Treatment in Psychiatry
Treatment in Psychiatry begins with a hypothetical case illustrating a problem in current clinical practice. The authors
review current data on prevalence, diagnosis, pathophysiology, and treatment. The article concludes with the authors'
treatment recommendations for cases like the one presented.
Aspergers Syndrome: Diagnosis and Treatment
Karen Toth, Ph.D.
Bryan H. King, M.D.
Marc is a 15-year-old male who pre-
sents with his parents for evaluation be-
cause of significant symptoms of anxiety
and depressed mood. Marc responds ver-
bally when greeted in the waiting room
but avoids eye contact. He has an above-
average IQ, with significantly higher ver-
bal than nonverbal abilities. Academic
difficulties in elementary school led to a
diagnosis at age 8 of nonverbal learning
disability. Marc continues to struggle aca-
demically and is falling further and fur-
ther behind in school. He has strong in-
terests in the Titanic and baseball that
involve recitation of facts, dates, and
numbers. He will talk at length on these
topics, often using language that is more
formal than expected for his age, but he
is unable to sustain conversations on
other topics. Although Marc prefers to in-
teract with adults, he does describe him-
self as having friends; later his parents re-
veal that he does not interact with peers
outside of school, and when asked, Marc
is unable to describe what it means to be
a friend. Marcs parents are very con-
cerned about the widening gap between
Marcs social development and that of his
peers. Marcs history includes perinatal
problems, and his family history includes
autism spectrum disorder.
Aspergers syndrome (AS) is considered to be a variant of
autism rather than a distinct disorder, similar if not equiv-
alent to high-functioning autism. The condition was first
recognized and labeled autistic psychopathy by As-
perger in 1944 (1). Aspergers most famous cases were pa-
tients described as having above-average intellectual and
language abilities, with significant disturbances in social
and affective communication. However, Asperger also de-
scribed cases of patients with low intellectual and lan-
This article is featured in this months AJP Audio.
958 ajp.psychiatryonline.org
guage abilities, similar to those Kanner (2) described as
autistic in 1943. The similarities Asperger noted among
these individuals with widely varying intellectual and lan-
guage abilities presaged the current notion of a spec-
trum of autistic disorders (3). Aspergers contribution to
the field went beyond merely identifying and describing
this condition; he was concerned that affected children
would be misunderstood and maltreated, so he sought to
increase awareness of autism. He also advocated an ap-
proach to education that involved individualized atten-
tion, an emphasis on strengths rather than weaknesses,
and engagement in learning by tapping into the childs
special interests. These approaches continue to be used
today in the education of children with AS.
Diagnosis
Although Asperger first described cases in 1944, the
term Aspergers syndrome as a diagnostic label did not
come into use until several decades later when Wing (4)
argued that autism included not only children who were
aloof but also those who were socially active but odd in
their behavior. Wing proposed a spectrum of disorders
with varying degrees of severity in each of the three symp-
tom domains that together comprise the diagnostic crite-
ria for autism, namely, impairment in social interaction,
impairment in communication, and restricted, repetitive,
and stereotyped patterns of interests and behaviors. At
about the same time that AS became a widely used de-
scriptive label, the term high-functioning autism was
also being used to refer to children with autism who were
relatively more able, in either verbal or nonverbal intelli-
gence (5). Clinically, these two labels are sometimes used
interchangeably, often describing children with autism
who are atypical in their presentation and who frequently
initiate social interactions (albeit lacking in reciprocity) as
opposed to those who are more avoidant or aloof.
DSM-IV-TR provides criteria for a differential diagnosis of
AS based on intact cognitive ability (absence of mental retar-
dation or intellectual disability), no delays in early language
milestones (i.e., use of single words by age 2 and phrases by
age 3; see Table 1). However, this does not imply that lan-
guage acquisition in AS is normal; for example, there may be
deficits in pragmatic (i.e., social use of) language or use of
overly formal or repetitive language. Hence, this distinction
remains problematic. Results of research that has attempted
to support a distinction between AS and high-functioning
autism have thus far been mixed. The following section pre-
sents a brief review of this research (see also reference 6).
Am J Psychiatry 165:8, August 2008

Aspergers Syndrome vs. High-Functioning
Autism
Over the past two decades, a growing body of research
has attempted to address the diagnostic and phenotypic
ambiguity between AS and high-functioning autism.
Some authors believe that the neuropsychological and be-
havioral profiles of AS and high-functioning autism differ
(e.g., reference 7), while others have argued that there is
little empirical evidence for a distinction between these
two disorders (e.g., references 8, 9). Ozonoff and col-
leagues (10) conducted a comprehensive study that exam-
ined differences based on external criteria (cognitive/
intellectual profiles, executive func-
tion, language, current symptoms,
early history, and course of illness) as
opposed to criteria involving the def- A primary focus of
inition of the two syndromes. They intervention programs nosed
found few group differences in cur-
rent symptom presentation and cog- for individuals with AS is factors in the pathophysiology of AS
nitive function but many differences on enhancing social
in early history. Individuals with AS
outperformed those with high-func- competence.
tioning autism on the comprehen-
sion subtest of the WISC-III and in
expressive language ability, but there were no differences
on measures of executive function (flexibility and plan-
ning). Individuals with AS also had better imaginative and
creative abilities and more circumscribed interests,
whereas those with high-functioning autism showed a
greater insistence on sameness. Early history variables
were best able to differentiate the two disorders. Com-
pared with children with AS, those with high-functioning
autism were more impaired in early language develop-
ment and behavior over the preschool period, had more
severe lifetime symptoms, and had a greater need for spe-
cialized education services. Ozonoff et al. concluded that
AS and high-functioning autism appear to be on the same
spectrum but differ primarily in severity of developmental
course. However, in terms of prognosis, the preschool-age
differences they identified had largely disappeared by ad-
olescence, indicating that the prognosis for individuals
with high-functioning autism may be better than previous
studies have reported.
A more recent study (11) examined the core symptom
domain of social interaction and used the Wing and Gould
(12) classification system (aloof, passive, and active but
odd) to evaluate potential differences in quality of social
interaction between individuals with AS and those with
autism. Results showed that individuals with AS tended to
be active but odd in presentation as compared with the
more aloof and passive profile of those with autism, sup-
porting the view that these two groups may differ both in
symptom severity (i.e., quantitatively) and in the quality of but a variant on the milder end of the spectrum (5).
their social impairment.
There continues to be much debate regarding the over-
lap and differentiation of these two disorders. It is fueled
in part by a tautological dilemma wherein the disorders
Am J Psychiatry 165:8, August 2008
TREATMENT IN PSYCHIATRY
are defined on the basis of severity of impairment, so stud-
ies that appear to confirm differences relating to severity
of impairment are to be expected. More systematic studies
of both quantitative and qualitative aspects of functioning
are needed.
Epidemiology and Pathophysiology
Current estimates indicate that AS occurs at a rate of
about 2.5/10,000, as compared to 60/10,000 for all autism
spectrum disorders (that is, autistic disorder, pervasive de-
velopmental disorder not otherwise specified, and AS).
These rates represent an upward trend over time, due at
least in part to changes in case definition and improved
awareness (13). The rates for AS have
not been well established because of the
most paucity of research with carefully diag-
studies
samples. Likewise, relatively few
of genetic and environmental
have involved large and well-character-
ized samples. One such study examined
in detail the family, prenatal, and perin-
atal histories of 100 male children with
AS who were followed into late adoles-
cent and early adulthood (14). Results indicated a paternal
family history of autism spectrum disorder in about 50% of
the sample, and pre- and perinatal risk factors in about
25% of cases. Pre- and perinatal factors included prenatal
exposure to alcohol, severe postnatal asphyxia, neonatal
seizures, and prematurity.
Even fewer studies have examined risk factors by diag-
nostic subgroup. One such study examined obstetric risk
factors and found fewer pregnancy and labor complica-
tions in patients with AS than in those with autism, perva-
sive developmental disorder not otherwise specified, and
comparison subjects; those with AS were more likely to
have a forceps or vacuum delivery than those with autism,
but they did not differ from comparison subjects on a
number of other pre- and perinatal variables (15).
Most studies of pre- and perinatal risk factors conclude
that these factors do not operate independently in autism
but may be related to extant fetal abnormalities or to
genetic or environmental factors. This has led many re-
searchers to speculate whether children with similar
genetic risk factors vary in phenotypic expression (i.e.,
symptom severity) due to exposure to different levels of en-
vironmental risk. Regarding genetic factors, a genome-wide
scan for susceptibility loci was performed on a sample of in-
dividuals with AS, identifying two loci (on chromosomes 1
and 3) that have similarly been implicated in the genetics of
autistic disorder (16). Studies such as these support the pre-
vailing view that AS is not a separate disorder from autism
Evidence-Based Assessment
In spite of the continuing debate regarding diagnostic
issues, an evidence-based, best-practice assessment ap-
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TREATMENT IN PSYCHIATRY

TABLE 1. DSM-IV-TR Criteria for Autistic Disorder and Aspergers Disorder

Criteria for Autistic
Domain of Functioning and Symptom Checklist Disorder Criteria for Aspergers Disorder
Social interaction 2 or more 2 or more symptoms
symptoms
Marked impairment in the use of multiple nonverbal
behaviors such as eye-to-eye gaze, facial expression, body
postures, and gestures to regulate social interaction
Failure to develop peer relationships appropriate to
developmental level
A lack of spontaneous seeking to share enjoyment, interests,
or achievements with other people (e.g., by a lack of
showing, bringing, or pointing out objects of interest)
Lack of social or emotional reciprocity
Communication 1 or more No clinically significant delay in cognitive or adaptive
symptoms abilities; early language milestones met on time
(single words by age 2, phrases by age 3); other
communication impairments may be present
Delay in, or total lack of, the development of spoken
language (not accompanied by an attempt to compensate
through alternative modes of communication such as
gesture or mime)
In individuals with adequate speech, marked impairment in
the ability to initiate or sustain a conversation with others
Stereotyped and repetitive use of language or idiosyncratic
language
Lack of varied, spontaneous make-believe play or social
imitative play appropriate to developmental level
1 or more
Restricted, repetitive, stereotyped interests and behaviors symptoms 1 or more symptoms
Encompassing preoccupation with one or more stereotyped
and restricted patterns of interest that is abnormal either
in intensity or focus
Apparently inflexible adherence to specific, nonfunctional
routines or rituals
Stereotyped and repetitive motor mannerisms (e.g., hand or
finger flapping or twisting, or complex whole-body
movements)
Persistent preoccupation with parts of objects

proach for autism spectrum disorders, including AS, in-
cludes a core diagnostic assessment as well as additional
assessment for treatment planning, as described below.
The instruments mentioned here are tools only and
should not be used, in and of themselves, to make a diag-
nosis (17).
Core Diagnostic Assessment
A comprehensive assessment for AS should include, at
minimum, a detailed developmental history and review of
social, communication, and behavioral development.
Most centers use a tool such as the Autism Diagnostic In-
terviewRevised (18, 19) for this purpose. Direct observa-
tion of the patient, using the Autism Diagnostic Observa-
tion Schedule (20, 21), is also essential to gather the kind of
information (i.e., observations of social behavior) neces-
sary for a diagnosis. The Autism Diagnostic Observation
Schedule is a semistructured interview that requires es-
tablished reliability and therefore is often conducted by
practitioners specifically trained in autism spectrum dis-
orders. Diagnostic tools specific to AS have been devel-
oped, but in general they have not been standardized with
participants with confirmed diagnoses of AS, and psycho-
metric properties have not been well studied. These in-
clude the Autism Spectrum Screening Questionnaire (22),
the Gilliam Asperger Disorder Scale (23), the Asperger Syn-
drome Diagnostic Scale (24), and the Adult Asperger As-
sessment (25).
Additional Assessment for Treatment Planning
A comprehensive evaluation should also include
screening for medical and psychiatric issues, including
seizures, sleep difficulties, significant sensory issues dis-
rupting daily function, anxiety and depression, and other
psychiatric and behavioral issues. In addition, a review of
school records and previous testing and interventions, as
well as consultation with the childs teachers for their ob-
servations, particularly of peer interactions, is important
to inform diagnosis and treatment planning. Assessment
of intellectual, language, adaptive, and neuropsychologi-
cal functioning may be conducted to further inform edu-
cational planning and treatment. Finally, an occupational
therapy evaluation, with assessment of strategies to miti-
gate sensory issues, may be warranted, along with assess-
ment of the family system (e.g., stress, depression, access
to community resources), to improve outcomes for chil-
dren with AS (26).
Comorbid Psychiatric Disorders
The most common comorbid diagnosis in individuals
with AS and high-functioning autism is depression, occur-

960 ajp.psychiatryonline.org Am J Psychiatry 165:8, August 2008


ring in as many as 41% of patients (27). Other psychiatric
disorders or symptoms that have been reported include
anxiety (8%), bipolar disorder (9%), schizophrenia (9%),
attempted suicide (7%), hallucinations (6%), mania (5%),
psychotic disorder not otherwise specified (3%), schizoid
personality disorder (3%), and obsessive-compulsive dis-
order (OCD) (1%). To compare these rates to those in chil-
dren with autism, in a recent study of 109 children with
autism (28), the most prevalent diagnoses were specific
phobia (44%), OCD (37%), attention deficit hyperactivity
disorder (ADHD) (31%), and depression (10%). The rela-
tively high rate of ADHD in Leyfer and colleagues sample
(28) is of interest in light of the fact that the current DSM
specifically excludes comorbidity with autism. Whether
such a trumping rule is appropriate is the subject of cur-
rent debate. Care must be taken when diagnosing certain
other disorders, such as schizophrenia and psychosis, be-
cause the intense preoccupations and interests seen in in-
dividuals with AS can resemble delusions and disorders of
thinking (29). In these cases, a detailed history must be ob-
tained to determine the presence of such idiosyncratic in-
terests prior to the onset of a presumed psychosis. It could
also be argued that personality traits, for example schizoid
or obsessive-compulsive, are much more common than
currently reported in individuals with high-functioning
autism or AS and that the differential diagnosis in this do-
main is potentially very complicated.
Treatment
The average age at diagnosis of AS is about 11 years,
compared with 5.5 years for autism (30). This is problem-
atic, as prognosis is related not only to cognitive and lan-
guage abilities but also to the provision of early, appropri-
ate, structured education programs (31) and interventions
aimed at improving social competence (32, 33). A limited
number of studies have examined the efficacy of treat-
ment approaches specific to AS or high-functioning au-
tism. No single methodology or intervention strategy has
been identified as the most effective or shown to be suc-
cessful for all participants, nor is there a single compre-
hensive treatment program for individuals with these dis-
orders. Common approaches to treatment include adult-
directed behavioral programs, such as those using princi-
ples of applied behavior analysis, naturalistic child-cen-
tered approaches, or a combination approach drawing on
behavioral, developmental, and social-pragmatic princi-
ples (34). The National Research Council and the Commit-
tee on Educational Interventions for Children With Autism
have identified critical variables for treatment planning,
including prioritizing goals based on core challenges in
social communication, establishing proactive approaches
to problem behaviors, individualizing modes of instruc-
tion, implementing supports across contexts, planning for
transitions, addressing psychiatric comorbidity, and pro-
viding family support and education (35).
Am J Psychiatry 165:8, August 2008
TREATMENT IN PSYCHIATRY
Interventions to Improve Social Competence
A primary focus of most intervention programs for indi-
viduals with AS is on enhancing social competence; here
we describe both general and newer, targeted approaches.
Social skills are typically taught using a variety of meth-
ods and in different settings, such as friendship groups at
school, classroom activities, privately taught social skills
group therapy programs, buddy or mentoring programs,
and through individual and dyadic (i.e., pairing the child
with AS with a peer) therapy. Methods or strategies for
teaching social skills include direct instruction, role play-
ing, modeling, social stories, in vivo practice with peers,
and constructive feedback. The social stories technique
refers to stories that can be written and illustrated to fit
any scenario, with the goal of providing information on
what people in a given situation are doing, thinking, and
feeling. Social stories indicate the sequence of events,
identify significant social cues and their meaning, and
script for the child what he or she should do or say. Social
stories are especially helpful in new situations, which of-
ten cause anxiety because they are unknown and unpre-
dictable, but they are useful in any situation to enhance
the childs understanding of what is likely to occur and to
explain what is expected of the child. The perspective of all
participants in a given social story is carefully delineated,
as theory of mind skills (i.e., the ability to take anothers
point of view) are often impaired in people with AS and
must be directly taught (36).
Other general techniques for teaching social skills in-
clude first breaking skills down into smaller subskills and
then teaching each skill through modeling and role plays.
For example, conversation skills can be broken down into
a number of subskills, such as greeting others, initiating
topics, staying on topic, maintaining reciprocity, using
nonverbal communication (eye contact, facial expres-
sions, gestures) appropriately, checking in to see if the lis-
tener is still interested, and appropriately ending conver-
sations (i.e., saying goodbye). Higher-level skills can
include accepting suggestions, handling criticism, resolv-
ing conflicts, and showing empathy. Understanding the
childs cognitive profile is essential in tailoring a social
skills program to an individual childs needs and strengths.
For example, verbal strategies should be utilized with chil-
dren with better-developed verbal abilities, while visual
strategies (e.g., social stories) should be emphasized with
children with higher visual problem-solving skills.
Targeted Intervention Strategies
In recent years, a number of intervention studies have
focused on teaching discrete aspects of social compe-
tence, such as joint attention, emotion recognition, and
theory of mind abilities. In general, these studies have in-
dicated positive results, but they have been limited by
small sample sizes (many are best characterized as pilot
studies) and lack of long-term follow-up. Nevertheless,
they point to the utility of focused and individualized
treatment strategies to augment more broad-based edu-
cational and social skills interventions for children with
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TREATMENT IN PSYCHIATRY
autism and AS. In a training study of theory of mind and
executive function, Fisher and Happ (37) found that in a
relatively short period (i.e., 510 days of training), children
with autism spectrum disorders could improve their per-
formance on theory of mind tasks but not on executive
function tasks. In a study that examined the use of assis-
tive technology to teach emotion recognition to students
with AS, LaCava and colleagues (38) found improved per-
formance not only on basic and complex emotions that
were directly taught via a computer software program but
also on complex voice emotion recognition for emotions
not specifically included in the training software. Finally,
Turner-Brown and colleagues (39) demonstrated the util-
ity of a group-based cognitive behavioral intervention to
teach theory of mind and other social communication
skills to adults with high-functioning autism.
In sum, a comprehensive treatment plan for a child or
adolescent with AS should capitalize on strengths, target
specific areas of impairment (social, academic, adaptive)
as well as comorbid medical or psychiatric disorders, and
be implemented across settings to ensure success and
generalization of skills. Additionally, there is emerging
evidence to support the use of interventions targeting
discrete aspects of social functioning to augment more
broad-based intervention approaches.
Summary and Recommendations
AS, although first identified in 1944, is a relatively new
diagnostic label referring to a set of behavioral character-
istics shared by children with autism. Children and adults
with AS typically have higher intellectual and linguistic
abilities than those with autism but are quite impaired in
their social communication skills. Individuals with AS are
also at higher risk for certain psychiatric and medical dis-
orders, such as depression, anxiety, and seizures. Diagnos-
ing AS can be tricky, as the diagnostic criteria are not
clearly differentiated from those defining autistic disorder.
The prevailing view in the literature is that AS is not a dis-
tinct disorder but a milder variant of autism. Whether or
not this is so, children with AS are typically diagnosed at
much older ages than those with autism, and thus appro-
priate and targeted interventions are often not initiated at
early ages, when they may have the greatest impact. Nev-
ertheless, a number of strategies, including those promot-
ing social competence, are widely used with children with
AS and have been shown to have a positive impact on out-
comes. Pharmacotherapy for associated conditions in AS
has not been systematically studied and is currently in-
formed by research in the general population.
After careful review of developmental
history, school records, and past medical
records as well as time spent directly ob-
serving and interacting with Marc, he was
diagnosed as having Aspergers syn-
962 ajp.psychiatryonline.org
drome, anxiety disorder not otherwise
specified, and depression not otherwise
specified. Marcs anxiety was determined
to be related to both school and social in-
teractions. His depression, which did not
meet full criteria, was based on a history
of social failure and rejection and his re-
port of lessened interest in and activities
related to his areas of intense focus (e.g.,
he reported that baseball was less enjoy-
able). Recommended interventions in-
cluded working with an autism specialist,
privately or through the school district,
who could advocate for Marc and his par-
ents to ensure that he received addi-
tional specialized education services and
accommodations to address his aca-
demic difficulties. For Marcs anxiety and
depression, treatment with a selective se-
rotonin reuptake inhibitor as well as indi-
vidual psychotherapy was recom-
mended. Since individuals with AS, even
those who are highly verbal, tend to re-
spond best to behavioral strategies, a
concrete, skills-based approach to psy-
chotherapy was recommended rather
than a primarily cognitive approach. Tar-
geted social skills interventions to pro-
mote prosocial skills and expand Marcs
peer group were recommended for im-
plementation once his anxiety and de-
pression improved. Finally, a recommen-
dation for private speech and language
therapy to address pragmatic deficits as
well as social skills deficits was made.
Marcs parents were directed to state and
local resources and support groups. The
diagnosis was discussed with Marc di-
rectly, and he was given a list of excellent
web sites that provide both information
and community for adolescents and
adults with AS.
Received Feb. 21, 2008; revision received April 26, 2008; accepted
April 28, 2008 (doi: 10.1176/appi.ajp.2008.08020272). From the Chil-
drens Hospital and Regional Medical Center; and the Department of
Psychiatry and Behavioral Sciences, University of Washington, Seat-
tle. Address correspondence and reprint requests to Dr. King, Direc-
tor of Child and Adolescent Psychiatry, Childrens Hospital and Re-
gional Medical Center, 4800 Sand Point Way, N.E., Seattle, WA 98105;
bryan.king@seattlechildrens.org (e-mail).
Dr. Toth receives support from NIH. Dr. King has received research
funding from Autism Speaks and NIH and has served as a consultant
for Biomarin and Neuropharm and as an unpaid consultant for Sea-
side Therapeutics and Nastech.
References
1. Asperger H: Die autistischen Psychopathen im Kindesalter.
Archiv fr Psychiatrie und Nervenkrankheiten 1944; 117:76
Am J Psychiatry 165:8, August 2008

136 [translated by Frith U, Autistic psychopathy in childhood,
in Autism and Asperger Syndrome. Edited by Frith U. Cam-
bridge, England, Cambridge University Press, 1991, pp 3692]
2. Kanner L: Autistic disturbances of affective content. Nerv Child
1943; 2:217250
3. Wing L: Past and future research on Asperger syndrome, in As-
perger Syndrome. Edited by Klin A, Volkmar F, Sparrow S. New
York, Guilford, 2000, pp 418432
4. Wing L: Aspergers syndrome: a clinical account. Psychol Med
1981; 11:115129
5. Frith U: Emanuel Miller lecture: confusions and controversies
about Asperger syndrome. J Child Psychol Psychiatry 2004; 45:
672686
6. Reitzel J, Szatmari P: Learning difficulties in Asperger syn-
drome, in Asperger Syndrome: Behavioral and Educational As-
pects. Edited by Prior M. New York, Guilford, 2003, pp 3554
7. Klin A, Volkmar FR, Sparrow SS, Cicchetti DV, Rourke BP: Valid-
ity and neuropsychological characterization of Asperger syn-
drome: convergence with nonverbal learning disabilities syn-
drome. J Child Psychol Psychiatry 1995; 36:11271140
8. Schopler E: Are autism and Asperger syndrome different labels
or different disabilities? J Autism Dev Disord 1996; 26:109110
9. Schopler E: Premature popularization of Asperger syndrome,
in Asperger Syndrome or High-Functioning Autism? Edited by
Schopler E, Mesibov GB, Kunce LJ. New York, Plenum, 1998, pp
385399
10. Ozonoff S, South M, Miller JN: DSM-IV-defined Asperger syn-
drome: cognitive, behavioral, and early history differentiation
from high-functioning autism. Autism 2000; 4:2946
11. Ghaziuddin M: Defining the behavioral phenotype of Asperger
syndrome. J Autism Dev Disord 2008; 38:138142
12. Wing L, Gould J: Severe impairments of social interaction and
associated abnormalities in children: epidemiology and classi-
fication. J Autism Dev Disord 1979; 9:1129
13. Fombonne E: Epidemiological surveys of autism and other per-
vasive developmental disorders: an update. J Autism Dev Dis-
ord 2003; 33:365382
14. Gillberg C, Cederlund M: Asperger syndrome: familial and pre-
and perinatal factors. J Autism Dev Disord 2005; 35:159166
15. Glasson EJ, Bower C, Petterson B, de Klerk N, Chaney G, Hall-
mayer JF: Perinatal factors and the development of autism: a
population study. Arch Gen Psychiatry 2004; 61:618627
16. Ylisaukko-oja T, Nieminen-von Wendt T, Kempas E, Sarenius S,
Varilo T, von Wendt L, Peltonen L, Jrvel I: Genome-wide scan
for loci of Asperger syndrome. Mol Psychiatry 2004; 9:161168
17. Ozonoff S, Goodlin-Jones BL, Solomon M: Evidence-based as-
sessment of autism spectrum disorders in children and adoles-
cents. J Clin Child Adolesc Psychiatry 2005; 34:523540
18. Lord C, Rutter M, LeCouteur A: Autism Diagnostic Interview
Revised: a revised version of a diagnostic interview for caregiv-
ers of individuals with possible pervasive developmental disor-
ders. J Autism Dev Disord 1994; 24:659685
19. Rutter M, LeCouteur A, Lord C: Autism Diagnostic Interview
Revised Manual. Los Angeles, Western Psychological Services,
2003
20. Lord C, Risi S, Lambrecht L, Cook EH Jr, Leventhal BL, DiLavore
PC, Pickles A, Rutter M: The Autism Diagnostic Observation
ScheduleGeneric: a standard measure of social and commu-
nication deficits associated with the spectrum of autism. J Au-
tism Dev Disord 2000; 30:205223
Am J Psychiatry 165:8, August 2008
TREATMENT IN PSYCHIATRY
21. Lord C, Rutter M, DiLavore PC, Risi S: Autism Diagnostic Obser-
vation Schedule Manual. Los Angeles, Western Psychological
Services, 2002
22. Ehlers S, Gillberg C, Wing L: A screening questionnaire for As-
perger syndrome and other high-functioning autism spectrum
disorders in school age children. J Autism Dev Disord 1999; 29:
129141
23. Gilliam JE: Gilliam Asperger Disorder Scale. Austin, Tex, PRO-ED,
2001
24. Myles BS, Bock SJ, Simpson R: Asperger Syndrome Diagnostic
Scale. Austin, Tex, PRO-ED, 2001
25. Baron-Cohen S, Wheelwright S, Robinson J, Woodbury-Smith
M: The Adult Asperger Assessment (AAA): a diagnostic method.
J Autism Dev Disord 2005; 35:807819
26. Hauser-Kram P, Warfield ME, Shonkoff JP, Krauss MW: Children
with disabilities: a longitudinal study of child development
and parent well-being. Monogr Soc Res Child Dev 2001; 66:1
131
27. Howlin P: Outcome in adult life for more able individuals with
autism or Asperger syndrome. Autism 2000; 4:6383
28. Leyfer OT, Folstein SE, Bacalman S, Davis NO, Dinh E, Morgan J,
Tager-Flusberg H, Lainhart JE: Comorbid psychiatric disorders
in children with autism: interview development and rates of
disorders. J Autism Dev Disord 2006; 36:849861
29. Ghaziuddin M: Asperger syndrome: associated psychiatric and
medical conditions. Focus Autism Other Dev Disabl 2002; 17:
138144
30. Howlin P, Asgharian A: The diagnosis of autism and Asperger
syndrome: findings from a survey of 770 families. Dev Med
Child Neurol 1999; 41:834839
31. Kunce LJ, Mesibov GB: Educational approaches to high func-
tioning autism and Asperger syndrome, in Asperger Syndrome
or High-Functioning Autism? Edited by Schopler E, Mesibov GB,
Kunce LJ. New York, Plenum, 1998, pp 227262
32. Mesibov GB: Treatment issues with high-functioning adoles-
cents and adults with autism, in High Functioning Individuals
with Autism. Edited by Schopler E, Mesibov GB. New York, Ple-
num, 1992, pp 143156
33. Howlin P, Yates P: The potential effectiveness of social skills
groups for adults with autism: information update. Autism
1999; 3:299307
34. Tsatsanis KD, Foley C, Donehower C: Contemporary outcome
research and programming guidelines for Asperger syndrome
and high-functioning autism. Topics in Language Disorders
2004; 24:249259
35. National Research Council: Educating Children With Autism.
Washington, DC, National Academy Press, 2001
36. Attwood T: Strategies for improving the social integration of
children with Asperger syndrome. Autism 2000; 4:85100
37. Fisher N, Happ F: A training study of theory of mind and exec-
utive function in children with autistic spectrum disorders. J
Autism Dev Disord 2005; 35:757771
38. LaCava PG, Golan O, Baron-Cohen S, Myles BS: Using assistive
technology to teach emotion recognition to students with As-
perger syndrome: a pilot study. Remedial and Special Educa-
tion 2007; 28:174181
39. Turner-Brown LM, Perry TD, Dichter GS, Bodfish JW, Penn DL:
Brief report: feasibility of social cognition and interaction train-
ing for adults with high functioning autism. J Autism Dev Dis-
ord (Epub ahead of print, Feb 2, 2008)
ajp.psychiatryonline.org 963