How parents can help children with Asperger's Syndrome to grow and prosper

If you are raising a child with Asperger's Syndrome, it can be a real challenge to find answers to your questions and make decisions while trying to keep pace with the latest developments in research and changes in the growth and behavior of your child. This book comes to the rescue by combining the latest medical information and interventions with clearcut strategies to help your child thrive at home and at school.Covers the biological, psychological, social, and spiritual development of children with Asperger's syndrome from 18 months through adolescence Presents the most up-to-date scientific data on Asperger's Syndrome, including the latest neuro-imaging research Offers practical strategies for shaping social interactions, coping with repetitive thoughts and behavior, addressing sensory needs or avoidance, encouraging interests without enabling obsessions, and other challenges Reviews the advantages and disadvantages of available medical treatments, complementary therapies, and early intervention strategiesWritten by a medical doctor and an educator who has a child with Asperger's

From getting a diagnosis, to finding the best schooling options, to helping your child with day-to-day issues and challenges, Asperger's Syndrome is an essential practical resource you will turn to again and again for reliable and current information.

Author: Melinda Docter Ed.D., Syed Naqvi MD
Paperback: 224 pages
Company: Wiley (2010-09-07)
ISBN: 0470140143
List Price: $16.95
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Let these two Asperger's experts guide you through the basic information you need to know to help your child. In this straightforward and helpful book, you will learn how to:Get the right diagnosis and understand the resultsDetermine the best options for educationHelp your child learn to socialize with other kidsAvoid sensory overload by recognizing triggersWhen Your Child Has . . . Asperger's Syndrome defines the syndrome in clear and complete terms that will help you help your child. Now, you can understand your child's needs and help him or her lead a happy and successful life.

William Stillman is the author of Demystifying the Autistic Experience. He is on several autism/Asperger's advisory boards; has been appointed to Pennsylvania's Autism Task Force; and offers much more information at WilliamStillman.com. He lives in Hershey, PA.

Vincent Iannelli, M.D., is the author of The Everything Father's First Year Book. A board-certified pediatrician and fellow of the American Academy of Pediatrics, he is also an associate professor of pediatrics at UT Southwestern Medical Center. He has nine years of clinical experience and now runs a private practice. Dr. Iannelli lives in Hearth, TX.

Author: William Stillman
Paperback: 224 pages
Company: Adams Media (2008-06-01)
ISBN: 159869667X
List Price: $6.95
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Asperger Syndrome now affects an estimated 10 million children and adults in the United States. Here, Lawton takes an evenhanded look at AS, its development and symptoms, the biological and potential genetic components, the associated physical complaints, and how natural medicine can help. She includes a history of early treatment and current drug and psychotherapy treatments, and explains how diet, blood sugar, and food sensitivities or allergies can play a role. She also looks at the controversy over vaccinations and explains blood tests that can pinpoint a rationale for herbal and homeopathic treatments. The book includes a chapter specifically addressing what is safe to do on your own and when you should seek the help of a medical practitioner. Resources include a listing of AS traits, books that are reliable sources of information, and authoritative Web sites.

The spotlight on Asperger Syndrome has been widening with recent attention from mainstream media. This neurological condition, often misdiagnosed as Attention Deficit Disorder, Obsessive Compulsive Disorder, or high-functioning autism is increasingly being recognized, and now affects an estimated 10 million children and adults in the United States alone. Unlike autistic individuals, Asperger sufferers have normal or above normal language, intelligence and cognition, and are often seen as brilliant—verbose with formal speech patterns and superior memory—but they have odd interests, unusual reactions to the environment, inflexibility in routines, poor interaction with people, and inability to form age-appropriate relationships. There is no known cure, but as Suzanne Lawton explains in this work, there are approaches that can reduce or remove the symptoms. While traditional medications are the only option for some sufferers, there are those who can benefit from the natural treatments offered by herbal medicine, diet and nutrition, homeopathy, and amino acids. These drug-free approaches also reduce the physical problems common to Asperger suffers, including stomachaches and headaches and irritable bowel syndrome. says Lawton.

Recent FDA warnings regarding the use of psychotropic medications with children (previous treatment has focused on anti-anxiety, anti-depressant, and mood-stabilizing drugs) have fueled the outcry of parents who want to get their children off drugs to avoid the side effects. Here, Lawton takes an evenhanded look at Asperger Syndrome, its development and symptoms, the biological and potential genetic components, the associated physical complaints, and how natural medicine can help. She includes a history of early treatment and current drug and psychotherapy treatments, and explains how diet, blood sugar, and food sensitivities or allergies can play a role. She also looks at the controversy over vaccinations and explains blood tests that can pinpoint a rationale for herbal and homeopathic treatments. Lawton includes a chapter specifically addressing what is safe to do on your own and when you should seek the help of a medical practitioner. Resources include a listing of AS traits, books that are reliable sources of information, and authoritative Web sites.

Psychiatr Pol. 2011 Sep-Oct; 45(5): 749-58
Bryńska A

Pervasive Developmental Disorders (PPD) refers to the group of disorders characterised by delayed or inappropriate development of multiple basic functions including socialisation, communication, behaviour and cognitive functioning. The term,,autistic spectrum disorders" was established as a result of the magnitude of the intensity of symptoms and their proportions observed in all types of pervasive developmental disorders. Asperger's Syndrome (AS) remains the most controversial diagnosis in terms of its place within autism spectrum disorders. AS if often described as an equivalent of High Functioning Autism (HFA) or as a separate spectrum-related disorder with unique diagnostic criteria. Another important issue is the relationship between AS and speech disorders. Although it is relatively easy to draw a line between children with classical autism and speech disorders, the clear cut frontiers between them still remain to be found. The main distinguishing feature is the lack of stereotypic interests and unimpaired social interaction observed in children with speech disorders, such as semantic-pragmatic disorder.

Biomark Insights. 2011; 6: 127-33
Russo AJ, Devito R

To assess plasma zinc and copper concentration in individuals with Asperger's Syndrome, Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) and autistic disorder, and to analyze the efficacy of zinc therapy on the normalization of zinc and copper levels and symptom severity in these disorders.Plasma from 79 autistic individuals, 52 individuals with PDD-NOS, 21 individuals with Asperger's Syndrome (all meeting DSM-IV diagnostic criteria), and 18 age and gender similar neurotypical controls, were tested for plasma zinc and copper using inductively-coupled plasma-mass spectrometry.Autistic and PDD-NOS individuals had significantly elevated plasma levels of copper. None of the groups (autism, Asperger's or PDD-NOS) had significantly lower plasma zinc concentrations. Post zinc and B-6 therapy, individuals with autism and PDD-NOS had significantly lower levels of copper, but individuals with Asperger's did not have significantly lower copper. Individuals with autism, PDD-NOS and Asperger's all had significantly higher zinc levels. Severity of symptoms decreased in autistic individuals following zinc and B-6 therapy with respect to awareness, receptive language, focus and attention, hyperactivity, tip toeing, eye contact, sound sensitivity, tactile sensitivity and seizures. None of the measured symptoms worsened after therapy. None of the symptoms in the Asperger's patients improved after therapy.These results suggest an association between copper and zinc plasma levels and individuals with autism, PDD-NOS and Asperger's Syndrome. The data also indicates that copper levels normalize (decrease to levels of controls) in individuals with autism and PDD-NOS, but not in individuals with Asperger's. These same Asperger's patients do not improve with respect to symptoms after therapy, whereas many symptoms improved in the autism group. This may indicate an association between copper levels and symptom severity.

J Autism Dev Disord. 2012 Jan 20;
Sawyer AC, Williamson P, Young RL

Psychiatry Res. 2011 Dec 30; 194(3): 230-4
Girgis RR, Slifstein M, Xu X, Frankle WG, Anagnostou E, Wasserman S, Pepa L, Kolevzon A, Abi-Dargham A, Laruelle M, Hollander E

Evidence from biochemical, imaging, and treatment studies suggest abnormalities of the serotonin system in autism spectrum disorders, in particular in frontolimbic areas of the brain. We used the radiotracers [(11)C]MDL 100907 and [(11)C]DASB to characterize the 5-HT(2A) receptor and serotonin transporter in Asperger's Disorder. Seventeen individuals with Asperger's Disorder (age=34.3 ± 11.1 years) and 17 healthy controls (age=33.0 ± 9.6 years) were scanned with [(11)C]MDL 100907. Of the 17 patients, eight (age=29.7 ± 7.0 years) were also scanned with [¹¹C]DASB, as were eight healthy controls (age=28.7 ± 7.0 years). Patients with Asperger's Disorder and healthy control subjects were matched for age, gender, and ethnicity, and all had normal intelligence. Metabolite-corrected arterial plasma inputs were collected and data analyzed by two-tissue compartment modeling. The primary outcome measure was regional binding potential BP(ND). Neither regional [¹¹C]MDL 100907 BP(ND) nor [¹¹C]DASB BP(ND) was statistically different between the Asperger's and healthy subjects. This study failed to find significant alterations in binding parameters of 5-HT(2A) receptors and serotonin transporters in adult subjects with Asperger's disorder.

Psychol Med. 2011 Dec 20; 1-11
Anckarsäter H, Hofvander B, Billstedt E, Gillberg IC, Gillberg C, Wentz E, Råstam M

BACKGROUND: A subgroup of persons with anorexia nervosa (AN) have been proposed to have sociocommunicative problems corresponding to autism spectrum disorders [ASDs, i.e. DSM-IV pervasive developmental disorders (PDDs): autistic disorder, Asperger's disorder, PDD not otherwise specified (NOS)]. Here, clinical problems, personality traits, cognitive test results and outcome are compared across 16 subjects (32%) with teenage-onset AN who meet or have met ASD criteria (AN+ASD), 34 ASD-negative AN subjects and matched controls from a longitudinal Swedish study including four waves of independent assessments from the teens to the early thirties.MethodThe fourth wave included the Structured Clinical Interview for DSM-IV (SCID)-I and the SCID-II (cluster C, i.e. 'anxious' PDs) interviews, the Asperger Syndrome Diagnostic Interview, self-assessments by the Autism Spectrum Quotient and the Temperament and Character Inventory, neurocognitive tests by subscales from the Wechsler scales, continuous performance tests, Tower of London, and Happé's cartoons. RESULTS: The ASD assessments had substantial inter-rater reliability over time (Cohen's κ between 0.70 and 0.80 with previous assessments), even if only six subjects had been assigned a diagnosis of an ASD in all four waves of the study, including retrospective assessments of pre-AN neurodevelopmental problems. The AN+ASD group had the highest prevalence of personality disorders and the lowest Morgan-Russell scores. The non-ASD AN group also differed significantly from controls on personality traits related to poor interpersonal functioning and on neurocognitive tests. CONCLUSIONS: A subgroup of subjects with AN meet criteria for ASDs. They may represent the extreme of neurocognitive and personality problems to be found more generally in AN.

Psychiatr Pol. 2011 Sep-Oct; 45(5): 759-68
Bryńska A, Lipińska E, Matelska M

Repetitive and stereotyped behaviours in the form of stereotyped interests or specific routine activities are one ofthe diagnostic criteria in pervasive developmental disorders. The occurrence of repetitive behaviours in patients with pervasive developmental disorders is a starting point for questions about the type and classification criteria of such behaviours. The aim of the article is to present case studies of patients with pervasive developmental disorders and co-morbid symptoms in the form of routine activities, tics, obsessive-compulsive symptoms or stereotyped behaviours. The first case study describes a patient with Asperger's syndrome and obsessive compulsive symptoms. The diagnostic problems regarding complex motor tics are discussed in the second case study which describes a patient with Asperger's syndrome and Gilles de la Tourette syndrome. The third and fourth case study describes mono-zygotic twins with so called High Functioning Autism whose repetitive activities point to either obsessive compulsive symptoms, stereotypic movements, need for absolute consistency or echopraxia. The possible comorbidity of pervasive developmental disorders and symptoms in the form of repetitive behaviours, possible interactions as well as diagnostic challenges is discussed in the article.

BMC Pediatr. 2011; 11: 111
Adams JB, Audhya T, McDonough-Means S, Rubin RA, Quig D, Geis E, Gehn E, Loresto M, Mitchell J, Atwood S, Barnhouse S, Lee W

ABSTRACT:Vitamin/mineral supplements are among the most commonly used treatments for autism, but the research on their use for treating autism has been limited.This study is a randomized, double-blind, placebo-controlled three month vitamin/mineral treatment study. The study involved 141 children and adults with autism, and pre and post symptoms of autism were assessed. None of the participants had taken a vitamin/mineral supplement in the two months prior to the start of the study. For a subset of the participants (53 children ages 5-16) pre and post measurements of nutritional and metabolic status were also conducted.The vitamin/mineral supplement was generally well-tolerated, and individually titrated to optimum benefit. Levels of many vitamins, minerals, and biomarkers improved/increased showing good compliance and absorption. Statistically significant improvements in metabolic status were many including: total sulfate (+17%, p = 0.001), S-adenosylmethionine (SAM; +6%, p = 0.003), reduced glutathione (+17%, p = 0.0008), ratio of oxidized glutathione to reduced glutathione (GSSG:GSH; -27%, p = 0.002), nitrotyrosine (-29%, p = 0.004), ATP (+25%, p = 0.000001), NADH (+28%, p = 0.0002), and NADPH (+30%, p = 0.001). Most of these metabolic biomarkers improved to normal or near-normal levels.The supplement group had significantly greater improvements than the placebo group on the Parental Global Impressions-Revised (PGI-R, Average Change, p = 0.008), and on the subscores for Hyperactivity (p = 0.003), Tantrumming (p = 0.009), Overall (p = 0.02), and Receptive Language (p = 0.03). For the other three assessment tools the difference between treatment group and placebo group was not statistically significant.Regression analysis revealed that the degree of improvement on the Average Change of the PGI-R was strongly associated with several biomarkers (adj. R2 = 0.61, p < 0.0005) with the initial levels of biotin and vitamin K being the most significant (p < 0.05); both biotin and vitamin K are made by beneficial intestinal flora.Oral vitamin/mineral supplementation is beneficial in improving the nutritional and metabolic status of children with autism, including improvements in methylation, glutathione, oxidative stress, sulfation, ATP, NADH, and NADPH. The supplement group had significantly greater improvements than did the placebo group on the PGI-R Average Change. This suggests that a vitamin/mineral supplement is a reasonable adjunct therapy to consider for most children and adults with autism.Clinical Trial Registration Number: NCT01225198.

Practitioner. 2011 Nov; 255(1745): 27-30, 3
Allely CS, Wilson P

Autism is a disorder of social communication, originally described as a triad of impaired social interaction, communication, and imagination, associated with a rigid, repetitive pattern of behaviour. More recently the core deficit has been described as a lack of social instinct. The term autism spectrum disorder (ASD) includes autism, atypical autism and Asperger's syndrome. According to NICE, diagnostic assessment should start within three months of referral. The decision to refer should be made on the basis of signs or symptoms. Information from all sources (i.e. medical history, parental concerns, clinical judgement) should be used to diagnose ASD based on ICD-10 or DSM-IV criteria. Clinicians should not rely on any one autism-specific diagnostic tool alone to diagnose ASD. Diagnosis is based primarily on the recognition and interpretation of behavioural symptoms. CHAT or the modified version (M-CHAT) are simple checklists that can be used for the assessment of young children in primary care when ASD is suspected. They can identify clinical features indicative of increased risk but should not be used to rule out ASD.

Turk J Pediatr. 2011 May-Jun; 53(3): 352-5
Kilinçaslan A, Tanidir C, Tutkunkardaş MD, Mukaddes NM

Williams syndrome (WS) is a genetic disorder caused by the hemizygous microdeletion in chromosome 7q11.23. It is characterized by dysmorphic face, cardiovascular disease, idiopathic hypercalcemia, mental retardation, and an uneven profile of cognitive-linguistic abilities and deficits. The presence of autistic features in individuals with WS is a controversial issue. While there are reports that describe them as overly friendly with excessive sociability and good empathic skills, some recent studies focus more on the qualitative impairment of their social abilities. Here, we report the clinical presentation and follow-up of an eight-year-old boy with WS and clear problems in his social interaction, non-verbal communication and circumscribed interests. To our knowledge, this is the first case report on the coexistence of WS and Asperger's disorder. It also differs from previous papers on the comorbidity of WS and autism spectrum disorders, by depicting a highly verbal, nonretarded child followed for seven years through adolescence.

Seishin Shinkeigaku Zasshi. 2011; 113(11): 1145-53
Ohta H

Individuals with Asperger's disorder and high functioning autism often don't have diagnosis during the childhood because of their high intelligence. It is not easy to diagnose adults as pervasive developmental disorder, because the information about their state and episodes in the childhood depends on the retrospective memories by caregivers and themselves. Although some researchers proposed that biological indicators might be useful for diagnosis, they have not found reliable indicators yet. Diagnosis of pervasive developmental disorder based only on biological indicators has limitations, because pervasive developmental disorder is biologically heterogeneous, and the diagnosis criteria were made based on abnormal behaviors, but not on the biological characteristics. However it is expected that the biological indicators that are useful to diagnose will be found in the near future. The outlines of neuroimaging and eye tracking studies that are relatively simple and useful methods, including findings of our studies, are introduced in this review.

Autism Res. 2012 Feb 1;
Heyer NJ, Echeverria D, Woods JS

Autism (AUT) is a complex neurodevelopmental disorder that, together with Asperger's syndrome and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), comprises the expanded classification of autistic spectrum disorder (ASD). The heterogeneity of ASD underlies the need to identify biomarkers or clinical features that can be employed to identify meaningful subtypes of ASD, define specific etiologies, and inform intervention and treatment options. Previous studies have shown that disordered porphyrin metabolism, manifested principally as significantly elevated urinary concentrations of pentacarboxyl (penta) and coproporphyrins, is commonly observed among some children with ASD. Here, we extend these observations by specifically evaluating penta and coproporphyrins as biological indicators of ASD among 76 male children comprising 30 with validated AUT, 14 with PDD-NOS, and 32 neurotypical (NT) controls. ASD children (AUT and PDD-NOS) had higher mean urinary penta (P 

Psychopathology. 2012 Feb 4; 45(2): 130-132
Cui JF, Chen YH, Zhang XD, Wang Y, Gao DG, Zou XB

No abstract available.

Neurocase. 2011 Nov 25;
Ramachandran VS, Miller L, Livingstone MS, Brang D

The claim that some individuals see colored halos or auras around faces has long been part of popular folklore. Here we report on a 23-year-old man (subject TK) diagnosed with Asperger's disorder, who began to consistently experience colors around individuals at the age of 10. TK's colors are based on the individual's identity and emotional connotation. We interpret these experiences as a form of synesthesia, and confirm their authenticity through a target detection paradigm. Additionally, we investigate TK's claim that emotions evoke highly specific colors, allowing him, despite his Asperger's, to introspect on emotions and recognize them in others.

Biol Psychiatry. 2012 Mar 1; 71(5): 427-33
Enticott PG, Kennedy HA, Rinehart NJ, Tonge BJ, Bradshaw JL, Taffe JR, Daskalakis ZJ, Fitzgerald PB

The neurobiology of autism spectrum disorder (ASD) is not particularly well understood, and biomedical treatment approaches are therefore extremely limited. A prominent explanatory model suggests that social-relating symptoms may arise from dysfunction within the mirror neuron system, while a recent neuroimaging study suggests that these impairments in ASD might reduce with age.Participants with autism spectrum disorder (i.e., DSM-IV autistic disorder or Asperger's disorder) (n = 34) and matched control subjects (n = 36) completed a transcranial magnetic stimulation study in which corticospinal excitability was assessed during the observation of hand gestures.Regression analyses revealed that the ASD group presented with significantly reduced corticospinal excitability during the observation of a transitive hand gesture (relative to observation of a static hand) (p < .05), which indicates reduced putative mirror neuron system activity within ventral premotor cortex/inferior frontal gyrus. Among the ASD group, there was also a negative association between putative mirror neuron activity and self-reported social-relating impairments, but there was no indication that mirror neuron impairments in ASD decrease with age.These data provide general support for the mirror neuron hypothesis of autism; researchers now must clarify the precise functional significance of mirror neurons to truly understand their role in the neuropathophysiology of ASD and to determine whether they should be used as targets for the treatment of ASD.

Duodecim. 2011; 127(15): 1571-7
Waris P, Kulomäki T, Tani P

Literature on Asperger's syndrome (AS) has mainly described symptoms that are manifested in boys. Only recently, attention has been paid on the features in AS girls that differ from the typical clinical picture and may complicate the detection of the syndrome. Because AS girls may react passively in general or compensate or hide their difficulties by other abilities, the need for support is not necessarily brought up. In that case this developmental disorder easily remains unrecognized. Recognition of the syndrome at an early stage makes early supportive actions possible.

Prim Care Companion CNS Disord. 2011; 13(5):
Okamura T, Isoya K, Hosoda M

Explore (NY). 2011 Nov; 7(6): 384-90
Alcantara J, Alcantara JD, Alcantara J

In addition to impacting the affected child and his/her family's quality of life, recent estimates place the lifetime cost for an individual with ASD at $3.2 million and $35 billion for the entire birth cohort. Given the clinical heterogeneity of ASD, treatment approaches are multidisciplinary including alternative therapies, particularly when no pharmaceutical agent is effective for the core symptoms of ASD. Chiropractic is a popular alternative therapy for children. A systematic review of the literature was performed to provide context for future research endeavors in this field.A systematic review of the literature on the chiropractic care of patients with ASD utilized 8 databases. Eligibility criteria for inclusion included: (1) the study was a primary investigation/report published in an English peer-reviewed journal; (2) the study involved patients ≤18 years; and (3) patients are diagnosed with autism, Asperger's Syndrome, PDD-NOS, or ASD.Our systematic review of the literature revealed a total of five articles consisting of three case reports, one cohort study and one randomized comparison trial. The literature is lacking on documenting the chiropractic care of children with ASD.At the heart of the core symptoms of ASD (ie, impaired social interactions, deficits in communication and repetitive or restricted behavioral patterns) is abnormal sensory processing. Preliminary studies indicate that the chiropractic adjustment may attenuate sensorimotor integration based on somatosensory evoked potentials studies.We encourage further research for definitive studies on chiropractic's effectiveness for ASD. However, given the ineffectiveness of pharmaceutical agents, a trial of chiropractic care for sufferers of autism is prudent and warranted.

Psychother Psychosom. 2012 Feb 2; 81(2): 130
Ogliari A, Battaglia M

J Dev Behav Pediatr. 2012 Jan; 33(1): 84-6
Phelps R, Eisert D, Schulz S, Augustyn M

CASE:: Alex is a 9-year-old boy brought to you, his primary care provider, for a "fifth opinion." You have cared for Alex since he was adopted from a Romanian orphanage at 3 years of age. He has been physically healthy with normal growth parameters and no evidence of fetal alcohol syndrome. Alex has long-standing history of social difficulties, impulsivity, lying, controlling, manipulative behaviors, violent outbursts at home with subsequent lack of remorse, and excessive chatter. You referred Alex to an interdisciplinary child development clinic 2 years ago, where he was diagnosed with reactive attachment disorder (RAD) and attention deficit hyperactivity disorder (ADHD). He was noted to have normal cognitive and language skills. Attachment therapy, stimulant therapy, and school accommodations for ADHD were recommended.Alex received some individual counseling with the school psychologist for a year after the first evaluation, with little improvement in core behaviors. The following year, Alex established care with a psychiatrist and a private counselor. The psychiatrist prescribed a succession of stimulants, each of which worked for only a short time and then had waning effect. The counselor worked with Alex and his parents on managing Alex's behavior, which the family reports has been somewhat helpful.Alex's parents express great frustration and sadness that parenting Alex has been such an ongoing struggle since he was adopted. They note that Alex is superficially friendly, chatty, and charming, with everyone he encounters, including strangers, but he never progresses past such superficial interaction, even with his adoptive parents. The parents express that they are deeply wounded that Alex is not more loving and is not more appreciative of the fact that they rescued him from the orphanage.His parents asked his pediatric clinician about Autism as they observe Alex's lack of real affection and social connection with parents or peers. They also note that Alex has difficulty verbalizing his feelings and that he lies frequently, chatters tangentially, and he can watch the Discovery channel for hours. A neurologist, to whom Alex was referred to evaluate staring spells, reassured the family that the spells did not seem to be epilepsy and also diagnosed Alex with "Asperger's syndrome." The school psychologist, after 2 years of equivocation, recently made Alex eligible for autism spectrum services.During the interview and examination, Alex is funny, friendly, and a bit silly. He uses normal eye contact, seems to enjoy the neuromotor examination, and is eager to show you his cool, new handshake. He engages in easy banter, using normal vernacular and prosody. After the visit, you call the therapist to express your opinion that the RAD diagnosis is valid after all and to ask whether the family is engaged in attachment therapy. The therapist refutes the RAD diagnosis, endorsing Asperger's syndrome (AS) instead and notes that Alex is making good progress in school and in therapy, where he is learning pragmatic skills and basic social skills with the use of social stories.Where do you head next?

Brain Dev. 2011 Nov 17;
Mori T, Mori K, Fujii E, Toda Y, Miyazaki M, Harada M, Hashimoto T, Kagami S

PURPOSE: To evaluate the GABA(A) receptor in the autistic brain, we performed (123)I-IMZ SPECT in patients with ASD. We compared (123)I-IMZ SPECT abnormalities in patients who showed intellectual disturbance or focal epileptic discharge on EEG to those in patients without such findings. SUBJECTS AND METHODS: The subjects consisted of 24 patients with ASD (mean age, 7.3±3.5years), including 9 with autistic disorder (mean age, 7.0±3.7years) and 15 with Asperger's disorder (mean age, 7.5±3.2years). We used 10 non-symptomatic partial epilepsy patients (mean age, 7.8±3.6years) without intellectual delay as a control group. For an objective evaluation of the (123)I-IMZ SPECT results, we performed an SEE (Stereotactic Extraction Estimation) analysis to describe the decrease in accumulation in each brain lobule numerically. RESULTS: In the comparison of the ASD group and the control group, there was a dramatic decrease in the accumulation of (123)I-IMZ in the superior and medial frontal cortex. In the group with intellectual impairment and focal epileptic discharge on EEG, the decrease in accumulation in the superior and medial frontal cortex was greater than that in the group without these findings. CONCLUSION: The present results suggest that disturbance of the GABAergic nervous system may contribute to the pathophysiology and aggravation of ASD, since the accumulation of (123)I-IMZ was decreased in the superior and medial frontal cortex, which is considered to be associated with inference of the thoughts, feelings, and intentions of others (Theory of Mind).