'I Felt Like I was Floating in Space': Autistic Adults' Experiences of Low Mood and Depression.

It is recognised that a high proportion of adults on the autism spectrum experience depressive symptoms. However, limited research has explored autistic peoples' experiences of low mood and depression. The aim of this study was to explore the lived experiences of low mood and depression for adults on the autism spectrum. The study employed Interpretive Phenomenological Analysis to investigate the experiences of 8 adults (7 males and 1 female), aged between 19 and 51, who had a diagnosis of autism without co-occurring learning disabilities, and experienced low mood or depression. All participants recorded their thoughts and feelings in a mood diary for 1 week and participated in a semi-structured interview. Three superordinate themes emerged from the data: 'Autism has made me the person I am', 'I can't function in the world' and 'It's like trying to do accounts on the futures market': Making sense of emotions. Findings highlight a need for specialist mental health provision for adults who are on the autism spectrum. Limitations of this study and implications for future research are discussed.

A case of co-occuring synesthesia, autism, prodigious talent and strong structural brain connectivity.

BACKGROUND: Synesthesia is a sensory phenomenon where certain domain-specific stimuli trigger additional sensations of e.g. color or texture. The condition occurs in about 4% of the general population, but is overrepresented in individuals with Autism Spectrum Disorder (ASD), where it might also be associated with the presence of prodigious talents. CASE PRESENTATION: Here we describe the case of a young transsexual man with Asperger Syndrome, synesthesia and a prodigious talent for foreign language acquisition. In our case, not only letters, numbers, spoken words, music, noises, weekdays and months lead to highly consistent, vivid color sensations but also his own and others' emotions, geometric shapes, any mathematical symbol, and letters from an unfamiliar alphabet (Hebrew). These color associations seem to aid categorization, differentiation and storage of information and might thereby contribute to the young man's language acquisition ability. We investigated the young man's structural brain connectivity in comparison to adults with or without ASD, applying global fiber tracking to diffusion-weighted Magnetic Resonance Imaging (MRI) data. The case presented with increased connectivity, especially between regions involved in visual and emotion processing, memory, and higher order associative binding regions. An electroencephalography experiment investigating synesthetic color and shape sensations while listening to music showed a negligible occipital alpha suppression, indicating that these internally generated synesthetic sensations derive from a different brain mechanism than when processing external visual information. CONCLUSIONS: Taken together, this case study endorses the notion of a link between synesthesia, prodigious talent and autism, adding to the currently still sparse literature in this field. It provides new insights into the possible manifestations of synesthesia in individuals with ASD and its potential contribution to prodigious talents in people with an otherwise unexceptional cognitive profile. Additionally, this case impressively illustrates how synesthesia can be a key element not only of sensory perception but also social and emotional processing and contributes to existing evidence of increased brain connectivity in association with synesthesia.

[Autism spectrum symptoms in children with congenital blindness]. / Autismus-Spektrum-Symptome bei Kindern mit Geburtsblindheit.

Autism spectrum symptoms in children with congenital blindness Abstract. Objective: Previous studies reported increased rates of autistic symptoms in children with impaired visual abilities (IV). However, the application of existing screening questionnaires for autism spectrum disorders (ASD) proved problematic, as intact visual abilities are typically required. The current study examines the general applicability of three autism-screening questionnaires in children with congenital blindness. Methods: Autistic symptoms were assessed in 15 children with congenital blindness, 15 children with ASD (without IV), and 20 typically developing controls (aged from 8 to 14 years), using the Social Communication Questionnaire, the Marburg Rating Scale for Asperger's Syndrome, and the Social Responsiveness Scale. Results: Items assessing motor, mimic/gesture-related, or joint attention deficits were identified as highly prevalent in children with congenital blindness. These children scored, in general, higher on ASD-screening questionnaires than typically developing controls but lower than sighted children with ASD. Depending on the screening questionnaire used, between 23 % and 67 % of the sample with congenital blindness reached clinical cutoff scores for ASD. SRS total score was negatively correlated to cognitive empathy and verbal IQ in those children. Conclusions: Mothers of children with congenital blindness reported increased autistic symptoms in ASD-screening questionnaires. ASD and IV might share a broad range of symptoms. Future development and validation of screening instruments specifically adapted to the needs of persons with impaired visual abilities seem necessary.

Comprehending conjunctive entailment of disjunction among individuals with Asperger syndrome.

Although individuals with Asperger syndrome (AS) are often described to be semantic-pragmatic disordered, it is still unclear to what extent their semantic comprehension is impaired. The primary goal of this study is to understand the sentence comprehension of adults with AS by investigating their reading processes of sentences involving the conjunctive entailment of disjunction. More specifically, their on-line processes of reading globally ambiguous sentences containing huo 'or' in Mandarin Chinese, which can be understood as either a conjunction or a disjunction in simple negative statements, were recorded. The results indicated that both AS and typically developing groups tended to interpret the ambiguous huo as a conjunction. Additionally, both groups consistently spent significantly more time judging the appropriateness of disjunction-biased sentences. It is argued that, for adults with AS, at least some aspects of semantic knowledge are intact. Future studies are suggested to focus on different sentence types to further explore to what extent that semantics is impaired among individuals with AS.

Autism spectrum disorder (ASD) in girls. Co-occurring psychopathology. Sex differences in clinical manifestation. / Zaburzenia ze spektrum autyzmu (ASD) u dziewczat. Wspólwystepujace zespoly psychopatologiczne. Róznice miedzyplciowe w obrazie klinicznym.

OBJECTIVES: The study aims to define the differences in clinical manifestation among adolescent girls and boys with autism spectrum disorder (ASD). METHODS: The study group consisted of 15 adolescent girls and 16 adolescent boys with diagnosis of autismor Asperger syndrome and their parents. Adolescents were assessed with ADOS (Autism Diagnostic Observation Schedule, Polish adaptation of the assessment), algorithms of ADOS and ADOS-2 (revised version) were compared. Structured interview was conducted with parents, they fulfilled AQ (Autism Quotient), ASAS (Australian Scale for Asperger Syndrome), GQ-ASC (Girls' Questionnaire for Autism Spectrum Conditions). Medical records were analyzed. Results were analyzed using statistical methods. RESULTS: Patients were assessed with ADOS Module 4. Results indicated statistically significant differences between ASD girls and ASD boys in communication section, both verbal and gestures. The mean scores of AQ for ASD girls and ASD boys were M = 33.0 and M=30.9, and of ASAS M =57% and M =61% respectively. ASD girls had more psychiatric hospitalisations than ASD boys (60% vs. 31%), and they were more often treated with antidepressants (67% vs. 31%), anxiolytics (20% vs. 6%), mood stabilizers (40% vs. 19%). ASD boys were more often treated with psychotropic medications (50% vs. 47%) and stimulants (44% vs. 20%) than ASD girls. CONCLUSIONS: ASD girls are at risk of receiving non-spectrum classification in ADOS or ADOS-2 while their developmental history and clinical manifestation confirm ASD. Clinical data suggests that ASD girls present more abnormalities in sensory profile. ASD girls are at greater risk for developing anxiety, depression, suicidal ideation, and for psychiatric hospitalization. ASD boys appear to be at greater risk for co-occurring ADHD, OCD and tics.

Gastric necrosis and perforation in a patient with Asperger's syndrome.

Acute gastric necrosis is a very rare but potentially fatal condition which has been reported in patients with abnormal eating behaviours.We describe the case of a 24-year-old female with a background of Asperger's syndrome, who presented with abdominal pain and gross distension. She underwent an emergency exploratory laparotomy and was found to have a massively distended, necrotic stomach. A total gastrectomy was performed with interval reconstruction planned. This case reports the surgical management of a rarely seen condition and highlights the importance of recognising gastric necrosis and its causes, which include patients with abnormal eating behaviours, the majority of whom are young females. This is the first report highlighting gastric necrosis in a patient with Asperger's syndrome and coincides with a growing recognition of the association between eating disorders and the autistic spectrum. It is also a rare example of patient survival following total gastric necrosis with perforation.

Enhanced cognition and emotional recognition, and reduced obsessive compulsive symptoms in two adults with high-functioning autism as a result of deep Transcranial Magnetic Stimulation (dTMS): a case report.

We report reduced repetitive behaviors similar to obsessive compulsive disorder and improved emotional recognition and cognitive abilities in two young patients diagnosed with high-functioning Autism as a result of deep transcranial magnetic stimulation (dTMS). The patients received daily high-frequency (5 Hz) dTMS with HAUT-coil over the medial prefrontal cortex for a period of 5-6 weeks. A computerized cognitive battery, tasks for testing emotional recognition, and clinical questionnaires were used to measure the effects of treatment. TMS might have modulated networks related to metalizing abilities and self-referential processes since both patients reported improved sociability and communication skills.

The effect of methylphenidate on anxiety and depression symptoms in patients with Asperger syndrome and comorbid attention deficit/hyperactivity disorder.

The objective of this study was to assess the response of anxiety and depression symptoms to methylphenidate (MPH) treatment in patients with Asperger syndrome (AS) combined with attention deficit/hyperactivity disorder (ADHD). A group of 12 patients with AS/ADHD, aged 8-18 years, received 12 weeks of MPH treatment. The severities of ADHD, anxiety, and depression symptoms were assessed by means of the ADHD Rating Scale (ADHD-RS), Screen for Child Anxiety Related Emotional Disorders, and the Children's Depression Inventory. The severity of ADHD and depression symptoms was reduced significantly (P<0.0003 and P=0.046, respectively). No improvement in total anxiety symptoms was found, but a significant reduction was obtained in the school-related subscale of the Screen for Child Anxiety Related Emotional Disorders (P=0.0054). A positive correlation was found between the reductions in ADHD-RS and Children's Depression Inventory scores (r=0.59, P=0.039). MPH treatment may be safe, tolerable, and effective in alleviating depression and school-related anxiety symptoms in patients with AS and ADHD.

Olanzapine-induced Priapism in a Child with Asperger's Syndrome.

BACKGROUND: Priapism is a potentially painful and prolonged erection that occurs in the absence of any stimulation. Olanzapine has been reported to induce priapism in several adult cases with schizophrenia and/or mood disorders but very rarely reported in children. CASE REPORT: 9-year-old male with Asperger's Syndrome (AS) referred to our clinic with the complaints of inattention, hyperactivity and impulsivity. He was diagnosed with attention deficit hyperactivity disorder (ADHD) and given methylphenidate treatment which ameliorated his ADHD symptoms. He started to have severe loss of appetite after methylphenidate treatment so olanzapine 2.5 mg/day was added to cope with severe inappetence. However he experienced priapism after olanzapine and priapism resolved after ceasing the drug. His mother restarted olanzapine because he benefited from olanzapine. But the same episodes occurred soon after olanzapine again and his mother had to stop the medication. CONCLUSION: Because atypical antipsychotics are now widely used in children, unusual side effects such as priapism should be taken into consideration for the differential diagnosis.

Asperger syndrome in males over two decades: Quality of life in relation to diagnostic stability and psychiatric comorbidity.

This study examined objective quality of life (work, academic success, living situation, relationships, support system) and subjective quality of life (Sense of Coherence and Short-Form Health Survey-36) in an adult sample of males ( n = 50, mean age: 30 years) with Asperger syndrome diagnosed in childhood and followed prospectively over two decades. The association between long-term diagnostic stability of an autism spectrum disorder and/or comorbid psychiatric disorders with quality of life was also examined. The results showed great variability as regards quality of life. The subsample that no longer fulfilled an autism spectrum disorder had full-time jobs or studies (10/11), independent living (100%), and reported having two or more friends (100%). In the stable autism spectrum disorder group, 41% had full-time job or studies, 51% lived independently, and 33% reported two or more friends, and a significant minority had specialized employments, lived with support from the government, or had no friends. Academic success was positively correlated with IQ. A majority of the total group scored average Sense of Coherence scores, and the mean for Short-Form Health Survey-36 was above average regarding psychical health and below average regarding mental health. Stability of autism spectrum disorder diagnosis was associated with objective but not subjective quality of life, while psychiatric comorbidity was associated with subjective but not objective quality of life.

Age-related differences in inhibitory control and memory updating in boys with Asperger syndrome.

Deficits in specific executive domains are highly prevalent in autism spectrum disorder; however, age-related improvements in executive functions (reflecting prefrontal maturational changes) have been reported even in individuals diagnosed with autism. The current study examined two components of cognitive flexibility (inhibition of prepotent responses and memory monitoring/updating) by using a random-motor-generation task (MPT) in a group of 23 boys with Asperger syndrome (AS) and 23 matched healthy controls. We found poorer inhibition and more repetitive responses in younger AS children solely, but comparable memory monitoring/updating skills across groups. Overall, our findings correspond well with previous studies and reveal that even in AS specific EFs may improve with age and, thus, call for a more differentiated view of executive (dys) function profiles in children diagnosed with AS. Tests such as the random-motor-generation task may help to disentangle more specific processes of executive deficits in autism spectrum disorder as compared to the more classical tests.

[Impact of anxiety disorders on quality of life of adolescents with autism spectrum disorder without intellectual disability]. / Impact des troubles anxieux sur la qualité de vie des adolescents avec un trouble du spectre autistique sans déficience intellectuelle.

INTRODUCTION: The prevalence of anxiety disorders has been recently estimated at 42 % in a population of adolescents with autism spectrum disorder without intellectual disability. This rate is more than two times higher than in adolescents without developmental disorders (around 20 %). Besides, according to recent studies, the quality of life of adolescents with ASD without mental retardation seems to be lower than adolescents with typical development. We guess that anxiety disorders may be responsible for a low quality of life in adolescents with ASD. OBJECTIVES: The aim of this study was to describe the relationship between quality of life and anxiety disorders. The first objective was to determine if anxiety disorders are a risk factor for having a low quality of life in adolescents with ASD. The second objective was to confirm this link with another comparison using a control group of adolescents with an anxiety disorder but without ASD. Our hypothesis was that anxiety disorder is a risk factor to decrease the quality of life of adolescents with ASD. METHODS: This research was a transversal descriptive and comparative study. Sixty-six adolescents aged between 11 and 18years old were included: 46 with ASD without mental retardation and 20 controls (with anxiety disorders without ASD). Among the ASD group, 20 patients were identified as having an anxiety disorder according to international classifications of mental diseases, and 26 adolescents had no psychiatric comorbidity. Quality of Life (QoL) was reported in five domains with the KIDSCREEN-27, for each patient in the three different groups. Diagnosis of anxiety disorders was assessed using the Kiddie-SADS-PL. The level of anxiety was measured with a self-report questionnaire (RC-MAS). We compared the anxiety rates and the QoL levels between the two groups of adolescents with ASD, one with anxiety disorders, the other without anxiety disorder. Comparisons were also made with QoL data from the general population. RESULTS: Quality of life in the two different groups of adolescents with ASD without mental retardation (with and without anxiety disorders) was significantly lower than in adolescents in the general population. Those rates were significantly lower in the group with ASD and anxiety disorders than in the group with ASD without anxiety disorders for the domain of "physical well-being" only. There was no significant difference between the groups regarding the four other domains of the Kidscreen-27. Moreover, there was no difference between adolescents with ASD and adolescents without ASD regarding the perceived level of anxiety. CONCLUSION: This study shows that anxiety disorders could be a risk factor for impairment of the "physical well-being" dimension of QoL in adolescents with ASD without intellectual disability. Results highlight the interest of a self-evaluation of anxiety level in a population of adolescents with ASD. Findings about self-report of QoL might be temper probably due to the insight difficulties that meet patients with ASD reported in literature review. Further research need to be done with larger samples of patients using self-evaluation coupled with hetero-evaluation such as parents' reports and clinicians' reports.

Impaired social cognition processes in Asperger syndrome and anorexia nervosa. In search for endophenotypes of social cognition. / Zaburzenia procesów spolecznego poznania w zespole Aspergera i jadlowstrecie psychicznym. W poszukiwaniu endofenotypów spolecznego poznania.

A growing number of publications indicates presence of significant deficits in social cognition in patients with anorexia nervosa (AN). These deficits appear to be comparable in qualitative and quantitative dimension with impairment of the same functions among people with Asperger syndrome (AS). The aim of this study is to identify subject areas in the field of impairment of social cognition processes among people with Asperger syndrome and anorexia nervosa taking into consideration the potential contribution of genetic pathways of oxytocin and vasopressin in the pathogenesis of these diseases. In the first part of the paper a systematic analysis of studies aimed at the evaluation of the processes of social cognition among patients with AN and AS has been carried out. The results of a significant number of studies confirm the presence of deficits in social cognition in AN and AS. In addition, among patients with AN and AS there exists a similar structure and distribution of the brain functions in regions responsible for social cognition. The second part of the paper describes the role of the oxytocin-vasopressin system (OT-AVP) in the processes of social cognition in AN and AS. Its genetic basis and the possible importance of single nucleotide polymorphisms within the genes: OXT, AVP, CD38, OXTR, AVPR1A and LNPEP have also been presented.

Exploratory Study of Childbearing Experiences of Women With Asperger Syndrome.

Increasing numbers of girls have been diagnosed with Asperger syndrome and other autism spectrum disorders (ASDs) over the past two decades; therefore, more women with ASDs are entering the childbearing phase of their lives. Little is known about the childbearing experiences of women with ASDs. This qualitative study describes the childbearing experiences of eight women with Asperger syndrome. Four major themes emerged: Processing Sensations, Needing to Have Control, Walking in the Dark, and Motherhood on My Own Terms. Clinicians can provide sensitive, individualized care by asking women with Asperger syndrome about their specific sensory experiences, counseling them about coping strategies for sensory intrusions, providing targeted support, and modifying the clinical environment to decrease distressing stimuli.

[Asperger's syndrome symptoms in children, adolescents and young adults] / Quand évoquer le syndrome d'Asperger chez l'enfant, l'adolescent et le jeune adulte ?

Asperger's syndrome symptoms in children, adolescents and young adults. Asperger syndrome (AS) is a neurodevelopemental disorder which is classified into autism- spectrums disorders (ASDs). AS is characterized by significant difficulties in social interaction and nonverbal communication, stereotyped and restricted patterns of behaviour, activities and interests. There is no clinically significant delay in cognitive development nor general delay in language. However, there are specific abnormalities such as literal interpretations, miscomprehension of nuance, unusually pedantic and formal speech. Clinical aspects are very heterogeneous and vary depending on age and psychiatric comorbidities. Among the associated disorders, Attention Deficit Hyperactivity Disorder, mood and anxiety disorders are commonly found. To identify these conditions and offer appropriate treatment, elevated vigilance is needed in clinical practice.

Quand évoquer le syndrome d'asperger chez l'enfant, l'adolescent et le jeune adulte ? Le syndrome d'Asperger est un trouble neuro-développemental faisant partie de la grande famille des troubles du spectre de l'autisme. Les personnes ayant un syndrome d'Asperger ont des difficultés dans le domaine des interactions sociales, de la communication verbale et non verbale et peuvent avoir une bizarrerie comportementale avec des stéréotypies et des intérêts restreints. Ils n'ont pas de retard du langage et le développement cognitif n'est pas marqué par un retard global mais par des atteintes spécifiques dans certains domaines comme les fonctions exécutives. Les aspects cliniques sont très hétérogènes, ils varient en fonction de l'âge et des comorbidités psychiatriques. Parmi les troubles associés on retrouve fréquemment le trouble de déficit de l'attention avec ou sans hyperactivité. Une prise en charge précoce, multidisciplinaire et intégrative permet une meilleure qualité de vie et une diminution des complications psychiatriques telles que les troubles anxieux, la dépression et les conduites suicidaires.

Evaluation of Asperger Syndrome in Youth Presenting to a Gender Dysphoria Clinic.

PURPOSE: There is evolving evidence that children and adolescents with gender dysphoria have higher-than-expected rates of autism spectrum disorder (ASD), yet clinical data on ASD among youth with gender dysphoria remain limited, particularly in North America. This report aims to fill this gap. METHODS: We conducted a retrospective review of patient chart data from 39 consecutive youth ages 8 to 20 years (mean age 15.8 years, natal male: n = 22, natal female: n = 17) presenting for evaluation at a multidisciplinary gender clinic in a large U.S. pediatric hospital from 2007 to 2011 to evaluate the prevalence of ASD in this patient population. RESULTS: Overall, 23.1% of patients (9/39) presenting with gender dysphoria had possible, likely, or very likely Asperger syndrome as measured by the Asperger Syndrome Diagnostic Scale (ASDS). CONCLUSION: These findings are consistent with growing evidence supporting increased prevalence of ASD in gender dysphoric children. To guide provision of optimal clinical care and therapeutic intervention, routine assessment of ASD is recommended in youth presenting for gender dysphoria.