High-functioning autism spectrum disorder as a basic disorder in adult psychiatry and psychotherapy: psychopathological presentation, clinical relevance and therapeutic concepts

  • Ludger Tebartz van Elst
  • Marion Pick
  • Monica Biscaldi
  • Thomas Fangmeier
  • Andreas Riedel
Review

Abstract

Autism spectrum disorder (ASD) is characterized by deficits in social cognition and competence, communication, highly circumscribed interests and a strong desire for routines. Besides, there are specific abnormalities in perception and language. Typical symptoms are already present in early childhood. Traditionally autism has been regarded as a severe form of neurodevelopmental disorder which goes along with overtly abnormal language, learning difficulties and low IQ in the majority of cases. However, over the last decades, it has become clear that there are also many patients with high-functioning variants of ASD. These are patients with normal language at a superficial level of description and normal and sometimes above average intelligence. In high-functioning variants of the disease, they may run unrecognized until late in adult life. 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. In many such cases, there is a causal relationship between ASD and the comorbid psychiatric conditions in that the specific ASD symptoms result in chronic conflicts, misunderstandings and failure in private and vocational relationships. These problems in turn often lead to depression, anxiety and sometimes psychosis-like stress reactions. In this constellation, ASD has to be regarded as a basic disorder with causal relevance for secondary psychiatric syndromes. In this paper, we summarize the classical presentation of high-functioning ASD in adult psychiatry and psychotherapy and suggest a nosological model to classify different ASD conditions instead. To conclude, we outline first treatment concepts in out- and in-patient settings.

Keywords

Autism High-functioning autism Asperger’s syndrome Classification Adults Therapy Comorbidity 

Notes

Conflict of interest

LTvE has given lectures and workshops on the issues of autism, schizophrenia, depression, brain imaging, psychotherapy, epilepsy, etc. which were at least in part supported by the following companies: UCB, GSK, Lilly, Janssen CilAG, Lundbeck. He has been advisor to UCB with respect to psychiatric aspects in epilepsy. The other authors declare that they have no conflict of interest.

This article is part of the supplement “Bridging the gap between Neurobiology and Psychosocial Medicine.” This supplement was not sponsored by outside commercial interests. It was funded by the German Association for Psychiatry and Psychotherapy (DGPPN).

References

  1. 1.
    World Health Organisation DoMH (2001) Internationale Klassifikation psychischer Störungen. BernGoogle Scholar
  2. 2.
    Brugha TS, McManus S, Smith J, Scott FJ, Meltzer H, Purdon S, Berney T, Tantam D, Robinson J, Radley J, Bankart J (2012) Validating two survey methods for identifying cases of autism spectrum disorder among adults in the community. Psychol Med 42:647–656PubMedCrossRefGoogle Scholar
  3. 3.
    Brugha TS, McManus S, Bankart J, Scott F, Purdon S, Smith J, Bebbington P, Jenkins R, Meltzer H (2011) Epidemiology of autism spectrum disorders in adults in the community in England. Arch Gen Psychiatry 68:459–465PubMedCrossRefGoogle Scholar
  4. 4.
    Kim YS, Leventhal BL, Koh YJ, Fombonne E, Laska E, Lim EC, Cheon KA, Kim SJ, Kim YK, Lee H, Song DH, Grinker RR (2011) Prevalence of autism spectrum disorders in a total population sample. Am J Psychiatry 168:904–912PubMedCrossRefGoogle Scholar
  5. 5.
    CDC (2013) Epidemiology, autism spectrum disorder. http://www.cdc.gov/ncbddd/autism/data.html. 4-7-2013. Ref type: internet communication
  6. 6.
    Hofvander B, Delorme R, Chaste P, Nyden A, Wentz E, Stahlberg O, Herbrecht E, Stopin A, Anckarsater H, Gillberg C, Rastam M, Leboyer M (2009) Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry 9:35PubMedCrossRefGoogle Scholar
  7. 7.
    Lugnegard T, Hallerback MU, Gillberg C (2011) Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome. Res Dev Disabil 32:1910–1917PubMedCrossRefGoogle Scholar
  8. 8.
    Levy SE, Mandell DS, Schultz RT (2009) Autism. Lancet 374:1627–1638PubMedCrossRefGoogle Scholar
  9. 9.
    Tebartz van Elst L (2013) Asperger-Syndrom und Autismusbegriff: historische entwicklung und moderne Konzepte. In: Tebartz van Elst L (ed) Das Asperger-Syndrom im Erwachsenenalter und andere hochfunktionale Autismus-Spektrum-Störungen Berlin, pp 3–12Google Scholar
  10. 10.
    Bleuler E (1911) Dementia praecox oder die Gruppe der Schizophrenien. Deiticke, LeipzigGoogle Scholar
  11. 11.
    Ssucharewa G (1926) Die schizoiden Psychopathien im Kindesalter. Mon Psychiat Neurol 60:235–261CrossRefGoogle Scholar
  12. 12.
    Remschmidt H, Kamp-Becker I (2008) Das Asperger-Syndrom. Springer, BerlinGoogle Scholar
  13. 13.
    Asperger H (1944) Die autistischen Psychopathen im Kindesalter. Archiv für Psychiatrie Nervenkrankheiten 117:76–136CrossRefGoogle Scholar
  14. 14.
    Kanner L (1943) Autistic disturbances of affective contact. Nerv Child 2:217–250Google Scholar
  15. 15.
    APA (1994) Diagnostic and statistical manual of mental disorders: (DSM-IV), 4th edn. APA, Washington, DCGoogle Scholar
  16. 16.
    Lewine JD, Andrews R, Chez M, Patil AA, Devinsky O, Smith M, Kanner A, Davis JT, Funke M, Jones G, Chong B, Provencal S, Weisend M, Lee RR, Orrison WW Jr (1999) Magnetoencephalographic patterns of epileptiform activity in children with regressive autism spectrum disorders. Pediatrics 104:405–418PubMedCrossRefGoogle Scholar
  17. 17.
    Tuchman R, Moshe SL, Rapin I (2009) Convulsing toward the pathophysiology of autism. Brain Dev 31:95–103PubMedCrossRefGoogle Scholar
  18. 18.
    Tuchman R, Rapin I (2002) Epilepsy in autism. Lancet Neurol 1:352–358PubMedCrossRefGoogle Scholar
  19. 19.
    Rapin I (1995) Autistic regression and disintegrative disorder: how important the role of epilepsy? Semin Pediatr Neurol 2:278–285PubMedCrossRefGoogle Scholar
  20. 20.
    Tebartz van Elst L, Perlov E (2013) Epilepsie und Psyche. BerlinGoogle Scholar
  21. 21.
    Lord C, Petkova E, Hus V, Gan W, Lu F, Martin DM, Ousley O, Guy L, Bernier R, Gerdts J, Algermissen M, Whitaker A, Sutcliffe JS, Warren Z, Klin A, Saulnier C, Hanson E, Hundley R, Piggot J, Fombonne E, Steiman M, Miles J, Kanne SM, Goin-Kochel RP, Peters SU, Cook EH, Guter S, Tjernagel J, Green-Snyder LA, Bishop S, Esler A, Gotham K, Luyster R, Miller F, Olson J, Richler J, Risi S (2012) A multisite study of the clinical diagnosis of different autism spectrum disorders. Arch Gen Psychiatry 69:306–313PubMedCrossRefGoogle Scholar
  22. 22.
    Sharma S, Woolfson LM, Hunter SC (2012) Confusion and inconsistency in diagnosis of Asperger syndrome: a review of studies from 1981 to 2010. Autism 16:465–486PubMedCrossRefGoogle Scholar
  23. 23.
    Riedel A (2013) Spezifische mit Autismus Spektrum Störungen vergesellschaftete Syndrome. In: Tebartz van Elst L (ed) Das Asperger Syndrom im Erwachsenenalter und andere hochfunktionale Autismus-Spektrum-Störungen. Medizinisch Wissenschaftliche Verlagsgesellschaft, Berlin, pp 34–43Google Scholar
  24. 24.
    Rutter M, Silberg J, O’Connor T, Simonoff E (1999) Genetics and child psychiatry: II empirical research findings. J Child Psychol Psychiatry 40:19–55PubMedCrossRefGoogle Scholar
  25. 25.
    Lichtenstein P, Carlstrom E, Rastam M, Gillberg C, Anckarsater H (2010) The genetics of autism spectrum disorders and related neuropsychiatric disorders in childhood. Am J Psychiatry 167:1357–1363PubMedCrossRefGoogle Scholar
  26. 26.
    Robinson EB, Koenen KC, McCormick MC, Munir K, Hallett V, Happe F, Plomin R, Ronald A (2011) Evidence that autistic traits show the same etiology in the general population and at the quantitative extremes (5%, 2.5%, and 1%). Arch Gen Psychiatry 68:1113–1121PubMedCrossRefGoogle Scholar
  27. 27.
    Lundstrom S, Chang Z, Rastam M, Gillberg C, Larsson H, Anckarsater H, Lichtenstein P (2012) Autism spectrum disorders and autistic like traits: similar etiology in the extreme end and the normal variation. Arch Gen Psychiatry 69:46–52PubMedCrossRefGoogle Scholar
  28. 28.
    Moreno-De-Luca A, Myers SM, Challman TD, Moreno-De-Luca D, Evans DW, Ledbetter DH (2013) Developmental brain dysfunction: revival and expansion of old concepts based on new genetic evidence. Lancet Neurol 12:406–414PubMedCrossRefGoogle Scholar
  29. 29.
    Cohen D, Pichard N, Tordjman S, Baumann C, Burglen L, Excoffier E, Lazar G, Mazet P, Pinquier C, Verloes A, Heron D (2005) Specific genetic disorders and autism: clinical contribution towards their identification. J Autism Dev Disord 35:103–116PubMedCrossRefGoogle Scholar
  30. 30.
    Tebartz van Elst L (2013) Die Bedeutung der Autismus-Spektrum-Störungen für die Erwachsenenpsychiatrie und-psychotherapie. In: Tebartz van Elst L (ed) Das Asperger-Syndrom im Erwachsenenalter und andere hochfunktionale Autismus-Spektrum-Störungen. Medizinisch Wissenschaftliche Verlagsgesellschaft, Berlin, pp 95–103Google Scholar
  31. 31.
    Lehnhardt FG, Gawronski A, Volpert K, Schilbach L, Tepest R, Vogeley K (2012) Psychosocial functioning of adults with late diagnosed autism spectrum disorders–a retrospective study. Fortschr Neurol Psychiatr 80:88–97PubMedCrossRefGoogle Scholar
  32. 32.
    Riedel A (2013) Klinische Diagnostik und Erfahrungen aus der Sprechstunde für Autismus-Spektrum-Störungen. In: Tebartz van Elst L (ed) Das Asperger Syndrom im Erwachsenenalter and andere hochfunktionale Autismus-Spektrum-Störungen. Medizinisch Wissenschaftliche Buchgesellschaft, Berlin, pp 107–128Google Scholar
  33. 33.
    Tebartz van Elst L (2013) Medikamentöse Therapie im Erwachsenenalter. In: Tebartz van Elst L (ed) Das Asperger-Syndrom im Erwachsenenalter und andere hochfunktionale Autismus-Spektrum-Störungen. Medizinisch Wissenschaftliche Verlagsgesellschaft, Berlin, pp 260–273Google Scholar
  34. 34.
    Fangmeier T, Lichtblau A, Peters J, Biscaldi-Schafer M, Ebert D, Van Elst LT (2010) Psychotherapy of Asperger syndrome in adults. NervenarztGoogle Scholar
  35. 35.
    Ebert D, Fangmeier T, Lichtblau A, Peters J, Biscaldi-Schäfer M, Tebartz van Elst l (2013) Asperger-Autismus und hochfunktionaler Autismus bei erwachsenen. Das Therapiemanual der Freiburger Autismus-Studiengruppe. Hogrefe, GöttingenGoogle Scholar
  36. 36.
    Kiresuk T, Sherman S (1968) Goal attainment scaling, a general method for evaluating comprehensive community mental health programs. Community Ment Health J 4:441–453CrossRefGoogle Scholar
  37. 37.
    Hautzinger M, Pauli P (2009) Psychotherapeutische methoden. Enzyklopädie der psychologie: psychologische interventionsmethoden—band 2. Hogrefe, GöttingenGoogle Scholar
  38. 38.
    Winter K, Pick M, Radtke M, Tebartz van Elst L (2013) Stationäre Therapie von Autismus-Spektrum-Störungen. In: Tebartz van Elst L (ed) Ds Asperger-Syndrom im Erwachsenenalter und andere hochfunktionale Autismus-Spektrum-Störungen. Medizinisch Wissenschaftliche Verlagsgesellschaft, Berlin, pp 310–321Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Ludger Tebartz van Elst
    • 1
  • Marion Pick
    • 1
  • Monica Biscaldi
    • 2
  • Thomas Fangmeier
    • 1
  • Andreas Riedel
    • 1
  1. 1.Department of Psychiatry and PsychotherapyUniversity Medical Center FreiburgFreiburgGermany
  2. 2.Department of Child and Adolescent Psychiatry and PsychotherapyUniversity Medical Center FreiburgFreiburgGermany

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