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Asperger’s Syndrome and Adult Outcomes.

Asperger’s Syndrome and Adult Outcomes. Asperger’s Syndrome Conference (Autism Cymru), 6 th June 2005. Millennium Stadium, Cardiff. Prof. Michael Fitzgerald. Outcome of Asperger’s syndrome / High Functioning Autism. Ludwig Wittgenstein (Tractatus – Philosophical investigations).

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Asperger’s Syndrome and Adult Outcomes.

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  1. Asperger’s Syndrome and Adult Outcomes. Asperger’s Syndrome Conference (Autism Cymru),6th June 2005.Millennium Stadium, Cardiff. Prof. Michael Fitzgerald.

  2. Outcome of Asperger’s syndrome / High Functioning Autism • Ludwig Wittgenstein (Tractatus – Philosophical investigations). • Isaac Newton – One paranoid psychotic episode. • W. B. Yeats – Late marriage, special wife of persons with Asperger’s syndrome.

  3. Outcome of Asperger’s syndrome / High Functioning Autism • Bruce Chatwin – AIDS. • Vincent van Gogh (+ Bipolar). • George Orwell – Poor care of health.

  4. Outcome of Asperger’s syndrome / High Functioning Autism • Simone Weil – Eating disorder. • Erik Satie – Alcoholism. • Andy Warhol – Neglect of health. • Ramanujan – Neglect of health.

  5. Outcome of Asperger’s 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 Asperger’s syndrome ICD-10. • Persons with Asperger’s 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) • Better outcome now High Functioning Autism / Asperger’s syndrome possibly due to better treatment now.

  9. Adult Outcome (Howlin, 2004) • 12% very good outcome. • 10% good outcome. • 19% fair outcome.

  10. Adult Outcome (Howlin, 2004) • IQ 70+ better outcome. But IQ not a consistent factor with outcome. • Some adults with initial IQ of 100+ functioning much less well than those of IQ 70. • Rituals / stereotyped behaviours and anxiety problems. Major impact on outcome for some.

  11. Adult Outcome (Howlin, 2004) • Communication generally improved. • 15% epilepsy. • 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) • Social involvement with peers improved and adaptive behaviour skills. • Early intervention improves cognitive ability and social skills in high functioning individuals.

  13. Adolescent Outcome Autism (2005, USA) (C. McGovern / M. Sigman) • Mid childhood to adolescence – less symptomatic. • Need cognitive skills of good early and adolescence interventions. • Howlin (1997) ‘Intervention in childhood can have a major impact on life in adulthood’.

  14. Many Follow-up studies (Howlin) report: • Increases in verbal IQ. • Improvements in self awareness and self control. • Decreases in autistic symptomatology. • No increase in schizophrenia as compared to general population.

  15. Psychiatric Problems Associatedwith Autism / Asperger’s syndrome • Attention Deficit Hyperactivity Disorder (most common second diagnosis) 6 – 12 years 50% ADHD. • Depression (30%) and anxiety (plus PTSD) Asperger’s syndrome misdiagnosed as Bipolar because of mood lability. • Psychiatric episodes.

  16. Psychiatric Problems Associatedwith Autism / Asperger’s syndrome • Tourette syndrome. • Eating disorder (full criteria not common). • Obsessive Compulsive Disorder (full criteria not common).

  17. Psychiatric Problems Associatedwith Autism / Asperger’s syndrome • Gender Identity Disorder. • Violent outbursts. • School refusal.

  18. Psychiatric Problems Associatedwith Autism / Asperger’s syndrome • Selective Mutism (Autism can be misdiagnosed as Selective Mutism). • Social Anxiety Disorder (DSM-IV does not allow co-occurrence with Autism but it does co-occur).

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

  20. Forensic Problems • Lack of awareness of social impact. • Misunderstanding social cues. • Lack of remorse (although most persons with Asperger’s 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) • Pragmatic Language Therapy. • Education. • Social Skills Therapy. • Mind Reading Skills plus Mind Reading Skills CD ROM. • ‘Teach’ empathy. • Supported employment.

  23. References • Howlin P. (1997). Prognosis in Autism: Do specialist treatments affect long term outcome. European Child and Adolescent Psychiatry, 6, 2, 55 – 72. • Morgan H. (1996). Adults with Autism. A guide to theory and practice. Cambridge University Press. • 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 • Howlin P. (2004). Adult outcome for children with autism. Journal of Child Psychology and Psychiatry, 45, 2, 212 – 229. • Gilchrist A. (2001). Development and current functioning in adolescents with Asperger’s syndrome: Comparative study. Journal of Child Psychology and Psychiatry, 42, 2, 227 – 240. • Ghaziuddin M. (2005). Mental health aspects of Autism and Asperger’s syndrome. Jessica Kingsley Press: London.

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

  27. References • Fitzgerald M. (Ed). Material on Asperger’s 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 • 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. • Fitzgerald M., Kinsella A. (1990). The burden on a family having a child with special needs. Irish Journal of Psychological Medicine, 7: 109 – 113.

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