Social & Psychiatric Functioning in Adolescents with Aspergers Syndrome Compared with Conduct Disorder

By Green, J., Gilchrist, A., Burton, D., and Cox, A., (2000), Journal of Autism and Developmental Disorders, Vol. 30, No. 4.

Lack of standardised phenotypic definition has made outcome studies of Asperger syndrome (AS) difficult to interpret. This paper reports psychosocial functioning in 20 male adolescents with AS, defined according to current ICD-10 criteria, and a comparison group of 20 males adolescents with severe conduct disorder. Subjects were gathered from clinical referral. Evaluation used standardised interviewer rated assessments of social functioning and psychiatric morbidity. The AS group showed severe impairments in practical social functioning despite good cognitive ability and lack of significant early language delay. High levels of anxiety and obsessional disorders were found in AS; depression, suicidal ideation, tempers, and defiance in both groups.

... individuals with conduct disorder also have problems in social interaction and the perception of others which at least superficially have some similarities with difficulties in AS. These problems of social functioning in CD have usually been considered to arise from abnormal social learning rather than the intrinsic developmental difficulties of AS.

Only 50% of the AS group were independent in basic self-care (e.g., washing, cleaning teeth) and only 1 AS subject was able fully to organise his own daily routine.

The AS group were significantly more likely to be impaired on perception of others’ annoyance and understanding of others’ annoyance but equally likely to have problems in threshold for annoyance, perception of their own roles in problems, display of annoyance outside or within the family, range of cues used to detect annoyance experience of teasing or coping with teasing.

Items concerning relationships are the most distinct of self-reported abnormality in the AS group and differed markedly form the CD group. On the basis of the young peoples’s reports, none of the AS group was judged to have ever had a friendship of normal quality.

The AS and CD groups did not differ significantly in reported feelings of love or sexual feelings; nor was there any apparent difference in the understanding of concepts of friendship, loneliness, or marriage.

The level of overall psychiatric symptomatology reported by parents was equally high in AS and CD groups.

The AS group were significantly more likely to have had sleeping difficulties, obsessions or compulsions, and disinhibition, and less likely to have had restlessness with others (outside the home), stealing, or to have recently used tobacco or alcohol.

At interview, observed mental state or behavioural abnormalities were significantly more common in the AS group. They were significantly more abnormal on anxiety, nonfacial tics and emotional responsiveness but less often had abnormal gross activity level. AS children were also significantly more likely to be judged physically unattractive. Thirteen (65%) of the AS group were found to have had an emotional disorder in the past 3 months additional to symptoms attributable solely to their core disorder; 9 (45%) had had an externalising disorder (conduct disorder, persuasive inattention, or overactivity), and 6 (30%) had two or more comorbid disorders.

Parents of AS subjects reported that other professionals had rarely made diagnoses of comorbid disorder; only in 1 case were parents aware that an AS subject had received another diagnosis (of depression).

The design of this study allowed for an exploration of social impairment and mental health in Asperger syndrome, as reported by parents and the subjects themselves in their everyday lives. The comparison with another significantly impaired group who had conduct disorder acted to throw into relief the different profiles of disability found in the two disorders to highlight for the AS group the psychosocial difficulties related to the core disorder.

Strict entry criteria for the AS group utilising current ICD-10 criteria resulted in the rejection of half the referred cases (usually on the grounds of early language delay); suggesting that the diagnosis of AS was used by the referring clinicians in a broader sense than the ICD-10 definition.

This use of the term AS by U.K. clinicians echoes similar findings in the U.S.

Of the social impairments in AS individuals, perhaps the most striking result is their profound lack of ability for independent living, given their intelligence and often good functioning in other areas.

The results founds in this study must be considered in the context of the fact of the AS group and some of the CD group being referred from psychiatry colleagues for the study. Both groups show high levels of psychiatric morbidity.

Externalising symptoms are common in both groups and underline the fact that AS is at times misdiagnosed at presentation as conduct disorder.

This current study finds no psychotic symptomatology is reported in either group.

We have shown that AS individuals can often represent a good abstract knowledge of relationships and emotions in conversation and that mask a profound lack of practical social ability in everyday life.