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Asperger ’ s Disorder for the General Practitioner: Diagnosis, Misdiagnosis, and Missed Diagnosis Presented by Debra Moore, Ph.D. Fall Creek Counseling Associates www.sacramentopsychology.com
Could it be Asperger ’ s … ?
Your child or teen clients who … ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Your adult clients who … ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis
Pervasive Developmental Disorders ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pervasive Developmental Disorders ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Autistic Spectrum Disorders ,[object Object],[object Object],[object Object]
DSM-IV ,[object Object],[object Object],[object Object],[object Object],[object Object]
DSM-IV (continued) ,[object Object],[object Object],[object Object],[object Object],[object Object]
DSM-IV (continued) C.   The disturbance causes clinically significant impairment in social, occupational or other important areas of functioning. D. There is  no  clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years)
DSM-IV (continued) E. No clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood. F. Criteria are not met for another specific PDD or Schizophrenia.
The Question of Sensory Dysregulation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Guidelines for Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
“ Aspies ” “ Neurotypicals ”
The   History of Asperger ’ s Disorder ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],History …………… .
Asperger ’ s writings were basically ignored for almost 20 years. Then ……… ..
……… along came Lorna Wing …… .. ,[object Object]
It took another 13 years before the term  “ Asperger ’ s Disorder ”  was included in the DSM. ,[object Object],[object Object]
Missed Diagnosis
3 important concepts Theory of Mind Central Coherence Executive Functioning
Theory of Mind (also called mentalizing) a specific cognitive capacity:  the ability to understand that others have beliefs, desires and intentions that are different from one's own. thought to be hard wired.
[object Object],[object Object],[object Object],Mentalizing & Social Behavior
Examples of social behavior that requires mentalizing: ,[object Object],[object Object],[object Object],[object Object]
Studies of social behavior in Asperger's: ,[object Object],[object Object],[object Object]
More studies: ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Asperger's and empathy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Language Impairment in Asperger's phonology , the ability to handle speech sounds; syntax , the ability to operate rules of grammar;  semantics , the ability to understand and create meaning,  pragmatics , the ability to use language for the purpose of communication . This last ability,  pragmatics , is universally a problem in Asperger's.
Asperger ’ s and Language Acquisition ,[object Object],[object Object],[object Object],[object Object],[object Object]
Conversational language in the absence of mentalizing : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Central Coherence ,[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Information in Context ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
where-is-the-ship-what-see-was-leaf ,[object Object],[object Object],[object Object],[object Object]
What is attended to:  social vs. nonsocial ,[object Object],[object Object]
Missing the big picture Those with Asperger ’ s may use binoculars all the time, and isn ’ t interested in sharing the view with others.
Patterns ,[object Object],[object Object],[object Object],[object Object]
“ Stimulus over-selectivity ” ,[object Object],[object Object]
Attention and Asperger's ,[object Object],[object Object],[object Object]
Sensations and repetitions ,[object Object],[object Object],[object Object]
Routines and Rigidity ,[object Object],[object Object],[object Object],[object Object]
The Appeal of Logic ,[object Object],[object Object],[object Object]
A Modern Fixation Tragedy ,[object Object],[object Object]
When things  aren ’ t logical   –   an obsession about imposing logic may appear. ,[object Object],[object Object]
Executive Functions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Executive functioning impairment & lack of central coherence … ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Is Asperger ’ s Disorder hereditary? ,[object Object],[object Object],[object Object]
Diagnostic Rating Scales  for Asperger ’ s Disorder
The Australian Scale for Asperger's Disorder by Tony Attwood, PhD. ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],AQ Test:  Asperger's-Spectrum Quotient
GADS: The Gilliam Asperger's Disorder Scale James E. Gilliam   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Asperger Disorder Diagnostic Scale (ASDS)   Brenda Smith Myles, Stacey Jones Bock and Richard L. Simpson  ,[object Object],[object Object],[object Object]
Misdiagnosis
or is it … ? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
High Functioning Autism :  IQ over 70; 25% of Autistic population   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Semantic Pragmatic Language Disorder ,[object Object],[object Object],[object Object],[object Object]
Hyperlexia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sensory Integration Disorder ,[object Object],[object Object],[object Object],[object Object]
ADD/ADHD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Childhood Onset Bipolar ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Depression ,[object Object],[object Object],[object Object],[object Object],[object Object]
Anxiety disorder including OCD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Personality Disorders ,[object Object],[object Object],[object Object],[object Object],[object Object]
Personality Disorders: Cluster A ,[object Object],[object Object],[object Object]
Paranoid Personality Disorder ,[object Object],[object Object],[object Object]
Schizoid Personality Disorder ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Schizotypal Personality Disorder ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Personality Disorders: Cluster  B ,[object Object],[object Object],[object Object],[object Object]
Asperger's vs. Antisocial ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Borderline Personality Disorder ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Narcissistic Personality Disorder ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Similarities stem from different origins ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Personality Disorders: Cluster  C ,[object Object],[object Object],[object Object]
Avoidant Personality Disorder ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Avoidant : wants to go to the prom, but is too shy and nervous to ask anyone. If someone fixes him up with someone he is comfortable with, he ’ ll go and may have a good time. Schizoid : doesn ’ t particularly want to go and doesn ’ t ask anyone. Asperger ’ s : wants to go and asks the head cheerleader and doesn ’ t understand why she laughs at him.
Dependent Personality Disorder ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Obsessive-Compulsive Personality Disorder ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Schizophrenia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Differences: ,[object Object],[object Object],[object Object]
The End

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Aspergers Slide Show

  • 1. Asperger ’ s Disorder for the General Practitioner: Diagnosis, Misdiagnosis, and Missed Diagnosis Presented by Debra Moore, Ph.D. Fall Creek Counseling Associates www.sacramentopsychology.com
  • 2. Could it be Asperger ’ s … ?
  • 3.
  • 4.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11. DSM-IV (continued) C. The disturbance causes clinically significant impairment in social, occupational or other important areas of functioning. D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years)
  • 12. DSM-IV (continued) E. No clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood. F. Criteria are not met for another specific PDD or Schizophrenia.
  • 13.
  • 14.
  • 15. “ Aspies ” “ Neurotypicals ”
  • 16.
  • 17.
  • 18. Asperger ’ s writings were basically ignored for almost 20 years. Then ……… ..
  • 19.
  • 20.
  • 22. 3 important concepts Theory of Mind Central Coherence Executive Functioning
  • 23. Theory of Mind (also called mentalizing) a specific cognitive capacity: the ability to understand that others have beliefs, desires and intentions that are different from one's own. thought to be hard wired.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.
  • 29.
  • 30. Language Impairment in Asperger's phonology , the ability to handle speech sounds; syntax , the ability to operate rules of grammar; semantics , the ability to understand and create meaning, pragmatics , the ability to use language for the purpose of communication . This last ability, pragmatics , is universally a problem in Asperger's.
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37.
  • 38. Missing the big picture Those with Asperger ’ s may use binoculars all the time, and isn ’ t interested in sharing the view with others.
  • 39.
  • 40.
  • 41.
  • 42.
  • 43.
  • 44.
  • 45.
  • 46.
  • 47.
  • 48.
  • 49.
  • 50. Diagnostic Rating Scales for Asperger ’ s Disorder
  • 51.
  • 52.
  • 53.
  • 54.
  • 56.
  • 57.
  • 58.
  • 59.
  • 60.
  • 61.
  • 62.
  • 63.
  • 64.
  • 65.
  • 66.
  • 67.
  • 68.
  • 69.
  • 70.
  • 71.
  • 72.
  • 73.
  • 74.
  • 75.
  • 76.
  • 77.
  • 78. Avoidant : wants to go to the prom, but is too shy and nervous to ask anyone. If someone fixes him up with someone he is comfortable with, he ’ ll go and may have a good time. Schizoid : doesn ’ t particularly want to go and doesn ’ t ask anyone. Asperger ’ s : wants to go and asks the head cheerleader and doesn ’ t understand why she laughs at him.
  • 79.
  • 80.
  • 81.
  • 82.