Asperger's Syndrome: A Review of Characteristics



Running head: ASPERGER’S SYNDROME: A REVIEW OF CHARACTERISTICS Asperger's Syndrome: A Review of CharacteristicsKimberly HughesALHE 4060 Research in Allied HealthAbstractThe purpose of this study is to increase awareness among parents in the early detection of Asperger Syndrome in adolescents that display social isolations and eccentric behavior.Recognizing the symptoms of Asperger Syndrome is sometimes hard to identify, many children go undiagnosed or misdiagnosed as having another related condition. Comprehending the criteria that is used to diagnosis AS may help in the early identification and intervention when treatment and therapies are likely to become more successful. Asperger’s Syndrome: Evaluate Diagnoses and TreatmentsAsperger’s Syndrome (AS) is a form of autism spectrum disorder (ASD), one of a distinct group of neurological conditions characterized by two primary areas of deficit: social interaction, and repetitive or restrictive patterns of thought and behavior (APA, 2000). Lorna Wing was the first to use the term “Asperger’s syndrome” in an academic paper published in 1981. She described a group of children and adults who had characteristics that resembled the profile of abilities and behavior originally described by an Austrian pediatrician named Hans Asperger (Wing, 1981). In 1944, Hans Asperger described a condition he termed “autistic psychopathy”, meaning autism (self) and psychopathy (personality disease) to describe what he considered a personality disorder (Attwood, 1998). Leo Kanner an Austrian-American psychiatrist published a paper in 1943 that described characteristics of a group of children that shared similar features as Asperger (Kanner, 1943). The distinction between both papers was Kanner described the children with a more severe expression of autism, while Asperger described more able children (Attwood, 1998).Interest in AS has seemed to increase, following its “official” recognition in the U.S. diagnostic system (DSM-IV; American Psychiatric Association, 1994) and the international one (ICD-10; World Health Organization, 1993). Despite the prevalent interest, there still the debate in the controversy in the diagnostic criteria which has been a source of confusion among parents and clinicians (Mattila, et al., 2007). Several factors complicate the diagnosis of Asperger syndrome. First, there is a lack of consensual agreement on the diagnostic criteria (Klin, Volkmar, & Sparrow, 2000). Second, the term Asperger syndrome is often interchangeable with high-functioning autism (HFA), characterizing those who function at the high end of the autism spectrum, a term interchangeable with pervasive development disorder (Ghaziuddin, 2002). Even with the increase in information of research and descriptions of symptoms the etiology of AS is still unknown. It is imperative to identify a more applicable identification of characteristics that can improve early diagnosis and avoid misdiagnoses. The aim of the present paper is to review historical background, epidemiology, diagnostic features, and overall management/treatment of 156 individuals that exhibit Asperger syndrome. Further, the study will examine the profile of development of behaviors in these individuals to investigate whether the behavior profile might assist in earlier intervention of AS.MethodsThis proposed study is to provide further evaluation on suspected children who exhibit Asperger syndrome. First, I completed and submitted all relevant forms of the proposed study required to IRB education program. Second, a cohort of 156 youths was assembled between the ages 12 through 18 years to participate in the study. The cohort had received their diagnoses independently from a licensed professional (e.g., psychologist, psychiatrist) using the DSM-IV criteria for AS. Third, parents or guardian completed the proper forms that protect the patients’ privacy regarding personal and medical information, thus, complying with HIPPA.ParticipantsThirty-three females (21%) and 123 (79%) male youths with AS ages 12 through 18 years (mean age: 14.97). Their mean full scale intelligence quotient (FSIQ) as measure by the Wechsler Intelligence Scales (Wechsler, 1991) was 102.63 (SD = 22.25). Ten percent of the sample had IQs greater than 130. Three had an FSIQ in the 6; two had a verbal IQ (VJQ) in the average range, while one had a similar performance IQ(PIQ).Eighty-six (55%) of the participants had co-morbid diagnoses, which included attention deficit hyperactive disorder (ADHD; 40%), depression (12%), anxiety disorder (7 %), Tourette Syndrome (3%), oppositional defiant disorder (5%), obsessive compulsive disorder (5%), and bipolar disorder (2%). In addition, these adolescents were prescribed a mean of 2.89 (range 1-9) medications classified as central nervous system stimulant (49%), antidepressant (41%), antipsychotic (24%), or antihypertensive (9%).ProcedureInstruments included the following: (a) the family Demographic Profile (Myles B. S., Hagiwara, Carlson, & Simpson, 1999); (b) the Vineland Adaptive Behaviors Scales (Sparrow, Balla, & Cicchetti, 1984); (c) the Behavior Assessment System for Children—Parent Rating System (Reynold & Kamphaus, 1992); and (d) The Early Adolescent Temperament (Ellis & Rothbart, 2001). Further, parents asked their child’s teacher to complete the (a) BASC—Student Self-Report of Personality (Reynold & Kamphaus, 1992), (b) the Empathy Quotient (EQ) Questionnaire (Baron-Cohen, The essential difference: Male and female brains and the truth about autism, 2003), (c) the Systemizing Quotient (SQ) Questionnaire (Baron-Cohen, The essential difference: Male and female brains and the truth about autism, 2003), and (d) the Adolescent/Adult Sensory Profile (Brown & & Dunn, 2002) independently or through an interview with the authors. Finally, parents were asked to report their child’s intellectual quotient as gathered from school or clinical records.InstrumentsBrief review of the instruments reported in this article.The Family Demographic Profile. This instrument (Myles B. S., Hagiwara, Carlson, & Simpson, 1999) was developed to identify children with AS and family characteristics, including the characteristics of immediate and extended family characteristics.Empathy Quotient Questionnaire. The EQ (Baron-Cohen, 2003) is a self-report questionnaire consisting of an affective component, a cognitive component, and a mixed component. It was originally developed for use with adults of normal intelligence. This 60-item scale measure the ability to empathize. Specifically, the EQ measure an individual’s drive to identify another person’s emotions and thoughts and to provide an appropriate emotional response to his or her emotional state. EQ ranges from low to maximum..Systemizing Quotient Questionnaire. The SQ (Baron-Cohen, 2003) is a 60-item scale that measure an individual’s drive to analyze, explore, and construct a system. Participants can receive a score in one of five categories that range from low to maximum.Vineland Adaptive Behavior Scale. The VABS (Sparrow, Balla, & Cicchetti, 1984) is a semi-sturctured interview designed to assess personal and social skills. Specifically, the VABS assesses adaptive behavior by measuring a person’s performance in the following four domains: Communication Skills, Daily Living Skills, Social Skills and Motor Skills. Standard scores are used.Behavior Assessment System for Children. The BASC (Reynold & Kamphaus, 1992) is a multidimensional assessment used to evaluate a child’s behavior, emotions, self-perceptions, and personal history. It consists of three types of tools, the Parent Rating Scales (PRS), the Teacher Rating Scales (TRS), and the Self-Report of Personality (SRP).The Parent Rating Scale measures a child’s adaptive and problem behaviors in community and home settings whereas the Teacher Rating Scale is a comprehensive measure of both adaptive and problem behaviors in the school setting, both the PRS and TRS adaptive skills composite scores consist of Leadership and Social Skills. The TRS also includes study skills in this domain. Similar to the VABS, social skills include social adaptation in composite score: School Maladjustment, Clinical Maladjustment, and Personal Adjustment. Clinical Scales are scored on a 5-point scale using t-scores wherein a score of 70 and above is Clinical Significant and a score of 30 and below is very low. The Adaptive Scales also use a 5-point scale; however, here a score of 70 and above is considered very high and a score of 30 and below is considered clinically significant.Early Adolescent Temperament Questionnaire—Revised. The EATQ-R (Ellis & Rothbart, 2001) assesses temperament and mood in adolescents. The Temperament Scales, which focus primarily on self-regulation, include Activation Control, Affiliation, Attention, Fear, Frustration, High-Intensity Pleasure, Inhibitory Control, and Shyness, The Behavioral Scales, which focus on temperament traits relat to socialization, include Aggression and Depressive Mood. The instrument is scored using a 5-point scale wherein 1 = almost always untrue and 5= almost always true. This instrument is completed by the parents.ResultsFamily HistoryData on family history were collected on participants and their family members using the Family Demographic Profile (Myles et al., 1999). In total, 86 parents completed the measure.Participants’ siblings were primarily diagnosed with academic challenges (25%), followed by ADHD (13%) and AS (4%). Data on sibling order revealed that 27% of first-born and 26% of second-born siblings had exceptionalities. By comparison, 13% of third-born siblings had disabilities whereas no reported special needs were reported among fourth-born siblings.Cognitive ProfilesIntellectual skills. According to one of the primary diagnostic standards for AS, the DSM-IV-TR (APA, 2000), there is no clinically significant delay in cognitive develpoment among individuals with AS.Participants with AS in the current study had a significantly higher VIQ (M = 109.28, SD = 19.62) than PIQ (M = 99.42, SD = 19.78), t(59) = 4.054, p < .001. Both of these scores, as well as participants’ FSIQ (M = 102.63, SD = 22.25) fell in the average range.Adaptive BehaviorAccording to DSM-IV-TR (APA, 2000), individuals with AS demonstrate no clinically significant delay in adaptive behavior other than in social interaction. In order to assess the adaptive behaviors of participants with AS, the current study utilized two assessment tools: the VABS (Sparrow et al., 1984) and the BASC CITATION Rey92 \l 1033 (Reynold & Kamphaus, 1992).Vineland Adaptive Behavior Scales. Results revealed that the participants with AS had low or moderately low levels of adaptive skills (low; M = 67.75, SI) = 18.26), socialization (low; M = 62.27, SD = 20.25), adaptive composite score (low; M A 64.28, SD) = 19.42), and maladaptive behavior (low; M = 21.36, SD = 8.43).Behavior Assessement System for Children. The BASC’s Adaptive Skills subdomain, which is composed of Leadership, Social Skills, and Study Skills, wasa also used to assess adaptive behaviors. Parents reported that their children’s adaptive behavior skills were in the at risk range while the teachers indicated that their students’ skills were in the average range. A significant difference was found between the two groups’ perception on Leadership, t(67) = -6.718, p < .001, Social Skills, t(67) = -8.122, p < .001, and Composite Score, t(67) = -9.700, p < .001.BehaviorThe BASC wasa also used to assess behavior issues in the adolescents with AS as perceived by parents, teachers, and the students themselves. Externalizing Problems Composite. A significant difference existed between parents’ and teachers’ perceptions of Hyperactivity, Aggression, and Conduct Problems, t(67) = -6.725, p < .001. Parents reported that their adolescent obtained an At-Risk Externalizing Problems Composite (M = 60.96, SD = 12.94). In contrast, teachers indicated that their student performed in the Average range (M= 51.53, SD = 9.04).Three subscales comprising the Externalizing Problems Composite, parents reported their adolescent’s functioning as being in the At-Risk range in Hyperactivity (M = 68.35, SD = 16.91), and in the Average range for Agression (M = 56.96, SD = 11.71) and Conduct Problems (M = 52.49, SD = 10.61). In contrast, teachers’ data indicated that Attention (M=56.40, SD = 10.38), Hyperactivity (M = 54.88, SD = 12.15), and Conduct Problems (M = 46.50, SD = 5.31) were perceived in the Average range.Internalizing Problems Composite. Parents’ and teachers’ data differed significantly with regard to the IPC, t(67) = -3.062, p < .005 (.003). Parents reported that their adolescent were in the At-Risk in Anxiety (M = -55.09, SD = 12.94) and Depression (M = 65.04, SD = 16.25), but Average in Somatization (M = -55.09, SD = 13.89). Teachers considered their students to be Average in all subscales, with ratings similar to parents in Somatization.TemperamentParents completed the EATQ-R on their adolescent with AS to assess his or her temperament using eight subscales and behaviors divided into two domains. Temperament Scales. Parents reported higher scores on the temperament scales of Affiliation (M = 2.09, SD = .75), Fear (M =2.95, SD .79), Frustration (M = 3.94, SD = .66), and Shyness (M = 3.00, SD = 1.05). Lowest scores were assigned to the subscale of Activation Control (M = 2.09, SD =.75).Behavioral Scales. The EATQ-R Behavioral Scales include Agression and Depressive Mood. Parents’ m ean scores were above those of peers in the morning sample in the area of Agression (M = 3.09, SD =.84) and Depressive Mood (M = 2.99, SD =.62).DiscussionBased on the findings of the current study, AS is shown to emerge in adolescents. Overall, the research yields a profile of complexity of AS as expressed by adolescents. The children present a wide variety of disabilities as demonstrated in the study. The findings has tremendous ramifications for instruction. While daily living skills are often taught to individuals with cognitive disabilities, instruction in this area needs to be expanded to include individuals with AS, despite their average IQ to above-average IQ. In short, studies on the adaptive behaviors of individuals with AS suggest that challenges in this area are part of the characteristics of AS despite their exclusion from the current diagnositic criteria. AS is still in its early stages, and this holds true in terms of the comprehending the characteristics of individuals with AS. Clearly, more research on this topic is needed to develop a foundation for understanding adolescents with AS as an essential component of improving their educational experiences. Obivously support from teachers, therapists, and parents, as well as appropriate interventions is nescessary. 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