سندرم آسپرگر
Abstract
۱٫ The controversy over the classification of Asperger’s syndrome
۲٫ In children and adolescents
۳٫ In adult population
۴٫ Conclusion
۵٫ Search strategy and selection criteria
Disclosure of interest
References
Abstract
Asperger’s syndrome is a neurodevelopmental disorder which is part of the large family of autism spectrum disorders. People with Asperger’s syndrome have difficulties in social interactions, verbal and non-verbal communication, and may display behavioural oddities, with stereotypies and limited interests. They show no language delay and their cognitive development is not marked by an overall delay but by specific impairments in certain areas such as the executive functions. The clinical presentations are very heterogeneous, varying according to age and psychiatric comorbidities. Screening, diagnosis and specialized treatment are not made any easier by the diversity of the clinical manifestations. Asperger’s syndrome is often diagnosed belatedly, at 11 years of age on average and even in adulthood in some cases. This late diagnosis has a significant impact on the risks of depression and a poor quality of life. However, in adulthood or in adolescence, certain situations, personality traits and cognitive profiles or certain comorbidities should suggest the hypothesis of an Asperger-type autism spectrum disorder. We propose here a review of the clinical situations at different ages of life that could help with the screening and the referral of patients to specialized clinicians for diagnosis and appropriate treatment.
The controversy over the classification of Asperger’s syndrome
The nosography of psychiatric disorders is relatively complex, and the successive classifications have not helped to clarify the issue, particularly in child and adolescent psychiatry. However, this evolution reflects new scientific discoveries that have led to the better understanding of certain neurodevelopmental disorders, thereby causing changes to diagnostic criteria. Asperger’s syndrome, which was first described by the Russian psychiatrist Grounia Efimovna Soukhareva [1] and by the German psychiatrist Asperger (1943) [2], who gave his name to it after the work done by Lorna Wing (1981) [3] appeared in the chapter “Pervasive Development Disorders” in DSM-IV alongside autistic disorder [4]. At the time of DSM-IV-TR [5], the large family of pervasive developmental disorders (PDD) included 5 subtypes: • autistic disorders (including Kanner’s childhood autism); • childhood disintegrative disorder; • Rett syndrome; • unspecified developmental disorders (PPD-NOS); • Asperger’s syndrome. DSM-5 [6] groups these various subtypes into a broader category called “Autistic Spectrum Disorders” (ASD), with the exception of Rett syndrome which has been removed from the classification on the basis of recent genetic data and the fact that neuropediatricians have always considered it to be a progressive developmental encephalopathy. In the new DSM-V approach, a limited dimensional aspect is included, and not just a categorial one, with the notion of a continuum [4]. ASDs encompass a broad spectrum of neurodevelopmental disorders with levels of severity ranging from childhood autism with language impairment to so-called “highlevel” autism. Autism is a relatively common disorder: prevalence in the general population is estimated to be between 0.6–۱% [۷,۸]. Different risk factors which may affect early brain development have been identified, of which genetic factors seem to play a predominant role [9] but also certain environmental, and particularly perinatal, factors [10].