Thesis: Asperger's Syndrome About Sixty-Five Years Ago Hans

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Asperger's Syndrome

About sixty-five years ago Hans Asperger put forward a description of a distinct profile of abilities and behaviors in young children that he called "autistic psychopathy" - which means autism ("self") and psychopathy ("personality disease"). Asperger termed children who had the syndrome "little professors" because they had the skill to discuss topics in deep detail. The Web site www.Spiritus-Temporis.comexplains that both Leo Kanner and Hans Asperger worked on defining what is now known as Asperger's Syndrome, but that Asperger was more "positive" in his assessment of the malady "due to the political climate at the time." That political climate was the Nazi regime, a fascist government that was known to be intolerant of weakness and disabilities.

Asperger is believed to have suffered from the very disease he is credited with naming; he was apparently a loner, a remote person who did not make friends easily, but a bright young man who was drawn to the poetry of Franz Grillparzer. The person given credit for later naming the disease "Asperger's syndrome" was Lorna Wing, according to Spiritus-Temporis.

While Asperger's Syndrome (as) is not to be confused with autism - because they are distinctly different to the trained medical mind - according to the best available science research as is indeed part of what is called "the autistic spectrum." and, in addition, wherever one finds information on as, there will inevitably also be data and research on autism nearby. The Harvard Mental Health Letter (Harvard University, (www.health.harvard.edu) states that as should be, by definition, set apart from "more severe forms of autism," which are linked with mental retardation, and nearly total social isolation. as, the Harvard publication continues, is distinguished from "high-functioning" autism on the grounds that it suggests "better verbal than nonverbal intelligence."

Some very recent and pertinent information relative to as vs. autism is found in research project conducted by the Department of Psychology, University of Florida, Gainesville (Teitelbaum, et al. 2006); the report explains that the "early severe deficits in social behavior and language abnormalities found in children with autism do not [necessarily] occur in as," hence, unfortunately, the as child tends not to be diagnosed until "much later than autistic children."

It is worth mentioning at the outset of this research that the category PDD-NOS (pervasive developmental disorders - not otherwise specified) is often "misleading" in the literature referencing as (Thompson, et al., 2004). The Department of Psychiatry and Behavioural Neurosciences at McMaster University (Ontario) compared (tested) 216 children with autism, 33 with as, and 21 children diagnosed with PDD-NOS, and found that for the level of functioning, the PDD-NOS children had scores somewhere "...between those of autism and as." Hence, since PDD-NOS has no "specific criteria" and is "often used as a diagnosis of exclusion," the researcher, teacher, parent and doctor need to approach all labels with knowledge and restraint.

Epidemiology of Asperger's Syndrome

Information on the prevalence of Asperger's Syndrome varies from source to source; According to Tony Attwood, author of the Compete Guide to Asperger's Syndrome and among the most respected international experts on as, the ratio (of patients he has worked with) is 4.68 males to one female; that reflects 984 clients with as (811 males and 173 females). He writes that one in every 250 individuals in Australia shows signs of as.

Meanwhile, research conducted by the Stanford University Child and Adolescent Psychiatry center (http://aarr.stanford.edu/)reports that "results have not been conclusive" in terms of the prevalence of as in the U.S. because only "four [empirical] studies" have been conducted (through 2003), and only "autism" was measured (while an estimated 2 per 10,000 within those autism demographics likely had as, the Stanford site claims). Dr. R. Kaan Ozbayrak (http://www.aspergers.com/index.htm) reports on a population study in Goteborg, Sweden; the "minimum prevalence of Asperger's Disorder was 36 per 10,000 children," Ozbayrak writes. Of those numbers, 55 out of 10,000 boys were diagnosed with as, and 15 per 10,000 girls had as. The male-female ratio in Goteborg's research was 4:1. Traditionally, according to the Website of Ozbayrak the prevalence of as is around 4 to 5 per 10,000 children. Meantime, another research project involving Sweden - Swedish Epidemiologic Study (Gilberg and Gilberg) - indicates that 10-26 children per 10,000 with "normal intelligence rate" had as. Overall, Wing and Gould show that 1.1 per 10,000 children who "had been autistic" earlier in life were shown later to have as.

Assessments of Children for Asperger's Syndrome

To know precisely what syndrome afflicts their child is among the most important pieces of information a parent can ever desire. There are currently a number of screening (assessment) tests that are being used with primary-school-age children, according to Williams, et. al, (www.sagepublications.com).They include the Australian Scale for Asperger Syndrome (Attwood, 2001); the Children's Social Behavior Questionnaire (Luteijn, et al., 2000); the Pervasive Developmental Disorders Questionnaire (Baird et al., 2000); the Asperger Syndrome Screening Questionnaire (Ehlers and Gillberg, 1993; Ehlers et al., 1999); the Autism Behaviour Checklist (Krug et al., 1980); the Gilliam Autism Rating Scale (Gilliam, 1995; South et al., 2002); and the Social Communication Questionnaire (Berument et al., 1999).

Also available for professionals and parents - listed on the Web site of the company called "Publishers, Psychological and Educational Publications" - is the Asperger Syndrome Diagnostic Scale (ASDS), which can be completed, say the authors, by "anyone who knows the child...well." That includes parents, teachers, siblings, paraeducators, speech-language pathologists, psychologists, and other professionals who have close contact with the subject. There are 50 items on the questionnaire, all "yes/no," which can be answered in roughly fifteen minutes. This test is designed for children 5 to 18 years of age. Of course this test is only the preliminary evaluation for an as child; there is a more in-depth assessment proceeding needed once the initial identification of the affliction is completed.

Another among the several assessment strategies that may soon be widely used for diagnosing as in children is the Child Asperger Screening Test (CAST), which is being researched for use in the general population by the University of Cambridge, UK, according to an article written by professor Jo Williams and six Cambridge colleagues (www.phpc.com.ac.uk).

CAST initially consists of a parental questionnaire; to test its accuracy, researchers distributed the questionnaire to 1,925 children ages 5-11 in Cambridgeshire schools in the UK. A sample of participants received a complete diagnostic assessment, conducted "blind to screen status," the UK report explained. The sensitivity of the CAST, "at a designated cut-point of 15, was 100%"; the specificity was 97% and "...the positive predictive value was 50%," when using the group's "consensus diagnosis as the gold standard."

The authors point out diagnosis for as can be as late as 11 years of age, even though parents may have been worrying about the unusual and even antisocial behavior of their child for several years. With good screening such as CAST potentially could provide, though, the diagnosis could well be done much earlier, which would be desirable, the authors write, to allow time for "genetic counselling"; to gain strong parental support; and also to allow for "earlier intervention." And though the authors believe CAST is an honest evaluator of as in children, there is presently "insufficient evidence" to recommend screening for "autism spectrum conditions" (e.g., as) as a public health service, the writers noted.

In order to have a grasp of all the effort that goes into testing an assessment strategy for its validity and applicability, it is interesting to follow this CAST survey; indeed, one of the reasons that the diagnosis (early) of as in younger children has been relatively slow in emerging is the difficulty in testing the tests and questionnaires. Researchers are sometimes feeling their way through the maze of behavioral and institutional dynamics. In terms of the 1,925 students who took the CAST questionnaire home with them, the response rate from parents was 26%, overall. That means 74% did not feel it was important enough to fill out properly.

And when the CAST questionnaires were tallied and those parents whose children potentially might have as were identified, the schools with the highest response rate (33% of parents filled out the questionnaire) ended up with the lowest percentage of children on the "special needs resister" (18%); and conversely, the school with the lowest number of returned questionnaires (20% of parents completed the questionnaire) had the highest percentage of students on the "special needs register" (66% had some kind of issue relative to ADD, autism or as). This shows that those who perhaps need help the most were the least likely to participate in a process that offers help. The authors say that "this study demonstrates that CAST has a good accuracy for use as a screening [for as] test, with high sensitivity."

There is, as has been mentioned, an urgent need for healthcare professionals to develop the tools for early diagnosis (leading to early assessment strategies); and in that regard there is exciting research being reported by Department of Psychology, University of Florida, Gainesville… [END OF PREVIEW]

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