Der Nervenarzt – Mai 2011
La revue allemande Der Nervenarzt propose un dossier spécial sur l’autisme dans son numéro de Mai 2011.
Les articles sont en langue allemande et sont consultables sur le site de l’éditeur.
1. Banaschewski T, Poustka L, Holtmann M. [Autism and ADHD across the life span. Differential diagnoses or comorbidity ?]. Nervenarzt ;2011 (May) ;82(5):573-580.
Exclusion criteria of the DSM-IV-TR and ICD-10 do prevent dual diagnoses of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASD). However, inattention, impulsivity and hyperactivity are amongst the most frequent associated symptoms of ASD. Psychopathological, neuropsychological, brain imaging and genetic studies suggest possible pathophysiological links between ASD and ADHD. Thus, standard diagnostic procedures for both disorders should assess the presence of potential comorbid symptoms of the other disorder. Treatment strategies for ADHD symptoms in the context of ASD overlap with those for patients with ADHD, but lower dosages and slower titration might be recommendable.
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2. Bolte S. [Psychobiosocial interventions for autism]. Nervenarzt ;2011 (May) ;82(5):590-596.
A multitude of interventions is offered for the treatment of autism spectrum disorders (ASD). However, only few have demonstrated scientific evidence, and even the evaluated methods need further examination of their mechanisms and scope. This article provides a brief summary of the premises and principles of successful psychobiosocial ASD intervention. ABA, TEACCH, PECS, social skills and cognitive training are described as examples for established approaches to ASD. Training of mu-suppression using neurofeedback and reanimation of the fusiform gyrus and amygdala using computer-aided facial affect recognition training are introduced as neurobiologically based ASD interventions.
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3. Dziobek I, Kohne S. [Brain imaging in autism spectrum disorders. A review]. Nervenarzt ;2011 (May) ;82(5):564-572.
In the past two decades, an increasing number of functional and structural brain imaging studies has provided insights into the neurobiological basis of autism spectrum disorders (ASD). This article summarizes pertinent functional brain imaging studies addressing the neuronal underpinnings of ASD symptomatology (impairments in social interaction and communication, repetitive and restrictive behavior) and associated neuropsychological deficits (theory of mind, executive functions, central coherence), complemented by relevant structural imaging findings. The results of these studies show that although cognitive functions in ASD are generally mediated by the same brain regions as in typically developed individuals, the degree and especially the patterns of brain activation often differ. Therefore, a hypothesis of aberrant network connectivity has increasingly been favored over one of focal brain dysfunction.
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4. Fangmeier T, Lichtblau A, Peters J, Biscaldi-Schafer M, Ebert D, van Elst LT. [Psychotherapy of Asperger syndrome in adults]. Nervenarzt ;2011 (May) ;82(5):628-635.
There is an increase in awareness in professionals that the Asperger syndrome (AS) in adulthood is associated with specific problems and burdens which may well differ from those in childhood and adolescence. The core symptoms of AS generally persist into adulthood, however in contrast to childhood and adolescence there is no specific support system for adults in Germany. Also the environment of the afflicted patient changes thus producing different challenges and problems. In addition a subgroup of patients with high functioning AS primarily presents in adulthood generally due to secondary psychosocial problems, depression or anxiety. Difficulties in social interaction, problems with modified daily routines and unforeseen situations cause severe frustration for the majority of the patients. While several therapy programs have been developed and implemented for children and adolescents, for adults there are none. Also there is a lack of comprehensive concepts addressing the specific needs of adult patients with AS. From an economic perspective this is particularly unfortunate since affected people often have good or excellent partial abilities and might be very valuable employees. In this article existing therapeutic concepts for AS are summarized and a newly designed group therapy program for adult patients with Asperger syndrome in Freiburg is introduced (Freiburg Asperger-spezifische Therapie fur Erwachsene, FASTER) which specifically addresses the needs and problems of adult patients with AS.
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5. Klauck SM, Poustka L, Chiocchetti A. [Genetics and animal modeling of autism spectrum disorders. New developments]. Nervenarzt ;2011 (May) ;82(5):553-562.
Autism spectrum disorders (ASD) are pervasive developmental disorders with a complex phenotype in respect to communication, verbal development, and social behavior. Manifold molecular genetic analyses point towards a multifactorial genetic predisposition. For the identification of central key mechanisms large consortia have performed linkage analysis, genome-wide association, and copy number variation (CNV) studies, which led to the characterization of risk factors for ASD like CNV and single nucleotide polymorphisms but also single rare mutations. The so far associated genomic regions and candidate genes impact neuronal development especially the establishment of the synaptic cleft, secretion of surface proteins, or dendritic translation. These findings point towards deficits of translation-dependent cell-cell connectivity and synaptic plasticity for ASD. Animal models are relevant to analyze the pathomechanisms of single genetic risk variants at the cellular, tissue-specific, and behavioral levels.
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6. Meyer-Lindenberg A. [Autism spectrum disorders]. Nervenarzt ;2011 (May) ;82(5):551-552.
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7. Nickl-Jockschat T, Michel TM. [Genetic and brain structure anomalies in autism spectrum disorders. Towards an understanding of the aetiopathogenesis ?]. Nervenarzt ;2011 (May) ;82(5):618-627.
Autism spectrum disorders (ASD) are pervasive development disorders with high heritability and an as yet unclear aetiology. So far molecular genetic research was able to identify several candidate genes for the disorder which are functionally linked to neurotransmission and neuronal migration, cortical organisation and synaptic plasticity. MRI studies repeatedly showed a higher total brain volume for ASD patients. The volume increase was most pronounced for the frontal and the temporal lobes and peaked in early childhood. A combination of molecular genetic and structural imaging research appears promising for a further characterization of ASD aetiology.
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8. Poustka L, Banaschewski T, Poustka F. [Psychopharmacology of autism spectrum disorders]. Nervenarzt ;2011 (May) ;82(5):582-589.
Autism spectrum disorders (ASD) are persistent, heterogeneous conditions that display many comorbid problems. Especially maladaptive behaviours like increased irritability, aggression, impulsivity and self-injurious behaviours are perceived as enormously stressful and can interfere with interventions targeting social and communication deficits. Medication treatments focussing on troubling comorbid problems in ASD can be fundamentally ameliorative, although core features of the disorder itself cannot be sufficiently treated. While atypical antipsychotics and stimulant medication have been proven to be effective in large multisite networks of ASD, serotonin reuptake inhibitors are of limited efficacy. Novel pharmacotherapies to improve social impairment are in the early stages of research.
