British Medical Bulletin Advance Access published online on February 23, 2009
British Medical Bulletin, doi:10.1093/bmb/ldp006
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Recognition and treatment of Asperger syndrome in the community
,
,*
Department of Psychiatry, University of Cambridge, Cambridge, UK
Centre for the Study of Conflict and Reconciliation, University of Sheffield, Sheffield, UK
¶ Sheffield Health and Social Care Trust, Sheffield, UK
* Correspondence to: Digby Tantam, Centre for the Study of Conflict and Reconciliation, School of Health and Related Research, Regent's Court, 30 Regent Street, Sheffield S1 4DA, UK. E-mail: Djht2{at}medschl.cam.ac.uk; D.Tantam{at}sheffield.ac.uk
Sources of data: We conducted a systematic review of the current literature for this review, but as there are many gaps in the research literature, we have supplemented this by our own clinical experience.
Areas of agreement: There is a general agreement that Asperger syndrome (AS) is one of the autistic spectrum disorders, that it is a developmental disorder which is either present at birth or develops shortly after and that there is a strong hereditary component.
Areas of controversy: The fundamental impairment of AS is in the social arena, but what causes this is disputed. We propose that it is a disorder of non-verbal communication. Another important area of controversy is the extent to which AS may remit.
Growing points: Many people with AS develop secondary psychiatric disorders in adolescence and adulthood, some of which may be linked genetically, notably bipolar disorder [DeLong R, Nohria C (1994) Psychiatric family history and neurological disease in autistic spectrum disorders. Dev Med Child Neurol, 36, 441–448] or be explicable by some other association, but many patients and carers attribute their anxiety and low mood to bullying. The prevalence, treatment and prevention of co-morbid mental health problems are rapidly developing areas of interest. Some people with AS are known to commit offences, and when they commit they are more likely to be violent offences against strangers. How much of a risk that is presented by people with AS, and how to assess this risk, is another growing area of concern.
Areas timely for developing research: The social impairments of people with AS include deficits in empathy, self-awareness and executive function. Many of these are quintessentially human characteristics, and the study of people with AS provides opportunities for using neuroimaging to compare people with AS and controls and identify which areas of the brain are concerned with these ‘higher functions’. The study of AS, like that of other fronto-striatal disorders, is also throwing light on the role of networks in the brain and on how networks are formed during embryogenesis.
Keywords: Asperger • diagnosis • detection • community • treatment • management
Accepted for publication January 19, 2009.