Last week after writing about the DSM-V “Temper Dysregulation Disorder with Dysphoria,” I received several emails asking my opinion regarding the proposed merger of autism and Asperger’s disorder into a single ’spectrum’ category.  This change has clearly generated some significant political debate in the media and the blogosphere, with some in favor of the change (see for example Dr. Roy Ginker’s NYT article), while others have expressed reservations about the potential impact that this change may have in the autism and Asperger’s community. So I wanted to keep my contribution to this discussion somewhat removed from the political/social issues associated with the change, and instead focus on the scientific/clinical basis for this specific move.  Thus, my aim with this post is not to take a position for or against the proposed DSM-V changes. Instead, I simply want to provide some background information about some of the research data and clinical issues that may have contributed to the DSM-V committee’s decision to propose the merger of all ASDs into a single category. Read More

FOCUS ON AUTISM WEDNESDAY:

When conducting assessments with individuals with autism or other developmental disorders clinicians are often interested in examining the person’s  “adaptive functioning” or how the person actually functions in every day life, usually in specific domains such as communication, sociability, motor functioning, and daily living skills. Clinicians and researchers are also interested in exploring the factors that predict adaptive functioning. One obvious candidate factor is cognitive capacity, or IQ.  It is expected that the more cognitive skills you have, the better you would do in daily living demands. However, researchers have shown that for individuals with high functioning autism, cognitive functioning is not always correlated with adaptive functioning. That is, some individuals may present cognitive skills that are within normal levels, yet display impaired adaptive functioning. Yet, less is known about the relationship between cognitive functioning and adaptive skills among children with more severe autism. For example, do children with low cognitive skills present even lower adaptive functioning or do these kids show higher adaptive functioning than expected based on their cognitive skills? Knowing this information could have implications for treatment, especially for the manner we use cognitive skills as a proxy for prognosis and to guide expectations. Read More

The issue of public masturbation in kids with autism is probably one of the most uncomfortable topics for parents to discuss with their clinicians or pediatricians. I usually can sense when a parent wants to bring up the topic, and the parents are usually relieved when I address the issue directly. Inappropriate sexual behaviors (public masturbation or nudity, sexually touching of strangers, etc) are actually not that uncommon among children with a variety of developmental disorders, including autism. Read More

Part II review of: Fred R. Volkmar, Matthew State, Ami Klin (2009). Autism and autism spectrum disorders: diagnostic issues for the coming decade Journal of Child Psychology and Psychiatry, 50 (1-2), 108-115 DOI: 10.1111/j.1469-7610.2008.02010.x

Much controversy and confusion remains about the differences between high functioning autism and Asperger’s syndrome. As the authors described, there are many areas of overlap as well as differences between the original Asperger’s proposal and autism. Read More

A review of Efrosini Kalyva (2008). Comparison of Eating Attitudes between Adolescent Girls with and without Asperger Syndrome: Daughters’ and Mothers’ Reports Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-008-0648-5

The marked gender difference in the rate of autism spectrum diagnoses has resulted in a major gender disparity in research. That is, the overwhelming majority of studies on autism are conducted with boys, and studies examining mostly girls are very rare. The study I’m reviewing today was conducted at the University of Sheffield in Greece. The author wanted to examine the rates of eating problems reported by girls with Asperger’s syndrome when compared to typically developing girls. The study included 56 girls with AS and 56 typically developing girls (Age 12 to 18). The AS was diagnosed by a multidisciplinary team via ADI and ADOS using USA cutoff points. The comparison sample was selected from the local school system. The AS and the typically developing girls were match for Body Mass Index (BMI). The girls and their mothers completed the Eating Attitude Test. This test assesses a wide range of eating behaviors (“I have gone on eating binges”) and attitudes (“I’m terrified about being overweight”) associated with several eating disorders.

The results indicated that, when compared to typically developing girls, girls with AS were more likely to endorse more symptoms associated with bulimia and food preoccupation. However, no difference between the groups were noted on dieting behaviors. The author reached the same conclusion when examining mother’s reports of their daughters eating habits and attitudes.

Please note that these results suggest increased symptoms of eating disorders among the AS girls, but this may not necessarily translate to actual diagnoses of eating disorders. That is, the study did not include a comprehensive evaluation for actual eating disorders. Thus, the differences in rates of eating disorder among the two groups of girls is unknown.