Talk:Asperger's syndrome

Intro & Rationale

G'day,

Imported this from WP. It has received a fairly high rating, bronze star or something like that. However, it does need paring down and many of the sources remain to be checked out. Meanwhile, I would like some help on the info box in the upper right hand corner. At this time, I have made quite a few small changes and rewrites. I will put it on CZ:Live status today. Let me know if you think this is jumping the gun. Thomas Simmons 12:21, 21 March, 2007 (EPT)

One hope I have for this article is that it can ultimately lose the undue emphasis on "controversy" and "criticism" that seem so common in wikipedia articles. For example, the section which is titled "History" includes summaries of disputes over diagnostic criteria and whether AS and HFA should be differentiated. These sorts of things certainly need to be discussed somewhere in the article but I don't think that the reader needs a constant reminder of the controversy.

I have a small library of (reputable) books on Asperger's and autism and am going on nine years of raising an Aspie. I'd be happy to help improve and "Citizendifying" this article. Jacob Jensen 12:38, 5 April 2007 (CDT)

Re: Jacob Jensen reworks of History " I don't think that Asperger was named to "honor" Asperger". Agreed. She pointedly says that his original terminology was misleading and simply named the syndrome to avoid the ambiguity that resulted.

Re: deletion because "Wing and DSM-IV classification were redundant." Also effective.

With regard to "undue emphasis on "controversy" and "criticism". It should be discussed at length, I agree. Was not really tuned into the emphasis but see it now. Believe it to be the work of multiple authors who were not writing the article as a whole, simply adding bits and pieces with their own motivation as it evolved (or devolved) as the case may be. The disputes over nomenclature are real. I am in the process of reviewing thousands of abstracts on PubMed and the terminology is diverse as are definitions and diagnostic instruments. On first glance, the criteria for diagnosis and the means by which this is done indicates a great deal of divergence in definition and methodology.

Additionally, I for one welcome insights from those who are personally involved in this matter. Thomas Simmons 15:43 6 April, 2007 (EPT)

Good, it sounds like we are on the same page. As a parent, Ifound it very difficult in many cases to get straightforward information about AS until I started diving into the primary sources. In my opinion, the appropriate tone for most of the article should be similar to the introductory paragraphs of the medical/psychological literature - providing adequate depth regarding generally accepted knowledge before dredging up the dirty laundry of the research community. There is considerable controversy surrounding diagnostic criteria, standardized test methods, where AS fits on the "spectrum" (if at all), and what sorts of biomedical or behavioral supports are appropriate. This should all be discussed at length but shouldn't pervade every aspect of the article.

I look forward to working with you on this. I checked out your user page and you seem to have an excellent breadth of experience to do this topic justice. I will be traveling for much of next week but might start moving some of the "controversy" talk to the talk page. Also, feel free to argue with me over changes. I enjoy the collaborative nature of these wiki things and thing that a back and forth between multiple authors usually creates better articles. Jacob Jensen 12:42, 6 April 2007 (CDT)

Let's work up an outline. We can also use it to decide what other articles to write in relation to this (or it will lose focus and get unwieldy - a common problem in WP). Your concerns are paramount in my opinion. I know we are writing for graduate level students but our audience will hopefully be broader. That means if folks that are dealing with this situation come looking we can impart the information they need. So, we need to know what categories to look at. I usually approach this as a teacher, thinking about how I would present this to university students, high school students and peers (this also influences my style of writing). Thomas Simmons 09:28, 10 April, 2007 (EPT)

Some References

There are some recent references that seem whorthwhile not listed. I am citing a few below-with excerpts.

Foster B. King BH. Asperger syndrome: to be or not to be?. [Review] [49 refs] [Journal Article. Review] Current Opinion in Pediatrics. 15(5):491-4, 2003 Oct. UI: 14508298 Purpose of review: Asperger syndrome is a pervasive developmental disorder characterized by impairments in social interactions, such as nonverbal behaviors, failure to develop peer relationships, and lack of social reciprocity with restricted, repetitive and stereotyped patterns of interest or behavior. The diagnosis of Asperger syndrome is increasingly common, and it is timely to review its phenomenology and treatment.Recent findings: As there is a growing public awareness and acceptance of Asperger syndrome, clinical research has produced mixed results that do not clearly discriminate Asperger syndrome from high-functioning autism. However, research does indicate that children with pervasive developmental disorder achieve better outcomes when diagnosis is made early and appropriate community supports can be marshaled....Such individuals may have an all-absorbing, narrow or peculiar interest to the exclusion of other activities. Speech and language is often described as pedantic: expressive language may be fine, but with impairment of comprehension leading to misinterpretation of literal and implied meanings. Nonverbal communication problems include a restricted use of gesture, limited or inappropriate facial expression, and a peculiar, stiff gaze [5,6]....The population of children with autism has long been distinguished by its bimodal IQ distribution. Approximately two thirds of children with autism have some degree of cognitive impairment, and the remainder may have intellectual function in the normal range or above—so-called “high-functioning” children with autism (HFA). Moreover, some of the latter group will present with no history of delayed speech. All else seeming equal, is the absence of developmental speech delay a meaningful diagnostic distinction? [3,11–14]....ecent studies may be taken to suggest that HFA can be differentiated from AS on the basis of outcome [15], developmental trajectories, family history [16], and comorbid medical illness [14–19]. Psychological testing has also been suggested as a means of differentiating these conditions [20–23]. AS children are reported to have distinct Wechsler Intelligence Scale for Children III profiles with higher full-scale IQ and often a higher verbal IQ than performance IQ [17,19,22,24]. On the other hand, if the AS population is defined by a measure of severity (ie, no delayed language) and subsequently compared with HFA on the basis of severity (outcomes, IQ, etc.), is there not a potential problem with circularity?...Fombonne has suggested a “conservative prevalence” of Asperger syndrome of 2 per 10,000 [25]. In the United States, a recent study in New Jersey set the prevalence in a defined community, the Brick Township, at nearly 3 per 1000 [26]. These prevalence rates are lower than those for autism, but both conditions share a male preponderance [1,25–27•]....On average, the diagnosis of AS is not made until the age of 11 [27•]. Yet, the parents of these children can typically trace concerns about their children's development to as early as 30 months of age. In light of this discrepancy, many pediatric organizations have underscored the importance of early surveillance and developmental screening [15,19,29,30]....Although research suggests a genetic contribution to AS, no specific gene has yet been identified, and it is likely that multiple factors play a role in the expression of autism given the phenotypic variability seen in this group of children [31]. Recently, investigators identified an association between certain behavioral traits within a subpopulation of children with autism, specifically, insistence on sameness and repetitive behavior, and the GABARB3 gene [32••]....While most patients with AS have normal physical exams, labs and magnetic resonance imaging [33], some recent studies raise interest in certain observations about children with AS such as macrocephaly [34], motor coordination [35], and even low body weight [36]. Gillberg and de Souza's recent comparison study of head circumference in children with autism, AS, and attention deficit hyperactivity disorder found subgroups of AS that could be distinguished by macrocephaly present at birth or that developed during early childhood [34]....Some pediatricians find it useful to use screening tools or checklists. One such instrument is the Checklist for Autism in Toddlers (CHAT) [11]. Although generally sensitive, milder symptoms of autism may be missed by this instrument. In one study, 60% of children that did not meet criteria when screened using the CHAT later were diagnosed with an autism spectrum disorder [14]. Children with mental retardation, language disabilities, and hearing impairments may score in the high range for autism on the CHAT as well. Another available screening tool, the Childhood Autism Rating Scale, is easily learned and administered, has good inter-rater reliability, and seems to have reasonable sensitivity [14]....Two recent functional magnetic resonance imaging studies found specific differences between controls and children with AS. Oktem et al. [33] found a lack of expected frontal lobe activation in response to a judgmental task, and Critchley et al. [37] found differences in activation of cerebellar, mesolimbic and temporal lobe cortical regions when processing facial expressions in HFA subjects compared with controls. selected ref Wing L, Potter D: The epidemiology of autistic spectrum disorders: Is the prevalence rising? Ment Retard Dev Disabil Res Rev 2002, 8:151–161. This article nicely details multiple factors that may be contributing to the apparent rise of incidence and prevalence of autism spectrum disorders. • Shao Y, Cuccaro ML, Hauser ER, et al.: Fine mapping of autistic disorder to Chromosome 15q11-q13 by use of phenotypic subtypes. Am J Hum Gen 2003, 72:539–548. This is a very exciting development in the genetics of autism in which a genetic locus associated with the disorder was identified after subclassification of subjects on the basis of the severity of their repetitive behaviors.• Murphy DG, Critchley HD, Schmitz N, et al.: Asperger syndrome: A proton magnetic resonance spectroscopy study of brain. Arch Gen Psychiatry 2002, 59:885–891. Although the number of subjects was relatively small, this study documented that AS subjects have abnormalities in neuronal integrity of the prefrontal lobe, which was related to severity of clinical symptoms.

Nancy Sculerati 18:43, 6 April 2007 (CDT)

Nancy, thank you very much. Good stuff. Thomas Simmons 09:29, 10 April, 2007 (EPT)

At some point, given the massive amount of work taking place in this area (e.g. genetics), we'll need to develop an article on etiology. And we'll need to do an article on "Etiology" as well :) Thomas Simmons 09:38, 10 April, 2007 (EPT)

Classification and diagnosis

Not sure why the classification of the syndrome was removed. The note said, "RMV, permissions" which was too cryptic to comprehend. Given its substantive nature, it is appropriate that such deletions be discussed here first.--Thomas Simmons 11:35, 11 November 2007 (CST)

I believe I can explain the edit. As explained in the template I just put in, the APA doesn't like their diagnostic criteria used without their permission. I've left the criteria in for someone more knowledgeable about the syndrome than me to rewrite it into a narrative. Perhaps you'd like to take a crack at it? Richard Pettitt 10:39, 10 December 2007 (CST)