High-Functioning Autism Thesis

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Asperger Syndrome (AS) and high functioning autism are oftentimes considered the same thing (or at least indistinguishable from each other) and the differences between the two are relatively minute. According to WEB MD (Autism, 2015) the revised Diagnostic and Statistical Manual of Mental Disorders (DSM-V) which was published in 2013, now lists Asperger's and autistic disorder as only one condition for diagnostic purposes, whereas previously they were listed separately. The new condition is now known as autism spectrum disorder. Some experts believe that the two should still be classified separately and Moran (2014) calls Aspergers disorder a close relative of autism that can be distinguished by limited social interaction that does not coincide with a significant delay in acquiring language skills as is normally found with autism. Moran further describes Aspergers as distinctive from autism with restrictive and highly idiosyncratic patient interests.

One patient in the Moran study could be used as an example of just how the psychiatric and psychosocial influences on patients with AS can be very consuming. In the study, the patient was described as being so focused on a Japanese card game that it became totally consuming even at the "exclusion of all other age-appropriate attachments or interests" (p. 3). Such behavior can make it very difficult to treat Aspergers; for example, the question can be raised of how to effectively and efficiently treat a number of patients if they all happened to have different idiosyncratic and/or obsessive interests apart from the other patients with the same diagnosis. Implications are that they really cannot be effectively treated in group setting but that may not necessarily hold true.

A recent study touted the fact that effective methods of treatment for Asperger's included individual psychotherapy, training in the social skills, modifying behavior treatment, parent education, sensory integration and educational interventions (Longhurst, Richards, Copenhaver, Morrow, 2010). The same study, however, determined that group treatment of autism and Asperger's were very effective when modeled after the Positive Peer Culture (PPC) group meeting model as long as accommodations were made to incorporate each of the student's unique strengths and limitations into the program. Therapists conduct formal group therapy sessions five days a week. These sessions are modeled after the Positive Peer Culture (PPC) group meeting (Vorrath Sc Brendtro, 1985) with adjustments made to accommodate the students' unique strengths and limitations.

Implications seem to be therefore, that psychiatric treatment can be effective in helping those young men and woman who suffer from Asperger's Syndrome. As Longhurst et al. (2010) states "these students spend each and every day trying to think, feel, and behave in ways that are totally foreign to their experience" (p. 40) which would be a difficult maneuver for anyone, let alone young children and youth experiencing the travails of life in general. Oftentimes, these young people are so immersed in their own specific interests that their interactions with others are severely limited and they cannot share their feelings or thoughts with anyone but themselves.

Fonseca (2009) may have described it best when writing that it is most interesting that the bi-directional transactions within the dyadic space are necessary in order to acquire shared feelings, yet oftentimes AS results in severe impairment of these processes.

In the study, Fonseca found that some patients were so impaired that it led to an identification of a relationship style that only the patient could occupy, not the patient and another. Of course, that was only in the dialogic space, but such a lack of interaction coupled with the obsessive like behavior and interest in only certain items, would grossly affect a young person's ability to assimilate into regular society; this could certainly be true even if other aspects of social skills were still determined to be 'normal'. Fonseca also found that autistic symptoms can also be understood as an expression of anxiety and a deficit of developed structures, both of which increases the patient's inability to cope with separateness. Living a separate life, even whilst in the midst of societal living is tough on almost every human being, those individuals affected by Asperger's can often find themselves having to cope with the isolation that such a disorder often results in.

Tebartz van Elst et al. (2013) found that traditional autism can often be defined as a severe neurodevelopmental disorder with negative variables such as overtly abnormal language, low IQ's (in a majority of cases) and learning difficulties.

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Some of the differences between traditional autism and Asperger's or high-functioning autism include the fact that patients diagnosed as high-functioning oftentimes have normal to above average intelligence, and many times are not even diagnosed until they reach adulthood. Many of the problems associated with traditional autism are not present with high-functioning patients but according to Tebartz van Elst et al. (2013) "high-functioning ASD is associated with a very high prevalence of comorbid classical psychiatric disorders such as depression, anxiety, ADHD, tics, psychotic symptoms or emotionally unstable syndromes" (p. 189).

Many of these disorders can cause unbalance in patient lives. Depression especially can be very debilitating. Stanners et al. (2014) found that "depression has a substantive negative impact on quality of life" (p. 3) and that many ADHD and autistic children do not even understand that it is depression that they are experiencing. Additionally, the Stanners et al. study found that depression is often "under-diagnosed and under-treated" (p. 3). Along with depression is the fact that many of these high-functioning sufferers also suffer from ADHD. There are a variety of possible causes for ADHD, and while it is certainly interesting that many of these high-functioning patients also show signs of ADHD, there has not been one single risk factor that can be pointed to as the primary culprit. Currently, 90% of ADHD patients are prescribed with medical treatments that include stimulant medications, which has also led to a rise in addiction levels within this group of patients (Pellow, Tech, Solomon, 2011).

Many of these implications of Asperger's and high-functioning autism lead to difficulties in diagnosis and treatment. From an assessment viewpoint, patient diagnosis is almost always an exercise of persistence and patience. There are a number of assessment models, however, that assist in diagnosis, including the psychological adaptive mechanism (PAM) model that assists the psychologist in a systematic clinical assessment (Beresford, 2014). Additional considerations (besides the necessary assessment) include the costs and expenses of psychiatric treatment for these young patients in need of help coping with their disorder. Just because they are deemed high-functioning, does not necessarily translate into handling the everyday stress of interacting with the rest of society.

Costs associated with treatment does not have to translate into financial expenses but the cost consequences of poorly made decisions oftentimes will result in difficult scenarios for the patients. Ban et al. (2014) found that the HRU (cost consequences) are oftentimes poorly understood and their study recommended that medications for treatment be considered when monotherapy is insufficient. Oftentimes autism is treated with medications that treat seizures and the emotional and behavioral issues that are often associated with autism (Autism, 2015) but these treatments may not necessarily be what are best for the high-functioning or Asperger patient.

Assessing these patients in a psychological manner can take many different forms and psychological assessment "intersects with everyday life and culture in a number of ways" (Macfarlane, Blampied, Macfarlane, 2011, p. 5). These assessments should take place, but careful analysis of the results of such assessments are recommended due to the various outcomes coinciding with autism in general, and high-functioning autism disorder in particular. With autistic children experiencing the effects of the disorder well into adulthood and psychological, as well as medical, costs being what they are, the psychiatric and psychosocial implications will continue to affect these patients in a myriad of ways. It makes sense, therefore, to ensure that assessments, diagnosis, and treatments are done in a professional manner and that they are carried out promptly and efficiently. It is important that the medical community work together to address the implications associated with Asperger's and high-functioning autism by developing a comprehensive understanding of those implications.

With so many children and young people experiencing the effects of these disorders, complemented by the fact that the disorders can often last into adulthood, and even through the patient's entire life, better diagnosis, assessments and treatments would likely translate into improved quality of life for these patients......

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