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Asperger syndrome (a specific autism spectrum disorder): Management and prognosis in children and adolescents

Author
L Erik von Hahn, MD
Section Editors
Carolyn Bridgemohan, MD
Marc C Patterson, MD, FRACP
Deputy Editor
Mary M Torchia, MD

INTRODUCTION

The American Psychiatric Association recognized Asperger disorder (also called Asperger syndrome) as a specific entity by publishing diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) in 1994 [1]. A modest literature on Asperger syndrome has emerged since then, though there are no clearly defined clinical criteria to separate Asperger syndrome from the autism spectrum as a whole [2-4]. (See "Asperger syndrome (a specific autism spectrum disorder): Clinical features and diagnosis in children and adolescents", section on 'Terminology'.)

The management and prognosis of Asperger syndrome will be reviewed here. The clinical features and diagnosis are discussed separately. (See "Asperger syndrome (a specific autism spectrum disorder): Clinical features and diagnosis in children and adolescents".)

An overview of the management and prognosis of autism spectrum disorder is also provided separately. (See "Autism spectrum disorder in children and adolescents: Overview of management".)

TERMINOLOGY

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published in 2013, Asperger syndrome is encompassed within the diagnosis of autism spectrum disorder (ASD) [5]. However, Asperger syndrome remains a distinct entity in the International Classification of Diseases, 10th Revision (ICD-10) [6].

In this topic review, we will use the term “Asperger syndrome/autism spectrum disorder (ASD)” to describe children who have clinical features compatible with an ICD-10 diagnosis of Asperger syndrome (table 1). In the United States, the DSM-5 terminology is “autism spectrum disorder” with particular specifiers for severity and associated conditions (eg, “without significant language or intellectual impairment”). The autism subgroup addressed in this topic review is included in the DSM-5 as “autism spectrum disorder of Level 1 severity without intellectual impairment”. (See "Autism spectrum disorder: Diagnosis", section on 'Diagnostic criteria'.)

                           

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Literature review current through: Nov 2016. | This topic last updated: Tue Nov 29 00:00:00 GMT 2016.
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References
Top
  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-IV, 4th ed, American Psychiatric Association, Washington, DC 1994.
  2. Klin A, Volkmar FR. Asperger syndrome: diagnosis and external validity. Child Adolesc Psychiatr Clin N Am 2003; 12:1.
  3. Tantam D, Girgis S. Recognition and treatment of Asperger syndrome in the community. Br Med Bull 2009; 89:41.
  4. Macintosh KE, Dissanayake C. Annotation: The similarities and differences between autistic disorder and Asperger's disorder: a review of the empirical evidence. J Child Psychol Psychiatry 2004; 45:421.
  5. American Psychiatric Association. Autism spectrum disorder. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Association, Arlington, VA 2013. p.50.
  6. World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Clinical descriptions and diagnostic guidelines. www.who.int/classifications/icd/en/bluebook.pdf (Accessed on June 04, 2013).
  7. Saulnier CA, Volkmar FR. Asperger syndrome. In: The Zuckerman Parker Handbook of Developmental and Behavioral Pediatrics for Primary Care, 3rd ed, Augustyn M, Zuckerman B, Caronna EB (Eds), Lippincott Williams & Wilkins, Philadelphia 2011. p.120.
  8. Woodbury-Smith MR, Volkmar FR. Asperger syndrome. Eur Child Adolesc Psychiatry 2009; 18:2.
  9. Prizant BM, Wetherby AM. Understanding the continuum of discrete-trial traditional behavioral to social-pragmatic developmental approaches in communication enhancement for young children with autism/PDD. Semin Speech Lang 1998; 19:329.
  10. National Research Council Committee on Educational Interventions for Children with Autism. Educating Children with Autism, Lord C, McGee JP (Eds), National Academy Press, Washington, DC 2001.
  11. Tsatsanis KD, Foley C, Donehower C. Contemporary Outcome Research and Programming Guidelines for Asperger Syndrome and High-Functioning Autism. Topics in Language Disorders 2004; 24:249.
  12. Myers SM, Johnson CP, American Academy of Pediatrics Council on Children With Disabilities. Management of children with autism spectrum disorders. Pediatrics 2007; 120:1162.
  13. Ospina MB, Krebs Seida J, Clark B, et al. Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review. PLoS One 2008; 3:e3755.
  14. Koegel L, Matos-Freden R, Lang R, Koegel R. Interventions for Children With Autism Spectrum Disorders in Inclusive School Settings. Cogn Behav Pract 2012; 19:401.
  15. Kasari C, Lawton K. New directions in behavioral treatment of autism spectrum disorders. Curr Opin Neurol 2010; 23:137.
  16. Attwood T. Frameworks for behavioral interventions. Child Adolesc Psychiatr Clin N Am 2003; 12:65.
  17. Johnson CP, Myers SM. Autism spectrum disorders. In: Developmental-Behavioral Pediatrics: Evidence and Practices, Wolraich ML, Drotar DD, Dworkin PH, Perrin EC (Eds), Mosby Elsevier, Philadelphia 2008. p.519.
  18. Baranek GT. Efficacy of sensory and motor interventions for children with autism. J Autism Dev Disord 2002; 32:397.
  19. Dawson G, Watling R. Interventions to facilitate auditory, visual, and motor integration in autism: a review of the evidence. J Autism Dev Disord 2000; 30:415.
  20. Rogers SJ, Ozonoff S. Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence. J Child Psychol Psychiatry 2005; 46:1255.
  21. Schaaf RC, Miller LJ. Occupational therapy using a sensory integrative approach for children with developmental disabilities. Ment Retard Dev Disabil Res Rev 2005; 11:143.
  22. Moree B, Davis T. Cognitive-behavioral therapy for anxiety in children diagnosed with autism spectrum disorders: modification trends. Research in Autism Spectrum Disorders 2010; 4:346.
  23. Reaven J. The treatment of anxiety symptoms in youth with high-functioning autism spectrum disorders: developmental considerations for parents. Brain Res 2011; 1380:255.
  24. Verté S, Geurts HM, Roeyers H, et al. Executive functioning in children with an Autism Spectrum Disorder: can we differentiate within the spectrum? J Autism Dev Disord 2006; 36:351.
  25. Myles BS, Simpson RL. Effective practices for students with Asperger Syndrome. Focus on Exceptional Children 2001; 34:1.
  26. Krasny L, Williams BJ, Provencal S, Ozonoff S. Social skills interventions for the autism spectrum: essential ingredients and a model curriculum. Child Adolesc Psychiatr Clin N Am 2003; 12:107.
  27. Pennington RC, Delano ME. Writing instruction for students with autism spectrum disorders: A Review. Focus on Autism and Other Developmental Disabilities 2012; 27:158.
  28. Rao PA, Beidel DC, Murray MJ. Social skills interventions for children with Asperger's syndrome or high-functioning autism: a review and recommendations. J Autism Dev Disord 2008; 38:353.
  29. Cappadocia MC, Weiss JA. Review of social skills training groups for youth with Asperger syndrome and high-functioning autism. Research in Autism Spectrum Disorders 2011; 5:70.
  30. Kasari C, Rotheram-Fuller E, Locke J, Gulsrud A. Making the connection: randomized controlled trial of social skills at school for children with autism spectrum disorders. J Child Psychol Psychiatry 2012; 53:431.
  31. Andanson J, Pourre F, Maffre T, Raynaud JP. [Social skills training groups for children and adolescents with Asperger syndrome: A review]. Arch Pediatr 2011; 18:589.
  32. Senju A. Atypical development of spontaneous social cognition in autism spectrum disorders. Brain Dev 2013; 35:96.
  33. Palmen A, Didden R, Lang R. A systematic review of behavioral intervention research on adaptive skill building in high-functioning young adults with autism spectrum disorder. Research in Autism Spectrum Disorders 2012; 6:602.
  34. Williams K. Understanding the student with Asperger Syndrome: Guidelines for Teachers. Intervention in School and Clinic 2001; 36:287.
  35. Lawrence DH, Alleckson DA, Bjorklund P. Beyond the roadblocks: transitioning to adulthood with Asperger's disorder. Arch Psychiatr Nurs 2010; 24:227.
  36. Matson JL, Dempsey T. Autism spectrum disorders: Pharmacotherapy for challenging behaviors. J Dev Phys Disabil 2008; 20:175.
  37. Russell Lang R, Koegel LK, Ahbaugh K, et al. Physical exercise and individuals with autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders 2010; 4:565.
  38. Towbin KE. Strategies for pharmacologic treatment of high functioning autism and Asperger syndrome. Child Adolesc Psychiatr Clin N Am 2003; 12:23.
  39. McCracken JT, McGough J, Shah B, et al. Risperidone in children with autism and serious behavioral problems. N Engl J Med 2002; 347:314.
  40. Shea S, Turgay A, Carroll A, et al. Risperidone in the treatment of disruptive behavioral symptoms in children with autistic and other pervasive developmental disorders. Pediatrics 2004; 114:e634.
  41. Nagaraj R, Singhi P, Malhi P. Risperidone in children with autism: randomized, placebo-controlled, double-blind study. J Child Neurol 2006; 21:450.
  42. Arnold LE, Vitiello B, McDougle C, et al. Parent-defined target symptoms respond to risperidone in RUPP autism study: customer approach to clinical trials. J Am Acad Child Adolesc Psychiatry 2003; 42:1443.
  43. Aman MG, Farmer CA, Hollway J, Arnold LE. Treatment of inattention, overactivity, and impulsiveness in autism spectrum disorders. Child Adolesc Psychiatr Clin N Am 2008; 17:713.
  44. Parikh MS, Kolevzon A, Hollander E. Psychopharmacology of aggression in children and adolescents with autism: a critical review of efficacy and tolerability. J Child Adolesc Psychopharmacol 2008; 18:157.
  45. White SW, Oswald D, Ollendick T, Scahill L. Anxiety in children and adolescents with autism spectrum disorders. Clin Psychol Rev 2009; 29:216.
  46. Posey DJ, Erickson CA, Stigler KA, McDougle CJ. The use of selective serotonin reuptake inhibitors in autism and related disorders. J Child Adolesc Psychopharmacol 2006; 16:181.
  47. Ipser JC, Stein DJ, Hawkridge S, Hoppe L. Pharmacotherapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev 2009; :CD005170.
  48. Hollander E, Phillips A, Chaplin W, et al. A placebo controlled crossover trial of liquid fluoxetine on repetitive behaviors in childhood and adolescent autism. Neuropsychopharmacology 2005; 30:582.
  49. Martin A, Scahill L, Klin A, Volkmar FR. Higher-functioning pervasive developmental disorders: rates and patterns of psychotropic drug use. J Am Acad Child Adolesc Psychiatry 1999; 38:923.
  50. West L, Brunssen SH, Waldrop J. Review of the evidence for treatment of children with autism with selective serotonin reuptake inhibitors. J Spec Pediatr Nurs 2009; 14:183.
  51. Research Units on Pediatric Psychopharmacology Autism Network. Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity. Arch Gen Psychiatry 2005; 62:1266.
  52. Faraone SV, Buitelaar J. Comparing the efficacy of stimulants for ADHD in children and adolescents using meta-analysis. Eur Child Adolesc Psychiatry 2010; 19:353.
  53. Hazell P. Drug therapy for attention-deficit/hyperactivity disorder-like symptoms in autistic disorder. J Paediatr Child Health 2007; 43:19.
  54. Leskovec TJ, Rowles BM, Findling RL. Pharmacological treatment options for autism spectrum disorders in children and adolescents. Harv Rev Psychiatry 2008; 16:97.
  55. Posey DJ, Puntney JI, Sasher TM, et al. Guanfacine treatment of hyperactivity and inattention in pervasive developmental disorders: a retrospective analysis of 80 cases. J Child Adolesc Psychopharmacol 2004; 14:233.
  56. Fankhauser MP, Karumanchi VC, German ML, et al. A double-blind, placebo-controlled study of the efficacy of transdermal clonidine in autism. J Clin Psychiatry 1992; 53:77.
  57. Jaselskis CA, Cook EH Jr, Fletcher KE, Leventhal BL. Clonidine treatment of hyperactive and impulsive children with autistic disorder. J Clin Psychopharmacol 1992; 12:322.
  58. Jesner OS, Aref-Adib M, Coren E. Risperidone for autism spectrum disorder. Cochrane Database Syst Rev 2007; :CD005040.
  59. Barnard L, Young AH, Pearson J, et al. A systematic review of the use of atypical antipsychotics in autism. J Psychopharmacol 2002; 16:93.
  60. Huffman LC, Sutcliffe TL, Tanner IS, Feldman HM. Management of symptoms in children with autism spectrum disorders: a comprehensive review of pharmacologic and complementary-alternative medicine treatments. J Dev Behav Pediatr 2011; 32:56.
  61. Miral S, Gencer O, Inal-Emiroglu FN, et al. Risperidone versus haloperidol in children and adolescents with AD : a randomized, controlled, double-blind trial. Eur Child Adolesc Psychiatry 2008; 17:1.
  62. McVoy M, Findling R. Child and adolescent psychopharmacology update. Psychiatr Clin North Am 2009; 32:111.
  63. Correll CU, Manu P, Olshanskiy V, et al. Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents. JAMA 2009; 302:1765.
  64. Almandil NB, Liu Y, Murray ML, et al. Weight gain and other metabolic adverse effects associated with atypical antipsychotic treatment of children and adolescents: a systematic review and meta-analysis. Paediatr Drugs 2013; 15:139.
  65. Scahill L, Jeon S, Boorin SJ, et al. Weight Gain and Metabolic Consequences of Risperidone in Young Children With Autism Spectrum Disorder. J Am Acad Child Adolesc Psychiatry 2016; 55:415.
  66. Stein MT. Risperidone (Risperdal). JW Pediatr Asolesc Med 2007; 6:20.
  67. American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 2004; 27:596.
  68. Seltzer MM, Shattuck P, Abbeduto L, Greenberg JS. Trajectory of development in adolescents and adults with autism. Ment Retard Dev Disabil Res Rev 2004; 10:234.
  69. Cederlund M, Hagberg B, Billstedt E, et al. Asperger syndrome and autism: a comparative longitudinal follow-up study more than 5 years after original diagnosis. J Autism Dev Disord 2008; 38:72.
  70. Holwerda A, van der Klink JJ, Groothoff JW, Brouwer S. Predictors for work participation in individuals with an Autism spectrum disorder: a systematic review. J Occup Rehabil 2012; 22:333.
  71. Gillberg IC, Helles A, Billstedt E, Gillberg C. Boys with Asperger Syndrome Grow Up: Psychiatric and Neurodevelopmental Disorders 20 Years After Initial Diagnosis. J Autism Dev Disord 2016; 46:74.
  72. Gilchrist A, Green J, Cox A, et al. Development and current functioning in adolescents with Asperger syndrome: a comparative study. J Child Psychol Psychiatry 2001; 42:227.
  73. Green J, Gilchrist A, Burton D, Cox A. Social and psychiatric functioning in adolescents with Asperger syndrome compared with conduct disorder. J Autism Dev Disord 2000; 30:279.
  74. Seltzer MM, Krauss MW, Shattuck PT, et al. The symptoms of autism spectrum disorders in adolescence and adulthood. J Autism Dev Disord 2003; 33:565.
  75. Howlin P. Outcomes in adult life for more able individuals with autism or Asperger syndrome. Autism 2000; 4:63.
  76. Mawhood L, Howlin P, Rutter M. Autism and developmental receptive language disorder--a comparative follow-up in early adult life. I: Cognitive and language outcomes. J Child Psychol Psychiatry 2000; 41:547.