1. www. Decaturfamilypsychiatry.com
160 Clairemont Ave Ste 445
Decatur,
GA 30030
www. Decaturfamilypsychiatry.com

5. Just In: Aspergers Prevalence Predicted To Fall To Zero
PHARMA & HEALTHCARE 
12/04/2012

6. Classic Autism
A child labeled today as having an Autism Spectrum Disorder may look very different from the child diagnosed 30 years ago with Autism. At that time we diagnosed children who more closely resembled the children first described by Dr. Leo Kanner, in the seminal paper, Kanner, L. (1943), Autistic Disturbances of Affective Contact, Nervous Child 2, pp

7. Types of Autism Spectrum Disorders/ Pervasive Developmental Disorders
Autistic Disorder
Asperger’s Disorder
Rett’s Disorder
Childhood Disintegrative Disorder
Pervasive Developmental Disorder-
Not otherwise specified

8. Asperger’s Disorder Impairments in social interaction
Problems with nonverbal social interactions such as eye gaze, facial expression, gestures and/or body posture
Problems with peer relationships and an inability to form peer relationships appropriate to his/her age
Problems with shared pleasure or enjoyment and a failure to seek such interaction with other people. (For example not pointing out interesting objects or not bringing a toy or object to an adult to share in the interest.)
Problems with normal give-and-take of social interactions like taking turns or expressing emotions when socially appropriate

9. Autism Spectrum Disorders
Persistent deficits
Social communication/ interaction
Restricted, repetitive pattern of behavior, interests, activities
Present, early developmental period; may manifest later
Impairment, assess each deficit separately
Severity (each deficit)
Requiring support, requiring substantial support, requiring very substantial support
Specifiers
With/ without accompanying intellectual impairment
With/ without accompanying language impairment
Associated with known medical or genetic condition or
environmental factor
Associated with another neurodevelopmental, mental, or
behavioral disorder
With catatonia

10. Communication Disorders
Social (Pragmatic) Communication Disorder
Persistent difficulties – social use of verbal & nonverbal communication
Social
Change with context/ listener
Rules of conversation/ story-telling
Non explicit
Functional limitations
Onset, early developmental period

11. Changes
Consolidation of all variants into 1 disorder Specifiers to indicate specific characteristics

14. J Am Acad Child Adolesc Psychiatry. 2012 Apr;51(4):368-83. doi: 10
J Am Acad Child Adolesc Psychiatry. 2012 Apr;51(4): doi: /j.jaac Epub 2012 Mar 14. Sensitivity and specificity of proposed DSM-5 diagnostic criteria for autism spectrum disorder. McPartland JC, Reichow B, Volkmar FR.

15. Asperger - 1944 “Autistic Psychopathy” Series of cases – all male
Marked social problems
Good cognitive/language skills
Motor problems
Circumscribed interests
Positive family hx (esp. fathers)

16. Asperger: 1944 Unusual circumscribed interests
- all absorbing, interfered with functioning
- family life would revolve around these
Motor Skills - Often clumsy - poor body awareness

17. Asperger: 1944 Social Disability Communication Problems
couldn’t join groups
lack of friends even though interested in others
intellectualization of affect
conduct problems (noncompliant/negativistic)
Communication Problems
verbosity, one sided style
impaired nonverbal skills
idiosyncratic communication
“little professors”

18. Asperger Syndrome Limited Interest until early 1980’s
Limited Interest until early 1980’s
- Van Krevelen in 1970’s – emphasized personality trait
Wing (1981) synthesis and case series
modifications in Asperger’s description
some features
- mild MR
possible language problems
possible continuity with autism
case reports

19. Asperger’s 1981 - 1994 Lack of consistent criteria
- markedly different views of the syndrome developed
Issue of risk psychosis/violence
Comparisons to Autism

20. Other Diagnostic Constructs
From Neuropsychology
- Nonverbal Learning Disabilities (NLD)
From Neurology
- Right Hemisphere Syndromes
- Developmental Disabilities of the Right Hemisphere
From Psycholinguistics
- Semantic-Pragmatic Disorder
Also
- “Hyperplexia”, Schizoid Personality in Childhood,
OC Behaviors, . . .

21. Asperger’s Syndrome Inconsistencies in Use
Issues with lack of consensual criteria
AS = higher functioning autism (without MR)
AS = adults with autism
AS = PDD-NOS/ “mild autism”
AS = shyness/ “nerds” (shades into normalcy)
AS = complex profiles associated with social problems
AS = distinctive disorder

22. Autism Spectrum Disorders
Persistent deficits
Social communication/ interaction
Restricted, repetitive pattern of behavior, interests, activities
Present, early developmental period; may manifest later
Impairment, assess each deficit separately
Severity (each deficit)
Requiring support, requiring substantial support, requiring very substantial support
Specifiers
With/ without accompanying intellectual impairment
With/ without accompanying language impairment
Associated with known medical or genetic condition or
environmental factor
Associated with another neurodevelopmental, mental, or
behavioral disorder
With catatonia

23. Communication Disorders
Social (Pragmatic) Communication Disorder
Persistent difficulties – social use of verbal & nonverbal communication
Social
Change with context/ listener
Rules of conversation/ story-telling
Non explicit
Functional limitations
Onset, early developmental period

24. A particularly common problem in adolescents/adults
Depression
A particularly common problem in adolescents/adults
Growing awareness may risk for depression
? Genetic vulnerability
Drug Treatments
- Importance of careful diagnosis (difficulties in dx)
- Track changes over time in mood and symptoms
- Agents: SRIs, tricycle antidepressants
- Need for appropriate monitoring, keep in mind time
course and potential side effects

25. Anxiety Various agents available Risk for anxiety problems
- Origins unclear - social limitations? Intrinsic?
- Frequent victimization, difficulties in dealing with
transitions, lack of empathy yet sufficient ability to
realize that they are not “ getting it”
Various agents available
- SSRIs
-minor tranquilizers, buspirone
- alpha-adrenergic agonist medications
- issues of disinhibition

26. Anxiety Risk for anxiety problems
- Origins unclear - social limitations? Intrinsic?
- Frequent victimization, difficulties in dealing with
transitions, lack of empathy yet sufficient ability to
realize that they are not “ getting it”
Various agents available
- SSRIs
-minor tranquilizers, buspirone
- alpha-adrenergic agonist medications
- issues of disinhibition

27. Don’t loose sight of the big picture
Goals for Education
Academic Curriculum
Don’t loose sight of the big picture
Long-term goals
- each item evaluated in terms of benefits for
socialization, vocational potential, and quality of life
- avoid curriculum inflexibility (i.e. strict adherence
to credit system)
- curriculum modification: the concept of “secondary gains”
Emphasis on strengths that may serve vocational goals
Mentorship, specific projects
Foster motivation, self-initiative, and positive self-concept