Posts Tagged ‘High Functioning Autism’

Rethink Mental Illness

Rethink Mental Illness (Photo credit: Wikipedia)

Here at Applied Behavioral Strategies, the mission is to improve the quality of life through effective intervention. One way we hope to do that is by reviewing research articles for readers. Today’s topic is in direct response to the Newtown Shootings. People have asked if Asperger’s is related and clearly it is not.

Is mental illness related to the shootings? We are still unclear on this; but we do know that mental illness has been associated with many if not all of the previous shootings. And sadly, mental illness can find its way in to anyone’s life at any time. Thus, today’s research review is on an article about mental illness and Asperger’s syndrome.

Luigi Mazzone, Liliana Ruta, and Laura Reale authored the article called “Psychiatric Comorbidities in Asperger’s Syndrome and High Functioning Autism”. The Annals of General Psychiatry published the paper in 2012.

Background Information

Individuals with Asperger’s and High Functioning Autism must exhibit several characteristics in order to be diagnosed with the condition. Specifically, individuals must:

  • show delays or differences in language skills
  • exhibit deficits in social skills
  • engage in stereotyped or ritualistic behaviors

Because of the language delays, professionals may have difficulty identifying signs of other comorbid psychiatric conditions. Additionally, the stereotyped or ritualistic behaviors may also make it difficult to determine if challenging behaviors are related to the Asperger’s and Autism spectrum or if those behaviors are signs of some comorbid condition.

Purpose of the Paper

The authors conducted a literature review. The authors stated that the purpose of their paper was to “examine the interplay between common psychiatric comorbidities and Asperger’s Syndrome and High Functioning Autism.” The authors planned to “discuss which psychiatric disorders have been more frequently reported in association with Asperger’s Syndrome and High Functioning Autism.” The authors wanted to identify the difficulties that clinicians and researchers face when making a correct diagnosis of a comorbid condition in Asperger’s Syndrome. Finally, the authors wanted to discuss the role of the environment and comorbid conditions.


The authors conducted a term search to identify all related articles. Next, the authors reviewed the reference lists in each article to find additional related articles. Once the authors located all the articles, they screened the articles for scientific quality and eliminated studies that lacked scientific rigor.


Internalizing Conditions. Internalizing conditions result in individuals having internal thoughts and sensations that are not easily identified by observers. The authors found that a number of studies reported internalizing comorbid conditions with Asperger’s syndrome and high functioning autism. These conditions included:

  • depression
  • bipolar disorder
  • anxiety
  • obsessive compulsive disorder

Externalizing Conditions. Externalizing conditions result in individuals engaging in behaviors that are observable to observers. The authors reported that a number of studies reported externalizing comorbid conditions with Asperger’s and High Functioning Autism. Due to diagnostic criteria, professionals cannot label a child with Asperger’s and ADHD. However, professionals know that many children with Autism Spectrum Disorders (including Asperger’s) also have attention issues and high levels of activity.

The authors noted that “high-functioning autism disorders are over-represented in the criminal population” but that this may be due to undiagnosed comorbid psychiatric conditions. The authors go on to point out that individuals with Asperger’s syndrome have issues with theory of mind (e.g., perspective taking, understanding the thoughts and feelings of others) and that this deficit may impair their social judgment resulting in “the risk of violating norms and laws.” The second point the authors make is that “individuals with Asperger’s Syndrome often show a strong sense of right and wrong, and once they have understood the rules they are likely to stick to them more rigidly than most people.”

Tic Disorders. The authors noted that a number of studies reported a comorbidity of Asperger’s syndrome and high functioning autism with tic disorders such as Tourette syndrome.

Difficulties in Diagnosing

The authors discussed the difficulties in appropriate diagnosing individuals with Asperger’s syndrome and high functioning autism. They noted, in particular, that several diagnostic scales are available. However, they also pointed out that those scales were not normed on individuals with Asperger’s syndrome and high functioning autism. Thus, professionals must use caution.

The authors note that additional research is needed in order to fully understand the relationship between autism spectrum disorders and risks for comorbid psychopathology.

The Role of the Environment

The authors discussed how the environment may influence the expression of psychiatric disorders. The authors identified the role of stress in the family. For many years, research has shown that stress is high for parents, and in particular, mothers.

The authors also discuss the role of the respondent during the diagnostic process. The authors noted that parents and teachers report behaviors differently. The differences may be attributed to the context of the respondent or it may be due to the fact that the individual’s behaviors are different in each context.

The authors also discussed the role of genetics in that individuals with Asperger’s syndrome tend to have relatives with other psychiatric conditions. Professionals need to complete an appropriate family history as part of the initial evaluation.

Finally, the authors discuss the role of social relationships. Given the social and behavioral difficulties experienced by individuals on the spectrum, they are much more likely to have social difficulties (e.g., making and keeping friends, engaging in social routines and activities). This may lead to depression and anxiety leading to a vicious cycle and potentially to the onset of comorbid conditions.


The authors close with implications for practice and these are important for all of us.

  1. Correct diagnosis. Teachers and parents are closest to children on the spectrum. They have a responsibility to make sure that individuals obtain additional diagnoses if they suspect comorbid conditions.
  2. Appropriate assessment tools. Researchers need to develop appropriate assessment tools so that professionals may appropriately diagnose individuals with comorbid conditions.
  3. Treatment. All individuals need appropriate intervention for the conditions in which they are diagnosed.

Readers, how many of your children/clients have been diagnosed with comorbid conditions? How long did it take to get that diagnosis? Has treatment changed as a result of the diagnosis?

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