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The Asperger-Syndrome is a pervasive developmental disorder with problems in primarily social and communicative competence, empathy, associated with motor awkwardness and/or clumsiness and highly circumscribed interests. Deficient social interaction, communication and repertoires are considered core. Oddly, Asperger's patients tend to be stronger in verbal intelligence than non-verbal, the opposite of autism. The reliability of the diagnosis is still questionable and efforts are being made to improve agreement between raters. Yale researchers say, "(T)he validity and usefulness of this specific diagnostic concept is far from resolved" (Child Adolesc Psychiatr Clin N Am. 2003 Jan;12(1):1-13). Asperger's syndrome is a diagnosis given mainly to boys (4:1), while severe autism is evenly split (JAMA. 2003 Jan 1;289(1):49-55). Asperger's in fact is almost certainly a combination of different diseases which appear to be unrelated to autism. The Asperger's diagnosis is being used for a wide variety of children, some of whom have very serious problems and others much less serious. Already, efforts are being made to force universities to develop special support systems for students diagnosed as Asperger's (Work. 2001;17(3):183-190). Autism: Nocturnal Production Low: In a study of 49 children and adolescents with autistic disorder and 88 normal children, nocturnal production of melatonin was reduced in autism. Nocturnal excretion of 6-sulphatoxymelatonin in children and adolescents with autistic disorder. Tordjman S, Anderson GM, et al. niversite de Rennes, France. Biol Psychiatry. 2005 Jan 15;57(2):134-8. There is a report with adolescents and adults with autism and Asperger's measuring increased levels of Asperger's Patients Often Non-Verbal Learning Disabilities: In a study of 100 males with Asperger syndrome (AS), ages 5 1/2 to 24 with the average age 11, there was a high rate (51%) of non-verbal learning disability (defined as Verbal IQ more than 15 points higher than Performance IQ), but otherwise there was little support for the notion of a core right-hemisphere brain dysfunction. There was a very high rate of close relatives with autism spectrum problems, but also high rates of prenatal and perinatal problems, including prematurity and postmaturity. Non-verbal learning disability test results applied in about half the group. There was a subgroup of individuals with AS who had macrocephalus. However, there was no support for an association of AS with low body mass index. One hundred males with Asperger syndrome: a clinical study of background and associated factors. Cederlund M, Gillberg C. University of Goteborg, Sweden. Dev Med Child Neurol. 2004 Oct;46(10):652-60. Genetics of Asperger's Different From Autism: The family psychiatric history of 58 children with AS diagnosed according to DSM-IV criteria (48 males; average age 13; IQ 105) were studied. All subjects had a history of mild autistic social deficits; focused special interests; normal level of intelligence; and an odd and often pedantic manner of speaking. None had a previous diagnosis of autism. Of the 58, three had first degree relatives with AS; nine (15%) had a family history of schizophrenia; and 35 (60%) had a family history of depression. Of the 64 siblings, four had a diagnosis of AS and none of autism. Compared with a group of 39 subjects with normal intelligence autism (high functioning autism, HFA; 33 males; age 15; IQ 86) subjects with AS were more likely to have relatives with depression; schizophrenia; and the broader autistic phenotype. A family history study of Asperger syndrome. Ghaziuddin M. University of Michigan. J Autism Dev Disord. 2005 Apr;35(2):177-82. Genetics: Asperger's More Depression, Schizophrenia, and AS in Family: T Insomnia Very Common with Adult Aspergers: In a study of 20 Asperger adults, frequent insomnia was reported in sleep questionnaire 90% (18/20), in sleep diary 75% (15/20) and in free description 85% (17/20) displayed insomnia. Insomnia is a frequent finding in adults with Asperger syndrome. Tani P, Lindberg N, et al. University of Helsinki, Finland. Insomnia: Melatonin Supplement Appeared to Help in Open Trial: In an unreliable 14-day open trial, melatonin 3 mg/night was given to 15 children with Asperger disorder with measures of sleep quality, tiredness, and behavior. Sleep patterns of all the children improved, and half of them displayed excellent responses. Time to fall asleep decreased from 40 minutes to 21 minutes (p = 0.002), whereas sleep duration remained steady at 477 minutes and 480 minutes. Behavioral measures also displayed a significant improvement, and most of the effect disappeared after the discontinuation of the melatonin (p = 0.001). Effectiveness of melatonin in the treatment of sleep disturbances in children with Asperger disorder. Paavonen EJ, Nieminen-von Wendt T, et al. University of Helsinki. J Child Adolesc Psychopharmacol. 2003 Spring;13(1):83-95. Ed: Melatonin does help in many animal models of stroke and Alzheimer's disease. MRI Studies Lack Replicability Stanford Study Suggests Asperger's Not Part of Autism Spectrum: In a case-control study of 13 low-functioning autism (LFA; IQ<70), 18 high-functioning autism (HFA; IQ>or=70), and 21 ASP boys, intersite differences were seen for subject age, IQ, and cerebellum measures. Cerebral gray matter volume was enlarged in both HFA and LFA compared with controls (P =.009 and P =.04, respectively). Cerebral gray matter volume in ASP was intermediate between that of HFA and controls, but nonsignificant. Exploratory analyses revealed a negative correlation between cerebral gray matter volume and performance IQ within HFA but not ASP. A positive correlation between cerebral white matter volume and performance IQ was observed within ASP but not HFA. Investigation of neuroanatomical differences between autism and Asperger syndrome. Lotspeich LJ, Kwon H, et al. Stanford. Arch Gen Psychiatry. 2004 Jun;61(6):606. MRI Study Finds Only Small Increase in Mild Abnormalities; Not Consistantly: MRIs of 28 Asperger children and adults were compared to 23 controls. Mild inconsistent alterations were detected in 13/28 of the individuals with Asperger Syndrome compared to 6/23 controls. No consistent focal brain abnormalities for Asperger Syndrome were detected. A quantitative controlled MRI study of the brain in 28 persons with Asperger syndrome. Nieminen-von Wendt T, Salonen O, et al. Helsinki University. Int J Circumpolar Health. 2002;61 Suppl 2:22-35. Restless Lower Limbs May Be Common: The movement disturbances and brain imaging suggest a dopaminergic deficit in movement regulation in Aspergers. In a study of 10 AD patients with 10 healthy controls, measuring their rest-activities by actometry, lower limb motor activity was significantly higher with a rhythmic, periodic movement pattern similar to akathisia. These findings suggest a hypothesis of idiopathic akathisia and a special sensitivity to adverse effects of neuroleptic drugs. Lower limb motor restlessness in Asperger's disorder, measured using actometry. Tuisku K, Tani P, et al. Helsinki University, Finland. Psychiatry Res. 2004 Aug 30;128(1):63-70. Test for Asperger's Unreliable: The Asperger's Syndrome Diagnostic Scale (2001) was reviewed to determine it's reliability, validity, and clinical utility in the diagnostic process for pervasive developmental disorder, specifically Asperger's syndrome. Concerns were raised about validity of the instrument, population upon which the instrument was normed, capability of the instrument to provide accurate differential diagnoses, and properties of the scale. The measure was determined to hold promise as a research tool, but there appears to be little evidence that it can distinguish among the various types of pervasive developmental disorder or diagnosis Asperger syndrome specifically. Review of the Asperger Syndrome Diagnostic Scale. Goldstein S. J Autism Dev Disord. 2002 Dec;32(6):611-4. Thomas E. Radecki, M.D., J.D. |