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

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.

Glutathione metabolism in the prefrontal brain of adults with high-functioning autism spectrum disorder: an MRS study

“…ASD is a neurodevelopmental disorder characterized by difficulties in social communication and unusually restricted, repetitive behavior and interests with a strong desire for routines [1, 2]. In addition, there are specific abnormalities in language, sensory, and social perception [2].…”

“…In addition, there are specific abnormalities in language, sensory, and social perception [2]. ASD is an etiologically and phenotypically heterogeneous disorder [3].…”

“…ASD is an etiologically and phenotypically heterogeneous disorder [3]. In daily clinical practice, phenotypes with subnormal and normal/above average intelligence are distinguished [2, 4]. While the International Classification of Diseases, tenth edition (ICD-10) distinguishes childhood autism (F84.0), atypical autism (F84.1), and Asperger syndrome (ICD-10 F84.5) (www.dimdi.de/static/de/klassi/icd-10-gm/kodesuche/onlinefassungen/htmlgm2015/block-f80-f89.htm), in the current fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), these categories are summarized into a single category called ASD (299.00) (www.dsm5.org).…”

“…ASD is associated with high prevalence rates of comorbid classical psychiatric disorders such as depression, anxiety, attention deficit hyperactivity disorder (ADHD), psychotic symptoms, or emotionally unstable syndromes [7, 8]. The increasing importance of ASD is caused by the high prevalence rates, the fact that ASD is a life-long condition, and the high rates of psychiatric comorbidity [2]. …”

Selected topics of the DGPPN Congress 2012

“…In adults with Asperger syndrome, Hermann et al [6] detected intact automatic processing of novel metaphors. Van Elst et al [7] review characteristics of autism spectrum disorder such as deficits in social cognition and competence as well as highly circumscribed interests and a strong desire for routines. The authors outline first treatment concepts for high-functioning autism that is associated with psychiatric diseases such as depression, anxiety, ADHD, psychotic symptoms or emotionally unstable syndromes.…”