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CPD: Key questions on autistic spectrum disorder

Dr Daphne Keen, consultant in neurodevelopmental paediatrics, on treating comorbid mental health problems in autism, the role of special schools and history-taking when considering an autism diagnosis.

Learning Objectives

This module will update you on diagnosing autistic spectrum disorder including:

  • Red flags in preschool and school-aged children
  • Managing comorbid mental health problems
  • The role of school in supporting the patient
  • Making consultations in general practice more friendly to people with autism

Author

Dr Daphne V Keen is a consultant in neurodevelopmental paediatrics with a small independent practice and a post-retirement, part time NHS contract at St George’s University Hospitals, London

What is the difference between Asperger’s syndrome and autism, or can these terms be used interchangeably?

Asperger’s syndrome described individuals with problems of social function with rigid or unimaginative thinking and narrow obsessional interests but whose cognition and language were unimpaired, in contrast to the impaired language and cognition of classical autism.

We now know that these diagnostic boundaries are in fact very fuzzy and unstable over time, and so the distinction between them is problematic. Individuals with good spoken language may have impaired understanding of higher-level conceptual or social language. Cognitive abilities may be highly uneven in profile. Individuals can move (in both directions) between categories over time.

As a result, the DSM-5 has adopted the umbrella term autistic spectrum disorder (ASD) and abandoned the other diagnostic labels, including Asperger’s syndrome.

In practice, however, there is still a common understanding and use of the term Asperger’s and there is a wealth of good professional and self-help literature under its flag. A diagnosis of Asperger’s may be preferred to suggest a less stigmatising, ‘mild’ condition. This can be misleading as some people may have very considerable impairments in function. On the other hand, many high flyers self-identify as having Asperger’s and see it as a badge of honour contributing to their success.

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