10.1038/nrn2024. PMID 17115076.

[63] Happé F, Frith U (2006). "The weak coherence account: detail-focused cognitive style in autism spectrum disorders". J Autism Dev Disord36 (1): 5–25. doi:10.1007/s10803-005-0039-0. PMID 16450045.

[64] Mottron L, Dawson M, Soulières I, Hubert B, Burack J (2006). "Enhanced perceptual functioning in autism: an update, and eight principlesof autistic perception". J Autism Dev Disord 36 (1): 27–43. doi:10.1007/s10803-005-0040-7. PMID 16453071.

[65] Ramachandran VS, Oberman LM (2006). "Broken mirrors: a theory of autism" (http:/ / cbc. ucsd. edu/ pdf/ brokenmirrors_asd. pdf) (PDF).Sci Am 295 (5): 62–9. doi:10.1038/scientificamerican1106-62. PMID 17076085. . Retrieved 2009-02-13.

[66] Nishitani N, Avikainen S, Hari R (2004). "Abnormal imitation-related cortical activation sequences in Asperger's syndrome". Ann Neurol 55(4): 558–62. doi:10.1002/ana.20031. PMID 15048895.

[67] Baron-Cohen S, Leslie AM, Frith U (1985). "Does the autistic child have a 'theory of mind'?" (http:/ / ruccs. rutgers. edu/ ~aleslie/Baron-Cohen Leslie & Frith 1985. pdf) (PDF). Cognition 21 (1): 37–46. doi:10.1016/0010-0277(85)90022-8. PMID 2934210. . Retrieved2007-06-28.

[68] Baron-Cohen S (2006). "The hyper-systemizing, assortative mating theory of autism" (http:/ / autismresearchcentre. com/ docs/ papers/2006_BC_Neuropsychophamacology. pdf) (PDF). Prog Neuropsychopharmacol Biol Psychiatry 30 (5): 865–72.doi:10.1016/j.pnpbp.2006.01.010. PMID 16519981. . Retrieved 2009-06-08.

[69] Murphy DG, Daly E, Schmitz N et al (2006). "Cortical serotonin 5-HT2A receptor binding and social communication in adults withAsperger's syndrome: an in vivo SPECT study" (http:/ / ajp. psychiatryonline. org/ cgi/ content/ full/ 163/ 5/ 934). Am J Psychiatry 163 (5):934–6. doi:10.1176/appi.ajp.163.5.934. PMID 16648340. .

[70] Gowen E, Miall RC (2005). "Behavioural aspects of cerebellar function in adults with Asperger syndrome". Cerebellum 4 (4): 279–89.doi:10.1080/14734220500355332. PMID 16321884.

[71] Campbell JM (2005). "Diagnostic assessment of Asperger's disorder: a review of five third-party rating scales". J Autism Dev Disord 35 (1):25–35. doi:10.1007/s10803-004-1028-4. PMID 15796119.

Asperger syndrome 13

[72] Auyeung B, Baron-Cohen S, Wheelwright S, Allison C (2008). "The Autism Spectrum Quotient: Children's Version (AQ-Child)" (http:/ /autismresearchcenter. com/ docs/ papers/ 2008_Auyeung_etal_ChildAQ. pdf) (PDF). J Autism Dev Disord 38 (7): 1230–40.doi:10.1007/s10803-007-0504-z. PMID 18064550. . Retrieved 2009-01-02.

[73] Baron-Cohen S, Hoekstra RA, Knickmeyer R, Wheelwright S (2006). "The Autism-Spectrum Quotient (AQ)—adolescent version" (http:/ /autismresearchcenter. com/ docs/ papers/ 2006_BC_Hoekstra_etal_AQ-adol. pdf) (PDF). J Autism Dev Disord 36 (3): 343–50.doi:10.1007/s10803-006-0073-6. PMID 16552625. . Retrieved 2009-01-02.

[74] Woodbury-Smith MR, Robinson J, Wheelwright S, Baron-Cohen S (2005). "Screening adults for Asperger Syndrome using the AQ: apreliminary study of its diagnostic validity in clinical practice" (http:/ / autismresearchcentre. com/ docs/ papers/2005_Woodbury-Smith_etal_ScreeningAdultsForAS. pdf) (PDF). J Autism Dev Disord 35 (3): 331–5. doi:10.1007/s10803-005-3300-7.PMID 16119474. . Retrieved 2009-01-02.

[75] Szatmari P, Bremner R, Nagy J (1989). "Asperger's syndrome: a review of clinical features". Can J Psychiatry 34 (6): 554–60.PMID 2766209.

[76] Gillberg IC, Gillberg C (1989). "Asperger syndrome—some epidemiological considerations: a research note". J Child Psychol Psychiatry 30(4): 631–8. doi:10.1111/j.1469-7610.1989.tb00275.x. PMID 2670981.

[77] Fitzgerald M, Corvin A (2001). "Diagnosis and differential diagnosis of Asperger syndrome" (http:/ / apt. rcpsych. org/ cgi/ content/ full/ 7/4/ 310). Adv Psychiatric Treat 7 (4): 310–8. doi:10.1192/apt.7.4.310. .

[78] Leskovec TJ, Rowles BM, Findling RL (2008). "Pharmacological treatment options for autism spectrum disorders in children andadolescents". Harv Rev Psychiatry 16 (2): 97–112. doi:10.1080/10673220802075852. PMID 18415882.

[79] Tantam D (2003). "The challenge of adolescents and adults with Asperger syndrome" (http:/ / www. childpsych. theclinics. com/ article/PIIS1056499302000536/ fulltext). Child Adolesc Psychiatr Clin N Am 12 (1): 143–63. doi:10.1016/S1056-4993(02)00053-6.PMID 12512403. .

[80] Shattuck PT, Grosse SD (2007). "Issues related to the diagnosis and treatment of autism spectrum disorders". Ment Retard Dev Disabil ResRev 13 (2): 129–35. doi:10.1002/mrdd.20143. PMID 17563895.

[81] Markel H (2006-04-13). "The trouble with Asperger's syndrome". Medscape Today (WebMD).[82] Toth K, King BH (2008). "Asperger's syndrome: diagnosis and treatment" (http:/ / ajp. psychiatryonline. org/ cgi/ content/ full/ 165/ 8/ 958).

Am J Psychiatry 165 (8): 958–63. doi:10.1176/appi.ajp.2008.08020272. PMID 18676600. .[83] Khouzam HR, El-Gabalawi F, Pirwani N, Priest F (2004). "Asperger's disorder: a review of its diagnosis and treatment". Compr Psychiatry

45 (3): 184–91. doi:10.1016/j.comppsych.2004.02.004. PMID 15124148.[84] Attwood T (2003). "Frameworks for behavioral interventions" (http:/ / www. childpsych. theclinics. com/ article/ PIIS1056499302000548/

fulltext). Child Adolesc Psychiatr Clin N Am 12 (1): 65–86. doi:10.1016/S1056-4993(02)00054-8. PMID 12512399. .[85] Krasny L, Williams BJ, Provencal S, Ozonoff S (2003). "Social skills interventions for the autism spectrum: essential ingredients and a

model curriculum" (http:/ / www. childpsych. theclinics. com/ article/ PIIS1056499302000512/ fulltext). Child Adolesc Psychiatr Clin N Am12 (1): 107–22. doi:10.1016/S1056-4993(02)00051-2. PMID 12512401. .

[86] Myles BS (2003). "Behavioral forms of stress management for individuals with Asperger syndrome" (http:/ / www. childpsych. theclinics.com/ article/ PIIS1056499302000482/ fulltext). Child Adolesc Psychiatr Clin N Am 12 (1): 123–41. doi:10.1016/S1056-4993(02)00048-2.PMID 12512402. .

[87] Towbin KE (2003). "Strategies for pharmacologic treatment of high functioning autism and Asperger syndrome" (http:/ / www. childpsych.theclinics. com/ article/ PIIS1056499302000494/ fulltext). Child Adolesc Psychiatr Clin N Am 12 (1): 23–45.doi:10.1016/S1056-4993(02)00049-4. PMID 12512397. .

[88] Paul R (2003). "Promoting social communication in high functioning individuals with autistic spectrum disorders" (http:/ / www.childpsych. theclinics. com/ article/ PIIS1056499302000470/ fulltext). Child Adolesc Psychiatr Clin N Am 12 (1): 87–106.doi:10.1016/S1056-4993(02)00047-0. PMID 12512400. .

[89] Matson JL (2007). "Determining treatment outcome in early intervention programs for autism spectrum disorders: a critical analysis ofmeasurement issues in learning based interventions". Res Dev Disabil 28 (2): 207–18. doi:10.1016/j.ridd.2005.07.006. PMID 16682171.

[90] Rao PA, Beidel DC, Murray MJ (2008). "Social skills interventions for children with Asperger's syndrome or high-functioning autism: areview and recommendations". J Autism Dev Disord 38 (2): 353–61. doi:10.1007/s10803-007-0402-4. PMID 17641962.

[91] Sofronoff K, Leslie A, Brown W (2004). "Parent management training and Asperger syndrome: a randomized controlled trial to evaluate aparent based intervention". Autism 8 (3): 301–17. doi:10.1177/1362361304045215. PMID 15358872.

[92] Newcomer JW (2007). "Antipsychotic medications: metabolic and cardiovascular risk". J Clin Psychiatry 68 (suppl 4): 8–13.PMID 17539694.

[93] Chavez B, Chavez-Brown M, Sopko MA, Rey JA (2007). "Atypical antipsychotics in children with pervasive developmental disorders".Pediatr Drugs 9 (4): 249–66. doi:10.2165/00148581-200709040-00006. PMID 17705564.

[94] Staller J (2006). "The effect of long-term antipsychotic treatment on prolactin". J Child Adolesc Psychopharmacol 16 (3): 317–26.doi:10.1089/cap.2006.16.317. PMID 16768639.

[95] Stachnik JM, Nunn-Thompson C (2007). "Use of atypical antipsychotics in the treatment of autistic disorder". Ann Pharmacother 41 (4):626–34. doi:10.1345/aph.1H527. PMID 17389666.

[96] Blacher J, Kraemer B, Schalow M (2003). "Asperger syndrome and high functioning autism: research concerns and emerging foci". CurrOpin Psychiatry 16 (5): 535–542. doi:10.1097/00001504-200309000-00008.

Asperger syndrome 14

[97] Coplan J, Jawad AF (2005). "Modeling clinical outcome of children with autistic spectrum disorders" (http:/ / pediatrics. aappublications.org/ cgi/ content/ full/ 116/ 1/ 117). Pediatrics 116 (1): 117–22. doi:10.1542/peds.2004-1118. PMID 15995041. . Lay summary (http:/ /stokes. chop. edu/ publications/ press/ ?ID=181) – press release (2005-07-05).

[98] Chiang HM, Lin YH (2007). "Mathematical ability of students with Asperger syndrome and high-functioning autism" (http:/ / aut. sagepub.com/ cgi/ reprint/ 11/ 6/ 547) (PDF). Autism 11 (6): 547–56. doi:10.1177/1362361307083259. PMID 17947290. . Retrieved 2009-03-06.

[99] Herera S (2005-02-25). "Mild autism has 'selective advantages'" (http:/ / www. msnbc. msn. com/ id/ 7030731/ ). CNBC. . Retrieved2007-11-14.

[100] Moran M (2006). "Asperger's may be answer to diagnostic mysteries" (http:/ / pn. psychiatryonline. org/ cgi/ content/ full/ 41/ 19/ 21).Psychiatr News 41 (19): 21. .

[101] Gillberg C (2008). "Asperger syndrome—mortality and morbidity". In Rausch JL, Johnson ME, Casanova MF (eds.). Asperger's Disorder.Informa Healthcare. pp. 63–80. ISBN 0-8493-8360-9.

[102] Fombonne E, Tidmarsh L (2003). "Epidemiologic data on Asperger disorder" (http:/ / www. childpsych. theclinics. com/ article/PIIS1056499302000500/ fulltext). Child Adolesc Psychiatr Clin N Am 12 (1): 15–21. doi:10.1016/S1056-4993(02)00050-0. PMID 12512396..

[103] Fombonne E (2007). "Epidemiological surveys of pervasive developmental disorders". In Volkmar FR. Autism and PervasiveDevelopmental Disorders (2nd ed.). Cambridge University Press. pp. 33–68. ISBN 0-521-54957-4.

[104] Mattila ML, Kielinen M, Jussila K et al (2007). "An epidemiological and diagnostic study of Asperger syndrome according to four sets ofdiagnostic criteria". J Am Acad Child Adolesc Psychiatry 46 (5): 636–46. doi:10.1097/chi.0b013e318033ff42. PMID 17450055.

[105] Cederlund M, Gillberg C (2004). "One hundred males with Asperger syndrome: a clinical study of background and associated factors".Dev Med Child Neurol 46 (10): 652–60. doi:10.1111/j.1469-8749.2004.tb00977.x. PMID 15473168.

[106] Gillberg C, Billstedt E (2000). "Autism and Asperger syndrome: coexistence with other clinical disorders". Acta Psychiatr Scand 102 (5):321–30. doi:10.1034/j.1600-0447.2000.102005321.x. PMID 11098802.

[107] Baron-Cohen S, Klin A (2006). "What's so special about Asperger Syndrome?" (http:/ / www. elsevier. com/ authored_subject_sections/S05/ S05_360/ pdf/ klin. pdf) (PDF). Brain Cogn 61 (1): 1–4. doi:10.1016/j.bandc.2006.02.002. PMID 16563588. .

[108] Lyons V, Fitzgerald M (2007). "Did Hans Asperger (1906–1980) have Asperger Syndrome?". J Autism Dev Disord 37 (10): 2020–1.doi:10.1007/s10803-007-0382-4. PMID 17917805.

[109] Osborne L (2002). American Normal: The Hidden World of Asperger Syndrome. Copernicus. p. 19. ISBN 0-387-95307-8.[110] Hippler K, Klicpera C (February 2003). "A retrospective analysis of the clinical case records of 'autistic psychopaths' diagnosed by Hans

Asperger and his team at the University Children's Hospital, Vienna". Philos. Trans. R. Soc. Lond., B, Biol. Sci. 358 (1430): 291–301.doi:10.1098/rstb.2002.1197. PMC 1693115. PMID 12639327.

[111] Wing L (1991). "The relationship between Asperger's syndrome and Kanner's autism". In Frith U. Autism and Asperger syndrome.Cambridge University Press. pp. 93–121. ISBN 0-521-38608-X.

[112] Wing L (1981). "Asperger's syndrome: a clinical account" (http:/ / www. mugsy. org/ wing2. htm). Psychol Med 11 (1): 115–29.doi:10.1017/S0033291700053332. PMID 7208735. . Retrieved 2007-08-15.

[113] Willey LH (1999). Pretending to be Normal: Living with Asperger's Syndrome. Jessica Kingsley. pp. 71, 104. ISBN 1-85302-749-9.[114] Williams CC (2005). "In search of an Asperger". In Stoddart KP. Children, Youth and Adults with Asperger Syndrome: Integrating

Multiple Perspectives. Jessica Kingsley. pp. 242–52. ISBN 1-84310-319-2. "The life prospects of people with AS would change if we shiftedfrom viewing AS as a set of dysfunctions, to viewing it as a set of differences that have merit."

[115] Dakin CJ (2005). "Life on the outside: A personal perspective of Asperger syndrome". In Stoddart KP. Children, Youth and Adults withAsperger Syndrome: Integrating Multiple Perspectives. Jessica Kingsley. pp. 352–61. ISBN 1-84310-319-2.

[116] Clarke J, van Amerom G (2008). "Asperger's syndrome: differences between parents' understanding and those diagnosed". Soc WorkHealth Care 46 (3): 85–106. doi:10.1300/J010v46n03_05. PMID 18551831.

[117] Allred S (2009). "Reframing Asperger syndrome: lessons from other challenges to the Diagnostic and Statistical Manual and ICIDHapproaches". Disabil Soc 24 (3): 343–55. doi:10.1080/09687590902789511.

[118] Baron-Cohen S (2008). "The evolution of brain mechanisms for social behavior". In Crawford C, Krebs D (eds.). Foundations ofEvolutionary Psychology. Lawrence Erlbaum. pp. 415–32. ISBN 0-8058-5957-8.

External links• Asperger's Syndrome (http:/ / www. dmoz. org/ Health/ Mental_Health/ Disorders/ Neurodevelopmental/

Autism_Spectrum/ Asperger's_Syndrome/ ) at the Open Directory Project

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Article Sources and ContributorsAsperger syndrome  Source: http://en.wikipedia.org/w/index.php?oldid=490577595  Contributors: *Ria777*, -- April, .Maximus Rex, 100110100, 119, 130.94.122.xxx, 1and1hosting, 1d1d, 21mar, 2D, 2ballen, 879(CoDe), 9014user, A Kiwi, A Man In Black, A bit iffy, A3r0, ACEOREVIVED, AFOH, AJackl, AS-IT, AaronAcademy, AaronY, Aaronbrick, Abb615, Abce2, Ace ETP, Ace of Spades, Acegikmo1, Acepectif, Achurch, Acroterion, Adam Bishop, Adam78, Adam7davies, AdamM, Addicted2Sanity, Addshore, AdjustShift, Admbws, Adolphus79, Adrianstott, Aebarschall, Aeosynth, AgnosticPreachersKid, Ahoerstemeier, Airconswitch, Aj175004, Ajaxkroon, Ajsh, Akamad, Alan Peakall, Alansohn, Alderbourne, Aldie, Alec - U.K., Alecf, Alex.tan, AlexPlank, Alexishorn, Ali, Alientraveller, Alister Namarra, Alixtii, Allstarecho, Allweareisair, AlphaJAKE, Altenmann, Alvaro, Amalthea, Amillar, Amplitude101, AmyNelson, Andjam, Andonic, Andres, Andrew Hampe, Andrew William Hampe, AndrewGordanDavis, Andrewlp1991, Andrij Kursetsky, Andy M. 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Image Sources, Licenses and ContributorsFile:Riboflavin penicillinamide.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Riboflavin_penicillinamide.jpg  License: GNU Free Documentation License  Contributors: Originaluploader was Poindexter Propellerhead at en.wikipediaFile:FMRI.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:FMRI.jpg  License: Public Domain  Contributors: Frank C. Müller, Solipsist, Superborsuk, Was a bee, 2 anonymous edits

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