Outcome of Autismspectrum Disorders A comparative followup study of males with Asperger Syndrome AS

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Outcome of Autismspectrum Disorders A
comparative follow-up study of males with
Asperger Syndrome (AS) and Autism/Atypical Autism
(A)

• Mats Cederlund, M.D. 1
• Eva Billstedt, B.A. 1
• Bibbi Hagberg, B.A. 1
• Carina Gillberg, B.A., M.D., PhD. 1
• Christopher Gillberg M.D., PhD. 1,2
• 1 Department of Child and Adolescent Psychiatry
• University of Göteborg, Sweden
• 2 National Centre for Autism Studies
• Strathclyde University, Glasgow, UK

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Background Asperger Syndrome (AS) group

• 76 males (out of 100 possible cases) with AS
  (Gillberg Gillberg)
• Born 1967-1988
• Diagnosed 1985-1999
• 16 years old at follow-up
• 5 years follow-up time (5-19 year follow-up)
• FSIQ 70 (at original diagnosis)
• Mean age at original diagnosis 11.3 years (SD
  3.8, range 5.5-24.5)
• 70 out of 76 had a Diagnostic Interview for
  Social and COmmunication disorders (DISCO)
  completed.

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BackgroundAutism/Atypical Autism (A) group

• 77 males (out of 84 possible cases retreived from
  three population based studies (3 had died, 4
  declined participation).
• Born 1962-1984
• Diagnosed in the 1980s
• 16 years old at follow-up
• 13-22 year follow-up time
• 75 completed the DISCO interview and 70 of these
  fell in approximately the same age range as the
  70 males in the AS group selected for comparison
• 53/70 had Childhood Autism
• 17/70 had Atypical Autism (incl. 2 with
  Disintegrative Disorder)

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Questions asked

• Does AS have a better outcome than autism?
• Is a better outcome in ASD related to a higher
  level of intelligence?
• Is intellectual ability stable over time?
• Is there a difference in comorbid symptoms
  between the AS and A groups?

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Age distribution in study groups
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Instruments used

• DISCO-10
• Wechsler Intelligence Scales (WAIS-R, WAIS-III,
  WISC-III)
• Vineland Adaptive Behavior Scales
• Global Assessment of Functioning Scale (GAF)
• Psychiatric-medical examination
• Parent questionnaire
• Outcome criteria (Lotter 1978)

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Outcome criteria (Lotter 1978)

• a) being employed or in education at
• an age and IQ-appropriate level
• b) if over the age of 23 living independently
  
• or if 22 years or younger having two or
  more friends or
  a
  steady relationship
• Good outcome both a and b
• Fair outcome either a or b
• Restricted but acceptable outcome neither a or
  b, and not meeting criteria for a major
  psychiatric disorder other than autistic disorder
• Poor outcome obvious severe handicap, with no
  independent social progress or presence of a
  major psychiatric disorder, but with some clear
  verbal or non-verbal communicative skills
• Very poor outcome obvious very severe handicap,
  unable to lead any kind of independent existence,
  no clear verbal or non-verbal communication

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Clinical autism spectrum diagnoses at follow-up
fulfilled criteria for both AS, and AU, but
clinically judged better to fit the latter
diagnosis
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IQ/DQ/SQ-distribution in AS and autism groups at
follow-up compared to original diagnosis
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Overall outcome categories
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Outcome related to intellectual level in AS
4 individuals were not tested
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Outcome related to intellectual level in A group
(n70)
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GAF-scores AS and A groups
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Comorbidity in study groups
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Conclusion

• AS had a better outcome than Autism, but worse
  than expected taken the level of intelligence
  into account
• A better outcome was, at least partly, related to
  a better intellectual ability
• Intellectual ability was stable over time in the
  AS group, but there was a decline in intellectual
  ability in the Autism group
• SIB and hyperactivity were more frequent in the
  Autism group, and depression in the AS group.