Asperger syndrome natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]
Prognosis
- T
here is some evidence that as many as 20% of children with AS "grow out" of it, and fail to meet the diagnostic criteria as adults.
As of 2006, no studies addressing the long-term outcome of individuals with Asperger syndrome are available and there are no systematic long-term follow-up studies of children with AS. Individuals with AS appear to have normal life expectancy but have an increased prevalence of comorbid psychiatric conditions such as depression and anxiety that may significantly affect prognosis. Although social impairment is lifelong, outcome is generally more positive than with individuals with lower functioning autism spectrum disorders; for example, ASD symptoms are more likely to diminish with time in children with AS or HFA.[1] Although most students with AS/HFA have average mathematical ability and test slightly worse in mathematics than in general intelligence, some are gifted in mathematics[2] and AS has not prevented some adults from major accomplishments such as winning the Nobel Prize.[3]
Children with AS may require special education services because of their social and behavioral difficulties although many attend regular education classes.Adolescents with AS may exhibit ongoing difficulty with self-care, organization and disturbances in social and romantic relationships; despite high cognitive potential, most remain at home, although some do marry and work independently. The "different-ness" adolescents experience can be traumatic.[4] Anxiety may stem from preoccupation over possible violations of routines and rituals, from being placed in a situation without a clear schedule or expectations, or from concern with failing in social encounters; the resulting stress may manifest as inattention, withdrawal, reliance on obsessions, hyperactivity, or aggressive or oppositional behavior. Depression is often the result of chronic frustration from repeated failure to engage others socially, and mood disorders requiring treatment may develop.
Education of families is critical in developing strategies for understanding strengths and weaknesses;helping the family to cope improves outcome in children. Prognosis may be improved by diagnosis at a younger age that allows for early interventions, while interventions in adulthood are valuable but less beneficial. There are legal implications for individuals with AS as they run the risk of exploitation by others and may be unable to comprehend the societal implications of their actions.
Overview
It is believed that 20% of Asperger Syndrome patients 'grow out’ of their disorder and and do not meet the diagnostic criteria as adults, whereas many other patients improve.[5] Diagnosis of AS is often delayed and sometimes done in adulthood.[6] Social impairment is lifelong.[7] Early diagnosis and intervention in patients with AS may improve adaptation and adjustment of the child.[6] Asperger Syndrome (AS) is associated with several conditions such as attention deficit hyperactivity disorder (ADHD) (most common in pediatric patients)[8], depression (most common in adolescent and adult patients)[8][9] and anxiety disorders[9].
Natural History and Prognosis
- It is believed that 20% of Asperger Syndrome patients 'grow out’ of their disorder and and do not meet the diagnostic criteria as adults, whereas many other patients improve.[5]
- Diagnosis of AS is often delayed and sometimes done in adulthood.[6]
- Social impairment is lifelong.[7]
- Most attend regular education classes with additional support services.[7]
- Some need special education services because of their social and behavioral impairments.[7]
- Early diagnosis and intervention in patients with AS may improve adaptation and adjustment of the child.[6]
. - Screening for associated disorders is an important prognostic factor.[6]
Associated Conditions
Asperger Syndrome (AS) is associated with several conditions which include:
- Attention deficit hyperactivity disorder (ADHD) (most common in pediatric patients)[8]
- Depression (most common in adolescent and adult patients)[8][9]
- Bipolar disorder[8][9]
- Tourette Syndrome[8]
- Obsessive compulsive disorder (OCD)[8][9]
- Tic disorder[8]
- Anxiety disorders[9]
- Schizophrenia[10]
- Nonverbal learning disability[11]
- Difficulty in falling asleep, sleepiness after awakening and during daytime and poor sleep quality[12]
- There have been case-reports of Asperger Syndrome (AS) associated with aminoaciduria,[13] ligamentous laxity[14] and recurrent hypersomnia[15].
References
- ↑ Coplan J, Jawad AF (2005). "Modeling clinical outcome of children with autistic spectrum disorders". Pediatrics. 116 (1): 117–22. doi:10.1542/peds.2004-1118. PMID 15995041. Lay summary – press release (2005-07-05).
- ↑ Chiang HM, Lin YH (2007). "Mathematical ability of students with Asperger syndrome and high-functioning autism". Autism. 11 (6): 547–56. doi:10.1177/1362361307083259. PMID 17947290.
- ↑ Herera S (2005-02-25). "Mild autism has 'selective advantages'". CNBC. Retrieved 2007-11-14.
- ↑ Moran M (2006). "Asperger's may be answer to diagnostic mysteries". Psychiatr News. 41 (19): 21.
- ↑ 5.0 5.1 Seltzer MM, Krauss MW, Shattuck PT, Orsmond G, Swe A, Lord C (2003). "The symptoms of autism spectrum disorders in adolescence and adulthood". J Autism Dev Disord. 33 (6): 565–81. doi:10.1023/b:jadd.0000005995.02453.0b. PMID 14714927.
- ↑ 6.0 6.1 6.2 6.3 6.4 Mirkovic B, Gérardin P (2019). "Asperger's syndrome: What to consider?". Encephale. 45 (2): 169–174. doi:10.1016/j.encep.2018.11.005. PMID 30736970.
- ↑ 7.0 7.1 7.2 7.3 Klin A (2006). "Autism and Asperger syndrome: an overview". Rev Bras Psiquiatr. 28 (suppl 1): S3–S11. doi:10.1590/S1516-44462006000500002. PMID 16791390.
- ↑ 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 Ghaziuddin M, Weidmer-Mikhail E, Ghaziuddin N (1998). "Comorbidity of Asperger syndrome: a preliminary report". J Intellect Disabil Res. 42 ( Pt 4): 279–83. doi:10.1111/j.1365-2788.1998.tb01647.x. PMID 9786442.
- ↑ 9.0 9.1 9.2 9.3 9.4 9.5 Lugnegård T, Hallerbäck MU, Gillberg C (2011). "Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome". Res Dev Disabil. 32 (5): 1910–7. doi:10.1016/j.ridd.2011.03.025. PMID 21515028.
- ↑ Marinopoulou M, Lugnegård T, Hallerbäck MU, Gillberg C, Billstedt E (2016). "Asperger Syndrome and Schizophrenia: A Comparative Neuropsychological Study". J Autism Dev Disord. 46 (7): 2292–304. doi:10.1007/s10803-016-2758-9. PMID 26936160.
- ↑ Cederlund M, Gillberg C (2004). "One hundred males with Asperger syndrome: a clinical study of background and associated factors". Dev Med Child Neurol. 46 (10): 652–60. doi:10.1017/s0012162204001100. PMID 15473168.
- ↑ Tani P, Lindberg N, Joukamaa M, Nieminen-von Wendt T, von Wendt L, Appelberg B; et al. (2004). "Asperger syndrome, alexithymia and perception of sleep". Neuropsychobiology. 49 (2): 64–70. doi:10.1159/000076412. PMID 14981336.
- ↑ Miles SW, Capelle P (1987). "Asperger's syndrome and aminoaciduria: a case example". Br J Psychiatry. 150: 397–400. doi:10.1192/bjp.150.3.397. PMID 3664113.
- ↑ Tantam D, Evered C, Hersov L (1990). "Asperger's syndrome and ligamentous laxity". J Am Acad Child Adolesc Psychiatry. 29 (6): 892–6. doi:10.1097/00004583-199011000-00008. PMID 2273016.
- ↑ Berthier ML, Santamaria J, Encabo H, Tolosa ES (1992). "Recurrent hypersomnia in two adolescent males with Asperger's syndrome". J Am Acad Child Adolesc Psychiatry. 31 (4): 735–8. doi:10.1097/00004583-199207000-00023. PMID 1644738.