Adult Asperger Syndrome and the Utility of Cognitive-Behavioral Therapy

Asperger syndrome (AS) is a developmental disorder that was first recognized in the United States in 1994 with the publication of DSM-IV (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 1994). As a relatively new concept to the United States, both within the professional community and public awareness, the diagnosis has most often applied to children, but there is a large cohort of affected adults who have never been diagnosed or properly treated. Many of these individuals are now seeking treatment for the symptoms of AS and/or comorbid mental health problems (e.g., mood and anxiety disorders). Clinicians are in need of practical and evidence-based interventions to address the problems presented by this growing patient population, but there are few such resources available. This article will present a framework for conceptualizing the mental health needs of adults with AS, using the evidence-based approaches found in the cognitive-behavior therapy (CBT) literature to inform treatment.     

Dissociation between cognitive and affective empathy in youth with Asperger Syndrome

Autism spectrum conditions, among them Asperger Syndrome (AS), are generally described as entailing deficits in “cognitive empathy” or “theory of mind”. People with AS tend to have difficulties recognizing emotions, although the extent of these difficulties is still unclear. This study aimed to assess empathic profile in youth with AS (N = 38) and controls matched on age, sex and IQ. The study aimed to test if a dissociation between cognitive and affective empathy exists in AS. The study also aimed to explore emotion recognition in people with AS, and how it relates to emotional valence (positive, negative, and neutral emotions). The AS group scored lower than controls on cognitive empathy but scored within the average range on affective empathy. A deficit in emotion recognition was found in the AS group for positive emotions. These results confirm earlier findings in cognitive empathy and provide new insight about emotion recognition abilities in this population.     

Occupational Therapists' Experience Concerning Occupational Performance in Adults With Asperger Syndrome

Persons with Asperger Syndrome often seem to have difficulty performing everyday occupations. This study aimed to describe occupational therapists' experience concerning abilities to occupational performance among adults with Asperger Syndrome. Data were collected in interviews with eight occupational therapists and analyzed using a qualitative method. Results showed that clients with Asperger Syndrome often possess abilities but seem to have difficulties knowing when, where, and how they should use them. The ability to adapt behavior in accordance with cues from the environment was identified as the core category. Environment plays a major role in how these persons interact in different situations.     

fMRI of parents of children with Asperger Syndrome: a pilot study

BACKGROUND: People with autism or Asperger Syndrome (AS) show altered patterns of brain activity during visual search and emotion recognition tasks. Autism and AS are genetic conditions and parents may show the 'broader autism phenotype.' AIMS: (1) To test if parents of children with AS show atypical brain activity during a visual search and an empathy task; (2) to test for sex differences during these tasks at the neural level; (3) to test if parents of children with autism are hyper-masculinized, as might be predicted by the 'extreme male brain' theory. METHOD: We used fMRI during a visual search task (the Embedded Figures Test (EFT)) and an emotion recognition test (the 'Reading the Mind in the Eyes' (or Eyes) test). SAMPLE: Twelve parents of children with AS, vs. 12 sex-matched controls. DESIGN: Factorial analysis was used to map main effects of sex, group (parents vs. controls), and sexxgroup interaction on brain function. An ordinal ANOVA also tested for regions of brain activity where females>males>fathers=mothers, to test for parental hyper-masculinization. RESULTS ON EFT TASK: Female controls showed more activity in extrastriate cortex than male controls, and both mothers and fathers showed even less activity in this area than sex-matched controls. There were no differences in group activation between mothers and fathers of children with AS. The ordinal ANOVA identified two specific regions in visual cortex (right and left, respectively) that showed the pattern Females>Males>Fathers=Mothers, both in BA 19. RESULTS ON EYES TASK: Male controls showed more activity in the left inferior frontal gyrus than female controls, and both mothers and fathers showed even more activity in this area compared to sex-matched controls. Female controls showed greater bilateral inferior frontal activation than males. This was not seen when comparing mothers to males, or mothers to fathers. The ordinal ANOVA identified two specific regions that showed the pattern Females>Males>Mothers=Fathers: left medial temporal gyrus (BA 21) and left dorsolateral prefrontal cortex (BA 44). CONCLUSIONS: Parents of children with AS show atypical brain function during both visual search and emotion recognition, in the direction of hyper-masculinization of the brain. Because of the small sample size, and lack of age-matching between parents and controls, such results constitute a pilot study that needs replicating with larger samples.     

学龄早期Asperger综合症儿童行为问题和注意、行为抑制功能研究

研究采用Achenbach儿童行为量表(父母用表)和注意、行为抑制及动作协调性行为任务对12名学龄早期的Asperger综合征儿童与29名在年龄及智力水平上与之匹配的正常儿童在行为问题、注意、行为抑制及动作协调等方面进行了比较.结果发现,在控制了年龄和智力因素后:1)Asperger综合征儿童的社会能力与正常儿童相比明显较差,同时常伴随有交往不良、社交退缩、焦虑、忧郁、强迫性、攻击性和多动等一系列行为问题;2)Asperger综合征儿童表现出一定的注意和行为抑制障碍,动作的协调性和灵活性较差.     

An islet of social ability in Asperger Syndrome: judging social attributes from faces

We asked adults with Asperger Syndrome to judge pictorial stimuli in terms of certain social stereotypes to evaluate to what extent they have access to this type of social knowledge. Sixteen adults with Asperger Syndrome and 24 controls, matched for age and intelligence, were presented with sets of faces, bodies and objects, which had to be rated on a 7-point scale in terms of trustworthiness, attractiveness, social status, and age, or, in the case of objects, price. Despite impaired performance on two important aspects of social cognition (second-order mentalizing and face recognition) the social judgements of the individuals with Asperger Syndrome were just as competent and consistent as those of their matched controls, with only one exception: there was a trend for them to be less able to judge the attractiveness of faces if they were the same sex. We explain this difference in terms of a weakness in mentalizing, specifically the ability to take a different point of view: While all other stereotypic attributions could be made from an egocentric point of view, judging the attractiveness of faces of one's own sex requires taking the perspective of someone of the opposite sex, a challenge for people with mentalizing problems. We conclude that individuals with Asperger Syndrome show preserved aspects of social knowledge, as revealed in the attribution of stereotypes to pictures of people. These findings suggest that there are dissociable subcomponents to social cognition and that not all of these are compromised in Asperger Syndrome.     

Finding a face in the crowd: testing the anger superiority effect in Asperger Syndrome

Social threat captures attention and is processed rapidly and efficiently, with many lines of research showing involvement of the amygdala. Visual search paradigms looking at social threat have shown angry faces 'pop-out' in a crowd, compared to happy faces. Autism and Asperger Syndrome (AS) are neurodevelopmental conditions characterised by social deficits, abnormal face processing, and amygdala dysfunction. We tested adults with high-functioning autism (HFA) and AS using a facial visual search paradigm with schematic neutral and emotional faces. We found, contrary to predictions, that people with HFA/AS performed similarly to controls in many conditions. However, the effect was reduced in the HFA/AS group when using widely varying crowd sizes and when faces were inverted, suggesting a difference in face-processing style may be evident even with simple schematic faces. We conclude there are intact threat detection mechanisms in AS, under simple and predictable conditions, but that like other face-perception tasks, the visual search of threat faces task reveals atypical face-processing in HFA/AS.     

Anxiety and Depression Symptoms in Children with Asperger Syndrome Compared with Attention-Deficit/Hyperactivity Disorder and Depressive Disorder

The objective of this study was to examine (a) anxiety and depression symptoms in children with Asperger syndrome (AS) compared to children with attention-deficit/hyperactivity disorder (ADHD) and children with depressive disorder; (b) parental anxiety and depressive symptoms in the three groups; and (c) the association between the anxiety and depression symptoms of children and their parents. The emotional and behavioral problems of 56 children with AS (48 boys, 8 girls, mean age, 9.39 ± 2.01 years) were compared with 56 ADHD children and 56 depressive disorder children, matched for age and sex. Their parents’ anxiety and depression symptoms were also compared. Trait-anxiety and internalizing problems in AS children were higher than those in ADHD children and as high as those in depressive disorder children (F = 8.83, p < 0.001 and F = 8.21, p < 0.001). Parents’ anxiety and depression symptoms did not differ among the three groups, but correlations between maternal anxiety and depression and children’s emotional and behavioral problems were most prominent in the AS group. We suggest that the assessment and treatment of children with AS should involve detailed assessment, possible concomitant treatment for comorbid anxiety and depression, and parental education about the effect of parental emotional states on children.     

Tactile sensitivity in Asperger syndrome

People with autism and Asperger syndrome are anecdotally said to be hypersensitive to touch. In two experiments, we measured tactile thresholds and suprathreshold tactile sensitivity in a group of adults with Asperger syndrome. In the first experiment, tactile perceptual thresholds were measured. Two frequencies of vibrotactile stimulation were used: 30 and 200 Hz. The results demonstrated significantly lower tactile perceptual thresholds in the Asperger group at 200 Hz but not at 30 Hz, thus confirming tactile hypersensitivity but only for one class of stimulus. A second experiment investigated whether self-produced movement affected the perception of touch in a group of adults with Asperger syndrome. A suprathreshold tactile stimulus was produced either by the participant (self-produced condition) or by the experimenter (externally produced condition) and participants were asked to rate the perception of the tactile stimulation. The results demonstrated that, while both Asperger and control groups rated self-produced touch as less tickly than external touch, the Asperger group rated both types of tactile stimulus as significantly more tickly and intense than did the control group. This experiment confirms the finding of tactile hypersensitivity, but shows that the perceptual consequences of self-produced touch are attenuated in the normal way in people with Asperger syndrome. An abnormality in this process cannot therefore account for their tactile hypersensitivity.     

A Comparison of Video Feedback and In Vivo Self-Monitoring on the Social Interactions of an Adolescent with Asperger Syndrome

Difficulties with social interactions and restrictive and repetitive interest patterns or behaviors are common among individuals with Asperger syndrome. These difficulties often pose barriers to establishing and maintaining social relationships. In the current study, 2 different interventions were compared that focused on improving the social interactions of a 14-year-old adolescent with Asperger syndrome. A reversal design was used to compare the effectiveness of video feedback and in vivo self-monitoring on inappropriate and appropriate social interactions during activities with a teacher. The procedures were replicated during activities with peers, and generalization was assessed during activities with the adolescent’s mother. Although video feedback resulted in slight reductions in inappropriate behavior, larger reductions occurred during in vivo self-monitoring. Treatment acceptability data indicated high participant satisfaction with both interventions; however, the in vivo self-monitoring was rated as slightly preferred.     

Egocentrism, allocentrism, and Asperger syndrome

In this paper, we attempt to make a distinction between egocentrism and allocentrism in social cognition, based on the distinction that is made in visuo-spatial perception. We propose that it makes a difference to mentalizing whether the other person can be understood using an egocentric ("you") or an allocentric ("he/she/they") stance. Within an egocentric stance, the other person is represented in relation to the self. By contrast, within an allocentric stance, the existence or mental state of the other person needs to be represented as independent from the self. We suggest here that people with Asperger syndrome suffer from a disconnection between a strong na?ve egocentric stance and a highly abstract allocentric stance. We argue that the currently used distinction between first-person and third-person perspective-taking is orthogonal to the distinction between an egocentric and an allocentric stance and therefore cannot serve as a critical test of allocentrism.     

Improving written language performance of adolescents with Asperger syndrome

The effects of a multicomponent intervention involving self-regulated strategy development delivered via video self-modeling on the written language performance of 3 students with Asperger syndrome were examined. During intervention sessions, each student watched a video of himself performing strategies for increasing the number of words written and the number of functional essay elements. He then wrote a persuasive essay. The number of words written and number of functional essay elements included in each essay were measured. Each student demonstrated gains in the number of words written and number of functional essay elements. Maintenance of treatment effects at follow-up varied across targets and participants. Implications for future research are suggested.     

Processing of compound visual stimuli by children with autism and Asperger syndrome

A typical modes of visual processing are common in individuals with autism. In particular, and unlike typically developing children, children with autism tend to process the parts of a complex object as a priority, rather than attending to the object as a whole. This bias for local processing is likely to be due to difficulties in assembling subparts into a coherent whole, as proposed by Frith ( 10 1989) using the term “weak central coherence” or WCC. This study was aimed to better characterize the processing of complex visual stimuli by children with autism. Thirteen children with autistic spectrum disorders were individually paired with children of two control groups, one matched on verbal mental age (VMA) and one matched on chronological age (CA). Participants from the three groups were tested in two tasks. The first task involved hierarchical global/local stimuli, inspired by Navon ( 30 1977). The second task employed compound face‐like or geometrical stimuli. This task emphasized the processing of configural properties of the stimuli (i.e., spatial relationships). Children from the three groups showed a perceptual bias favouring the global dimension of the stimuli in the first task. By contrast, children with autism were deficient compared to normal children for the processing of the configural dimensions of the stimuli in the second task. These results suggest that visual cognition of children with autism is characterized by a dissociation between global and configural processing, with global processing being preserved and configural processing being altered in these children, therefore delineating the extents and limits of the WCC theory (Frith, 10 1989).     

The capacity to tell a joke: Reflections from work with Asperger children

The capacity to tell a joke is a highly complex interpersonal event that depends upon the maturation of certain developmental achievements which are absent or stunted in children with Asperger's Syndrome. These include the ability to know another's mind, a sense of interpersonal timing and, most notably, a capacity for abstract thinking. The author discusses Freud's ( 1905 ) notion of joke‐work, which is akin to dream‐work, both of which are pathways to forming mental representations. Freud considered joke‐work as a mental activity that operated on the verbal level and the author examines the preverbal dimensions that are rooted in the earliest mother/infant interactions. An extended case discussion of the psychoanalytic treatment of an Asperger boy is offered to illustrate these points and to demonstrate the activity of joke‐work as a means of building mental representations.     

Comparison of pausing behavior in children who stutter and children who have Asperger syndrome

Purpose

The objective of this research was to compare the number and types of grammatical and non-grammatical silent pauses presented by stutterers and subjects with Asperger syndrome in their narratives.

Method

Ten children who stutter and four participants with Asperger syndrome (mean ages of both groups 10 years) were assessed at the Speech and Language Disorders Department of the Universidade Federal de São Paulo/Brasil. They narrated a story based on a pre-selected sequence of pictures. They were filmed and their productions were analyzed using version 5.0.47 of Praat (http://www.fon.hum.uva.nl/praat/download_win.html). Silent intervals in the speech that ranged from 0.25 to 4 s were considered pauses. The pauses were classified as grammatical and non-grammatical, depending on the words that preceded and followed them.

Results

Both groups presented grammatical and non-grammatical pauses and the former predominated. The children with Asperger syndrome produced a greater number of pauses than the stutterers.Educational objectives: The reader will be able to: (1) characterize the use of pauses in the oral narrative; (2) distinguish a grammatical pause from a non-grammatical pause regarding the use and function; (3) recognize the pattern of pause found in the two populations.     

多囊卵巢综合征与代谢综合征

高胰岛素血症和高雄激素血症是多囊卵巢综合征(PCOS)的两大基本特征,共同参与了PCOS的发生与发展,胰岛素抵抗是连接PCOS和MS的纽带.本文阐述了PCOS和MS的相互重叠、PCOS产生胰岛素抵抗的机制、胰岛素抵抗对PCOS的作用.指出早期识别PCOS,有利于及时纠正、阻断其内分泌紊乱,防止MS的发生.提高胰岛素敏感性的治疗措施包括生活方式调整和药物治疗,生活方式的调整主要是控制饮食、运动和改变生活方式,包括戒烟、戒酒;药物治疗主要是使用二甲双胍和噻唑烷二酮类药物,其他药物如右旋肌醇、N-乙酰半胱氨酸、生长抑素类似物、α糖苷酶抑制剂、内腓肽受体抑制剂也具有增强胰岛素敏感性的作用.     

多囊卵巢综合征与代谢综合征

高胰岛素血症和高雄激素血症是多囊卵巢综合征（PCOS）的两大基本特征,共同参与了PCOS的发生与发展,胰岛素抵抗是连接PCOS和MS的纽带。本文阐述了PCOS和MS的相互重叠、PCOS产生胰岛素抵抗的机制、胰岛素抵抗对PCOS的作用。指出早期识别PCOS,有利于及时纠正、阻断其内分泌紊乱,防止MS的发生。提高胰岛素敏感性的治疗措施包括生活方式调整和药物治疗,生活方式的调整主要是控制饮食、运动和改变生活方式,包括戒烟、戒酒;药物治疗主要是使用二甲双胍和噻唑烷二酮类药物,其他药物如右旋肌醇、N-乙酰半胱氨酸、生长抑素类似物、α糖苷酶抑制剂、内腓肽受体抑制剂也具有增强胰岛素敏感性的作用。