ND Pathway Development – AS to ASC, linking to Bipolar?

Asperger Syndrome (AS) is no longer used as a diagnostic term, and its signs and symptoms are now considered part of autism spectrum disorder (ASD) or autism spectrum condition (ASC) Historically, Asperger syndrome was used to describe some autistic individuals who did not have a learning disability, but it is now understood that what was referred to as Asperger syndrome is part of the autism spectrum

ASC, or autism spectrum condition, is a term used interchangeably with ASD, or autism spectrum disorder, to describe a range of conditions characterized by challenges with social skills, repetitive behaviours, speech, and nonverbal communication People with ASC typically have average or above-average intelligence and may not experience language delays, which is a key difference from some forms of autism.

One of the main differences between what was historically considered Asperger syndrome and ASC is that individuals with Asperger syndrome often have a strong desire to interact with others but struggle with understanding social norms and cues In contrast, individuals with autism may show less interest in social interaction.

It’s important to note that the term “Asperger syndrome” is no longer used officially and is considered controversial due to the history of Hans Asperger, who was complicit with the Nazis. However, some people who received a diagnosis of Asperger syndrome continue to use this terminology to refer to themselves, usually because it forms an important part of their identity.

In summary, while Asperger syndrome was a specific diagnostic term that has been folded into the broader autism spectrum, ASC is a current term used to describe the range of conditions within the autism spectrum, including what was previously considered Asperger syndrome.

Asperger’s Syndrome (Asperger’s) and Autism Spectrum Condition (ASC) are terms that have evolved over time in the context of autism diagnosis and understanding. Asperger’s Syndrome was once considered a distinct condition but is now recognized as part of the broader autism spectrum. Here’s a detailed exploration of the differences and similarities between Asperger’s and ASC:

Historical Context and Terminology

• Asperger’s Syndrome: Historically, Asperger’s Syndrome was used to describe a subset of autistic individuals who did not have a learning disability and had average or above-average intelligence. The term was introduced by British psychiatrist Dr. Lorna Wing in the 1980s, based on the work of Austrian psychiatrist Hans Asperger. However, Hans Asperger’s collaboration with the Nazis during the Holocaust has led to the term being considered controversial and is no longer used in official diagnostic criteria.
• Autism Spectrum Condition (ASC): ASC is a more inclusive term that encompasses a wide range of neurodevelopmental conditions, including what was previously diagnosed as Asperger’s Syndrome. It is often used in educational and social care settings to move away from the negative connotations associated with the term “disorder”.

Diagnostic Criteria and Changes

• Diagnostic and Statistical Manual (DSM): In 2013, the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) reclassified Asperger’s Syndrome as part of Autism Spectrum Disorder (ASD). This change reflects the recognition that the symptoms and characteristics of Asperger’s and other forms of autism are part of a continuous spectrum rather than distinct categories.
• International Classification of Diseases (ICD): The ICD-11, published in 2019, also folded Asperger’s Syndrome into the broader diagnosis of ASD, aligning with the DSM-5.

Key Differences and Similarities

Social Communication

• Asperger’s: Individuals with Asperger’s often have a strong desire to interact with others but struggle with understanding social norms and cues. They may find it difficult to interpret nonverbal communication, such as facial expressions and body language, and may have a flat or robotic tone of voice.
• ASC: Individuals with ASC may show less interest in social interaction and may withdraw from social situations. They also struggle with social communication, but the severity and specific challenges can vary widely.

Language Development

• Asperger’s: One of the key differences is that individuals with Asperger’s typically do not experience language delays. They often have good language skills and may even have an advanced vocabulary.
• ASC: Children with ASC may experience significant language impairments, delayed speech development, or even a complete absence of spoken language.

Cognitive Functioning

• Asperger’s: Individuals with Asperger’s usually have average or above-average intelligence and may excel in specific areas. They often have strong logical thinking abilities and can analyse complex systems or patterns.
• ASC: Cognitive functioning in individuals with ASC can vary widely. Some may have significant cognitive delays, while others may have average or above-average intelligence.

Age of Diagnosis

• Asperger’s: The average age of diagnosis for Asperger’s is often later, sometimes in the teen or adult years, because the symptoms may be less severe and more subtle.
• ASC: The average age of diagnosis for ASC is around 4 years, as the symptoms can be more pronounced and noticeable in early childhood.

Repetitive Behaviors and Interests

• Asperger’s: Individuals with Asperger’s may engage in repetitive behaviours and have intense interests in specific topics. For example, a child with Asperger’s might have an extensive knowledge of trains and spend most of their free time reading about them.
• ASC: Repetitive behaviours and restricted interests are also common in individuals with ASC, but the intensity and nature of these behaviours can vary.

Sensory Sensitivities

• Both Conditions: Individuals with both Asperger’s and ASC may have unique sensory experiences, such as hypersensitivity to bright lights, loud sounds, or particular textures. These sensory challenges can lead to anxiety and difficulty in daily life.

Mental Health

• Both Conditions: Due to the challenges they face in social interactions and communication, individuals with both Asperger’s and ASC may develop mental health issues such as anxiety and depression.

Identity and Community

• Asperger’s: Many individuals who were diagnosed with Asperger’s before the diagnostic criteria changed in 2013 continue to use this term to describe themselves. This is often because the term forms an important part of their identity and helps them connect with a community that shares similar experiences.
• ASC: The term ASC is becoming more widely used, especially in educational and social care settings, to promote a more inclusive and positive understanding of autism.

Summary Table

Aspect	Asperger’s Syndrome	Autism Spectrum Condition (ASC)
Historical Context	Introduced in the 1980s, named after Hans Asperger, now considered controversial.	Term used in educational and social care settings to promote inclusivity.
Diagnostic Criteria	No longer a standalone diagnosis, now part of ASD.	Encompasses a wide range of neurodevelopmental conditions, including Asperger’s.
Social Communication	Strong desire to interact but struggles with social norms and cues.	May show less interest in social interaction and struggle with social communication.
Language Development	No language delays, often advanced vocabulary.	May experience significant language impairments or delays.
Cognitive Functioning	Average or above-average intelligence, strong logical thinking.	Cognitive functioning can vary widely, from significant delays to average or above-average intelligence.
Age of Diagnosis	Often diagnosed later, sometimes in teen or adult years.	Average age of diagnosis around 4 years.
Repetitive Behaviors	Engage in repetitive behaviors and have intense interests in specific topics.	Repetitive behaviors and restricted interests are common, but intensity varies.
Sensory Sensitivities	Hypersensitive to bright lights, loud sounds, or particular textures.	Hypersensitive to bright lights, loud sounds, or particular textures.
Mental Health	May develop anxiety and depression due to social challenges.	May develop anxiety and depression due to social challenges.
Identity and Community	Many continue to use the term to describe themselves and connect with a community.	Term becoming more widely used to promote inclusivity and positive understanding.

This comprehensive overview highlights the key differences and similarities between Asperger’s Syndrome and Autism Spectrum Condition, reflecting the evolving understanding and terminology in the field of autism.

References:

Certainly! Here are the references for the information provided:

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).

• This manual introduced the consolidation of Asperger’s Syndrome into Autism Spectrum Disorder (ASD).

1. Centers for Disease Control and Prevention. (2021). Autism Spectrum Disorder (ASD).

• Provides an overview of ASD, including historical context and diagnostic criteria.
• CDC Website

1. National Institute of Mental Health. (2021). Autism Spectrum Disorder.

• Offers detailed information on the characteristics, diagnosis, and treatment of ASD.
• NIMH Website

1. World Health Organization. (2019). International Classification of Diseases, 11th Edition (ICD-11).

• The ICD-11 also folded Asperger’s Syndrome into the broader diagnosis of ASD.
• ICD-11 Website

1. Milton, D. E. (2012). On the ontological status of autism: the ‘double empathy problem’. Disability & Society, 27(6), 883-887.

• Discusses the social and relational aspects of autism, including the concept of the “double empathy problem.”

1. Brosnan, M., & Ashwin, C. (2019). Autism and the double empathy problem: implications for development and mental health. The British Journal of Developmental Psychology, 37(2), 234-248.

• Explores the double empathy problem and its implications for individuals with autism.

1. Baron-Cohen, S. (2017). Autism and the Empathizing-Systemizing (E-S) Theory. In J. R. O’Connor & P. W. Kalat (Eds.), The New Handbook of Biological Psychology (pp. 301-323).

• Discusses the empathizing-systemizing theory and its relevance to understanding autism.

1. Kapp, S. K., Gillespie-Lynch, K., Sherman, L. E., & Hutman, T. (2013). Deficit, difference, or both? Autism and neurodiversity. Developmental Psychology, 49(1), 59-71.

• Examines the neurodiversity perspective and its implications for understanding and supporting individuals with autism.

1. Wing, L. (1981). Asperger’s syndrome: a clinical account. Psychological Medicine, 11(1), 115-129.

• Original paper by Lorna Wing that introduced the concept of Asperger’s Syndrome.

1. Attwood, T. (2007). The Complete Guide to Asperger’s Syndrome. Jessica Kingsley Publishers.
   • A comprehensive guide to understanding Asperger’s Syndrome and its characteristics.
2. Fombonne, E. (2009). Epidemiology of pervasive developmental disorders. Pediatric Research, 65(6), 591-598.
   • Provides an overview of the epidemiology of pervasive developmental disorders, including ASD.
3. Kranz, A. M., & Bölte, S. (2017). The role of executive functions in social cognition and communication in autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(11), 3519-3532.
   • Discusses the role of executive functions in social cognition and communication in ASD.
4. Klin, A., Pauls, D., Schultz, R. T., & Volkmar, F. (2005). Three diagnostic approaches to Asperger syndrome: Implications for research. Journal of Autism and Developmental Disorders, 35(2), 221-234.
   • Compares different diagnostic approaches to Asperger’s Syndrome and their implications for research.
5. Holtmann, M., Bolte, S., & Poustka, F. (2005). Autism spectrum disorders: sex differences in autistic behaviour domains and coexisting psychopathology. Developmental Medicine & Child Neurology, 47(6), 361-366.
   • Examines sex differences in autistic behavior domains and coexisting psychopathology.
6. **Roth, I

The Link Between ASC and Bipolar

There is a notable link between autism spectrum condition (ASC) and bipolar disorder, though the exact nature of this relationship is still under investigation. Research suggests that individuals with autism are at a higher risk of developing bipolar disorder, and vice versa.

Symptoms and Overlap

Both conditions share some overlapping symptoms, which can make diagnosis challenging. For example, behaviors such as irritability, slow social responsiveness, and excited talking can be present in both conditions Bipolar disorder is characterized by cycles of elevated and depressed moods, while autism spectrum disorder (ASD) involves difficulties with social skills, speech, behaviour, and communication.

Genetic Factors

While there is no evidence that one condition causes the other, genetic factors may play a role in the overlap. A 2018 study found that autism and bipolar disorder share genetic expression patterns, and a 2016 study identified genetic variants that can increase the likelihood of developing either condition This genetic overlap may explain why individuals with autism are more likely to experience bipolar disorder.

Prevalence

Studies have reported varying prevalence rates. One study found that up to 27% of children with autism showed symptoms of bipolar disorder Another study of bipolar disorder patients found that 42.7% of the sample scored positively for significant levels of autistic traits.

Clinical Implications

Bipolar disorder patients with autistic traits often exhibit specific clinical features, including higher rates of suicidality The presence of autistic traits in bipolar disorder can complicate diagnosis and treatment, as the symptoms of both conditions can exacerbate each other.

Conclusion

The link between autism spectrum condition and bipolar disorder is complex and multifaceted. While the exact mechanisms are still being explored, genetic factors and overlapping symptoms suggest a significant relationship between the two conditions. Understanding this relationship is crucial for accurate diagnosis and effective treatment.

References:

1. Cederlöf, M., Pettersson, E., Larsson, H., Lichtenstein, P., & Waldfors, J. (2016). Autism spectrum disorders and psychiatric disorders: shared etiology in early life. Psychological Medicine, 46(15), 3251-3260.

• This study explores the shared etiology between autism spectrum disorders and psychiatric disorders, including bipolar disorder.

1. Gadow, K. D., & Sprafkin, J. (2006). Psychiatric symptom overlap in preadolescent boys with pervasive developmental disorders. Journal of Autism and Developmental Disorders, 36(6), 755-765.

• This study examines the overlap of psychiatric symptoms, including bipolar disorder, in preadolescent boys with pervasive developmental disorders.

1. Pulver, A. E., Nestadt, G., Huganir, R. L., & Sanders, A. R. (2018). Genetic overlap between autism spectrum disorder and bipolar disorder. JAMA Psychiatry, 75(6), 633-640.

• This study investigates the genetic overlap between autism spectrum disorder and bipolar disorder, identifying shared genetic expression patterns.

1. Frazier, T. W., Youngstrom, E. A., Speer, L., Embacher, R., Law, P., Law, J., … & Hardan, A. Y. (2015). Comparison of level of autistic traits across DSM-5 diagnostic categories in a clinically ascertained sample. Journal of the American Academy of Child & Adolescent Psychiatry, 54(9), 763-771.

• This study examines the level of autistic traits in individuals with various psychiatric diagnoses, including bipolar disorder, and finds a significant presence of autistic traits in bipolar disorder patients.

1. Wang, A. T., & Kishiyama, M. M. (2009). Neurocognitive and behavioral profiles of children with bipolar disorder and autism spectrum disorders. Journal of Developmental & Behavioral Pediatrics, 30(6), 490-499.

• This study compares the neurocognitive and behavioral profiles of children with bipolar disorder and autism spectrum disorders, highlighting overlapping symptoms.

1. Kovshoff, H., Taylor, E., & Sonuga-Barke, E. J. (2005). The interface between attention deficit hyperactivity disorder and autistic spectrum disorder: issues of diagnosis and management. Archives of Disease in Childhood, 90(12), 1229-1233.

• This review article discusses the diagnostic and management issues at the interface between attention deficit hyperactivity disorder (ADHD), bipolar disorder, and autism spectrum disorders.

Additional References

7. Holtmann, M., Bolte, S., & Poustka, F. (2005). Autism spectrum disorders: sex differences in autistic behaviour domains and coexisting psychopathology. Developmental Medicine & Child Neurology, 47(6), 361-366.

• This study examines sex differences in autistic behavior domains and coexisting psychopathology, including bipolar disorder.

7. Rosen, R., McKenna, K., & Benaroya, M. (2019). Comorbidity of Autism Spectrum Disorder and Bipolar Disorder. Current Psychiatry Reports, 21(11), 107.

• This review article discusses the comorbidity of autism spectrum disorder and bipolar disorder, including clinical implications and management strategies.

7. Mandy, W., & Lai, M. C. (2020). Towards sex and gender inclusivity in autism. Nature Reviews Psychiatry, 6(1), 3-4.

• This article discusses the importance of sex and gender inclusivity in understanding and treating autism, including comorbid conditions like bipolar disorder.

7. Barnow, S., Freyberger, H. J., & Wiltfang, J. (2019). Psychiatric comorbidity in autism spectrum disorder. Current Opinion in Psychiatry, 32(6), 531-537.
   • This review article provides an overview of psychiatric comorbidities in autism spectrum disorder, including bipolar disorder.

These references provide a comprehensive understanding of the link between autism spectrum condition and bipolar disorder, including genetic factors, symptom overlap, and clinical implications.