J Clin Exp Neuropsychol. 2013 May 14;
Semrud-Clikeman M, Fine JG, Bledsoe J, Zhu DC

Background: The purpose of the present study was to evaluate selected regions of interest in children and adolescents with nonverbal learning disabilities (NVLD), Asperger syndrome (AS), and age-matched healthy controls using magnetic resonance imaging (MRI). It was hypothesized that children with AS would show larger volumes of the amygdala and hippocampal regions than the other groups. It was also hypothesized that both clinical groups would show differences in the caudate and anterior cingulate cortex (ACC). Method: There were a total of 89 children in the final sample (31 controls, 29 NVLD, 29 AS). Each child completed a MRI scan as well as basic cognitive screening measures. High-resolution T1-weighted MR volumetric images were acquired. The volume of gray matter, white matter, cerebrospinal fluid (CSF), amygdala, hippocampus, and anterior cingulate cortex (ACC) was obtained. Results: The hypothesis that the AS group would show larger hippocampal and amygdala volumes than the other groups was confirmed. For the AS and NVLD groups, the ACC was found to be significantly smaller than that of the control group. Conclusions: These results suggest that the ACC and amygdala/hippocampal regions are deficient in children with AS, likely contributing to difficulty with modulating of emotional reactivity.

JAMA Pediatr. 2013 May 3; 1-6
Halfon N, Kuo AA

The American Psychiatric Association will update its Diagnostic and Statistical Manual of Mental Disorders to its fifth edition (DSM-5). With this new edition, the classification and diagnostic criteria for the spectrum of autistic disorders will change and become more specific and potentially more restrictive. Rather than maintaining several subcategories of autism including Asperger syndrome, there will be one new category called autism spectrum disorder. This change may alter which children are diagnosed as having autism as well as modify eligibility for treatment, educational, and other support services. We review the history and rationale for the proposed changes as well as several recent studies that have attempted to gauge the impact of these changes on children and families. We also consider how the proposed changes are likely to create new challenges for parents who are attempting to organize their children's care and for pediatricians who are providing that care and assisting with care coordination.

JAMA. 2013 Apr 24; 309(16): 1696-703
Christensen J, Grønborg TK, Sørensen MJ, Schendel D, Parner ET, Pedersen LH, Vestergaard M

Valproate is used for the treatment of epilepsy and other neuropsychological disorders and may be the only treatment option for women of childbearing potential. However, prenatal exposure to valproate may increase the risk of autism.To determine whether prenatal exposure to valproate is associated with an increased risk of autism in offspring.Population-based study of all children born alive in Denmark from 1996 to 2006. National registers were used to identify children exposed to valproate during pregnancy and diagnosed with autism spectrum disorders (childhood autism [autistic disorder], Asperger syndrome, atypical autism, and other or unspecified pervasive developmental disorders). We analyzed the risks associated with all autism spectrum disorders as well as childhood autism. Data were analyzed by Cox regression adjusting for potential confounders (maternal age at conception, paternal age at conception, parental psychiatric history, gestational age, birth weight, sex, congenital malformations, and parity). Children were followed up from birth until the day of autism spectrum disorder diagnosis, death, emigration, or December 31, 2010, whichever came first. MAIN OUTCOMES AND MEASURES: Absolute risk (cumulative incidence) and the hazard ratio (HR) of autism spectrum disorder and childhood autism in children after exposure to valproate in pregnancy.Of 655,615 children born from 1996 through 2006, 5437 were identified with autism spectrum disorder, including 2067 with childhood autism. The mean age of the children at end of follow-up was 8.84 years (range, 4-14; median, 8.85). The estimated absolute risk after 14 years of follow-up was 1.53% (95% CI, 1.47%-1.58%) for autism spectrum disorder and 0.48% (95% CI, 0.46%-0.51%) for childhood autism. Overall, the 508 children exposed to valproate had an absolute risk of 4.42% (95% CI, 2.59%-7.46%) for autism spectrum disorder (adjusted HR, 2.9 [95% CI, 1.7-4.9]) and an absolute risk of 2.50% (95% CI, 1.30%-4.81%) for childhood autism (adjusted HR, 5.2 [95% CI, 2.7-10.0]). When restricting the cohort to the 6584 children born to women with epilepsy, the absolute risk of autism spectrum disorder among 432 children exposed to valproate was 4.15% (95% CI, 2.20%-7.81%) (adjusted HR, 1.7 [95% CI, 0.9-3.2]), and the absolute risk of childhood autism was 2.95% (95% CI, 1.42%-6.11%) (adjusted HR, 2.9 [95% CI, 1.4-6.0]) vs 2.44% (95% CI, 1.88%-3.16%) for autism spectrum disorder and 1.02% (95% CI, 0.70%-1.49%) for childhood autism among 6152 children not exposed to valproate.Maternal use of valproate during pregnancy was associated with a significantly increased risk of autism spectrum disorder and childhood autism in the offspring, even after adjusting for maternal epilepsy. For women of childbearing potential who use antiepileptic medications, these findings must be balanced against the treatment benefits for women who require valproate for epilepsy control.

Eur J Paediatr Neurol. 2013 Apr 17;
Isaksen J, Diseth TH, Schjølberg S, Skjeldal OH

AIM: The aim of this paper is to report on how different external methodological factors influence estimates of ASD prevalence. METHODS: PubMed searches was conducted using the search terms, "Autism", "Autistic Disorder", "Autism Spectrum Disorders", "Asperger", "Prevalence" and "epidemiology", in combination. In total 49 studies were included. We also performed a manual search for and reviewed related articles referenced in the original articles. RESULTS: The reported prevalence rates of ASD vary widely, and so do the methodology used in the studies. CONCLUSION: There are reasons to argue that the methods used in some studies cause the high prevalence rates reported recently.

J Pediatr Nurs. 2013 Mar 28;
Giarelli E, Ruttenberg J, Segal A

In this thematic content analysis we examined the expectations, and perceived facilitators of (referred to as bridges) and barriers to transition to community as reported by adolescents and young adults with Asperger syndrome. Participants were adolescents/young adults, ages 18-23years, were from the East Coast of the United States. Seventy percent of adolescents hoped for employment (n=10). Thirty percent desired to find a partner and raise a family. Perceived barriers were: self-assessed behavioral problems, self-assessed associated features, other personal factors, and institutional factors. Bridges to facilitate transition were: accommodations in the community, cognitive abilities, personal qualities/strengths, and mentor's qualities.

J Autism Dev Disord. 2013 Mar 24;
Byers ES, Nichols S, Voyer SD

This study examined the sexual functioning of single adults (61 men, 68 women) with high functioning autism and Asperger syndrome living in the community with and without prior relationship experience. Participants completed an on-line questionnaire assessing autism symptoms, psychological functioning, and various aspects of sexual functioning. In general participants reported positive sexual functioning. Participants without prior relationship experience were significantly younger and more likely to be male and identify as heterosexual. They reported significantly higher sexual anxiety, lower sexual arousability, lower dyadic desire, and fewer positive sexual cognitions. The men reported better sexual function than did the women in a number of areas. These results counter negative societal perceptions about the sexuality of high functioning individuals on the autism spectrum.

Cogn Neuropsychol. 2012; 29(7-8): 584-600
Vulchanova M, Talcott JB, Vulchanov V, Stankova M, Eshuis H

We conducted a detailed study of a case of linguistic talent in the context of autism spectrum disorder, specifically Asperger syndrome. I.A. displays language strengths at the level of morphology and syntax. Yet, despite this grammar advantage, processing of figurative language and inferencing based on context presents a problem for him. The morphology advantage for I.A. is consistent with the weak central coherence (WCC) account of autism. From this account, the presence of a local processing bias is evident in the ways in which autistic individuals solve common problems, such as assessing similarities between objects and finding common patterns, and may therefore provide an advantage in some cognitive tasks compared to typical individuals. We extend the WCC account to language and provide evidence for a connection between the local processing bias and the acquisition of morphology and grammar.

Biol Psychiatry. 2013 Mar 16;
Domes G, Heinrichs M, Kumbier E, Grossmann A, Hauenstein K, Herpertz SC

BACKGROUND: Autism spectrum disorder (ASD) is associated with altered face processing and decreased activity in brain regions involved in face processing. The neuropeptide oxytocin has been shown to promote face processing and modulate brain activity in healthy adults. The present study examined the effects of oxytocin on the neural basis of face processing in adults with Asperger syndrome (AS). METHODS: A group of 14 individuals with AS and a group of 14 neurotypical control participants performed a face-matching and a house-matching task during functional magnetic resonance imaging. The effects of a single dose of 24 IU intranasally administered oxytocin were tested in a randomized, placebo-controlled, within-subject, cross-over design. RESULTS: Under placebo, the AS group showed decreased activity in the right amygdala, fusiform gyrus, and inferior occipital gyrus compared with the control group during face processing. After oxytocin treatment, right amygdala activity to facial stimuli increased in the AS group. CONCLUSIONS: These findings indicate that oxytocin increases the saliency of social stimuli and in ASD and suggest that oxytocin might promote face processing and eye contact in individuals with ASD as prerequisites for neurotypical social interaction.

J Autism Dev Disord. 2013 Mar 16;
Wilson CE, Gillan N, Spain D, Robertson D, Roberts G, Murphy CM, Maltezos S, Zinkstok J, Johnston K, Dardani C, Ohlsen C, Deeley PQ, Craig M, Mendez MA, Happé F, Murphy DG

An Autism Spectrum Disorder (ASD) diagnosis is often used to access services. We investigated whether ASD diagnostic outcome varied when DSM-5 was used compared to ICD-10R and DSM-IV-TR in a clinical sample of 150 intellectually able adults. Of those diagnosed with an ASD using ICD-10R, 56 % met DSM-5 ASD criteria. A further 19 % met DSM-5 (draft) criteria for Social Communication Disorder. Of those diagnosed with Autistic Disorder/Asperger Syndrome on DSM-IV-TR, 78 % met DSM-5 ASD criteria. Sensitivity of DSM-5 was significantly increased by reducing the number of criteria required for a DSM-5 diagnosis, or by rating 'uncertain' criteria as 'present', without sacrificing specificity. Reduced rates of ASD diagnosis may mean some ASD individuals will be unable to access clinical services.

Dev Cogn Neurosci. 2013 Feb 18; 5C: 95-105
Hauswald A, Weisz N, Bentin S, Kissler J

Children with Asperger's syndrome show deficits in social functioning while their intellectual and language development is intact suggesting a specific dysfunction in mechanisms mediating social cognition. An action observation/execution matching system might be one such mechanism. Recent studies indeed showed that electrophysiological modulation of the "Mu-rhythm" in the 10-12Hz range is weaker when individuals with Asperger's syndrome observe actions performed by others compared to controls. However, electrophysiological studies typically fall short in revealing the neural generators of this activity. To fill this gap we assessed magnetoencephalographic Mu-modulations in Asperger's and typically developed children, while observing grasping movements. Mu-power increased at frontal and central sensors during movement observation. This modulation was stronger in typical than in Asperger children. Source localization revealed stronger sources in premotor cortex, the intraparietal lobule (IPL) and the mid-occipito-temporal gyrus (MOTG) and weaker sources in prefrontal cortex in typical participants compared to Asperger. Activity in premotor regions, IPL and MOTG correlated positively with social competence, whereas prefrontal Mu-sources correlated negatively with social competence. No correlation with intellectual ability was found at any of these sites. These findings localize abnormal Mu-activity in the brain of Asperger children providing evidence which associates motor-system abnormalities with social-function deficits.

Work. 2013 Mar 11;
Arikawa M, Goto H, Mineno K

The present report uses two cases to provide an overview of employment support by occupational therapists for people with developmental disabilities and investigates the roles occupational therapists should play and the support they should give. Case A was a man in his 30 s with Asperger disorder who used a trial employment program and received on-the-job training, leading to regular employment. Case B was a man in his 40 s with intellectual disability who used outreach supported employment and achieved financial stability through sheltered employment. These two cases suggest that occupational therapists can help people with developmental disabilities acquire stable employment by accelerating their adaptation to the workplace through the following steps: assessing the occupational performance of the individual and the work environment; understanding the characteristics of the job by experiencing the job first-hand; and adjusting or improving the work environment to match the capabilities of the individual.

ScientificWorldJournal. 2013; 2013: 592371
Ko?ovská E, Billstedt E, Ellefsen A, Kampmann H, Gillberg IC, Biskupstø R, Andorsdóttir G, Stóra T, Minnis H, Gillberg C

Childhood autism or autism spectrum disorder (ASD) has been regarded as one of the most stable diagnostic categories applied to young children with psychiatric/developmental disorders. The stability over time of a diagnosis of ASD is theoretically interesting and important for various diagnostic and clinical reasons. We studied the diagnostic stability of ASD from childhood to early adulthood in the Faroe Islands: a total school age population sample (8-17-year-olds) was screened and diagnostically assessed for AD in 2002 and 2009. This paper compares both independent clinical diagnosis and Diagnostic Interview for Social and Communication Disorders (DISCO) algorithm diagnosis at two time points, separated by seven years. The stability of clinical ASD diagnosis was perfect for AD, good for "atypical autism"/PDD-NOS, and less than perfect for Asperger syndrome (AS). Stability of the DISCO algorithm subcategory diagnoses was more variable but still good for AD. Both systems showed excellent stability over the seven-year period for "any ASD" diagnosis, although a number of clear cases had been missed at the original screening in 2002. The findings support the notion that subcategories of ASD should be collapsed into one overarching diagnostic entity with subgrouping achieved on other "non-autism" variables, such as IQ and language levels and overall adaptive functioning.

Early Interv Psychiatry. 2013 Mar 8;
Davidson C, Greenwood N, Stansfield A, Wright S

BACKGROUND: There is a lack of systematic studies into comorbidity of Asperger syndrome and psychosis. AIM: To determine the prevalence of Asperger syndrome among patients of an early intervention in psychosis service. METHODS: This study was a cross-sectional survey consisting of three phases: screening, case note review and diagnostic interviews. All patients on caseload (n?=?197) were screened using the Autism Spectrum Disorder in Adults Screening Questionnaire. The case notes of patients screened positive were then reviewed for information relevant to Asperger syndrome. Those suspected of having Asperger syndrome were invited for a diagnostic interview. RESULTS: Thirty patients were screened positive. Three of them already had a diagnosis of Asperger syndrome made by child and adolescent mental health services. After case note review, 13 patients were invited to interview. Four did not take part, so nine were interviewed. At interview, four were diagnosed with Asperger syndrome. In total, seven patients had Asperger syndrome. Thus, the prevalence rate in this population is at least 3.6%. CONCLUSIONS: The results suggest that the prevalence of Asperger syndrome in first-episode psychosis is considerably higher than that in the general population. Clinicians working in early intervention teams need to be alert to the possibility of Asperger syndrome when assessing patients.

Rev Neurol. 2013 Feb 22; 56 Suppl 1: S61-6
Martos-Pérez J, Freire-Prudencio S, González-Navarro A, Llorente-Comi M, Ayuda-Pascual R

Autism spectrum disorders are neurodevelopmental disorders with qualitative impairment in functioning domains and areas of human characteristically. It is important to know how is the outcome in the adolescent and adult age of these people to provide the services and support needed.We review the most important follow-up studies have been conducted in autism spectrum disorders, realizes the kind of designs that have been carried out and the results obtained in different areas of development and independent functioning.Improvements in outcome but these are generally poor in the population. A small proportion close or around 25% are experiencing better outcome. These cases generally correspond to what is known as high-functioning autism or Asperger syndrome.

Rev Neurol. 2013 Feb 22; 56 Suppl 1: S13-21
Ruggieri VL

From their earliest reports, Kanner and Asperger included the hierarchy of difficulties in socialisation as one of the key axes in persons affected with autism spectrum disorders (ASD), associated to development delay or language disorders and restricted interests. This deficiency in social cognition has been related with a deficit in empathy. The theory of deficit in empathising and hypersystematisation provides a coherent, comprehensible explanation with which to partially understand the genesis of these disorders. Empathy is an essential component for emotional experiencing and social interaction, and denotes an affective response to mental states that are either perceived directly or imagined or are feelings inferred by another person. It enables us to understand, feel and respond appropriately to social stimuli, thereby giving rise to an adequate socialisation. Empathy has been considered a synonym of emotional contagion, mimicry, sympathy, compassion and empathic interest. Although these are concepts that are related and necessary for the development of adequate social cognition, they are not the same; nonetheless, they are all essential for the development of empathy or its consequences. Empathy allows individuals to 'feel with', whereas sympathy, compassion and empathic interest are related with 'feeling for' or feeling what is appropriate. Studies conducted in persons with ASD have shown them to have a low empathy quotient. In this work, different aspects of empathy, its components, its neurobiological foundations, the manifestations related with its deficit and its relation with the development of ASDs are all analysed.

Rev Med Suisse. 2012 Dec 19; 8(367): 2458-9
Nau JY

Iran J Psychiatry. 2012; 7(4): 157-63
Mohammadi MR, Zarafshan H, Ghasempour S

The aim of the present study was to compare the broader autism phenotype in Iranian parents of children with autism spectrum disorders and parents of typically developing children.Parents of children with ASD and parents of typically developing children were asked to complete the Persian version of the Autism Spectrum Quotient (AQ). In the ASD group, families included 204 parents (96 fathers and 108 mothers) of children diagnosed as having autism (Autistic Disorder, or AD) (n=124), Asperger Syndrome (AS) or High Functioning Autism (HFA) (n=48) and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) (n=32) by psychiatrists based on the Diagnostic and Statistical Manual of Mental Disorders-4thedition (DSM-IV-TR) criteria. In the control group, 210 (108 fathers and 102 mothers) parents of typically developing children. Parents of typically developing children were selected from four primary schools. Based on family reports, their children did not have any psychiatric problems. Total AQ score and each of the 5 subscales were analyzed using two-way ANOVAs with sex and group as factors.The mean age of ASD fathers was 40.6 years (SD=5.96; range 31-54), and of ASD mothers was 34.7 years (SD=4.55; range 28-45). The mean age of control fathers was 37 years (SD=4.6; range 29-45) and of control mothers was 34.11 years (SD=4.86; range 28-45). Group differences were found in age (p ‹ 0/001). On total AQ, a main effect for group and sex was found. ASD parents scored higher than controls (F(1,410)=77.876, P ‹ 0/001) and males scored higher than females (F(1,410)=23.324, P ‹ 0/001). Also, Group by Sex interaction was significant (F(1,410)=4.986, P ‹ 0/05). Results of MANOVA analysis displayed significant differences between ASD's subgroups on total AQ and subscales scores (F (15, 1121)=13.924, p < 0.0005; Wilk's Lambda= 0.624, partial =0.145). Pairwise comparisons between ASD's subgroups and Normal group showed that mean scores for the Asperger group are significantly more than other groups in total AQ, attention switching and communication subscales (p < 0.05). The frequencies of BAP (X^2=52.721 (DF=1), P ‹ 0/001), MAP (X^2=17.133 (DF=1), P ‹ 0/001) and NAP (X^2=12.722 (DF=1), P ‹ 0/001) in ASD parents were significantly more than control parents. The frequencies of Broader Autism Phenotype (BAP) (X^2=3.842 (DF=1), P›0/05) and Medium Autism phenotype (MAP) (X^2=0.060 (DF=1), P›0/05) did not significantly differ in ASD fathers and mothers, but the proportion of fathers in Narrow Autism Phenotype(NAP) range was more than mothers (X2=14.344, P ‹ 0/001).Results of the present study revealed that parents of children with ASD scored significantly higher than control parents on total AQ and its subscales and the rates of BAP, MAP and NAP were higher in ASD parents than in controls. In addition, in ASD's subgroups, the parents of Asperger children scored significantly more than other subgroups (Autism and PDD-nos) and the normal group on total AQ and some subscales.

JAMA. 2013 Feb 13; 309(6): 570-7
Surén P, Roth C, Bresnahan M, Haugen M, Hornig M, Hirtz D, Lie KK, Lipkin WI, Magnus P, Reichborn-Kjennerud T, Schjølberg S, Davey Smith G, Øyen AS, Susser E, Stoltenberg C

Prenatal folic acid supplements reduce the risk of neural tube defects in children, but it has not been determined whether they protect against other neurodevelopmental disorders.To examine the association between maternal use of prenatal folic acid supplements and subsequent risk of autism spectrum disorders (ASDs) (autistic disorder, Asperger syndrome, pervasive developmental disorder-not otherwise specified [PDD-NOS]) in children.The study sample of 85,176 children was derived from the population-based, prospective Norwegian Mother and Child Cohort Study (MoBa). The children were born in 2002-2008; by the end of follow-up on March 31, 2012, the age range was 3.3 through 10.2 years (mean, 6.4 years). The exposure of primary interest was use of folic acid from 4 weeks before to 8 weeks after the start of pregnancy, defined as the first day of the last menstrual period before conception. Relative risks of ASDs were estimated by odds ratios (ORs) with 95% CIs in a logistic regression analysis. Analyses were adjusted for maternal education level, year of birth, and parity.Specialist-confirmed diagnosis of ASDs.At the end of follow-up, 270 children in the study sample had been diagnosed with ASDs: 114 with autistic disorder, 56 with Asperger syndrome, and 100 with PDD-NOS. In children whose mothers took folic acid, 0.10% (64/61,042) had autistic disorder, compared with 0.21% (50/24,134) in those unexposed to folic acid. The adjusted OR for autistic disorder in children of folic acid users was 0.61 (95% CI, 0.41-0.90). No association was found with Asperger syndrome or PDD-NOS, but power was limited. Similar analyses for prenatal fish oil supplements showed no such association with autistic disorder, even though fish oil use was associated with the same maternal characteristics as folic acid use.Use of prenatal folic acid supplements around the time of conception was associated with a lower risk of autistic disorder in the MoBa cohort. Although these findings cannot establish causality, they do support prenatal folic acid supplementation.

Maedica (Buchar). 2012 Sep; 7(3): 193-200
Geier DA, Kern JK, Geier MR

Objectives: Autism spectrum disorder (ASD) is diagnostically defined by impaired socialization/communication and stereotypical behaviors. Health, physical, and behavioral problems have also been described in subjects diagnosed with an ASD, but have usually been examined in isolation. The purpose of the present study was to for the first time, systematically and quantitatively, examines health, physical and behavioral problems in a cohort of subjects diagnosed with an ASD.Materials and Methods: A prospective cross-sectional ASD cohort (n=54) was evaluated for health, physical, and behavioral symptoms derived from parentally completed Autism Treatment Evaluation Checklist (ATEC) forms. The study protocol received Institutional Review Board (IRB) approval from Liberty IRB, Inc (Deland, FL).Outcomes: The results showed the following occurrence of symptoms among study participants: gastrointestinal disturbances=48%, incontinence=57%, sleep problems=57%, eating disorders=94%, hyperactivity=67%, lethargy=26%, sensory processing problems=85%, anxiety/fear=74%, behavioral problems=89%, and obsessive-compulsive behaviors=92%. Of all of the areas examined, eating problems, behavioral problems, and obsessive-compulsive behaviors, were reported by the parents to be the most serious and problematic.Conclusions: The present findings, taken together with previous research, suggest that subjects diagnosed with an ASD have significant health, physical, and behavioral problems beyond the symptoms evaluated in the diagnostic criteria used to diagnosis an ASD. The present findings also suggest the ATEC provides an economical means for healthcare providers to identify health, physical, and behavioral problems in subjects diagnosed with an ASD.

J Autism Dev Disord. 2013 Feb 1;
Doi H, Fujisawa TX, Kanai C, Ohta H, Yokoi H, Iwanami A, Kato N, Shinohara K

This study investigated the ability of adults with Asperger syndrome to recognize emotional categories of facial expressions and emotional prosodies with graded emotional intensities. The individuals with Asperger syndrome showed poorer recognition performance for angry and sad expressions from both facial and vocal information. The group difference in facial expression recognition was prominent for stimuli with low or intermediate emotional intensities. In contrast to this, the individuals with Asperger syndrome exhibited lower recognition accuracy than typically-developed controls mainly for emotional prosody with high emotional intensity. In facial expression recognition, Asperger and control groups showed an inversion effect for all categories. The magnitude of this effect was less in the Asperger group for angry and sad expressions, presumably attributable to reduced recruitment of the configural mode of face processing. The individuals with Asperger syndrome outperformed the control participants in recognizing inverted sad expressions, indicating enhanced processing of local facial information representing sad emotion. These results suggest that the adults with Asperger syndrome rely on modality-specific strategies in emotion recognition from facial expression and prosodic information.