Asperger

1
Aspergers Syndrome and Adult Outcomes.

• Aspergers Syndrome Conference (Autism
  Cymru),6th June 2005.Millennium Stadium,
  Cardiff.
• Prof. Michael Fitzgerald.

2
Outcome of Aspergers syndrome / High Functioning
Autism

1. Ludwig Wittgenstein (Tractatus Philosophical
   investigations).
2. Isaac Newton One paranoid psychotic episode.
3. W. B. Yeats Late marriage, special wife of
   persons with Aspergers syndrome.

3
Outcome of Aspergers syndrome / High Functioning
Autism

1. Bruce Chatwin AIDS.
2. Vincent van Gogh ( Bipolar).
3. George Orwell Poor care of health.

4
Outcome of Aspergers syndrome / High Functioning
Autism

1. Simone Weil Eating disorder.
2. Erik Satie Alcoholism.
3. Andy Warhol Neglect of health.
4. Ramanujan Neglect of health.

5
Outcome of Aspergers syndrome / High Functioning
Autism

• I.Q.
• Relatively stable over time mean scores varying
  by less than 10 points.
• More variability individual children 10 20
  point variation usually in positive direction.
• Two year olds studied less stability greater
  gains.
• Significant increases in I.Q. for those
  participating in early intervention programmes.

6
Outcome 30 Year Follow-up in Denmark (F. W.
Larsen, 1997)

• 9 childhood Autism ICD-10.
• 9 Aspergers syndrome ICD-10.
• Persons with Aspergers syndrome had better
  outcome in terms of education, employment,
  autonomy, marriage.

7
Outcome 30 Year Follow-up in Denmark (F. W.
Larsen, 1997)

• Asperger - 56 had own homes (5).
• - (2) lived with parents.
• Autism 33 own homes.
• Over half still very considerably challenged in
  many ways.

8
Outcome Lord Verter (1992) Szatmari (1989)

1. Better outcome now High Functioning Autism /
   Aspergers syndrome possibly due to better
   treatment now.

9
Adult Outcome (Howlin, 2004)

1. 12 very good outcome.
2. 10 good outcome.
3. 19 fair outcome.

10
Adult Outcome (Howlin, 2004)

1. IQ 70 better outcome. But IQ not a consistent
   factor with outcome.
2. Some adults with initial IQ of 100 functioning
   much less well than those of IQ 70.
3. Rituals / stereotyped behaviours and anxiety
   problems. Major impact on outcome for some.

11
Adult Outcome (Howlin, 2004)

1. Communication generally improved.
2. 15 epilepsy.
3. 40 of those with no language when first
   assessed average 7 years (3 15 range) had
   developed useful language as adults.

12
Adolescent Outcome Autism (2005, USA) (C.
McGovern / M. Sigman)

1. Social involvement with peers improved and
   adaptive behaviour skills.
2. Early intervention improves cognitive ability and
   social skills in high functioning individuals.

13
Adolescent Outcome Autism (2005, USA) (C.
McGovern / M. Sigman)

1. Mid childhood to adolescence less symptomatic.
2. Need cognitive skills of good early and
   adolescence interventions.
3. Howlin (1997) Intervention in childhood can have
   a major impact on life in adulthood.

14
Many Follow-up studies (Howlin) report

1. Increases in verbal IQ.
2. Improvements in self awareness and self control.
3. Decreases in autistic symptomatology.
4. No increase in schizophrenia as compared to
   general population.

15
Psychiatric Problems Associated with Autism /
Aspergers syndrome

1. Attention Deficit Hyperactivity Disorder (most
   common second diagnosis) 6 12 years 50 ADHD.
2. Depression (30) and anxiety (plus PTSD)
   Aspergers syndrome misdiagnosed as Bipolar
   because of mood lability.
3. Psychiatric episodes.

16
Psychiatric Problems Associated with Autism /
Aspergers syndrome

1. Tourette syndrome.
2. Eating disorder (full criteria not common).
3. Obsessive Compulsive Disorder (full criteria not
   common).

17
Psychiatric Problems Associated with Autism /
Aspergers syndrome

1. Gender Identity Disorder.
2. Violent outbursts.
3. School refusal.

18
Psychiatric Problems Associated with Autism /
Aspergers syndrome

1. Selective Mutism (Autism can be misdiagnosed as
   Selective Mutism).
2. Social Anxiety Disorder (DSM-IV does not allow
   co-occurrence with Autism but it does co-occur).

19
Forensic Problems

1. 3 out of 132 (Ghaziuddin).
2. Lower than 7 of general population who commit
   crimes USA (20 24 age group).
3. Fascination with poisons, chemicals, fire
   setting, dislike babies or noise, sexual offences
   i.e. touching.

20
Forensic Problems

1. Lack of awareness of social impact.
2. Misunderstanding social cues.
3. Lack of remorse (although most persons with
   Aspergers syndrome / High Functioning Autism
   have extremely high moral standards).

21
Create Autism Friendly Environment (Howlin)

• Use visual cues and structure.
• Unconventional, controllable, predictable, and
• consistent.

22
Prevention / Intervention (Early Intervention)

1. Pragmatic Language Therapy.
2. Education.
3. Social Skills Therapy.
4. Mind Reading Skills plus Mind Reading Skills CD
   ROM.
5. Teach empathy.
6. Supported employment.

23
References

1. Howlin P. (1997). Prognosis in Autism Do
   specialist treatments affect long term outcome.
   European Child and Adolescent Psychiatry, 6, 2,
   55 72.
2. Morgan H. (1996). Adults with Autism. A guide
   to theory and practice. Cambridge University
   Press.
3. McGovern C., Sigman M. (2005). Continuity and
   change from early childhood to adolescence. In
   Autism Journal Child Psychology and Psychiatry,
   46, 4, 409 419.

24
References

1. Howlin P. (2004). Adult outcome for children
   with autism. Journal of Child Psychology and
   Psychiatry, 45, 2, 212 229.
2. Gilchrist A. (2001). Development and current
   functioning in adolescents with Aspergers
   syndrome Comparative study. Journal of Child
   Psychology and Psychiatry, 42, 2, 227 240.
3. Ghaziuddin M. (2005). Mental health aspects of
   Autism and Aspergers syndrome. Jessica Kingsley
   Press London.

25
References

1. Fitzgerald M., Matthews P., Birkbeck G., OConnor
   J. (1997). Irish Families Under Stress, Volume
   6. Autism a prevalence and psychosocial study in
   the Eastern Health Board area of Dublin. Dublin
   Eastern Health Board.
2. Coulthard P., Fitzgerald M. (1999). In God we
   trust? Organised religion and personal beliefs
   as resources and coping strategies, and their
   implications for health in parents with a child
   on the autistic spectrum. Mental Health,
   Religion and Culture Journal, 2, 1, 19 33.

26
References

1. Coulthard P., Fitzgerald M. (1999). Parenting
   adolescents on the autistic spectrum. European
   Child and Adolescent Psychiatry Journal, 8, 2,
   464.
2. Doherty K., Fitzgerald M., Matthews P. (2000).
   Services for autism in Ireland. Irish Journal of
   Psychology, 21, 1 2, 50 69.

27
References

1. Fitzgerald M. (Ed). Material on Aspergers
   syndrome / Autism in the following volumes
   Irish Families Under Stress Volume 1 (1991) ISBN
   0948 562 048, Volume II (1991) ISBN 0948 562 056,
   Volume III (1991) ISBN 0948 562 064, Volume IV
   (1995) ISBN 0948 562 099, Volume V (1996) ISBN
   0948 562 897, Volume VI (1996) ISBN 0948 562 34X.
   Eastern Health Board Dublin. Volume VIII
   (2003) ISBN 0948 562 706.

28
References

1. Fitzgerald M., Birkbeck G., Matthews P. (2002).
   Maternal burden in families with children with
   Autistic Spectrum Disorder. The Irish Journal of
   Psychology, 33, 1-2, 2 17.
2. Fitzgerald M., Kinsella A. (1990). The burden
   on a family having a child with special needs.
   Irish Journal of Psychological Medicine, 7 109
   113.