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Asperger syndrome only became recognised as a distinct diagnostic category in more recent versions of ICD 10 (WHO 1992) and DSM IV (APA 1994). Whilst a great deal of work has taken place since this time, there has been little research directed at understanding the experiences of families raising children with this diagnosis (Blacher 2003). This focus group study involved engaging directly with parents of children diagnosed with Asperger syndrome in order to understand something of their experiences with particular reference to what has or might be helpful. The aim of the study is to identify parent's perspectives and insights in order to inform service development.

The prevalence of autistic spectrum disorder (ASD) in the United States is approximately 1 in 150 children. Many health care providers are unaware of parental beliefs and treatments, both medical and complementary, that parents use for their child with ASD. Understanding these beliefs and practices concerning diagnosis, cause, and utilization of medical and complementary care may help physicians provide better comprehensive care. Parents of children with ASD from 2 private practices-one in New York and one in New Jersey-were mailed a 6-page, self-administered survey. In addition to demographics and ASD type, the survey asked parents who diagnosed their child and if there was a perceived delay in that diagnosis; whether they believed there was any causal reason for their child's autism; what chronic symptoms, if any, their child experiences; and, if they had used any complementary and/or alternative therapies and at whose recommendation. Respondents included 77 of the 150 parents (51%) contacted. Most children were diagnosed by a neurologist and/or developmental pediatrician (54% and 47%, respectively). Average perceived delay in diagnosis was 18 months. Parents most frequently cited immunizations (54%), genetic predisposition (53%), and environmental exposure (38%) as a cause of their child's autism. Approximately half of children were reported as having at least one gastrointestinal, neurological, and/or allergic symptom; more than a third had immunological symptoms. Almost all parents (95%) indicated some use of complementary and alternative medicine (CAM) therapies, with most of the self-reported referrals generated from a physician or nurse (44%). Systemic complaints, parental beliefs, and use of CAM practices warrant open discussion by all health care professionals who provide care to this population.

Objectives: Within a strong interdisciplinary framework, improvement in the quality of care for children with autistic spectrum disorders through a 2 year implementation program of Practice Parameters, aimed principally at improving early detection and intervention., Method: We developed Practice Parameters (PPs) for Pervasive Developmental Disorders and circulated the PPs to all child and adolescent psychiatrists practicing in the region., Results: PP development and parallel information strategies resulted in a significant decrease of 1.5 years in the mean-age-at-diagnosis. However, further analysis indicated that improvement was only transient., Conclusion: Despite the encouraging improvement in mean-age-at-diagnosis 2 years after PP implementation, other indicators showed a failure to maintain the improvements. A systematic screening program would be the most reliable method to reinforce the PPs.

Purpose: To review Asperger syndrome characteristics, assessment tools, interventions, outcomes, and the role of the nurse practitioner in diagnosing and caring for children with Asperger syndrome., Data Sources: Review of published literature on and diagnostic criteria of the condition., Conclusions: Asperger syndrome is a pervasive developmental disorder or an autism spectrum disorder that is thought to have an incidence higher than that of autism. Asperger syndrome is different from autism, with a lack of delayed language as the most distinct difference between Asperger syndrome and autism., Implications for Practice: Because of the importance of early diagnosis of Asperger syndrome for outcome improvement, screening at all well-child visits from infancy on is of utmost importance to primary care pediatric nurse practitioners. With early diagnosis, timely intervention is possible, which is proven to show improvement in outcomes.

This article reports the pilot study of electroencephalogram (EEG) biofeedback to improve focusing and decrease anxiety in 10 adolescent boys diagnosed with Asperger's syndrome attending a therapeutic day school. Five of the boys dropped out of the study before 12 sessions were completed. The analysis of pre- and post-intervention quantitative EEGs for the five students who completed the study showed a trend to "normalization", but did not reach statistical significance. All five boys who completed 24 sessions showed improved behavior as rated by parents and teachers, but other factors, such as maturation could not be ruled out as causes of the improvement. The challenges facing this research and proposals for further exploration are outlined.

Objectives: The aim of the study was to validate the German version of the Australian Scale for Asperger's Syndrome (ASAS). Furthermore, the scoring of the ASAS as applied by the Australian authors was verified., Methods: The mothers of 18 children with Asperger's Syndrome, those of 18 children referred for a possible diagnosis of Asperger's Syndrome, but who did not receive that diagnosis, and the mothers of 15 children with other mental disorders participated in the study. All of the children were inpatients at the University of Wuerzburg Hospital of Child and Adolescent Psychiatry., Results: According to an analysis of variance, the scale successfully differentiates among the three samples. A stepwise discriminant analysis was performed. Classification results show that the membership of the three groups could be labelled accurately (accuracy rate: 60.78%). The ASAS's scoring methodology appears to yield good results for German patients., Conclusions: The scale appears to be an adequate tool for screening purposes in that it correctly discriminates children and adolescents with Asperger's Syndrome.

The concept of autism has been broadened the last few years from 'early infantile autism' to 'an autistic spectrum'. Autism and related contact disorders are grouped together under 'pervasive developmental disorders' or 'autistic spectrum disorders'. The autistic disorder, Asperger's syndrome, pervasive developmental disorder not otherwise specified (PDD-NOS), Rett's disorder and the childhood disintegrative disorder all belong to this group. People with an autistic spectrum disorder have severe difficulties in the integration of perceived stimuli into a meaningful entity. More than two-thirds of the people with the autistic disorder (classical autism) are also mentally retarded. Although autism can still only be diagnosed at the behavioural level, there is considerable consensus regarding an underlying organic aetiology. Autism is clearly a multifactorial condition. Autism cannot be cured, but adequate intervention can significantly improve the quality of life of people with this disorder. Diagnosis and intervention are highly interrelated. In the intervention, a distinction is made between family-oriented and child-oriented strategies. Augmentative communication plays a key role in the treatment. People with autism need a lot of structure, clarity and predictability, also when they have become adults.

Asperger's disorder is a pervasive developmental disorder that shares similar features of social impairment disorder, restricted interests, and repetitive behaviors with autistic disorder. Although both Asperger's disorder and autistic disorder persist into adulthood, autistic disorder is usually apparent before the age of 3, while Asperger's disorder usually manifests itself at preschool age. Asperger's disorder in the majority of cases is not associated with delay in language development and there is an increased likelihood to seek social interactions and to engage in activities and friendship with others. In contrast to autistic disorder, most Asperger's disorder patients have normal intellectual functioning and some have motor clumsiness. Although the etiology of Asperger's disorder is still undetermined, this article will review the assessment and treatment interventions that could improve the prognosis of this illness. The historical background, epidemiology, diagnostic features, differential diagnosis, and course and overall management/treatment of Asperger's disorder will be discussed. Despite the absence of a cure for Asperger's disorder, the awareness of its distinctive clinical features that differentiate it from autistic disorder could improve its prognosis and differentiate response to treatment and comorbid conditions.

The author describes some aspects of a once-weekly psychoanalytic psychotherapy of a 12-year-old boy diagnosed with Asperger's syndrome. The patient's emotional and cognitive development had been impaired since early life, possibly due to an internal deficit and to the likelihood of inadequate environmental holding. He was unaware of having difficulties but was underachieving academically, was socially isolated and often visibly unhappy in his life. The patient's denial, splitting, and projection of emotion and insight presented the therapist with the difficult task of how to reach him. In order to communicate with him emotionally, the therapist created a modified technique which reflected the patient's development from part-object to whole-object relationships. This development became apparent in the sessions and was interpreted in the transference relationship. An account of the patient's early years was pieced together from a detailed commentary of what was being observed and intuited by the therapist during the sessions, as well as by an understanding of the countertransference. By the end of two years' treatment, the patient's sensitivity and creativity, which had been buried beneath a self-sufficient, autistic-like encapsulation, finally began to emerge in his communications with his therapist.

Purpose of Review: Asperger syndrome is a pervasive developmental disorder characterized by impairments in social interactions, such as nonverbal behaviors, failure to develop peer relationships, and lack of social reciprocity with restricted, repetitive and stereotyped patterns of interest or behavior. The diagnosis of Asperger syndrome is increasingly common, and it is timely to review its phenomenology and treatment., Recent Findings: As there is a growing public awareness and acceptance of Asperger syndrome, clinical research has produced mixed results that do not clearly discriminate Asperger syndrome from high-functioning autism. However, research does indicate that children with pervasive developmental disorder achieve better outcomes when diagnosis is made early and appropriate community supports can be marshaled., Summary: The history and phenomenology of Asperger syndrome is briefly reviewed, and recent literature relating to assessment and treatment is highlighted.

Autism has been becoming the focus of attention as its apparently increasing prevalence is better appreciated. According to some estimates, the frequency of children with autistic spectrum disorder (ASD) can be as high as 1 in 150. The diagnosis can be made as early as 2 years of age, and autistic patients often have a normal life span. Thus, in terms of the number of "patient years," ASD represents a market that is as large as that of the biggest neurological indication, Alzheimer's disease. Despite the clear unmet medical need, no effective treatment is available. This may be because the mechanism of ASD is not understood. The aim of the present paper is to review recent advances in autism research and to discuss some of the most stressing problems mainly from a preclinical research standpoint. We hope to draw attention to the need to study this devastating disease that places an enormous burden on the society in general and the relatives and caregivers of autistic patients in particular.

This article provides an overview of the history and clinical features of Asperger syndrome, and considers guidelines for clinical assessment and treatment. A review of issues related to external validity is provided, which points out the limitations of current research, and lists several potentially beneficial areas of investigation into the nosologic status of the condition. It concludes with a discussion of the unequivocal need of individuals with severe social disabilities for comprehensive and adequate educational services and other treatments irrespective of the fact that the validity and the utility of this specific diagnostic concept is far from resolved.

The current investigation replicated and extended the assessment and treatment methodology of elopement. The environmental variables that maintained elopement were identified in each case, and successful treatments were implemented for the 3 participants in settings that were similar to those in which elopement occurred.

This article outlines the ingredients the authors feel are critical to making social skills interventions successful for children with autism spectrum disorders. The authors described basic principles for teaching social skills that capitalize on the strengths of such children, while specifically addressing their deficits. The authors applied these widely used principles to group social skills intervention. In particular, social skills groups for children with ASD need to break down complex social behaviors into concrete steps and rules that can be memorized and practiced in a variety of settings. Abstract concepts must be made concrete through a variety of visual, tangible, "hands-on" activities that make socialization fun. Visual structure and predictable routines are essential. Also critical to the success of social skills intervention are instruction and activities that provide necessary support for the language abilities of the participants. A variety of learning opportunities must be used to teach the goals and skills most relevant to children with ASD. These skills must be integrated as intervention progresses. Furthermore, interactions that require the children to focus on peers create a positive social group culture. Within this culture and environment, self-awareness and positive self-esteem can be fostered. A behavior plan that specifies individual goals for group members and a specific system for delivering rewards should be included. Other important ingredients include generalization, which is encouraged through community outings, skill practice in more naturalistic settings, and collaboration with parents and teachers to work on skills outside the group intervention. Weekly therapy does little to change basic deficits of ASD unless there is daily practice and reinforcement of the skills being learned in more natural situations. The authors hope that outlining these principles and specific techniques will encourage more clinicians to offer social skills groups and thus increase their availability around the nation and world. Continued research and treatment for social skills is necessary to provide much needed empiric evidence to determine effectiveness of such interventions.

This article reviews a range of social communication interventions that have been developed for students with autism at the preschool, school age, and adolescent level. Adult-mediated and peer-mediated methods that use highly structured, child-centered, and hybrid methods are examined. Programs that provide information on generalization and maintenance are identified. A set of recommendations for programs that would seem to be most appropriate for students with Asperger syndrome is presented.

This article examines two frameworks for behavioral interventions, namely the developmental stages in friendship skills with remedial strategies for each stage, and modifications to Cognitive Behavior Therapy to accommodate the unusual profile of cognitive skills of people with Asperger disorder.

Although many children and youth with AS exhibit anxiety that may lead to challenging behaviors, stress and subsequent behaviors should be viewed as an integral part of the disorder [36]. As such, it is important to understand the cycle of behaviors to prevent seemingly minor events from escalating. Although understanding the cycle of tantrums, rage, and meltdowns is important, behavior changes will not occur unless the function of the behavior is understood and the student is provided instruction and support in using (1) strategies that increase social understanding and problem solving, (2) techniques that facilitate self-understanding, and (3) methods of self-calming. Because little research exists on the cycle of behaviors exhibited by students with AS and interventions appropriate at each stage, a systematic program of research is required to identify which techniques are most appropriate for children and youth, the context in which they can be used, and methods to ensure that individuals with AS generalize these skills to home, school, and community.

The "loss of self-evidence" has been noted by many, particularly in our country, as a fundamental dysfunction in schizophrenia. Recent recognition of this "loss of self-evidence" in personality disorders such as borderline cases, and developmental disorders such as autism and Asperger's syndrome is focusing renewed interest on this perspective. It is possible that investigation into this "loss of self-evidence" noted in the pervasive developmental disorders may provide clues into the process of its development and acquisition. This paper takes up the issue of "loss of self-evidence" illustrated through the treatment process of 2 patients (female, adulthood autism, adolescent Asperger's syndrome) the author has treated. The psychopathology of the "loss of self-evidence" seen in the pervasive developmental disorders is discussed through these cases in terms of development from the standpoint of clinical intervention for relationship disturbance. The conclusions are as follows. First, the grave psychopathology pertaining to "self-evidence" in the adult autism and adolescent Asperger's syndrome cases is discussed, wherein difficulty in controlling one's action by one's own will giving rise to serious estrangement between experience and consciousness is noted as the pathology held in common by the two. Next, through examination of the normal acquisition process of words and language, it is shown that the essence of the language disorder seen in pervasive developmental disorders lies in the acquisition of meanings of objects being based upon the absence of common experience between subject and caregiver. As such, words representing meaning and content as we see them are imprinted on such individuals, never harmonizing with their own experiential world, giving rise to serious estrangement between their experience and consciousness. Third, sharing what the child is focusing upon in the outer world and how he/she is relating to it in their experiential world, and approaching them with words appropriate to their interpretation, is pointed out as being of critical importance in the self-evidence. In support of this, it is asserted that the establishment of affective communication characterized by mutual resonance of body and affect, and the development of communication upon this basis will, for the first time, enable transmission of culture to such individuals in favorable form, emphasizing the exceptional importance of attachment formation (amae) as being the key to this process.

This article provides an overview of the history and clinical features of Asperger syndrome and considers guidelines for clinical assessment and treatment. A review of issues related to external validity is provided that points out the limitations of current research and lists several potentially beneficial areas of investigation into the nosologic status of the condition. It concludes with a discussion of the unequivocal need of individuals with severe social disabilities for comprehensive and adequate educational services and other treatments, regardless of the fact that the validity and usefulness of this specific diagnostic concept is far from resolved.

This article presents findings from the outcome literature on autism, Asperger syndrome (AS), and related disorders. The discussion of outcome principally focuses on life adaptation, but also considers outcome in AS in relationship to other diagnostic groups and across time. The current research in this area is neither substantial nor systematic. Thus, in this examination of the literature, the goal is to highlight salient findings, but also to put forward questions that might direct meaningful research in this area for the future and to consider implications for treatment.

The most common disorders within the category of Pervasive Developmental Disorders (PDD) are the Autistic Disorders. In the 1994 Diagnostic and Statistical Manual-IV, Asperger's Disorder became a distinct diagnosis within the Autistic category, as part of the disorders first diagnosed in childhood and adolescence. The terms Asperger's Disorder and Asperger's Syndrome are used interchangeably. Attention to and knowledge of Asperger's Syndrome (AS) are necessary to differentiate it from closely related disorders that have overlapping symptoms. There is much discussion about different definitions of Asperger's, different viewpoints of experts in the field, and the diagnostic dilemmas related thereto. Last, and most important, are the nursing implications. Nurses are in a position to identify children with Asperger's early. After identification, the necessary referrals, treatment options, support, and follow-up are essential for these children. Nurses need more knowledge about this disorder and need to be proactive in defining their role to help children with the disorder in the schools and the community.

Asperger's Syndrome(AS) is a severe developmental disorder characterized primarily by marked and sustained difficulties in social interaction and unusual patterns of circumscribed interests and behavioral peculiarities. AS differs from autism primarily in that there is no general delay or retardation in language. A 3. 5 year-old boy with AS was referred for psychological assessment and treatment. When the boy was 23 months old, he was assessed with Bayley Scales of Infant Development (2nd ed.). Both MDI and PDI were within normal limits. After the referral, this boy was assessed with WPPSI-R and then prescribed 5 weekly intervention sessions consisting of communication skills training. At a one week's follow-up the boy was reassessed with Leiter-R. The results of WPPSI-R and Leiter-R showed the boy was in the normal intelligence range. From the second session to the fifth session, the boy's mother recorded 526 of his utterances. According to the analysis of these speech data, the language development for this boy was at Stage V, which indicated that his language development was in the superior range for his age. After 5 intervention sessions, the improvements in the child's communication skills were such that no further sessions were warranted. This boy might represent a case of aberrant neurofunctional organization. He has defects in perceptual organization but has good pattern recognition, which is based on features. It is theorized that his excellent verbal ability competed with the perceptual organization, so that he compensated for perceptual organization with verbal ability. An intervention designed to inhibit verbal compensation and facilitate configural processing is recommended.

This research considers the prevalence of iron deficiency in children with autism and Asperger syndrome and examines whether this will influence guidelines and treatment. Retrospective analysis of the full blood count and, as far as available, serum ferritin measurements of 96 children (52 with autism and 44 with Asperger syndrome) was undertaken. Six of the autistic group were shown to have iron deficiency anaemia and, of the 23 autistic children who had serum ferritin measured, 12 were iron deficient. Only two of the Asperger group had iron deficiency anaemia and, of the 22 children who had their serum ferritin measured, only three were iron deficient. Iron deficiency, with or without anaemia, can impair cognition and affect and is associated with developmental slowing in infants and mood changes and poor concentration in children. This study showed a very high prevalence of iron deficiency in children with autism, which could potentially compromise further their communication and behavioural impairments.

The purpose of psychoanalytic psychotherapy is to help the child to grow and develop normally. Children who are able to play, process their problems in the play. The therapist's role is to engage with the play and verbalize the emotions and the interactions demonstrated in it. This case-presentation illustrates how the child can express and work his inner fears and anxieties in play-situations with the therapist and shows how this interaction helps the child to develop and individuate. Children diagnosed as having Asperger syndrome may have emotional problems, in which case psychoanalytical psychotherapy is one of the means of helping the child and the family.

Nurses in a variety of settings encounter children with the unfamiliar diagnosis of Asperger syndrome (AS). This disorder, which falls clinically along the autism spectrum, is receiving increasing attention because of its inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as one of the pervasive developmental disorders. The characteristic features of AS include deficits in social skills, atypical understanding of and use of pragmatic language, behavior problems, and a restricted set of interests. Cognitive abilities vary, and some children with AS have high intelligence. In addition, many children with AS have other conditions, such as attention deficit hyperactivity disorder, Tourette's syndrome, obsessive-compulsive disorder, and depression. The disorder can result in significant functional difficulties in the home, school, and community contexts. A case study highlights the features of AS, and a related individualized school health care plan demonstrates the school nurse's role in family and staff education, monitoring for comorbidities, behavioral management, medication management, support to family members, and referral.

Objectives: Asperger's Syndrome is a pervasive developmental disorder that manifest itself at pre-school age. It is characterized by qualitative impairments of social interaction, deficits in empathy, motor disturbances, and restricted repetitive and stereotyped patterns of behavior, interests and activities. A genetic etiology is assumed in context with brain dysfunctions and neuropsychological deficits which are all focused upon nonverbal learning, even though the general intellectual level is within the normal range. Treatment must take into account the individual aspects of each case and is based mainly on behavior therapy, group training of social skills, vocational training and adaptation, and if necessary, on medication. Medical treatment is indicated in the presence of special symptoms such as hyperactivity, aggressive behavior, sleep disorders, or depression.

Neuropsychiatric problems (Asperger syndrome, ADHD, reading and writing disorders) affect 6-10 per cent of all children in Sweden. Many of these disorders are never diagnosed. As a consequence, secondary behaviour problems and impaired family relations often follow. A study of 60 families with at least one child affected by one of the above mentioned disorders shows that quality of life can be increased and problems reduced if parents and children are informed of the child's disabilities and the child receives a special education programme. Families who do not receive this special treatment more often apply for medical care from other (more expensive) sources. Quite often do they find this treatment unsatisfactory.