Thought Disorders - HFS or AS

Sharon’s Note: As we struggle to determine “what” Daniel “is”, I continue to study various theories. And right now, for this day and age, that is about all I’m going to find – theories. Foundational to whatever theories I encounter, a Biblical view would have me consider that Daniel is first and foremost, made in the image of God, but also a “sinner” after Adam’s “kind”. That, at least, helps to address how I, as a parent, am to respond to his behaviors that are less than pleasing to the Lord or us. The largest issue I face right now is that we’ve made the difficult decision to give him psychotropic medication. The line is blurred between Asperger’s, Psychosis and High-Functioning Autism, as to how to view various “thought disorders”, including hallucinations. Of course, the Big Question, which may not be answerable is: Are the hallucinations real. The attached is a PubMed abstract describing a study to more clearly define areas of impaired thinking (poor reality testing, perceptual distortions, etc.) to which Daniel is prone.

Article: “Aspergers & thought disorder”:

and DSM-IV as a distinct diagnostic entity, it is still unclear to what extent it differs from high-functioning autism (HFA). Persons with HFA have been reported to show a variety of deficits of thought processes. Abnormalities such as poor reality testing, perceptual distortions, and areas of cognitive slippage have been described using the Rorschach inkblot test (Dykens, Volkmar, & Glick, 1991). Since AS has been conceptualized as a mild variant of autism, we hypothesized that persons with AS will have fewer abnormalities on the Rorschach test compared to persons with HFA. To test this hypothesis, we compared 12 subjects with AS (ICD-10, 10 male, mean age = 12.2 +/- 3.3 years, mean full-scale IQ = 99.6) with 8 subjects with HFA (ICD-10/DSM-III-R, 7 male, mean age = 12.2 +/- 3.8 years, mean full-scale IQ = 83.4) on the Rorschach test. AS subjects demonstrated a trend towards greater levels of disorganized thinking than the HFA group. They were also more likely to be classified as “Introversive” suggesting that AS subjects may have more complex inner lives involving elaborate fantasies, Also, AS subjects tended to be more focused on their internal experiences. However, overall, the Rorschach test was not found to differentiate the two diagnostic groups on the majority of structural variables. Implications of these findings are discussed with regard to the diagnostic validity of Asperger syndrome.

MeSH Terms:
Autistic Disorder/classification
Autistic Disorder/diagnosis
Autistic Disorder/psychology*
Introversion (Psychology)
Rorschach Test

Good report from Yale:
As in autism, treatment of AS is essentially supportive and symptomatic. Special educational services are sometimes helpful, although there is, as yet, very little reported experience on the effectiveness of specific interventions. Acquisition of basic skills in social interaction as well as in other areas of adaptive functioning should be encouraged. Supportive psychotherapy focused on problems of empathy, social difficulties, and depressive symptoms may be helpful, although it is usually very difficult for individuals with AS to engage in more intensive, insight-oriented psychotherapy. Associated conditions, such as depression, may be effectively treated.

Despite the paucity of published information on intervention strategies and issues, a few guidelines may be offered based on informal observations made by experienced clinicians, intervention strategies used with individuals with high-functioning autism, and Rourke’s (1989) suggested interventions for individuals with Nonverbal Learning Disabilities syndrome.

Yale child study center….

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