Outcome of Asperger’s Syndrome

To the Editor: The study by Peter Szatmari, M.D., et al. (1) is a laudable endeavor. Although the authors found no data on the outcome of children with Asperger’s syndrome, Asperger, as cited by Wing (2), emphasized the stability of the clinical picture throughout childhood and adolescence and at least into early adult life, with maturation bringing about an increase in skill level. This study thus confirms, in part, the original observation. Still, there is a paucity of information on the outcome of this disorder in late life.

Another aspect relevant to outcome in Asperger’s syndrome is its psychiatric comorbidity. Comorbid disorders are increasingly being recognized in patients with Asperger’s syndrome (3). It would be interesting to know how comorbidity modifies the course and prognosis of Asperger’s syndrome. We have observed patients with Asperger’s syndrome developing bipolar disorder in late adolescence and early adulthood and responding well to treatment with mood stabilizers. There is some literature suggesting an etiological link between the two conditions (4).

As is implicit in the article, the DSM-IV criteria for Asperger’s syndrome require a change. Relaxation of the criterion for qualitative impairment in social interaction vis-à-vis autistic disorder and the inclusion of features common in Asperger’s syndrome, such as pragmatically impaired speech and motor clumsiness, can be envisaged.

Another issue worth highlighting is the stability of neuropsychological deficits in Asperger’s syndrome. While using the Luria Nebraska Neuropsychological Battery, we observed impairment in more than one brain region (5). Hence, comprehensive neuropsychological assessment and its correlation with other outcome measures in Asperger’s syndrome are encouraged.