Talk:Asperger syndrome

lack of *demonstrated* empathy?

Isn't it a little extreme to say they lack empathy? They lack the meanns to fluently express themselves and understand others but they don't lack the ability to care how others feel. A lack of empathy sounds like something you'd associate more so with a psycopath not about someone who simply doesn't understand the world around them. Saying this about people who don't deserve seems disrespectful and condescending ... if people out there are using this article as a first source for info on aspegers then its setting a pretty bad impression. —Preceding unsigned comment added by 86.41.152.236 (talk) 22:30, 26 October 2009 (UTC)

The article doesn't say that people with Asperger's "lack empathy". It says that they have a "lack of demonstrated empathy", which is pretty much agrees with the previous comment. Eubulides (talk) 02:57, 27 October 2009 (UTC)

I have fixed this as even a demonstrated lack of empathy is not typical of AS. Gingermint (talk) 00:40, 8 November 2009 (UTC)

We have multiple reliable sources saying that a lack of demonstrated empathy is a core sign of Asperger syndrome. Do you have reliable sources to the contrary? Any edits to the article need to be based on reliable sources. Eubulides (talk) 00:49, 8 November 2009 (UTC)

As a psychologist I can assure you that lack of demonstrated empathy is not a "core sign" of Asperger's syndrome. If I did believe that then I'd have to practice in some backward place like England where medicine and the soft sciences are 50 years out of date. I believe that this article, which is full of errors, is the kind of thing that develops when people who are not expert in a field try (even with the best intentions) to research what they do not understand. Articles on Psychology should be written and researched by real psychologists. Gingermint (talk) 01:26, 8 November 2009 (UTC)

the argument from authority does not work here, WP:RS and in this case WP:MEDRS carry weight. Oh, and I am a psychologist too.... Dbrodbeck (talk) 05:43, 8 November 2009 (UTC)

On Wikipedia, unfortunately, your experience as a psychologist isn't what we base articles on. Per Wiki's core policy of WP:V, and the guideline of WP:MEDRS, text is based on reliable sources. Reviewing the full-text of the journal articles cited should help clear up your concerns. If you have other reliable sources that say differently, let's discuss them here. SandyGeorgia (Talk) 02:37, 8 November 2009 (UTC)

Asperger syndrome, like (other) mental disorders affects everyone differently, so I agree that we shouldn't claim that the lack of empathy affects all people with Asperger syndrome, although it should still definitely be noted as a symptom, and adding "often" or "may" is unnecessary. Perhaps finding a DSM list of symptoms would be best, if there is one. MichaelExe (talk) 02:50, 8 November 2009 (UTC)

Discussion here should be based on reliable sources, not editor opinion. SandyGeorgia (Talk) 03:02, 8 November 2009 (UTC)

Ok, then you explain the "lack of empathy" to the original poster. :) MichaelExe (talk) 03:14, 8 November 2009 (UTC)

That's not our "job" :) The original poster needs to understand Wiki policy, and refrain from expressing anecdotal opinion on talk, which consumes everyone's time for nothing :) You could, however, take that discussion to her talk page. SandyGeorgia (Talk) 03:20, 8 November 2009 (UTC)

I've already said what I'd wanted to; you've continued needless discussion, against your own standards. My standards don't stop me from trying to explain on the talk page of an article; it won't get me blocked (Wikipedia:Talk page guidelines is a behavioural guideline, not a policy). Besides, if one person has enough trouble understanding the "lack of empathy" to post about it, perhaps the article needs clarification on this, anyway. MichaelExe (talk) 03:30, 8 November 2009 (UTC)

Carry on then; my concern was that you cited wrongplanet to a new user, who is still working to learn about reliable sources. SandyGeorgia (Talk) 03:32, 8 November 2009 (UTC)

To the original poster: the lack of empathy (the ability to try and put yourself in someone's position, or feel what they feel) in a psychopath/sociopath/antisocial/dissocial and in Asperger syndrome (as well as other autism spectrum disorders, schizoid personality disorder, schizophrenia, etc.) is probably the only common symptom. What truly separates the former from the latter(s) is the recklessness and lack of remorse of the former. The personality types of people with Asperger syndrome tend to be INTJ, INTP, ISTJ, ISTP (in that order, from [1], although may be reasons why other personality types aren't on the forum) and introversion usually conflicts with antisocial behaviour. I'd say people with Asperger syndrome lack empathy because they focus their attention on objects, while a psychopath would focus on himself. Lack of empathy doesn't necessarily mean selfishness. MichaelExe (talk) 02:46, 8 November 2009 (UTC)

Wrong planet is not a reliable source; please see WP:RS, WP:MEDRS and WP:V; Wikipedia uses reliable sources. SandyGeorgia (Talk) 03:02, 8 November 2009 (UTC)

Here are some reviews supporting the lack of empathy in Asperger syndrome, if, by chance, we don't have enough already: PMID 1924004 PMID 16596080 PMID 15376613 PMID 11234553. MichaelExe (talk) 03:00, 8 November 2009 (UTC)

Lack of empathy is NOT in my DSM IV. And there is a reason for that. Gingermint (talk) 05:13, 8 November 2009 (UTC)

I should also add that some of the reviews you site regarding lack of empathy are about Clostridium septicum infection, which is of interest to oncologists but not psychologists. Nor would I consider PubMed.gov a reliable source. It looks like one, and someone who is not an expert in this field would not have any apparent reason for thinking it isn't a good source. This is one of the reasons why articles on medicine or psychology written or edited by non-experts (even very intelligent and well-meaning non-experts) are dangerous. Gingermint (talk) 05:22, 8 November 2009 (UTC)

Gingermint, you will find Wiki editing more enjoyable if you read WP:MEDRS and understood what PubMed is. SandyGeorgia (Talk) 05:26, 8 November 2009 (UTC)

SandyGeorgia is of course correct: PubMed is a database of sources, not a source itself. MichaelExe's reference to "PMID 1924004" is a typo; evidently Tantam & Girgis 2009 (PMID 19240041) was intended, as its abstract says "The social impairments of people with AS include deficits in empathy, self-awareness and executive function." The highest-quality source in MichaelExe's list is Baskin et al. 2006 (PMID 16596080), which says in its abstract that Asperger's is "characterized by a lack of social reciprocity and empathy, and severe difficulties in social integration". So far, all the reliable sources mentioned in this thread support the claim that lack of demonstrated empathy is a core sign of Asperger's. Eubulides (talk) 06:42, 8 November 2009 (UTC)

A note to MichalExe that got lost in yesterday's edit conflicts and re-threading here: to automatically link PMIDs, you can write them like this, with no colons. SandyGeorgia (Talk) 13:14, 8 November 2009 (UTC)

I cannot agree with Baskin JH, Sperber M, Price BH.. The DSM IV and the WHO do not agree. My colleagues do not agree. The WHO reads much like the DSM IV but with some additions:

WHO ICD 10

F84.5

Asperger's syndrome

"A disorder of uncertain nosological validity, characterized by the same type of qualitative abnormalities of reciprocal social interaction that typify autism, together with a restricted, stereotyped, repetitive repertoire of interests and activities. It differs from autism primarily in the fact that there is no general delay or retardation in language or in cognitive development. This disorder is often associated with marked clumsiness. There is a strong tendency for the abnormalities to persist into adolescence and adult life. Psychotic episodes occasionally occur in early adult life."

There is no mention of lack of empathy. Nor should there be. People with Asperger's are not psychotic. They are not sociopaths.

As for PubMed. It is, indeed, not a source. It a a place to look up sources. There are very (very!) brief abstracts for those wishing to actually do research. And the papers represented may not necessarily present down and solid facts but ideas, theories and questions. PubMed is, indeed, not a source. And (not to sound too much as one on a very high horse) it is not appropriate to site things one has not actually read.

At any rate, it is not, absolutely not a fact that those with Asperger's have a demonstrated lack of empathy and we do not utilize that as a criteria in diagnosis. Gingermint (talk) 01:00, 9 November 2009 (UTC)

The lack of empathy does not make someone psychotic (although your quote draws a such link) or a sociopath. Sociopaths don't care ("lack of remorse"); people with Asperger syndrome don't understand. Finally, this article doesn't claim "lack of empathy" to be a defining characteristic and doesn't suggest it as a criterion for diagnosis. Diagnosis of Asperger syndrome doesn't even mention the word "empathy". "lack of empathy" is also part of the history of Asperger syndrome, being in the Hans Asperger's description of the disorder. MichaelExe (talk) 01:14, 9 November 2009 (UTC)

Again, the Asperger syndrome article nowhere says that people with Asperger's "have a demonstrated lack of empathy". Nor does the article say anything about empathy and the DSM-IV. Please stick to what the article actually says. There is widespread agreement among reliable sources supporting claims along the line of what the article actually says, which is "The lack of demonstrated empathy is possibly the most dysfunctional aspect of Asperger syndrome." Here's a sample quote, this one from a reliable source in medical psychiatry: "A lack of demonstrated empathy in Asperger's disorder is one of its more dysfunctional associated features." This quote is from page 41 of: Rausch JL, Johnson ME (2008). "Diagnosis of Asperger's disorder". In Rausch JL, Johnson ME, Casanova MF (eds.) (ed.). Asperger's Disorder. Informa Healthcare. pp. 19–62. ISBN 0-8493-8360-9. {{cite book}}: |editor= has generic name (help)CS1 maint: multiple names: editors list (link) So far, no reliable sources have been proffered that disagree on this point. Eubulides (talk) 01:51, 9 November 2009 (UTC)

Gingermint, please assume good faith, I know I read the papers that are cited, and they are from peer reviewed journals. Please read WP:MEDRS. Your opinions, or mine, or anybody's do not matter, what matter is sources. Dbrodbeck (talk) 01:55, 9 November 2009 (UTC)

I generally say of myself that I have troubles with empathy or that I'm void of it at some very important times, but I have no idea if that's an extension of social problems, life experience, or any combination with AS, or who knows what more. I even jest about this on my userpage. It should not be listed without sources and it must vary a lot... surprises me that it's not sourced one direction or another anywhere social interactions are fairly well-studied. My extremely unofficial view is that it can be an extension of social interaction problems and AS might complicate it all, but this is more of a realization and matter to try to treat after diagnosis and review. Because of the extremes that a lack of empathy might mean (such as the tagging of sociopaths) and the line between empathy and bad intentions in criminal minds is quite blurry, I hardly think it would a valid diagnosis criteria and there there are plenty of other uncontroversial things to look at where in diagnosis that are more of the yes/no variety and far less subjective than defining empathy. ♪ daTheisen(talk) 23:28, 9 November 2009 (UTC)

While this is of course anecdotal, my experience would echo much of that discussed at empathy#Empathy and autism spectrum disorders: I'm quite able to empathize with people if they are making their feelings explicit, but I'm unable to read their emotional state if they're only expressing it through subtext (e.g. body language), _especially_ when they are putting on a false front in their verbal communications. John Darrow (talk) 05:22, 10 November 2009 (UTC)

Hello. I have aspergers syndrome, and I can tell you. Lack of empathy is not correct. I care for others. More than some of my friends. It isn't a lack of empathy. Please change it. Gelatart (talk) 14:42, 15 November 2009 (UTC)Gelatart

Asperger syndrome affects everyone differently. The "lack of empathy" is not a diagnostic criterion, just like clumsiness, but it is part of the history of Asperger syndrome, and many researchers have noticed it. "lack of empathy" doesn't necessarily mean someone with Asperger syndrome doesn't care, but that they have difficulty understanding other people's feelings, especially through non-verbal communication. MichaelExe (talk) 15:43, 15 November 2009 (UTC)

This is becoming tiring. The article does *not* say "lack of empathy"; it says lack of *demonstrated* empathy. Very different things. Please read. SandyGeorgia (Talk) 15:46, 15 November 2009 (UTC)

Well, if so many people are against its inclusion, there needs to be clarification, quite simply. When 20 people come to an article and say "wtf is this?" (as an example), something is definitely wrong. XP MichaelExe (talk) 15:50, 15 November 2009 (UTC)

This is an incredibly interesting discussion to me, in spite of the "heat." This, from my own personal experience seems to be the most misunderstood, and debated aspects of AS. I wonder if I might add a little "middle ground" perspective here as one who feels I can see both sides of this argument, and some of the possible reasons for this disagreement (one I have heard and discussed on many occasions over the past ten years).

In some ways, as in other discussions I have participated in on this subject, I can see areas of agreement where it appears you all agree, but perhaps don't even realize it. Yet the apparent disagreement, given the many discussions like this I have observed and participated in, is also not surprising and even understandable. Let me see if I can deconstruct this as a bullet list of points as I see them, both as points of agreement, and clarification of what the disagreements really are. (IMHO):

• Point of agreement: The article states that lack of demonstrated empathy is a symptom of AS
• Point of agreement: Lack of empathy (NOT lack of demonstrated empathy - that is debated) is not a symptom of AS
• Point of disagreement: Whether "lack of demonstrated empathy" is the same thing as "lack of empathy."
• Possible point of disagreement: Whether "lack of empathy" is a symptom of AS (moot, because the article doesn't state it anyway, so I'm not even going to address this).

The only thing worth addressing for purposes of this discussion is the third point: Whether or not lack of demonstrated empathy is the same thing as lack of empathy. I'm going to paraphrase from a brief scanning of this section, as well as from actual conversations I've had in an attempt to present both sides as succinctly as I can, as well as attempt to redirect the conversation (if possible), to what I believe the real issue is.

• Argument for "lack of demonstrated empathy" being the same as "lack of empathy:"
  • Lack of demonstrated empathy can be considered the same as lack of empathy due to the fact that, if empathy is not demonstrated, we have no way of knowing empathy exists. Even if the subject proclaims empathy, and can define the term with reasonable understanding, we still do not know whether it truly exists. If Charles Manson proclaimed empathy (an extreme and perhaps bad example because he has flatly stated he understands it, and does not empathize with anyone - however a good example, I think, for the sake of argument), would it be reasonable to believe him? The point here is not to suggest any link between Manson's psychopathy and Asperger's. The point is, if anyone says they are empathetic, can we believe them with no demonstrative evidence in their own behavior?
  • Another point, and one I actually am trying like the dickens to get my own kids to understand (two of whom have been diagnosed with AS, which I believe I and my third child also have - although we have not been diagnosed - yet), is that if we can't, or don't demonstrate empathy we claim to feel for others, in ways in which others can understand and accept, it is the same as if the empathy does not exist as far as others are concerned. People are not mind readers, and must assume, lacking outwardly apparent evidence that empathy does not exist.

• Arguments against "lack of demonstrated empathy" being the same as "lack of empathy:"
  • When we are evaluating whether someone else has empathy, we are not mind readers. One of AS symptoms is the lack of, or reduced ability to express oneself with obvious actions like facial expression, body language and specific actions on behalf of others. We must recognize that just because we can't "see" the empathy, does not mean it doesn't exist.

Both arguments have at least some merit, however both are faulty in their conclusions, if conclusions are drawn from either stance. Both base arguments on the same thing. We cannot read minds.

In a sense, this is a lot like the old question, "If a tree falls in the forest..."

While both arguments seem to make sense, and they do, reaching any conclusion at all from either is a slippery slope. On the one hand, "If we can't see it, it isn't there," and on the other hand, "If we can't see it, doesn't mean it isn't there, so we'll assume it is." Neither really makes sense, and the fact is (IMHO), it doesn't matter.

It is entirely possible that those with AS do experience empathy, but simply cannot express it. It is entirely possible that those with AS do not experience empathy, and that is why it isn't being expressed. No one can prove either position.

Personally I think that lack of empathy, and lack of ability to demonstrate are both symptoms of AS, but to varying degrees, and often not at all (to both), as is true with every symptom of AS. There is no one symptom present in every case. That's why it is called a "spectrum." But this is just my opinion, and doesn't matter either.

What does matter is "What can we do about it?" The real question here is whether the statement "The lack of demonstrated empathy is possibly the most dysfunctional aspect of Asperger syndrome." belongs in the article. I think it does. It is sourced, and well worded with the clear inclusion of the words "demonstrated" and possibly leaving the statement open to debate, as it should be.

On the other hand, given the debate here, as well as many personal conversations I have had with professionals on both sides of this debate, I think the very fact that this is debated should be included in the article. It is a hot topic, and should probably be included as part of a "Controversy" section, which is lacking in this article. Asperger's is a hotly debated topic. I'm very surprised not to see a controversy section here. There really, really needs to be one there.

That's my twenty buck's worth! ;) --SentientParadox (talk) 23:11, 19 November 2009 (UTC)

New Asperger photo

In April we had a long discussion about whether a photo of an older Hans Asperger looking at a child was suitable for the History section under a fair-use rationale. This older photo, Image:Hans Aspergersmall.jpg, was eventually removed from Wikipedia for reasons unrelated to that discussion. Another photo Image:Asperger-Vienna-clinic.jpeg is now available and can be used here under a fair-use rationale. Unlike the older-Asperger photo, this photo shows Asperger in action at the time he was doing the seminal research discussed in History; also, this photo is one of a series of photos that is discussed in the History section. This is a far stronger rationale than the one that applied to the previous (removed) photo, and it's appropriate to include the new photo in the History section. Eubulides (talk) 21:39, 11 November 2009 (UTC)

No, no, no, no, no. Why on Earth do we need to know what he looked like while he was doing his research? The image would add nothing to the article, and it is perfectly understandable and comprehensive without it. J Milburn (talk) 17:08, 12 November 2009 (UTC)

Agreed. The article is about Aspergers Syndrome not Asperger himself. - 4twenty42o (talk) 17:16, 12 November 2009 (UTC)

You may believe that you can know everything there is to know about AS by reading the perfectly understandable and comprehensive article, but eventually you may find that real life, with real people with AS, is rather different. Fenke (talk) 00:13, 13 November 2009 (UTC)

This article is not meant to be a substitute for real life. We're not pretending that, once you've read this article, you are an expert, or you have actually studied with Asperger. I'm not quite sure what your point is. J Milburn (talk) 11:13, 13 November 2009 (UTC)

He may have Asperger or be close to someone that does and is offended by the accompanied stigma or the way people throw around the term without any real experience with it (albeit not as bad as ADHD). Being able to recognize a few symptoms does not mean that you understand what it's like to have Asperger, especially since Asperger affects everyone differently. I think that may be the point.

Anywho, back on topic: I don't care much for that particular picture, and it doesn't help anyone's understanding of the disorder. The image of the boy is actually pretty useful, as well as the brain scan image. Pictures that are relevant to typical behaviour and neurology of Asperger syndrome are likely the most useful, although I can't think of any other pictures to put in this article. I like pictures, though. XP MichaelExe (talk) 12:19, 13 November 2009 (UTC)

Free images of major doctors/scientists may be nice additions. Obviously, we can't justify a non-free image of them. J Milburn (talk) 12:36, 13 November 2009 (UTC)

Agreed as well. The images the article does have do add to the understanding of Asperger's Syndrome, I don't see how adding a nonfree image of the guy whose name it happens to bear would enhance that sufficiently to justify a nonfree image. Seraphimblade ^{Talk to me} 15:28, 13 November 2009 (UTC)

The pretty picture of a brainscan does not add anything, you'd need an additional article to explain it and it is, as far as I can tell, not related to AS. The article is rather abstract and clinical, the picture of Asperger and the child could help to reduce the 'distance', illustrate that it is about people. Fenke (talk) 16:52, 13 November 2009 (UTC)

That would not matter. We do not use nonfree content due to preference, we use it if there is absolutely no alternative. Here, there are clear alternatives. We don't use nonfree content just because it would be nice. Seraphimblade ^{Talk to me} 01:47, 14 November 2009 (UTC)

The prior argument was that it does not add anything to the article. If it's the non-free nature of the image that makes it's aadition to the article unwanted, state as much, but don't start arguing about it's added value. Fenke (talk) 02:39, 14 November 2009 (UTC)

(indent reset) I thought I did state as much, but yes, the image's nonfree nature is what makes it unacceptable. If it were a free image, its addition would be a normal content decision. Nonfree images are held to a much higher standard, and the first one of those standards is that their purpose is indispensable and could not be served by free content. Here, a combination of the text article and free media can provide a very clear explanation of what Asperger's syndrome is without the need to resort to nonfree media, so we would not use it. Seeing that nonfree image is not crucial to a reader's understanding of what Asperger's syndrome is. It might look nice, but for a nonfree image, that's not enough. Seraphimblade ^{Talk to me} 11:00, 14 November 2009 (UTC)

• I assume that even those objecting to placing the image in the article would not object if the article merely wikilinked to the image's file page? I've done that, since the article does directly discuss the series of photographs in question. Also, I would like to hear comments that address the rationale given; the negative comments above are generic boilerplate that can be used to oppose the use of any free image, and don't seem to reflect consideration of this particular case. Eubulides (talk) 18:07, 14 November 2009 (UTC)
  • Seems a bit of an end run, and also might confuse readers expecting wikilinks to lead to articles. I would not be in support of that, though you could certainly wikilink to any article that has a legitimate need for it. As to addressing this case, it's replaceable. That may be boilerplate, but that's because the requirement is project wide and without exception. If it's replaceable, we don't use it. Seraphimblade ^{Talk to me} 18:33, 14 November 2009 (UTC)
    • What is it "an end run" around? What policy or guideline prohibits it? Does the policy or guideline also prohibit the other wikilinks to non-articles that are in Asperger syndrome? Why would it be confusing for a reader, who wikilinks on a phrase "photographs taken during his seminal work", to be sent to a photograph taken during his seminal work? Eubulides (talk) 06:58, 15 November 2009 (UTC)
      • It is an end run around nonfree content not being included in articles where it is replaceable. If we allowed that, it'd happen all over the place. I'm not sure there's any specific policy or guideline that states in so many words that article links are to other articles, but that's all we allow, for example, mainspace redirects to, and that's so widely true and practiced (that article wikilinks are only to other articles) that I don't think we particularly need a page with the policy tag to specifically say that's how it works. That just is how it works. Seraphimblade ^{Talk to me} 07:05, 15 November 2009 (UTC)
        • I don't see how it is an end run. The nonfree content is not being included in the article. There's nothing at all wrong with talking about a non-free image; the only prohibition is against displaying the image. Prohibiting wikilinks to non-articles is certainly not just "how it works", and I'm surprised to see an assertion to the contrary. Articles routinely wikilink to non-articles: Asperger syndrome links to Portal:Pervasive Developmental Disorders, for example. Eubulides (talk) 07:39, 15 November 2009 (UTC)
          • Not in the main prose (or it shouldn't). In any case, the portal space is a reader facing space, unlike the image space, which is mostly directed at other editors. J Milburn (talk) 11:14, 15 November 2009 (UTC)
            • I don't agree with this restriction: it is not a consequence of any Wikipedia policy or guideline. Rather than edit-war over whether wikilinks to file pages are OK, I replaced it with a wikilink to an article, which you've already indicated you have no objection to. Eubulides (talk) 07:12, 23 November 2009 (UTC)

Blog

I made what I regarded as a valuable contribution, giving a URL to a blog 'Asperger's is Just a Racket' that expressed what anyone reading this discussion must surely conclude, which is that nobody knows exactly what characterizes Asperger's syndrome. It kept getting deleted -- not, I note, criticized in the discussion section -- and I got told it was 'warring' and, bizarrely, that the blog was 'off-topic'. Since, previously, someone took the trouble to give my message a section of its own, there is evidently at least one other person out there who thinks the blog is valuable and germane to the discussion. There are bound to be others, and and I urge such people to work all the harder, against the tide, to disseminate the blog around the 'net.82.24.171.148 (talk) 17:08, 12 November 2009 (UTC)

Check out WP:RS. Blogs are generally frowned upon as reliable sources. If you can make the same argument with a reliable source.. such as the American Mental health Association or something to that effect you would probably receive a better response. - 4twenty42o (talk) 17:15, 12 November 2009 (UTC)

I have to agree with the above. Common blog, unknown writer, SPS, missing NPOV... It was being removed as rubbish by an author using an assumed named instead (no google results). For comparisons I've been in recently involving editors who tried to use a blog there as a resource, one was blocked for edit warring against a huge POV consensus, and another reached ArbCom in part because their blog was indirect evidence of massive and destructive POV pushing and spent months and months refusing to back down. By contrast and ironically, I ran into an edit war in an article about someone who shares this opinion and has made it publicly known, but is a celebrity with plenty of sources in their article so I reverted it back to its starting state and asked they discuss it more. Such is Wikipedia, where I could not in good faith participate in any official discussion regarding that. ♪ daTheisen(talk) 04:56, 15 November 2009 (UTC)

Oh, but worth mentioning as an odd-on, since it's Wikipedia such a thing would be open to discussion if you could prove it with scientific investigation, published research, etc etc. I'll say in advance that that would be incredibly difficult in this case. "Others" and a "tide" we'd have to see, since we operate on consensus, meaning a sole opinion or fringe view literally cannot represent an article. ♪ daTheisen(talk) 05:13, 15 November 2009 (UTC)

I'm afraid this just personifies the Catch-22-style 'downward spiral' that the blog was exposing. Peer review qualifies respectability, but peer review is not, itself, respectable. It is certainly not remotely pluralistic, and that is exactly how the various vested interests have engineered it to be. Just look at the way editors of eg. publications such as the British Medical Journal have resigned, owing to their being fed up with the way they, or academic institutions they have been affiliated with, have been made a pawn in the pharmaceutical corporations' game of chess. This, however, is the Internet, where one expects a higher degree of pluralism. The blog itself was simply a healthy bit of discussion, which is what this section was created for. 82.24.171.148 (talk) 13:47, 15 November 2009 (UTC)

<< text removed per WP:BLP >> Colin°^Talk 16:28, 15 November 2009 (UTC)

Please read WP:V, WP:RS, WP:MEDRS and WP:SOAP. Wikipedia-- and article talk pages-- are not soapboxes, and edits are based on reliable sources. If you would like to attempt to change Wiki's core policies, please take that discussion to the talk page of WP:V, and keep it off of this page, as this discussion is not relevant to this article. 13:54, 15 November 2009 (UTC)

Reliable source, as 'defined' by Wikipedia: <<In general, the most reliable sources are peer-reviewed journals and books published in university presses; university-level textbooks; magazines, journals, and books published by respected publishing houses; and mainstream newspapers. Electronic media may also be used. As a rule of thumb, the greater the degree of scrutiny involved in checking facts, analyzing legal issues, and scrutinizing the evidence and arguments of a particular work, the more reliable the source is.>> Nebulous. In any case, earlier in the discussion somebody posted a quote from a much-referenced medical encyclopedia affirming that Asperger's is of 'uncertain nosological validity'. The blog was merely a reasoned expansion upon this. It certainly provided something that the psychiatric literature is woefully lacking -- and which places it at the top of the pile by the above definition of 'reliable' -- namely, a rigorous philosophical and logical scrutinization of medical dogma.82.24.171.148 (talk) 14:29, 15 November 2009 (UTC)

I'm not sure what it is... maybe you're a parent and worried for a child and really want to think nothing is different? Perhaps you work at a disability firm and don't want to hear about it? A teacher sick a student you feel is just using it as an excuse for just not "getting it"? It must be something deeply embedded for this kind of frustration, but this isn't the place to just try to chat about it. Science, verifiability, consensus. That's what Wikipedia is for and not a blog. There's a reason this article has 'FA' status, and it's because a lot of editors have put a whole lot of time into making it as professional, accurate and presentable as possible. You can look through the rest of this talk page and see how much they'll discuss even minor changes; it means a lot. Anything you bring the table needs scholarly material behind it as just a start. ♪ daTheisen(talk) 17:10, 15 November 2009 (UTC)

Let's say that the notion of a neutral point of view is rather spurious and open to manipulation by those who can present an argument that, by sophistry, appears to be as such. Surely, failing neutrality per se, we should aspire to provide a balance among viewpoints. If I see injustice and sources of needless upset, I consider it my duty to attempt to rectify the situation. If clinical psychologists were competent at understanding the human mind or the nature of human idiosyncrasy, we would have more of them taking up careers as playwrights, actors and so on; but I have never known any great such talents to have emerged having had a former life in clinical psychology. So, since you ask, I think it is time psychologists had their wings clipped and their intellectual monopoly was dismantled.

I don't know what you mean by 'scholarly material'; if you are referring to peer review then I have already given my views, and I'll add that some of the all-time classic works in philosophy, science and so on, though published, were never subjected to peer review (they doubtless would have been rejected). —Preceding unsigned comment added by 82.24.171.148 (talk) 17:49, 15 November 2009 (UTC)

Simply put, a blog is not a reliable source. I think the only way to use a blog in a Wikipedia article is if we credit it to its author, and that this author is notable (educated). [Axial Connival] is hardly notable (his profile has only 33 views, so far, a google search yields only 2 results: [2], and the blogger does not even use his full name) and that one blog is his only.

Also, I'd like to redirect you to this page, although it is far from policy, some of the observations may apply to this situation, specifically: 1. When someone complains loudly about censorship, you may be certain they are up to no good. (not yet, but I'm waiting for it, tbh) and 9. Single-topic editors are rarely, if ever, either interested in or capable of NPOV. Additionally, if you look closely you will often find a conflict of interest. Although we're all forced to assume good faith, I would not be surprised that you are actually Axial Connival. Case and point, there's no way we can support such an anonymous user's blog. If he/she publishes such a criticism under his/her full name, including education (preferably MD or PhD) and background information, it may see a mention in this article, but until then, that user's opinion is moot. If you wish to support this user's opinion on Wikipedia, look for ways of doing so within the verifiability, notability and reliability policies of Wikipedia. I don't doubt that there is controversy because of Asperger's, but a blog is not a good start to point it out.

Finally, before someone accuses me of not assuming good faith, I'd like to point out that such an accusation is also in bad faith. XP MichaelExe (talk) 18:40, 15 November 2009 (UTC)

And at the end of all this, perhaps someone here will be kind enough to explain exactly what Asperger's is. Issues relating to antics in the medical profession are too grave to play games relating to the manner in which people should be allowed to comment.

There are probably individuals out there in positions that will enable them to confirm my suspicion that the majority of Asperger's diagnoses nowadays are undertaken upon delinquents who are using the medical profession to play the system. By the way, the concepts entertained in this discussion section exemplify the kinds of confusion exposed in the blog. At my last check, people who entirely lack empathy were otherwise known as psychopaths.82.24.171.148 (talk) 20:43, 15 November 2009 (UTC)

Not all people that lack empathy are psychopathic, sociopathic, antisocial or dissocial, because these also lack guilt and remorse (which are used as diagnostic criteria). Lack of empathy is also typical in Schizophrenia and some related disorders (schizoid personality disorder, for example) as well as narcissistic personality disorder. By being completely involved in one's own world, one would become self-sufficient to the point of indifference to having others around. [3] [4] [5] Perhaps this is more apparent in the schizoid personality disorder, but I think it still applies often enough to Asperger's. If you're looking for more information on what exactly Asperger syndrome is, this may prove useful. I agree that there needs to be some clarification on the "lack of empathy" issue, but the concept appears often enough in medical reviews to warrant its inclusion here. MichaelExe (talk) 21:04, 15 November 2009 (UTC)

When you look at the way schizophrenia has been redefined from decade to decade, there being suggestions that the redefinitions have been made to accord with governmental agenda (specifically, mind control techniques involving auditory [as distinct from visual] hallucinations), one must wonder about all other definitions in psychology. I recall reading in a respected Dictionary of Psychology (probably a Penguin publication) that autism was reckoned by some psychologists to be a form of schizophrenia. It strikes me that nobody has a clue about the true nature of any of these distinctions. And the theories associated with this sort of thing are truly appalling, just as they were in the era when everything psychological had something to do with sex.

The reason for the question mark over nosological validity is surely down to the fact that people with restricted, repetitive etc. behaviors will be best categorized, at least by the layperson, as 'boring', and those with 'sociological impairment' as 'shy'. If academe wants to make more of it than this, it needs to make a better justification than has thus far been presented.82.24.171.148 (talk) 23:23, 15 November 2009 (UTC)

Perhaps Fallibilism, Solipsism or Nihilism would suit you, because, after all, we could be wrong about everything. Or, if you think you know better than all of the other psychologists and psychiatrists, seek the publication of your opinion in a medical journal or the like.

I encourage you to pursue the acknowledgement of your views, but use better sources. There's no point continuing the argument over the blog, because you will not win. Move on, and look somewhere else for support of your conclusions. MichaelExe (talk) 00:03, 16 November 2009 (UTC)

I'm afraid seeking publication in peer-reviewed journals would be an immense waste of time for me. many of the most talented academics are leaving their profession in disillusionment at the system. I know someone, fairly well, who openly and unashamedly told me of his involvement in the 'medical peer-review mafia', to use his phrase.82.24.171.148 (talk) 01:32, 16 November 2009 (UTC)

Please just realise that a blog such as the one we are discussing is not a reliable source. You have had a number of editors tell you this. You claim things with no cites (on this page) and then tell us that 'you know some guy' or whatever. These are not reliable sources. Either do the work to find actual sources that agree with you, or move on. Oh and full disclosure, I am a member of the peer review mafia... Dbrodbeck (talk) 02:24, 16 November 2009 (UTC)

The attitude of the medical establishment towards aspects on Asperger's syndrome appears, to use the terminology of a French politician who commented on the British Conservative Party's attitude towards Europe, autistic.82.24.171.148 (talk) 17:09, 16 November 2009 (UTC)

Empathy

Perhaps we should try to include some clarification about the "lack of empathy" in autism spectrum disorders (versus that in psychopathy), or links to Empathy#Lack_of_empathy, Empathy#Empathy_and_autism_spectrum_disorders, Alexithymia and/or Theory_of_mind#In_autism. Some PubMed reviews that would help distinguish the "lack of empathy" in autism spectrum disorders are:

• PMID 19240041
• PMID 16958304
• PMID 18038346
• PMID 16157488

I didn't think it would be such an issue, but seeing as it has become one, we should look for means to clear things up. MichaelExe (talk) 22:39, 15 November 2009 (UTC)

There seems to be a lot of muddled thinking. As is commonly known, psychopaths lack empathy; and it is classic psychopathic behavior to live one's life spinning webs of deceit. But webs of deceit, as any ruthless con-man will tell you, require that one has a gift for reading the mind of one's victim. If psychologists want to say that people with Asperger's syndrome have little in the way of intuition (which hardly qualifies as a disorder!), they should simply come out and say so. For some reason they always steer clear of the word 'intuition', as though it brings them into territory in which they risk being cut to pieces by philosophers.82.24.171.148 (talk) 16:53, 16 November 2009 (UTC)

It would be helpful if posters here would stop furthering the meme that this article mentions "lack of empathy". It does not. It mentions well cited "lack of demonstrated empathy". SandyGeorgia (Talk) 16:55, 16 November 2009 (UTC)

But, taken on its own, that observation doesn't help anyone very much.82.24.171.148 (talk) 17:14, 16 November 2009 (UTC)

Maybe not.... Even I learned a good deal from this-- rather, it was the sort of rare publication where I nod at the whole thing... in agreement and not just of habit. You're getting somewhere on changes i nthat section, I think, if you put together what feels good out of ↑ up and ↓ down articles. Oh, and I'd have to say "demonstrated" as well, and that's also by far the politically correct thing to say since it could (and rightfully) be taken as a very harsh insult to be confronted on that. It can be easier on some, or you could end up in therapy for years trying to suck some normal social reactions from people to try to learn better. Even if I mostly don't understand the concept at some major events, even I know that empathy isn't some on/off switch, and I'd never deliberately seem heartless (the suggestion of no empathy). Logic can spark the concept of empathy, you might say. ♪ daTheisen(talk) 22:05, 18 November 2009 (UTC)

I'm sorry but I did not understand a single sentence in this. With the possibility of sarcasm, I did not even get whether you are 'for' or 'against' me. —Preceding unsigned comment added by 82.24.171.148 (talk) 22:30, 18 November 2009 (UTC)

MRS Findings

Might anyone want to take a crack at taking this into account? Arch. Gen. Psychiatry, 2002;59:885-891

I hope that I'm not horribly mistaken in the Archive of General Psychiatry being a reliable source. I've seen it cited in psychology articles, although few, such as Phobia. --Saerain (talk) 10:51, 16 November 2009 (UTC)

This is a single study-- not a review. Please see WP:MEDRS; if this 2002 study is mentioned in reviews, it might be included. SandyGeorgia (Talk) 16:57, 16 November 2009 (UTC)

Third paragraph is a mess

We shouldn't be talking about interventionists and people who think Asperger's isn't a syndrome in the same paragraph. Both views ought to be covered in separate paragraphs or sections, and the interventionist position ought to cover exactly what it's goals are before discussing how they are achieved, because it's not made very clear in the article. It ought to say something along the lines of "Treatments have been developed to help people with Asperger's syndrome do X, Y and Z" rather than the ambigious "Treatments for Asperger's syndrome." Mentioning "treatment for Asperger's" doesn't make clear exactly what the goal is. "Most individuals improve over time" - what, besides independent living, constitutes an improvement? Where do the disorders end and the personality type begin?

There seems to be no clear distinction between things other people who don't have the condition don't like and things that actually prevent the person with the condition form accomplishing their own goals. I'm confused over whether Asperger's is a set of undesirable (to others) social behaviors or just a different way of looking at the world which would be perfectly OK if everybody else looked at it that way too. --Nerd42 (talk) 16:24, 19 November 2009 (UTC)

• I understand your questions, probably because I hear them all the time in relation to AS. However I don't think getting into this much detail is a good idea. The problem is there is still much debate as to the preciseness of AS symptoms, what it really is, and what it really isn't. Getting into this much depth on the details is highly likely to start an editing war, using this article and talk page as a place for debate. I really think this article should stay as simple as possible, with a lot of "more info" links for people to investigate on their own, and leave it at that. --SentientParadox (talk) 19:31, 19 November 2009 (UTC)
• Edit: Though I do agree with your point on people who don't agree that Asperger's is even a syndrome. I've already begun to advocate for a Controversy section. --SentientParadox (talk) 23:17, 19 November 2009 (UTC)

Worsening via medication

I feel that the source given for the statement "for example, misdiagnosis can lead to medications that worsen behavior." (Fitzerald and Corvin, 2001) is not a very good source for that specific statement. The relevant element in the paper is simply "[...]; misdiagnosis as ADHD [leads] to the prescription of psychostimulants (e.g. methylphenidate), which can cause deterioration in behaviour in this population." and is unsourced. This is essentially a blank assertion, and if it is considered common knowledge in this study area, surely there are sources expounding on this specific aspect?

reposted: just because nobody wants to bother with it doesn't mean it's irrelevant. Circéus (talk) 18:12, 19 November 2009 (UTC)

If the Royal College of Psychiatry is not a reliable source, we may as well question every source that doesn't offer other sources. Where does it stop? If it did have sources, should we check those too, and the sources listed in the sources, and continue until we reach sources that don't cite sources, eventually throwing out the whole kit and kaboodle, claiming they are all based on blank assertions? If we start going down that road, there will be NO usable sources left for any Wikipedia articles. I find the source perfectly acceptable and in line with Wikipedia's reliability guidelines Just my two cents. :). --SentientParadox (talk) 19:26, 19 November 2009 (UTC)

I expect quite naturally that should I seek more details on an aspect of an article, I can do so by tracking the sources. This article is not concerned with medication in any significant way and I worry about the source because a similar approach lead to a blatant misrepresentation in Diffuse panbronchiolitis. To be honest, the article is useless at justifying the inclusion of this statement. It's basically an incidental blanket throwaway assertion and just because it's included in a peer-reviewed article doesn't mean that article is a good source for it! I can source physics articles from Surely You're Joking, Mr. Feynman!, but that doesn't mean it's a good source for such assertions!
Let's put it this way: is it so encyclopedically nonsensical to expect such a rather important statement to be sourced to (a) paper(s) who are specifically concerned with pharmacotherapy of Asperger's? Circéus (talk) 02:51, 20 November 2009 (UTC)

I respectfully disagree that it does not address the issue raised by the statement. The cited article does, in fact, specifically address misdiagnosis leading to medications that can worsen the condition of AS, and specifies certain examples in this paragraph. I agree that particular section of the article does not cite sources for the assertions made, however I do not see the paragraph in question as making any "blanket assertions." "Asperger syndrome can (italics added) be misdiagnosed as a variety of conditions (Box 6Go) requiring contradictory treatments" is not a blanket assertion. It is, rather, a statement of possibility, which the article here on Wikipedia reflects by its own inclusion of the word "can."

Whether the cited article cites its own sources for its own statement is a legitimate question however. For the purposes of a Wikipedia article, I feel the cited article is a perfectly acceptable source according to Wikipedia's standards. You clearly disagree. That's fine. It's bound to happen. Wikipedia's reliable source policy states "Where there is disagreement between sources, their views should be clearly attributed in the text." I take this to mean that when there is disagreement as to source reliability, the source in support of the statement should be attributed directly in the article text as the basis for the statement.

Considering that disagreement over sources is common on Wikipedia, in addition to the fact that much disagreement occurs on the subject of AS among professional organizations and individuals, I propose the statement here be changed to:

"According to the Royal College of Psychiatrists misdiagnosis can lead to medications that worsen behavior."

At least that specifies the statement is the opinion of a specific group. My own personal research however, has demonstrated the statement as is, is widely supported among professional experts specializing in Asperger's Syndrome. I'm aware enough of Wikipedia's standards and policies though, to understand that personal knowledge doesn't matter.--SentientParadox (talk) 17:30, 20 November 2009 (UTC)

First, that source is not the opinion of the Royal College of Psychiatrists, and it would be inaccurate to ascribe the opinion to that organization. Second and more important, that quote from WP:SOURCES is not talking about disagreement among Wikipedia editors; it's talking about disagreement among reliable sources themselves. If there were a significant disagreement among reliable sources whether misdiagnoses and treatment by the wrong medication could lead to behavior problems, then it'd be appropriate to cite reliable sources on both sides of the disagreement, attributing them in the text. However, so far we've seen no evidence of any such disagreement. On the contrary, what limited information I can find on the subject (e.g., see case 2 of Dossetor 2007, PMID 18095536) indicates that medication from misdiagnosis can lead to behavior problems. Eubulides (talk) 20:55, 20 November 2009 (UTC)

Please indulge me, Eubulides. I'm doing my best not to sound like a harassing single-issue wonk (having dealt with them elsewhere), but I'm not sure reading your answer whether or not you think my issues with the specific source used in the article are legitimate (namely that the article makes a throaway blanket statement that is not actually explicitly supported by anything else in the text). Circéus (talk) 21:50, 20 November 2009 (UTC)

My impression from reading the article is that the authors are summarizing their clinical experience. As such, this is not scientific evidence, and it's fairly low quality evidence from a WP:MEDRS point of view. So in that sense I agree with you. Asperger syndrome should not be presenting this point as if it were settled science. I'm not sure whether the point should be removed or simply reworded, though. What do you propose? Eubulides (talk) 23:12, 20 November 2009 (UTC)

"Some researchers/clinicians/scientists/doctors of the Royal College of Psychiatrists suspect that misdiagnosis can lead to the prescription of medications that could potentially worsen behavior." <-- We could use something on the lines of that, if you want to imply that it is a minority-view, and that the authors' opinion may not reflect that of the Royal College of Psychiatrists, in general. It's basically the lowest possible implied weight we can give to the statement. Diagnosis_of_Asperger_syndrome#Differential_diagnosis goes more in depth, so we could link to it or just leave it to that article altogether. MichaelExe (talk) 23:45, 20 November 2009 (UTC)

Generally speaking it's better to avoid in-text attribution (what I call a "Simon says style") of a claim like this. Particularly since the Royal College affiliation is so misleading. It'd be better to remove the claim entirely than to spend a lot of space on it to identify the sources in-text. This topic is not that important to the article, after all. Eubulides (talk) 23:53, 20 November 2009 (UTC)

If the claim has some merit, I'd love to see it referenced with a proper source, but a cursory (read: 3h spent on it) search on PubMed back when I first made my comment did not uncover anything I could use. Of course I might have been using improper search terms (mostly stuff around "pharmacotherapy"): I am not all that versed in the use of medical scientific sources research on such a specific issue. Removing the claim in the meantime might be the best option. Circéus (talk) 01:48, 21 November 2009 (UTC)

Possible sources

• Foster PMID 14508298

For some children with AS treated with selective serotonin reuptake inhibitors, behavioral activation can occur at surprisingly low doses. Many clinicians will err on the side of caution and introduce these agents, for example, citalopram or fluoxetine, in liquid form at just a milligram or two initially. Families should be cautioned to watch for increased impulsivity, aggression, and sleep disturbance as potential manifestations of selective serotonin reuptake inhibitor induced behavioral activation.

• McPartland PMID 17030291

Scahill and Martin [112] reviewed research on the use of medicines to treat ASDs and reported that research has shown beneficial effects of atypical antipsychotics, serotonin reuptake inhibitors, stimulants, and mood stabilizers in treating autistic symptoms. It has been hypothesized that, compared with other ASDs, individuals with AS respond differentially to medication [113], but insufficient data exist to support this conclusion. Only a few studies specifically have investigated outcomes for pharmacotherapeutic treatment of individuals with AS.

• [112] Scahill L, Martin A. Psychopharmacology. In: Volkmar F, Paul R, Klin A, et al, editors. Handbook of autism and pervasive developmental disorders, vol 1. 3rd edition. Hoboken (NJ): John Wiley & Sons; 2005. p. 1102–17.
• [113] McDougle CJ, Brodkin ES, Naylor ST, et al. Sertraline in adults with pervasive developmental disorders: a prospective open-label investigation. J Clin Psychopharmacol 1998; 18:62–6. PMID 9472844

• Towbin PMID 12512397

In addition to these, several other obstacles are related to the state of the field. First, no pharmacologic agent influences the core pragmatic social deficits such as misinterpreting cues or failure to appreciate social cues and nuances. As a result, there is no one algorithm to follow that targets the primary source of impairment or the greatest source of difficulty for the patient. Second, there is an absence of high quality, valid studies of the efficacy of different pharmacologic agents for specific symptoms in this population. Most of the studies are case reports or small-scale, open, unblinded trials [1]. This requires the clinician to take findings from studies of other disorders in the hope that the results translate to HFA/AS. This presumption is entirely theoretic at this point. Much of the time, a clinician has no way to gauge the patient's response in comparison with other individuals with this condition; global functioning may or may not be meaningfully improved. A third obstacle is the absence of treatment and outcome studies of HFA/AS with comorbid conditions. For example, it may be erroneous to presume that mood dysregulation and the response to mood stabilizers in the context of HFA/AS is identical to bipolar disorder in an otherwise ordinary adolescent. Nearly all treatment studies of other childhood disorders exclude persons with PDD spectrum disorders. Consequently, when a patient appears in the clinician's consulting room, unless one has the luxury of a previous relationship and sense of that patient's baseline functioning, one cannot know what the individual looks like when the comorbid condition is “resolved.” Most of the core social impairments are likely to remain, although functional gains are possible.

Individuals with HFA/AS also may be more prone to side effects. Typical children and adolescents may experience these as more of a nuisance than a source of major impairment, but persons with HFA/AS often find even minor side effects hard to tolerate. The exquisite and atypical sensory world of individuals with HFA/AS means that they may experience a greater variety and rate of these kinds of side effects. When side effects appear, they often outstrip the patient's ability to follow conventional advice “to just ignore it.” We do not know if the actual amount of discomfort is greater or if the means for self-soothing, distraction, or rationalization are insubstantial. In either case, some HFA/AS individuals cannot tolerate some medications because of “minor” side effects that patients who do not have HFA/AS handle with relative ease. In addition, they may be less likely to report side effects, or may allude to them in a manner that makes it much harder to detect them. Clinicians may be misled by comments that are offered in a flat, toneless manner, suggesting minor uneasiness for the patient when in fact they are extremely distressing. Similarly, highly concrete patients may not report side effects because the clinician does not ask about each specific one. Some patients stop their medication without telling the clinician in order to extricate themselves from the discomfort of side effects or having to talk about them.

SandyGeorgia (Talk) 04:36, 21 November 2009 (UTC)

Recent reviews discussing treatment (I don't have full text):

• PMID 17354570
• PMID 19159835
• PMID 18415882

SandyGeorgia (Talk) 04:08, 21 November 2009 (UTC)

Your quotes seems to relate to the uncertainty of ASD children reaction to treatment, which in my understanding, is pretty normal given the semi-experimental nature of pharmacology in AS disorders. PMID 19159835 is definitely not relevant. It never actually touches pharmacotherapy and the closest it gets is

"The nature of ASD places these children at risk for various medical complications; for example, they may present with lead poisoning from pica, and therefore, routine lead screening is indicated. Many children with autism visit the primary care clinics due to common infections, allergies, and illnesses. Management of these issues is sometimes complicated by various biological treatment protocols children with ASD might be trying. It is therefore important to maintain open communication with families about how they are caring for their children."

PMID 18415882, however, is much more interesting on that regard, even though it does not discuss the misdiagnosis angle, it looks like a pretty extensive review. Most relevantly it notes that typical ADHD medication (methylphenidate, amphetamines and atomotexine) were all found to have more adverse than useful effects in ASD children without ADHD, though the great variation in methodology and nosology might influence these results:

"Some patients with PDDs taking methylphenidate experienced adverse events such as increases in lethargy/social withdrawal, stereotypy, irritability, dysphoria, motor tics, and increased hyperactivity. The most frequently reported adverse effect was a decrease in appetite. It was determined that children with ASDs have less symptom amelioration and higher rates of significant adverse effects compared to those without ASDs."

"As a result of differences between past and contemporary nosology, however, some of these patients might not meet current diagnostic criteria for autistic disorder. Furthermore, some of these youth might meet current diagnostic criteria for an ASD but were given other diagnoses (e.g., schizophrenia) back in the 1970s. [...] Dextroamphetamine was reported to have a disorganizing and deteriorating effect, thus yielding poor clinical results. [...] The minimal positive effects of levoamphetamine were outweighed by adverse effects or worsening of preexisting “schizophrenic” symptoms."

"Atomoxetine is a nonstimulant agent recently approved for treating ADHD in children, adolescents, and adults. Like stimulants, in preliminary publications atomoxetine has had a lower response rate in patients with ASDs than in typically developing children with ADHD. [...] placebo-controlled, blind studies are necessary to determine atomoxetine's efficacy and safety for ADHD-like symptoms in ASDs."

I can get you a copy if you want (not a medical researcher, so am not clear how to best evaluate and integrate any interesting data). Circéus (talk) 07:10, 21 November 2009 (UTC)

I think we've got enough information on the general issue that we shouldn't just delete/disregard the original questioned source and text, but figure out how to reword it to be more comprehensive and inclusive of what these reviews do say about medication in the treatment of AS. For some reason, I could access the full Towbin article last night, but I can't now, but if I recall correctly, it placed the topic of medication in the context of the importance of the correct diagnosis. SandyGeorgia (Talk) 13:51, 21 November 2009 (UTC)

• Wow, thanks for tracking down all those sources! I can't read Towbin now either (the site is down for maintenance). I have just now read Leskovec et al. and it's pretty strong. In addition to what Circéus quoted there's also 'In a 1971, single-blind pilot study of ten children with autistic disorder and "schizophrenia," treatment with imipramine produced a mixture of stimulating, tranquilizing, and disorganizing effects.' This sort of thing clearly supports the "misdiagnosis can lead to medications that worsen behavior" of the article, even if it's not the direct support that Fitzgerald & Corvin 2001 provide. I have revised my opinion of their conclusion: I think it's backed not only by their clinical experience, but also by these old studies. There's a more recent quote by Fitzgerald "today many persons with Asperger's syndrome are misdiagnosed as having schizophrenia with the great negative consequences associated with this misdiagnosis" (Google Books snippet from: Fitzgerald M (2008). "Autism: Asperger's syndrome—history and first descriptions". In Rausch JL, Johnson ME, Casanova MF (eds.) (ed.). Asperger's Disorder. Informa Healthcare. pp. 1–7. ISBN 0-8493-8360-9. {{cite book}}: |editor= has generic name (help)CS1 maint: multiple names: editors list (link)) which, though it doesn't directly state that the problem is drug treatment leading to deteriorating behavior, certainly suggests that Fitzgerald hasn't changed his opinion since 2001.
• Reading all the above, I think that the sentence supported by Fitzgerald & Corvin should stay in. I suggest interchanging it with the next sentence, though, to make it clearer that it's talking about misdiagnosing AS as something else, rather than misdiagnosing something else as AS. I also think we should cite and summarize Towbin. Perhaps the following change to Medications? "Care must be taken with medications, as side effects may be more common and harder to evaluate in individuals with AS, and tests of drugs' effectiveness against comorbid conditions routinely exclude individuals from the autism spectrum.[citing Towbin] ; abnormalities Abnormalities".

Eubulides (talk) 14:42, 21 November 2009 (UTC)

Occasionally, I'm still capable of productive work :) I agree we should keep the original questioned text, as there is plenty of support in other reviews, and will leave it to you to expand text as needed to incorporate this new info. SandyGeorgia (Talk) 15:25, 21 November 2009 (UTC)

Members of Congress

A recent pair of edits made this change:

"Individuals with AS may collect volumes of detailed information on a relatively narrow topic such as dinosaurs or members of Congress a famous fictional character, without necessarily having genuine understanding of the broader topic."

with the edit summaries 'change "members of Congress" to "fashionable fictional characters" - this is the exact wording in the second source, and less US-centric' and 'changed "fashionable fictional characters" to "a famous finctional character" -- prior is too vague and confusing to possible readers; do agree on the change away from Congress'.

These changes depart from what is said by the cited source, Klin 2006 (PMID 16791390). It gives "members of congress" as an explicit example of "extraordinary amounts of factual information are learned about very circumscribed topics ... without a genuine understanding of the broader phenomena involved". In contrast, it gives "fashionable fictional characters" as an example of "strong interests ... [that] are ubiquitous" among both children with AS and neurotypical children. I've therefore reverted the change; we need to stick pretty closely to what the sources say. Eubulides (talk) 07:23, 23 November 2009 (UTC)

I agree with what you say. That would also suggest that "dinosaurs" needs to go as well for the same reason (to be replaced with snakes/names of stars e.t.c.)? Now for the reason I made that change: I was reading through the article I saw the "such as dinosaurs or members of Congress" line, and thought it was a little imperfect as it was perhaps too US-centric (just as "dinosaurs or members of parliament" might be a bit too specific), so decided to look at the source. Obviously I have no access to the first source, but the second source was online. When I read the second source given for that sentence, I saw the following text: "[...] such as dinosaurs or fashionable fictional characters" and just assumed that someone had changed our article over time. Also giving me that assumption was that I seemed to remember the bit about members of Congress not being in the article the last time I read it (which was a long time ago). (Skip to my final paragraph for those who aren't interested in a history of the section)

Indeed, a line similar to the line in question has been in the article ever since this series of edits by SandyGeorgia in August 2007. Back then it read as follows:

Individuals with AS may intensely amass encyclopedic volumes of detailed information on unusual topics of circumscribed interest that are typically unusual in degree or content. While many children have developmentally appropriate interests in topics such as dinosaurs or trains, a child with AS may be interested in transistors, subway tokens, deep fat fryers, or members of congress [...] Because topics such as dinosaurs and fictional characters often capture the interest of children, this symptom may go unrecognized, and may not be apparent until the interests become more unusual and focused over time.

In early September of the same year the opening sentence of that quote was changed by Zeraeph to "Individuals with AS may amass volumes of detailed information on their topics of special interest.". Later on that same month this was changed by your good self to read:

Individuals with AS may amass volumes of detailed information on a relatively narrow topic such as dinosaurs or deep fat fryers, without necessarily having genuine understanding of the broader topic. For example, a child might memorize camera model numbers while caring little about photography. [...] Because topics such as dinosaurs often capture the interest of children, this symptom may go unrecognized, and may not be apparent until the interests become more unusual and focused over time.

I think this is likely where the first bits of confusion came in as, like you say, this section then contradicted itself and the source in some way. It stayed mostly in this form for close to two years. In June 2009 it read:

Individuals with AS may collect volumes of detailed information on a relatively narrow topic such as dinosaurs, trains or deep fat fryers, without necessarily having genuine understanding of the broader topic. For example, a child might memorize camera model numbers while caring little about photography. [...] Although these special interests may change from time to time, they typically become more unusual and narrowly focused, and often dominate social interaction so much that the entire family may become immersed. Because narrow topics often capture the interest of children, this symptom may go unrecognized.

It was only at this point, on the 27th of June that the members of Congress line was inserted, replacing "trains or TV guides" (TV guides being a replacement for deep fat fryers added in the previous edit) with "members of congress".

Anyway. To summarise, I agree with your point completely, and I suggest that the bit about dinosaurs should also be removed for the reason you present above. However, I still feel that the bit about members of Congress is perhaps a bit too US-specific (is "personal information on members of congress" a good example of AS children all over the world, or is that merely an example used by the author due to the study being based in the US? I'd suggest the latter). With that in mind, there are six specific examples given in the paper: "snakes, names of stars, TV guides, deep fat fryers, weather information, personal information on members of congress". Obviously dinosaurs and fictional characters aren't included there like you say, but could we perhaps choose something more globally applicable? Names of stars would be a good example of a very specific interest, and for a second example perhaps snakes or weather information? Dreaded Walrus ^{t c} 09:28, 23 November 2009 (UTC)

Yes, that sounds reasonable, and thanks for catching the error about dinosaurs. I replaced the examples with "weather data or star names". Eubulides (talk) 07:02, 24 November 2009 (UTC)

Intense Narrow Interests

I've been struggling to accept this to be a valid "symptom" of AS since I first heard about it. The reason being is that it does seem to imply that the only people in the world with an intense, narrow interest in anything are people with Aspergers, which is plainly ridiculous. In my own personal experience, I've found that the capacity to have an intense interest in something is usually linked to intelligence, rather than any kind of disorder. What I do believe is indicative of Aspergers is the tendency to ensure that everything revolves around or is somehow related to their specific interest. For instance, in a conversation about work, an Aspergers participant might only contribute by talking about their interest in, lets say, the weapons of the 16th century British Army; so that if someone mentions how a flexible contract is a "double edged sword", the individual with Aspergers will chime in with a factoid about swords. I don't think it's at all abnormal to have an intense interest in something, what I do think is abnormal is the way in which people with Aspergers are so intensely focused on it, to the exclusion of all other matters, and have an overwhelming desire to express and relate that interest to everyone around them. I realise that you need reliable sources to support this, and that this is mostly my opinion, but I was hoping that someone here might see that this is more of a wording issue, and that with a little bit of digging we might be able to come up with something that supports this distinction. ▫Bad▫harlick♠ 19:53, 25 November 2009 (UTC)

The article does not currently use the phrase "intense narrow interests" so I don't see a problem. If there is a problem, could you please propose a specific wording change? Eubulides (talk) 20:01, 25 November 2009 (UTC)

I agree with the statement-- the focus can be incredibly unhealthy at times. For me, at least, I have only 3-4 things I'm "interested in" doing for fun and under that perhaps 1-2 under each of those as extreme interest. So, I suppose I'm saying that focus on interest of topics is narrowed significantly and ends at a very bright top. Unfortunately that's the sort of thing that finding sources on would be very difficult. It's the sort of thing that's almost impossible to test or be "certain" about. Trying to judge interest, high interest and obsessive and detailed interest can be hard. If the hyper-intense focus is on a particular person, that's arguably one (if not the only) potentially "dangerous" possibility of AS. Does yank at the body in unpleasant ways. There are a lot of really ridiculous things I've done that I now realize in hindsight weren't actually me doing what I thought I should do but was just going with it anyway since could always justify staying, no matter what other responsibilities I had tthen. A mostly harmless example would be when there is a notable Atlantic hurricane with aircraft patrols in it where I'll sit and stare at what's literally a raw line of numbers being spat out across the screen which is the incoming data from the plane given in real-time online. This is in a numerical format before decoded for reading, I mean. Since I don't want to miss even a 0.0001" of pressure drop I have to keep looking. Sure, I enjoy all things weather-related, but that one example and an equivalent for Tornadoes are things I openly admit I go a bit far with. The hyper-detailed interests are only amplified and extremely discouraging since there's scant another person on the planet to talk to about what they might want to on the same level they think of it. ♪ daTheisen(talk) 07:35, 26 November 2009 (UTC)

"The reason being is that it does seem to imply that the only people in the world with an intense, narrow interest in anything are people with Aspergers." (quoted from original poster) This is, in my experience, an unfortunate inference that many make about not just this symptom of AS, but all symptoms of AS. IMHO, too many people make the blanket assumption that because "this" or "that" is a symptom, this means that if one has the symptom one necessarily has AS. This simply isn't true, and I have seen NO evidence that anyone says it is. Impossible to prove a negative however. There are lists of possible symptoms of AS. Having one symptom does NOT mean one has AS. Also, the absence of a symptom does not mean one doesn't have it. There are several different systems for analysis of criteria. Some require a minimum number of symptoms before reaching a diagnosis, and not all agree on how many. I have never seen any evidence that anyone claims that narrow interests alone is a sign of AS, or that imply that only those with AS have abnormally narrow interests. I'm not surprised however, that issue is mentioned here. I have personally encountered Psychologists, Psychiatrists, and Pediatricians that have made the same mistake, quickly dismissing the presence of AS based on the absence of a single symptom. I have never seen any evidence whatsoever that the criteria of any system of diagnosis precludes AS on the basis of a single missing symptom, or that stipulates that any single symptom is an indicator. I see nothing in the Restricted and repetitive interests and behavior section of the article that indicates "Narrow Interests" alone as an indicator of AS, nor do I see anything in the section indicating that the symptom only applies to AS.--SentientParadox (talk) 17:07, 26 November 2009 (UTC)

Characteristics/Other: Perceptions

In the above subsection it says, "These include differences in perception and problems with motor skills, sleep, and emotions." Right after that, in the first sentence of the following paragraph, it also states, "Individuals with AS often have excellent auditory and visual perception." This might seem somewhat contradictory being that many may make a connection between "perception" in the first paragraph and depth perception as it applies to vision. I would think it may be better to specify that the perception referred to in the first sentence is more about mental perception, or maybe more accurately, how one with AS perceives life and the Universe in general as opposed to neurotypical individuals. That being such a commonly misunderstood aspect of Asperger's, I think it's important to be extremely clear what is meant by "perception." The paragraph lacks citations too, which would be good to add.

BTW: I will be more than happy to contribute more in the way of research myself fairly soon, when my own workload lightens up a bit. Also need to build up editing status before I can actually help edit this particular article. I do want to be sure nobody thinks I'm only here to criticize. I do have a very strong interest in AS, and plan to help out when and where I can. --SentientParadox (talk) 23:20, 26 November 2009 (UTC)

The two sentences are not condtradictory: the "perception" in the 1st sentence refers to the same thing that the "perception" in the 2nd sentence refers to. I don't see how a reader could conclude "depth perception" from the text, as the text doesn't mention depth perception. The first sentence is saying that there are differences in perception, not that every aspect of perception differs. If you can suggest wording that would make that clearer, please do. I added a source to support the 1st sentence in that paragraph; the second sentence is merely a structural one that summarizes the section. Eubulides (talk) 02:23, 27 November 2009 (UTC)

Alternative Terms

I think it should be noted this condition is colloquially referred to as ASS-BURGERS syndrome