Is Anorexia the Female Asperger's?

Parent Cafe
1

<p>Interesting research coming out of the UK. </p>

<p>

</p>

<p><a href=“The Times & The Sunday Times: breaking news & today's latest headlines”>The Times & The Sunday Times: breaking news & today's latest headlines;

2

<p>I’m really not sure what that article is saying about anorexia, but I can add from my own experience that eating disorders among teenage girls appear to be contagious. At first I thought OCD caused anorexia, and I still think that OCD is the origin when there is an epidemic of it. When you put an OCD/anorectic girl around other teenage girls, the anorexia appears to be contagious. Its scarey to watch as it evolves.</p>

3

<p>I’m not sure about the anorexia part of it, but I have seen difficulties with set-shifting–moving from one task to another–or easily moving from one strategy to another.</p>

<p>I’ve never thought about easy ‘set shifting’ as a crucial developmentaL skill–a skill along the lines of reading facial cues–but this article made me think that easy set-shifting is a crucial developmental skill, one that parents should strongly address. </p>

<p>I’d never thought about the follow-on implications of letting the natural tendancy run it’s course–but now I can see how the patterns add up to some damaging behavior.</p>

4

<p>Autism is a topic that is very personal to me since several family members are both diagnosed and undiagnosed. But I am not an expert in this area. And know next to nothing about anorexia nervosa. Still, this article triggered some very negative reactions in me. </p>

<p>Autism spectrum disorder is still a relatively new and far from understood concept. Initially, it was considered to be a spectrum because the degree of the symptoms varied so much, one was a little autistic, a lot autistic or somewhere in between. Now, as we continue to redefine our definitions of normal and abnormal brain development, ASD is becoming an umbrella for more and more outwardly dissimilar conditions. </p>

<p>Perhaps not surprisingly, the British (Uta Frith of University College London) also came up with the theory of weak central coherence to explain autism (which is but one of several prevailing theories on the cognitive deficits that define autism – all of which are no doubt equally valid and none of which are universally accepted; others include theory of mind, executive dysfunction, empathizing/systemizing), so it is perhaps not surprising that this theory continues to shape their research. It is concerning to me that ANY disorder that involves a cognitive deficit such as weak central coherence should automatically be part of the autism spectrum merely because of this similarity – as if the sole definition of autism is this one feature and this one feature is only a feature of autism and nothing else. </p>

<p>Autism/autism spectrum disorders are on the rise at an alarming rate. I do find it interesting that wheras the current incidence of autism spectrum disorders in the US is 1/150, it is 1/100 in the UK. (Only a few years ago, it was 1/166 in the US and just a decade or so ago it was 1 in 10,000!) Clearly, how we choose to define this disorder determines its incidence rates. Will it soon become so black and white that either one is normal or one is autistic solely because of the presence of ANY neurocognitive deficit (ie a brain deficit that one is born with as opposed to later brain injury)? Should we also categorize individuals with any form of OCD or mood disorder as autistic as well just because they also show signs of “weak central coherence”? To broaden the spectrum as widely as seems to be the current trend is a disservice to all individuals who are now or in the future will be diagnosed with ASD since the both the symptoms and necessary treatments are very dissimilar among these individuals. Of course, we should study the similarities between all of these disorders, and hopefully we can learn from them and apply similar treatments but that does not mean that we should treat them as the same. And ironically, to me at least, this trend in diagnosing seems to be symptomatic of autism itself – as Frith would say, not being able to “see the woods for the trees” (getting stuck on some of the specific details and losing sight of the big picture). </p>

<p>One of the issues brought up in the article, more in passing than anything else, is the possibility of social or cultural triggers of anorexia nervosa. </p>

<p>

</p>

<p>Even though there may be genetic factors and cognitive deficits at play in individuals who develop anorexia nervosa, and the OCD piece may also play a huge role in earlier treatment and PREVENTION of AN, I feel that it is equally important that we continue to study social or cultural triggers since this seems to be the biggest distinguishing factor between AN and ASD; as far as I know, even though research in autism has included looking at environmental factors, there are currently NO hypotheses of social or cultural “triggers” for autism/ASD (the days of “refrigerator mothers” are thankfully gone!).</p>

5

<p>The set shifting difficulty – that’s really interesting – I think I recognize that one in several members of my family. It seems a stretch to make a connection to Asperger’s or eating disorders in particular even if it is a shared trait, but I could see a relation to mental health issues in general, perhaps. Certainly the inability to be flexible or adaptable to change causes problems, particularly in our present culture which seems to me to demand that ability.</p>

6

<p>I apologize, cheers, that I haven’t yet had a chance to read the whole article. But I thought I’d chime in and try to explain the “set shifting” thing. However-- warning-- this may be too clinical sounding and boring. </p>

<p>As scansmom mentioned in her post, there are a lot of overlapping symptoms in different disorders. “Set-shifting” is an aspect of executive (frontal lobe)functioning. This involves organization, planning, problem-solving, cognitive flexibility, abstract thinking, staying on task in the face of interference,and, in the case of “set-shifting”, being able to change gears if you are cognitively “stuck”. I like to compare it to the ability to think of another way home if you are stuck in traffic. People with lots of different disorders (Obsessive-compulsive and other anxiety disorders, Aspergers Syndrome, Autism Spectrum disorders, etc.), can get overly focused on something and have trouble letting go and moving onto something else. Personally, I see anoresia and other eating disorders as part of the anxiety disorder spectrum (as is OCD). The overfocus on food, weight, control, etc is partt of their ruminative thinking. This is clinically different form the overfocused narrow interests of Autism spectrum or Aspergers folks.</p>

<p>OK, to all of you who I have bored to tears… you can wake up now.</p>

7

<p>It is interesting to me - can you explain how set-shifting ability is assessed?</p>

8

<p>Motheroftwo-
It is done as part of a neuropsychological evaluation.</p>

9

<p>Jym - I know it is done as part of such an evaluation but I was curious as to what the actual test assessing set-shifting consists of.</p>

10

<p>I found a couple of examples on wikipedia of some psych. tests used to test executive function deficits (often the easiest way to locate general info on different topics even if not the most reliable): The Wisconsin Card Sorting Test and the Hayling and Brixton tests (although there are several others)</p>

<p><a href=“http://en.wikipedia.org/wiki/Wisconsin_card_sort[/url]”>http://en.wikipedia.org/wiki/Wisconsin_card_sort&lt;/a&gt;&lt;/p&gt;

<p><a href=“http://en.wikipedia.org/wiki/Hayling_and_Brixton_tests[/url]”>http://en.wikipedia.org/wiki/Hayling_and_Brixton_tests&lt;/a&gt;&lt;/p&gt;

<p>Earlier, I came across some references to a study done on set shifting that suggests that this deficit is actually more common in high functioning autism than in Asperger’s Syndrome (I do not have a link but here is one journal cite: “A Deficit in Shifting Attention Present in High-Functioning Autism but Not Asperger’s Disorder.” Nicole J. Rinehart, et al., Autism: The International Journal of Research and Practice, v5 n1 p67-80, Mar 2001).</p>

<p>I also found a study published in 2006 (which also cites to Rinehart) that examines executive function deficits in individuals with autism/ASD, ADHD and an IQ-matched control group (which used the WCST or variations of it). To their surprise, they found less EF deficits in the ASD group (which they noted consisted primarily of individuals with Aspergers) than the ADHD group. These studies illustrate the wide variation that can exist even among the same type of cognitive deficit. The 2006 study concluded:</p>

<p>

</p>

<p><a href=“http://www.elsevier.com/authored_subject_sections/S05/S05_360/pdf/top2.pdf[/url]”>http://www.elsevier.com/authored_subject_sections/S05/S05_360/pdf/top2.pdf&lt;/a&gt;&lt;/p&gt;

<p>This conclusion that executive function problems become less noticeable with age tends to match up more with my personal experiences with Asperger’s.</p>

11

<p>There are many different tests that can be used, depending on the age, and the specifics of the referral question. It is a bit of a shame that some of the tests are available to be seen on the internet, as it ruins the intergrity of the tests.</p>

12

<p>Herein lies my conflict with overpathologizing.</p>

<p>We are too often conflating disorders and disabilities, based on overlapping or comorbid symptoms, and often misdiagnosing, as a result. There are ramifications to overpathologizing and over or misdiagnosing, make no doubt about it.</p>

<p>And contrary to the poster above, most people I know seem to see some worsening of executive function issues as we age. Personally, I feel like I have become quite a bit more inattentive and unfocused as a middle aged adult, much more than I ever was in my younger years.</p>

<p>I also, of course, agree with Jym about the ethical issues with information about psychological tests being available on the internet.</p>

13

<p>

</p>

<p>Interesting comment, since I always thought that researchers intentionally went into great detail describing their test methods when they write up their research papers, in order to ESTABLISH the integrity of their work (See, eg, link to study above, not that I really expected anybody to actually read it). I certainly learned more about these tests from that study than from the very general info in the wikipedia articles. Or is it the availability of these studies to lay people that you object to? </p>

<p>Allmusic, are you autistic as well? Just to clarify, I was only speaking about my experiences with Asperger’s Syndrome and autism and this has been mostly with younger children and young adults (very few adults have actually been diagnosed with Asperger’s Syndrome since it was not even an official diagnosis until the mid-90s). At any rate, I certainly was not attempting to suggest anything about declining cognitive abilities that occur in normal adults as a result of aging. Oh, and perhaps you need to find more cognitively stimulating activities to revitalize your neural pathways and slow down the cognitive declines that will otherwise occur? A personal favorite of mine is doing sudoku puzzles. ;)</p>

14

<p>Research papers are written for professionals in the field, and published in journals that are read, almost exclusively, by those professionals, or those in related fields. They are not written for, or always made available, to the lay public. Non-professionals who read professional journals, particularly before the information age made such information more readily available, are/were a self-selecting group. Often times one can only read an abstract of a study or journal article on-line, not the entire article.</p>

<p>This is very different from what is provided ( usually not by professionals) on Wikipedia, which is written for people ■■■■■■■■ for information on the internet (not calling you a ■■■■■, there, Scansmom). Often such information on the internet is just plain wrong, which is one reason that doctors encourage their patients not to diagnose themselves by a set of symptoms they read on a website. <disclaimer: i=“” have=“” not=“” read=“” wikipedia’s=“” entries=“” in=“” the=“” above=“” areas,=“” so=“” am=“” commenting=“” specifically=“” on=“” their=“” validity,=“” or=“”></disclaimer:></p>

<p>There is a reason that test data should not be available for general perusal on the internet. The APA, for example, under whose domain neuropsychological tests fall, has strict rules and guidelines about release or disclosure of test data, as it compromises the validity of the test. </p>

<p>

</p>

<p>Finally, while glibly questioning whether I am autistic, and suggesting that I do Sodoku puzzles to beef up my skills, is very cute (although doing cognitively stimulating tasks is certainly a great recommendation to slow down cognitive loss), be careful not to equate cognitive deline with all executive function deficits. Memory decline will affect executive function, without question, but there are discrete executive function processes that are separate from memory, both in aging patients and in children.</p>

<p>Part of the difficulty in interpreting relations among executive tasks (and their changes with age) can be traced to the more basic question of whether executive control reflects a single, unified ability or a family of distinct abilities. That’s what I was saying above: that there are multiple processes, not single processes, which are being lumped together, often to the detriment of both various neurocognitive disorders and patients.</p>

15

<p>There is a big problem with the Eating disorder = Asperger discussion which no one has brought up.</p>

<p>The CORE deficits in Autism (Asperger) are Central Coherence, Executive Functions AND (most importantly) lack of Theory of Mind. The diagnosis of an Autism disorder cannot be made without the social cognitive elements. The other theories explain other related patterns, but they do not explain them all.</p>

<p>To the best of my knowledge kids with Eating Disoders first and foremost have distorted senses of themselves. Theory of Mind (the appreciation that there is a person opposite you who has a mind and thinking of their own) is not a core deficit of EAting Disorders.</p>

<p>Autism isn’t everything and everything isn’t autism- or even related to it.</p>

<p>Executive dysfunction is also a core element of ADHD-- where it is, in fact the core neurocognitive pattern. Why no comparison to ADHD (kids with ADHD can also develop OCD and other anxiety patterns)? Because ADHD is no longer flavor of the month.</p>

16

<p>This link was posted recently- What Autistic Girls are made of - NYT 8/5/07</p>

<p>

</p>

17

<p>Well said, allmusic and anitaw!
In fact, funny you should mention ADHD as an executive dysfunction issue, anita. I had originally included that very issue in my post #6, but chose to delete it as I feared it would take the conversation in a different direction (ie talking about the different subcategories of ADHD, including the sluggish tempo subtype). As you probably know, Russell Barkley and others in the field of ADHD research and treatment had participated in a discussion of changing the term “ADHD” to “Dysexecutive Disorder” in the latest version of the DSM (Diagnostic and Statistical Manual), but if the term “ADHD” got changed yet again, many of the kids would no longer qualify for services under federal guidelines (because the term “ADHD” is used in federal guidelines for IDEA , Sect 504 and other educational regulations), so they had to do away with that idea.</p>

<p>Bottom line, as both anita and Allmusic stated so well, there are a lot of overlapping symptoms with very different etiologies. Both a person with anxiety and a person with ADHD- inattentive type can be internally distractible, but for different reasons. While many kids diagnosed with Aspergers meet criteria for a diagnosis for Nonverbal Learning Disabilities, certainly not all NLD kids have Aspergers.</p>

18

<p>Far from bored here. I’ve enjoyed reading the informed responses.</p>

19

<p>I know a child (teenage boy around 14) who has Aspergers and also an eating disorder. His eating disorder stems from an obsession with checking labels for fat content and he avoids anything with fat.</p>

20

<p>Going a little off-track here - and not to show that I am a ■■■■■ (lol!) but to try to re-emphasize my initial comments with a few examples.</p>

<p>As anitaw noted: “The diagnosis of an Autism disorder cannot be made without the social cognitive elements. The other theories explain other related patterns, but they do not explain them all.”</p>

<p>I agree that it is the social characteristics of autism that distinguish it from other disorders. However, even though it is understood that ASD is neurological, a diagnosis of ASD, and in particular, of Asperger’s Syndrome, does not rely on identifying a specific cognitive deficit, and in fact, this can be difficult to do if the diagnosis is done at an early age - which is when it would be the most beneficial as far as long-term treatment is concerned.</p>

<p>As I have said before, my big concern is that by comparing disorders based on similarities in cognitive deficits, we lose sight of the very real symptoms and behaviors that characterize Asperger’s Syndrome to begin with, because we automatically begin to define those characteristics in terms of deficiencies rather than what they are - qualitative behaviors that have been observed in the context of a specific society or social environment. This, in turn, detracts from the goals we should be focusing on with respect to treatment of Asperger’s - and not just treatment provided to the individual but the way in which the individual is treated by society. Many individuals with AS and researchers of AS would even argue that AS is not really a deficiency/disability/disorder but rather, a difference in cognitive learning styles:</p>

<p>Simon Baron-Cohen:</p>

<p>

</p>

<p><a href=“Yahoo | Mail, Weather, Search, Politics, News, Finance, Sports & Videos”>Yahoo | Mail, Weather, Search, Politics, News, Finance, Sports & Videos; (a link to this article can also be found on the O.A.S.I.S. website - an autism resource I would HIGHLY recommend for anyone interested in autism, especially parents)</p>

<p>In his article, Baron-Cohen lists several characteristics of autistic/AS individuals and notes:</p>

<p>

</p>

<p>And as Temple Grandin said:</p>

<p>

</p>

<p>from the book, Unwritten Rules of Social Relationships, by Temple Grandin and Sean Barron (2005)</p>

<p>[and, yeah, I realize this is something of a personal soapbox, but I honestly don’t think that is the same as “■■■■■■■■” LOL!]</p>