Dialogia e insight: narrativas de pais e filhos sobre o transtorno de asperger / Dialogismo y insigth: narrativas de padres y hijos sobre el trastorno de asperger / Dialogism and insight: parents and children narratives about asperger disorder

Resumo O presente estudo objetivou investigar os processos de insight em sujeitos com Transtorno de Asperger (TA). Entende-se por insight o conhecimento do próprio diagnóstico e os sentidos construídos a partir deste. O desenvolvimento doinsight é aqui compreendido não como função restrita à vida mental pessoal, mas como fenômeno intersubjetivo, forjado nas relações sociais. O arcabouço teórico que subsidia a presente pesquisa é a perspectiva genética de desenvolvimento avançada pela psicologia histórico-cultural. Para tanto, foram propostas a três díades de pais e adolescentes diagnosticados com TA duas tarefas de produção narrativa que investigaram aspectos relacionados às experiências Asperger. Os resultados sugerem que a característica central dos processos de insight no TA pode ser descrita como disrupção na transição do modo monológico para o modo dialógico de pensamento. Acredita-se que os resultados aqui encontrados contribuem para a compreensão da singularidade e eventicidade da existência e da experiência subjetiva.

Resumen El presente estudio tuvo como objetivo investigar los procesos de insight en sujetos con trastorno de Asperger (TA). Insight significa el conocimiento del diagnóstico mismo y los significados construidos a partir de él. El desarrollo del insight se entiende aquí no como una función restringida a la vida mental personal, sino como un fenómeno intersubjetivo, forjado en las relaciones sociales. El marco teórico que sustenta esta investigación es la perspectiva genética del desarrollo que adelanta la psicología histórico-cultural. Para ello, a tres díadas de padres y adolescentes diagnosticados de TA se les ofrecieron dos tareas de producción narrativa que investigaban aspectos relacionados con las experiencias de Asperger. Los resultados sugieren que la característica central de los procesos de insight en TA puede describirse como una interrupción en la transición del modo de pensamiento monológico al dialógico. Se cree que los resultados encontrados aquí contribuyen a la comprensión de la singularidad y la eventualidad de la existencia y la experiencia subjetiva.

Abstract The present article aimed to investigate insight processes in people with Asperger disorder. Insight is understood as the knowledge of one's own diagnosis and the senses built from it. The insight development is understood here not as a function of personal psychological life, but as an intersubjective phenomenon, forged in social relations. The theoretical framework that subsidizes this research is the genetic perspective of development advanced by cultural-historical psychology. For this purpose, two tasks of narrative production were proposed to three dyads of parents and teenagers with AD, which investigated aspects related to Asperger experiences. The results suggest that the central characteristic of insight processes in AD can be described as a disruption in the transition of a thinking monologic mode to a thinking dialogic mode. It is believed that the results here found contribute to the comprehension of singularity and occurrence of subjective experience and existence.

Large Forehead Mass Resulting From Chronic Head Banging.

Head banging is a commonly observed movement disorder which is typically self-limited. Complications secondary to this behavior are rare. In this report, the authors present the case of a 15-year-old patient who was treated for a forehead mass which developed secondary to chronic head banging. Surgical excision was performed for treatment of the lesion. Results from surgical pathology were notable for fibrosis consistent with history of chronic head banging. Preoperative magnetic resonance imaging and physical examination were also consistent with this diagnosis. This is a rare clinical entity that should be considered in patients presenting with a forehead mass and a history of head banging.

Las Emociones en Niños con Síndrome de Asperger / Emotions on Asperger's Syndrome

Las peculiaridades que presentan las personas con Síndrome de Asperger (SA) han sugerido el abordaje del mismo desde distintas perspectivas, por un lado, aspectos epistemológicos y cognitivos, por otro lado, neurobiológicos que tratan de describir este padecimiento. Dentro de las peculiaridades que se han descrito se encuentran aspectos cognitivos como la memoria, visuoespacialidad, habilidades sociales y emociones. Las emociones son esenciales para el desarrollo de habilidades sociales y se han encontrado peculiaridades al respecto en las personas con SA. De esta manera, el objetivo es revisar los hallazgos existentes sobre el estudio de las emociones en personas con Síndrome de Asperger que, a su vez, permitirán desarrollar posibles niveles de abordaje en el área clínica

The peculiarities presented among the Asperger's Syndrome have suggested approaching it from different perspectives; including epistemological, cognitive and neurobiological, pretending to explain this impairment. Among these peculiarities that have been described are cognitive aspects such as memory, visuospatial skills, social skills, and emotions. The emotion domain is basic to develop social abilities, and there are peculiarities found in the Asperger Syndrome's patients respect to this matter. According to this, the aim of this paper is to review the current findings respect to the emotions in people with the Asperger's Syndrome, as this allows developing tentative approaching levels within the clinic context.

Benefits of an individualized perioperative plan for children with autism spectrum disorder.

BACKGROUND: Perioperative care for children with autism spectrum disorder may be challenging. Previous investigators recommend development of an individualized perioperative management plan with caregiver involvement. AIM: The primary goal was to determine the usefulness of an individualized plan based on the decision to provide preoperative sedation stratified by autism spectrum severity level. Secondary goals were to assess the effectiveness of the plan based on subjective assessment of patient behavior at induction of anesthesia and caregiver satisfaction. METHODS: We developed an individualized plan for each child with autism spectrum disorder scheduled for anesthesia. Children were categorized by autism spectrum disorder severity level. With institutional ethics approval, we conducted a retrospective chart review to document need for preoperative sedation, sedation stratified by autism spectrum disorder severity level, behavior at induction, and caregiver satisfaction. RESULTS: Between 2012 and 2014, we successfully prepared a plan for 246 (98%) of 251 surgical or diagnostic procedures in 224 patients. Severity level was distributed as 45% Severity Level 1 and Asperger's, 25% Severity Level 2, and 30% Severity Level 3. The majority (90%) of cases were scheduled as day surgery. Preoperative sedation increased with increasing severity level: Severity Level 1 (21%) or Asperger's (31%), Severity Level 2 (44%), and Severity Level 3 (56%). The odds ratio for sedation use was 5.5 [CI: 2.6-11.5, P<.001] with Severity Level 3 vs Severity Level 1 patients. Cooperation at induction of anesthesia was 90% overall with preoperative sedation administered to 94 (38%) of the entire cohort. Cooperation was greatest in Severity Level 1 (98%) and Asperger's patients (93%) and somewhat less (85%) in patients in Severity Levels 2 and 3. The plan was helpful to guide sedation choices as cooperation did not differ between sedated and unsedated children at any severity level (overall χ2 =2.87 P=.09). Satisfaction among caregivers contacted was 98%. CONCLUSION: The results suggest that an individualized plan is helpful in the perioperative management of children with autism spectrum disorder and that knowledge of autism spectrum disorder severity level may be helpful in determining the need for preoperative sedation.

O enigma do autismo: contribuições sobre a etiologia do transtorno / The enigma of autism: contributions to the etiology of the disorder / El enigma del autismo: contribuciones a la etiología del trastorno

A ausência de uma explicação definitiva sobre as causas que levaram ao desenvolvimento do autismo em seus filhos é um enigma que gera grande sofrimento aos pais e dificuldades aos profissionais da saúde. Neste estudo foi realizada uma revisão crítica sobre as possíveis causas da síndrome autista, atualmente denominada de Transtorno do Espectro Autista (TEA), desde a primeira descrição realizada em 1943 até 2015. O artigo visa delinear o panorama atual de estudos sobre este tipo de transtorno a fim de explicitar os pontos de convergência e as diferenças entre os posicionamentos de pesquisadores que se dedicam ao tema. A análise sugere quatro paradigmas principais que pretendem circunscrever a etiologia do autismo: 1) o Paradigma Biológico-Genético; 2) o Paradigma Relacional; 3) o Paradigma Ambiental; e o 4) Paradigma da Neurodiversidade. Problematizar esses paradigmas constitui uma maneira de aprofundar a compreensão a respeito deste transtorno no contexto atual do desenvolvimento científico.

The lack of a definitive explanation for the causes of autism in children is an enigma that creates significant suffering among parents and difficulties for health professionals. This study is a critical review of the possible causes of autism, currently known as Autism Spectrum Disorder (ASD), spanning the period from the first description of the syndrome in 1943 until 2015. The objective of this article is to outline the current scenario of studies about this type of disorder in order to emphasize the points of convergence and the differences between the positions taken by the researchers who have dedicated themselves to this topic. The analysis suggests four main paradigms that attempt to encompass the etiology of autism: 1) the Biological-Genetic Paradigm; 2) the Relational Paradigm; 3) the Environmental Paradigm; and 4) the Neurodiversity Paradigm. By questioningthese paradigms, we hope to deepen comprehension of this disorder in the current scientific context.

La ausencia de una explicación definitiva sobre las causas que llevaron al desarrollo del autismo en sus hijos es un enigma que genera gran sufrimiento a los padres y dificultades a los profesionales de la salud. En este estudio se realizó una revisión crítica sobre las posibles causas del síndrome autista, actualmente llamado Trastorno del Espectro Autista (TEA), desde la primera descripción realizada en 1943 hasta 2015. El artículo busca delinear el panorama actual de estudios sobre este trastorno a fin de explicitar los puntos de convergencia y las diferencias entre las posiciones de investigadores dedicados al tema. El análisis sugiere cuatro paradigmas principales que pretenden circunscribir la etiología del autismo: 1) el Paradigma Biológico-Genético; 2) el Paradigma Relacional; 3) el Paradigma Ambiental; y 4) el Paradigma de la Neurodiversidad. Problematizar estos paradigmas constituye una manera de profundizar en la comprensión de este trastorno en el contexto actual de desarrollo científico.

[Screening interview for early detection of high-functioning autism spectrum disorders]. / Screening von Kindern und Jugendlichen mit hochfunktionaler Autismus-Spektrum-Störung anhand ausgewählter Items des ADI-R.

OBJECTIVE: Various different questionnaires are available for the screening of autism spectrum disorders (ASD). These screening instruments show high sensitivity and are able to identify a large number of individuals with ASD, but they lack the specificity to differentiate individuals with ASD from those children and adolescents with other complex neurobehavioural disorders (such as attention-deficit/hyperactivity disorder, emotional disorders, and others), especially for those without intellectual disabilities. METHOD: The present study evaluates the data of 309 individuals (153 with high-functioning ASD, 156 with other psychiatric disorders, IQ > 70) to find out whether selected items of the ADI-R can be used for an economic and sensitive screening of high-functioning ASD. RESULTS: The results show that 8 items of the ADI-R can be used to discriminate high-functioning ASD and other psychiatric disorders. A cutoff of 5 led to a sensitivity of 0.93 and a cutoff of 6 to a specificity of 0.74. CONCLUSION: The combination of early onset, serious abnormalities in social contact with stereotyped or compulsive-ritualized behaviour or interests can be detected with few interview questions for screening of ASD. Nevertheless, a more detailed and specific assessment in an expert setting should follow the screening process.

ADHD and nicotine use in schizophrenia or Asperger syndrome: a controlled study.

OBJECTIVE: To examine ADHD prevalence, rating scales, and relationship to nicotine use in adults with schizophrenia or Asperger syndrome. METHOD: Ninety-five individuals, 41 with schizophrenia and 54 with Asperger syndrome, were included. Self-rating of adult ADHD symptoms with the Wender-Reimherr Adult Attention Deficit Diagnostic Rating Scale (WRAADDS), parent rating of proband's ADHD childhood and adult life symptoms using the Swanson, Nolan, and Pelham Questionnaire (SNAP), and report of clinical ADHD diagnosis were included as ADHD measures. Nicotine use data were compared with data from a population sample. RESULTS: In all, 10% of the schizophrenia group and 30% of the Asperger syndrome group had a clinical ADHD diagnosis. Nicotine dependency in the whole sample was closely linked to ADHD. CONCLUSION: The prevalence of comorbid ADHD was high in schizophrenia and Asperger syndrome. The WRAADDS self-rating scale for ADHD can be one useful tool for assessing comorbid ADHD in these patient groups.

Cognición espacial: posiciones egocéntrica y alocéntrica en un grupo con Síndrome de Asperger / Spatial cognition in an Asperger syndrome group: egocentric and allocentric stances

Se han propuesto tres aproximaciones que intentan explicar las peculiaridades del Síndrome de Asperger (SA): disfunción ejecutiva, pobre teoría de la mente o dificultades en la coherencia central. En 2005, Frith y Vignemont proponen una desconexión entre posiciones egocéntrica a alocéntrica, planteando una nueva línea de caracterización del SA. Objetivo: En el presente estudio se comparó el desempeño del tránsito entre posiciones egocéntrica y alocéntrica, en un grupo de cinco niños con SA. Método: El grupo estuvo conformado por 4 niños y 1 niña, con edad promedio de 10 años. Se realizó una valoración detallada a fin de confirmar el diagnóstico y se aplicaron subescalas de la Evaluación Neuropsicológica Infantil. Se reporta el análisis del desempeño en la subescala Habilidades Espaciales. Resultados: Se observa un desempeño dentro del rango promedio observando diferencias estadísticamente significativas entre subdominios que conforman la subescala (014<0.05 F friedman), así como en las respuestas correctas cuando utilizaron marcos de referencia alocéntricos y egocéntrico en tareas de comprensión (gl 2, 0.041<0.05 Q Cochran) y expresión (gl 2, 0.022<0.05 Q Cochran) derecha-izquierda. Conclusión: En el caso del SA, se observa predominio del uso de la posición egocéntrica. El desempeño alocéntrico de los participantes es más eficaz cuando establecen relaciones desde un objeto dinámico vs estático. Se destaca la importancia de realizar un diagnóstico meticuloso del SA, a fin de valorar si las peculiaridades observadas en cognición espacial han sido generalizadas erróneamente a otros Trastornos del Espectro Autista debido a un diagnóstico equivocado.

Asperger Syndrome (SA) has been explained by three approaches: executive dysfunction, impaired theory of mind and central coherence. In 2005, Frith and Vignemont suggest a new approach, based in disconnection between egocentric and allocentric stances. The present study aimed to compare performance´s group of five children with AS in egocentric-allocentric transit task. Four boys and a girl, whose average age was 10 years old, formed the group. A comprehensive assessment confirmed de AS diagnostic. Children were assessed with Evaluacion Neuropsicológica Infantil subtests, and we report the Spatial Abilities subtest analysis. Standard scores were obtained by the group in average values, but there were significant differences (014<0.05 F friedman) between subdomains assessed by Spatial Abilities subtest. We also found significant differences in egocentric-allocentric stances in spatial notion understanding task (gl 2,0.041<0.05 Q Cochran), and spatial notion expression task (gl 2, 0.022<0.05 Q Cochran). Conclusion: AS group prevail taking egocentric stance. Allocentric performance is commonly efficient if individuals take stance from dynamic than static object. We highlight the importance of an accurate and comprehensive assessment in AS diagnosis to avoid generalization of AS features to another Spectrum Autistic Disorders because of a mistaken AS diagnosis.

ASSERT--the Autism Symptom SElf-ReporT for adolescents and adults: bifactor analysis and validation in a large adolescent population.

With a view to developing a brief screening instrument for autism symptoms in a general population of adolescents, seven items from the Asperger syndrome (and high-functioning autism) diagnostic interview were adapted for use as self-report in an online questionnaire for youths aged 16-19 years (N=10,220). The selected items target lack of social understanding (4 items) and rigid and repetitive behavior and interests (RRBI; 3 items). Factor analyses were performed, and the seven items were also validated against self-reported ASD diagnosis. Best statistical model fit was found for a bifactor model with one general factor and two domain specific factors tied to social difficulties and RRBI. Both the general and the domain specific factors were associated with self-reported ASD diagnoses. The scale (referred to as the Autism Symptom SElf-ReporT for Adolescents and Adults--ASSERT) had good screening properties with a receiver operating curve-area under the curve (ROC-AUC) of 0.87 and a diagnostic odds ratio (DOR) of 15.8. Applying a modified scoring of the scale further improved the screening properties leading to a ROC-AUC of 0.89 and a DOR of 24.9. The ASSERT holds promise as a brief self-report screen for autism symptoms in adolescents, and further studies should explore its usefulness for adults.

Adaptación y análisis psicométrico de la Escala Gilliam para evaluar trastorno de Asperger / Adaptation and psychometric analysis of the Gilliam Asperger’ Disorder Scale

La Escala Gilliam para evaluar Transtorno Asperger (Gilliam Asperger’s Disorder Scale, GADS) es una evaluación de calificación conductual, cuyo propósito es ayudar a que los profesionales diagnostiquen el Síndrome de Asperger (SA). Esta escala se utiliza para evaluar sujetos entre los 3 y 22 años y puede ser completada por cualquier persona que tenga contacto regular con un sujeto con SA. Los únicos estudios psicométricos queso conocen con resultados favorables son los de la muestra normativa. Es por esto que esta investigación intenta responder si la GADS conserva las propiedades psicométricas de la muestra normativa al aplicarla en la población chilena con SA. Se contó con una muestra no probabilística intencional compuesta por 36 sujetasen la fase piloto y 111 sujetos en la fase final. Las subescalas obtuvieron un alpha de Cronbach entre 0,73 y0,87, mientras que la escala global obtuvo 0,92. Se realizó un análisis factorial exploratorio, del cual se obtuvo una solución factorial de 8 factores en la fase final. Los resultados permiten concluir que la GADS cuenta con propiedades psicométricas adecuadas, lo que significa que es un instrumento confiable y válido para ser utilizado en la población chilena.

The Gilliam Asperger’s Disorder Scale (GADS) is a norm-referenced assessment designed to help professionals in Asperger Syndrome (AS) diagnosis. This scale is used to evaluate subjects between 3 and 22 years old and it can be completed by anyone who has regular contact with a subject with AS. The only known psychometric studies with positive results are those of the normative sample. Thus this research attempts to explain whether GADS retains the psychometric properties of the normative sample when applied to the Chilean population with AS. To this purpose it was selected a probabilistic intentional sample compose of 36 subjects in the pilot phase and 111 subjects in the final phase. The subscales obtained a Cronbach’s alpha between 0,73 and 0,87, while the global scored 0,92. It was carried out an exploratory factor analysis, thought which it was obtained a factor solution of 8 in the final phase. The results obtained allow to conclude that GADS has adequate psychometric properties, which means GADS is a valid and reliable instrument to be applied to Chilean population.

Desempeño ocupacional escolar de jóvenes con Síndrome de Asperger que asisten al sistema de educación regular / Performance occupational school youth with asperger syndrome attending the regular education system

El Síndrome de Asperger es un trastorno con una prevalencia aproximada de 2,6 - 4,8 por cada 1.000 habitantes, en nuestro país las cifras de este trastorno son desconocidas así como las investigaciones que describen la situación de estas personas. El acceso a la educación en igualdad de oportunidades es un derecho de todos los estudiantes , los jóvenes con este diagnóstico presentan problemas importantes en su desempeño escolar derivados de su condición o de las barreras y actitudes del contexto en donde destacan conductas de bullying y carencia de diseños educativos inclusivos que les permitan permanecer y egresar del sistema con éxito y en donde esta etapa se constituya en un aporte nutritivo para la vida de las personas que sea recordado con cariño y que promuevan la autoestima necesaria para la futura inclusión y participación social. En este escenario se desarrolla el presente estudio orientado a explorar el Desempeño Ocupacional Escolar de jóvenes con Síndrome de Asperger que asisten al Sistema Escolar Regular. El diseño corresponde a un estudio exploratorio con análisis de casos, se utilizaron técnicas de recolección de datos a través de una entrevista semiestructurada aplicada a dos jóvenes, sus madres, profesores e integrantes del equipo de salud. El método de análisis de los resultados se realizó utilizando el ATLASti. En ambos casos se registra escasa motivación para participar en ocupaciones propias del sistema escolar, desempeño escolar irregular con adaptaciones curriculares permanentes, excesiva dependencia familiar para la organización de la rutina, dependencia escasa y conflictiva relación con pares que provoca serias alteraciones de salud mental. El estudio además de recoger los obstaculizadores del proceso, describe facilitadotes personales y contextuales que serán un gran aporte al proceso de integración escolar de estos jóvenes en nuestro país.

Asperger syndrome is a disorder with a prevalence of approximately 2.6 to 4.8 per 1,000 inhabitants in our country the figures of this disorder are unknown and the investigations that describe the situation of these people. Access to education, equal opportunity is a right of all students, young people with this diagnosis have problems in school performance or arising out of its barriers and attitudes of the context in which behaviors include bullying and lack of inclusive designs that allow them access, remain in and graduate from an educational system successfully and where this stage constitute a nutritional contribution to the lives of people who will be remembered with affection and to promote self-esteem necessary for future inclusion and participation social. In this scenario, the present study is aimed at exploring the Occupational Performance School young Asperger Syndrome attending the regular school system. The design is an exploratory study with case studies; techniques were used for collecting data through a semistructured interview applied to two youths, their mothers, teachers and members of the health team. The method of analysis of the results was conducted using ATLASti. In both cases there is little motivation to engage in occupations of the school system, erratic performance in school with curricular adaptations permanent, over-reliance on the family organization of the routine, conflictual relationship with peers causing serious mental health disorders. The study also to collect hinder the process, describe personal and contextual facilitators to will be a great contribution to the process of school integration of these young people in our country.

Autism spectrum disorders according to DSM-IV-TR and comparison with DSM-5 draft criteria: an epidemiological study.

OBJECTIVE: The latest definitions of autism spectrum disorders (ASDs) were specified in DSM-IV-TR in 2000. DSM-5 criteria are planned for 2013. Here, we estimated the prevalence of ASDs and autism according to DSM-IV-TR, clarified confusion concerning diagnostic criteria, and evaluated DSM-5 draft criteria for ASD posted by the American Psychiatry Association (APA) in February 2010. METHOD: This was an epidemiological study of 5,484 eight-year-old children in Finland, 4,422 (81%) of them rated via the Autism Spectrum Screening Questionnaire by parents and/or teachers, and 110 examined by using a structured interview, semi-structured observation, IQ measurement, school-day observation, and patient records. Diagnoses were assigned according to DSM-IV-TR criteria and DSM-5 draft criteria in children with a full-scale IQ (FSIQ) ≥50. Patient records were evaluated in children with an FSIQ <50 to discover diagnoses of ASDs. RESULTS: The prevalence of ASDs was 8.4 in 1,000 and that of autism 4.1 in 1,000 according to DSM-IV-TR. Of the subjects with ASDs and autism, 65% and 61% were high-functioning (FSIQ ≥70), respectively. The prevalence of pervasive developmental disorder not otherwise specified was not estimated because of inconsistency in DSM-IV-TR criteria. DSM-5 draft criteria were shown to be less sensitive in regard to identification of subjects with ASDs, particularly those with Asperger's syndrome and some high-functioning subjects with autism. CONCLUSIONS: DSM-IV-TR helps with the definition of ASDs only up to a point. We suggest modifications to five details of DSM-5 draft criteria posted by the APA in February 2010. Completing revision of DSM criteria for ASDs is a challenging task.

Association study of the CNS patterning genes and autism in Han Chinese in Taiwan.

Autism is a complex neurodevelopmental disorder with high heritability. Despite different approaches worldwide to identify susceptibility loci or genes for autism spectrum disorders (ASDs), no consistent result has been reported. CNS patterning genes have been recognized as candidate genes for autism based on neuroimage and neuropathology evidence. This study investigated four candidate genes (WNT2, EN2, SHANK3, and FOXP2) by a tag SNP approach in a family-based association study. The trio samples include 1164 subjects from 393 families, including 393 probands (aged 9.1±4.0years; male, 88.6%) diagnosed with autistic disorder (n=373) or Asperger's disorder (n=20) according to the DSM-IV diagnostic criteria and confirmed by the Chinese ADI-R interview. Three tag SNPs of EN2 (7q36), 6 SNPs of WNT2 (7q31-33), 5 SNPs of SHANK3 (22q13.3), 3 SNPs of FOXP2 (7q31) were genotyped. TDT analysis was done to test the association of each tag SNP and haplotype. There was no association with autism for 17 tag SNPs of WNT2, EN2, SHANK3, and FOXP2 based on SNP analyses. Haplotype analyses did not reveal significant association except for the 6 tag SNPs of WNT2 gene showing a significant association on one haplotype composed of rs2896218 and rs6950765 (G-G) (p=0.0095). Other haplotypes composed of rs2896218 and rs6950765 (G-G) were also significantly associated with autism. The present study indicates that SHANK3 may not be a critical gene for the etiology of ASDs in Han Chinese population. Inconsistent findings in EN2 and FOXP2 in the Han Chinese population need further clarification. A haplotype of WNT2 (rs2896218-rs6950765: G-G) is significantly associated with ASDs in our trios samples, this finding warrants further validation by different sample and confirmation by functional study.

Use of Gilliam Asperger's disorder scale in differentiating high and low functioning autism and ADHD.

Little is known about the validity of Gilliam Asperger's Disorder Scale (GADS), although it is widely used. This study of 199 children with high functioning autism or Asperger's disorder, 195 with low functioning autism, and 83 with attention deficit hyperactivity disorder (ADHD) showed high classification accuracy (autism vs. ADHD) for clinicians' GADS Quotients (92%), and somewhat lower accuracy (77%) for parents' Quotients. Both children with high and low functioning autism had clinicians' Quotients (M=99 and 101, respectively) similar to the Asperger's Disorder mean of 100 for the GADS normative sample. Children with high functioning autism scored significantly higher on the cognitive patterns subscale than children with low functioning autism, and the latter had higher scores on the remaining subscales: social interaction, restricted patterns of behavior, and pragmatic skills. Using the clinicians' Quotient and Cognitive Patterns score, 70% of children were correctly identified as having high or low functioning autism or ADHD.

Adaptación, aplicación y evaluación de un programa en reconocimiento, manejo y expresión de emociones en niños con Síndrome de Asperger y sus padres / Adaptation, implementation and evaluation of a program in recognition, management and expression of emotions in children with Asperger Syndrome and their parents

El Síndrome de Asperger (SA) es un trastorno generalizado del desarrollo en el cual se encuentran afectadas diversas áreas de funcionamiento en el niño. En el área del desarrollo socio-emocional se encuentran algunas de sus principales dificultades, donde se describe un déficit en la regulación emocional, es decir en los niños con este síndrome, se aprecian dificultades tanto en el reconocimiento, como la expresión y manejo de las emociones. Lo que implica consecuencias negativas tanto en su desarrollo personal como en la interacción con pares y adultos. Es por esto que el presente artículo describe la adaptación al contexto nacional, del programa Exploring Feelings de Tony Attwood, centrado en la exploración emocional, la implementación experimental y la evaluación de resultados de éste. A través de este estudio se espera aportar a la escasa evidencia disponible acerca de tratamientos psicológicos con niños con SA, junto con aportar con técnicas terapéuticas, basadas en la evidencia y especialmente diseñadas para niños con SA, que queden disponibles para profesionales de la salud mental. El programa realizado para efectos de esta investigación consiste en 10 sesiones individuales de terapia cognitivo-conductual realizadas a 10 niños entre 8 y 12 años con SA, y 6 sesiones grupales de carácter psicoeducativo con los padres Los resultados indicaron diferencias estadísticamente significativas entre el grupo experimental y control, en donde en el primer grupo se obtuvieron cambios tanto en el aumento de la frecuencias de conductas observadas por los padres que implicaban una mejor regulación emocional, como en la cantidad y calidad de las respuestas otorgadas por los niños que implicaban un mejor manejo de la ansiedad y la rabia.

Asperger Syndrome (AS) is a pervasive developmental disorder in which there are affected several functional areas. Some of the main difficulties are located in the socio-emotional developmental area, and there are some descriptions about a deficit in emotion regulation, in children with this syndrome can be seen difficulties both in the recognition, the expression and control of emotions. This problem brings negative consequences in the personal development of the child, and also in the interaction with peers and adults. That is the reason this article describes the adaptation of Exploring Feelings by Tony Attwood to the national context, focusing on emotional exploration, experimental implementation and evaluation of outcome. This study is expected to contribute to the limited available evidence about psychological treatments with children with AS, and also to provide therapeutic evidence-based techniques, specially designed for children with AS, which are available for mental health professionals. The program made for the purpose of this research consists of 10 individual sessions of cognitive-behavioral therapy conducted for 10 children between 8 and 12 with AS, and 6 psychoeducational group sessions with parents. The results indicated statistically significant differences between the experimental and control group, where the first group had changes in the increased frequency of behaviors observed by parents involving a better emotional regulation, and the quantity and quality of answers given by children involving better management of anxiety and anger.

Shades of truth: cultural and psychological factors affecting communication in pediatric palliative care.

Communication with children who have life-threatening illnesses is a major challenge. Communication practices are greatly influenced by factors such as the child's age, the parents' wishes, and the cultural norms. This article presents the case of a 12-year-old Japanese boy with advanced hepatoblastoma. The patient also was diagnosed with Asperger's syndrome, which impairs interpersonal communication. The case is discussed from the perspective of clinical ethics, especially with regard to truth telling. The health care team faced an ethical dilemma because of the complications involved. Physicians treating children with cancer should be aware of these issues to be able to effectively communicate with their patients.

Cystic fibrosis, common variable immunodeficiency and Aspergers syndrome: an immunological and behavioural challenge.

INTRODUCTION: Cystic fibrosis (CF) is of particular importance in Ireland as the Irish population has both the highest incidence (2.98/10,000) and the highest carrier rate (1 in 19) in the world. Primary immunodeficiency has not been previously reported as co-existing with CF. CASE REPORT: We report a unique case of CF associated with a primary immunodeficiency syndrome--common variable immunodeficiency (CVID). DISCUSSION: Our patient has CF, CVID and the additional comorbidity of Aspergers syndrome. The challenges inherent in diagnosing and treating such a case are outlined herein and the successful management of this case is evidenced by the well-preserved lung function of our patient.

Basic reading skills in Swedish children with late developing language and with or without autism spectrum disorder or ADHD.

Reading skills at age 7-8 years were examined in a community-representative sample of 21 screened and clinically examined children with language delay (LD) followed prospectively from 2.5 years of age. The present study aimed to (1) determine whether these children with a history of LD had deficits in basic reading skills, i.e. decoding and comprehension, compared to the age norms of standardized tests, (2) analyze if there was a relationship between reading outcome and neuropsychiatric diagnosis by comparing three subgroups of children, LD pure, LD+ASD (autism spectrum disorder) and LD+ADHD, and, (3) determine what language measures at age 6 years were associated with the 7-8-year reading outcome. Both decoding and comprehension of single word reading were significantly below the norm for the whole LD group, where children with LD+ASD scored lowest, and children with LD highest. However, the differences between the three groups did not reach significance. Two reader groups were identified according to the results of word decoding and comprehension, respectively, resulting in the same 7 children. ANOVA revealed that the only differences on the 6-year language tests between the two groups were found on color naming and word memory. This study has shown that children with LD and subsequently identified neurodevelopmental problems such as ASD and ADHD experience continued deficits, demonstrated also in reading skills and that the picture of the reading problems seemed to resemble those of typically developing children.

An exploratory study of substance use and misuse among college students with and without ADHD and other disabilities.

OBJECTIVE: The present study investigated potential differences between college students with and without disabilities (including ADHD, Asperger's syndrome, executive functioning disorder, and learning, mental health, vision, hearing, and physical/chronic disabilities) regarding self-reported substance use and misuse, perceived stress, and sensation seeking. METHOD: Students responded to a Stimulant Survey Questionnaire (SSQ), Perceived Stress Scale (PSS), Sensation-Seeking Scale (SSS), and items from the National College Health Assessment (NCHA). RESULTS: The hypotheses were part supported as MANOVA results revealed that students with disabilities provided significantly lower ratings on the SSS and also reported lower alcohol and marijuana use. Students with ADHD were more likely to use or misuse prescription stimulant medication but were less likely to use alcohol than did students without ADHD. CONCLUSION: Students with disabilities compared to those without disabilities differed on levels of sensation seeking and alcohol and marijuana use.

The prevalence of autism spectrum disorders: impact of diagnostic instrument and non-response bias.

BACKGROUND: A large part of the variability in rates of autism spectrum disorders (ASD) across studies is non-aetiologic, and can be explained by differences in diagnostic criteria, case-finding method, and other issues of study design. AIM: To investigate the effects on ASD prevalence of two methodological issues; non-response bias and case ascertainment. We compared the findings of using a semi-structured parent interview versus in-depth clinical assessment, including an ASD specific interview. We further explored whether including information on non-responders affected the ASD prevalence estimate. METHOD: A total population of 7- to 9-year olds (N = 9,430) was screened for ASD with the autism spectrum screening questionnaire (ASSQ) in the Bergen Child Study (BCS). Children scoring above the 98th percentile on parent and/or teacher ASSQ were invited to participate in the second and subsequently in the third phase of the BCS where they were assessed for ASD using the Development and Well-Being Assessment (DAWBA), and the Diagnostic Interview for Social and Communication disorders (DISCO), respectively. RESULTS: Clinical assessment using DISCO confirmed all DAWBA ASD cases, but also diagnosed additional cases. DISCO-generated minimum prevalence for ASD was 0.21%, whereas estimated prevalence was 0.72%, increasing to 0.87% when adjusting for non-responders. The DAWBA estimate for the same population was 0.44%. CONCLUSION: Large variances in prevalence rates across studies can be explained by methodological differences. Both information about assessment method and non-response are crucial when interpreting prevalence rates of ASD.