Talk:Asperger syndrome/Archive 16

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Eubulides review of Sept. 6 version

Here's a review of Asperger syndrome, in particular the version of 2007-09-06 04:48:24 UTC. Most of these issues are copyediting-level items that I assume will be addressed in the next major pass, but a few are more-substantial issues. I'll try to put a bold title in front of the substantial issues. Generally speaking, the article has improved enormously in recent days but is currently considerably too long and way too repetitive; I assume this is intended at this point in the editing cycle.

Once you use words like "considerably too long and way too repetitive" I begin to suspect you are playing my tune Eubulides. :o) Can I comment comment thru in italic?

The lead

"AS is distinguished from other ASDs by linguistic and cognitive abilities that are relatively intact, and with average and high IQ score, and high functioning (meaning that most AS people are able to live independently)"

Let's lose the 2nd half of the sentence, starting with "and with average". The 2nd half is unsourced and controversial, to the extent that it is not a consequence of the 1st half. Take, for example, a hypothetical syndrome I'll call the "brown-eyed syndrome", which is characterized by having brown eyes and no significant cognitive delay. On average, people with brown-eyed syndrome have a higher IQ than typical. But this is by definition; once you give the definition, there's little need to spell out the rest in the lead.

I certainly follow you with it not being a consequence of the first half, no way do those two belong in the same sentence. Personally I feel that the normal to high IQ and capacity for independent autonomy may be the single most significant feature of AS and should be clearly stated in the lead, but leaving that aside, a citation is promised. Can we split it into two sentences for now and make the second one make sense?

It is certainly significant that those with AS have no significant cognitive delay and no clinically significant general delay in language. The capacity for independent autonomy is also worth mentioning. I'm not sure I agree that the IQ part should be in the lead, even if we can find a reliable source for it (and I'm not sure we can). IQ is not that important. Other things are more important. Eubulides 22:41, 6 September 2007 (UTC)

Interesting thought worth developing there, would you care to elaborate? If you are leaning towards the rejection of IQ snobbery you MIGHT persuade me on board?

While I agree that the second half of the sentence is dicey and part may be impossible to source ("most AS people are able to live independently" is probably true, but until someone polls most of the world's aspies, it may be unprovable), the nits I'd want to pick are different. What Eubulides says about brown eyed people is, of course, correct: aspies and other high functioning autistics are, by definition, going to have a skewed IQ distribution. I have seen a few studies documenting it, and the lowest average anyone came up with was 106, others were considerably higher. I think that many of us would resist any suggestion of a causal relationship, which is fine, evidence for one is sketchy at best, and researchers rarely get that speculative. Nevertheless, it is part of the definition, just as much as poor social skills are. "Cognitive abilities that are relatively intact," I'm not ecstatic with either. It makes it sound as if autism were categorically destructive of cognitive abilities, but that aspies are less damaged than others, which would be equally speculative. I'm thinking there there should be some middle ground that can be found in that sentence. Poindexter Propellerhead 00:20, 7 September 2007 (UTC)

I suppose anti IQ-snobbery is part of the motivation, but more importantly, "normal or even superior intelligence" is not part of the standard definition. It is not a core feature of AS; it is merely a corollary. The core feature of AS is no significant delay in language development and no cognitive impairment, and that's what ought to be in the lead. Let's put it a different way: mental retardation is associated with autism, but Autism does not mention mental retardation or IQ in its lead, because comorbid conditions like that aren't important enough to make the cut. There are too many other important things to summarize. And this is even though mental retardation is far more important a comorbid condition for autism than higher-than-average IQ is for AS. Given all this, it is pretty weird that Asperger syndrome spends puts IQ in its lead (and not merely in the lead, but in the lead's 2nd sentence). Eubulides 17:16, 7 September 2007 (UTC)

As I put it there, I'm happy to discuss my thinking. In the introduction I tried to move away from a strict diagnostic interpretation, but rather tried to give a broad overview of the subject. My thought was if I was a mother who suspects her child was an aspie, what infomation would I want? AS is a label, associated with autism. Intellegence is a question anybody new to the subject asks about, and I think it important that it be answered early. I think it notable that every introductionary leaflet I have read on the subject mentions intellegence. Indeed the precise term I used, "normal, or even superior intellegence" was taken directly from the source for that sentance. Deliberately so, so the reference can stand against any POV or OR arguments. The placing of the reference in the second sentence was more based on where it would fit in terms of the structure of the lead, rather than any sort of priority. If Eubulides feels there are other things that should be summarised in the lead that are not there currently, I'd be greatful if he/she would list them. --Michael Johnson 22:36, 7 September 2007 (UTC)

I disagree that intelligence is emphasized so prominently in every introduction to Asperger's. The NINDS fact sheet doesn't mention intelligence (other than as a historical note that Asperger himself observed "normal intelligence"). DSM-IV doesn't mention intelligence. The abstract of Klin's review doesn't mention intelligence. ICD-10 doesn't mention intelligence. Blacher et al. doesn't mention intelligence. That exhausts the list of all the freely available references in the first dozen references of Asperger syndrome, except for Brasic (the reference you mentioned). I was already unhappy with Brasic on other grounds (I don't think it is a high quality reference compared to Klin or McPartland, for example), and now you've give me another reason to dislike it. But anyway, Brasic by itself is a weak argument for mentioning intelligence in the lead, considering that it's the only one of the many main references to do so. As for other topics, the lead is already waaay too long: we should be throwing things out of it, not adding them. Eubulides 23:10, 7 September 2007 (UTC)

I was referring to general information and books I have read, and not the references you have given. But in any case that was not my primary motive for including it. Netherless you are welcome to edit it of course, or wait to see if any other editors wish to comment. As for the length, it does not seem to be excessive in comparison with other featured articles I am familiar with, for instance Evolution and Intelligent Design. It is certainly no longer than recent versions. But once again you are welcome to edit it. --Michael Johnson 00:33, 8 September 2007 (UTC)

Just one further note, I didn't choose any of the references, I simply used those that were in the version that SandyGeorge set up for me in her sandbox. I really have no comment on their validity one way or another, except to say they obviously had the support of previous editors. --Michael Johnson 00:44, 8 September 2007 (UTC)

As a result of further editing I have removed references to Brasic. To some extent Brasic is an encyclopedia entry and is therefore not a preferred source for Wikipedia anyway. Eubulides 20:47, 19 September 2007 (UTC)

I DO think that stressing that AS is combined with average and above average is important. It is a vital factor in beginning to grasp the real Aspie profile. Think about it, have you ever MET an Aspie who was intellectually subnormal? Of course not, and YET, in terms of services, provisions and categorisations we tend to get lumped in with people who are intellectually and educationally subnormal, which completely distorts the perception of the wqhole condition and those it is bestowed upon.The biggest disability a large proportion of us have is that we are so intelligent and intellectual we get percieved as "alien" from the get go, by everybody, meanwhile our other difficulties often prevent us from academic achievement commensurate with our intellect. While I think of it, the fact that most of us need to be taught and allowed to learn in a different way to the norm to achieve our potential MUST have some sources somewhere...and it is significant...to the article, though not necessarily to the lead. --Zeraeph 19:24, 9 September 2007 (UTC)

The number of Aspies I have met is irrelevant; what counts is what the reliable sources say. The current lead does say that those with AS have "general delay in language or cognitive development", which communicates the basic idea and is much better supported than the removed claim about "normal or even superior intelligence" being a characteristic. I do not agree that greater intelligence is the biggest disability for a large fraction of those with AS; that claim is not supported by reliable sources. The issue about different ways of learning is a different issue, one that is already alluded to in the lead's sentence about shift in attitudes. Perhaps the allusion could be made clearer, but even there there's no need for unsourced and not-that-relevant claims about IQ there. IQ is not that an important part of what makes those with AS different from neurotypicals. Eubulides 21:39, 9 September 2007 (UTC)

Yes but it IS a vital part of what makes those with AS different from the misconceptions of Neurotypicals...which might be of some passing importance. --Zeraeph 22:31, 9 September 2007 (UTC)

The main goal of Asperger syndrome's lead is not to fight misconceptions by neurotypicals; it is to describe AS clearly, reliably, and succinctly. Problems due to misconceptions can be documented by reliable sources and addressed in the proper place. Eubulides 22:47, 9 September 2007 (UTC)

The 3rd paragraph of the lead ("The diagnosis of AS is complicated...") is way too repetitive. Its 1st and 3rd sentences could be removed without harming the lead.

Definately agree there!

Classification

This section does not mention the broader autism phenotype, which is important to the question of the classification of AS. Conversely, it spends way too much time on AS versus HFA. That issue should be covered in one paragraph, not three, and the details pushed down into Diagnosis of Asperger syndrome.

Personally I don't think so much time needs be spent on explaining PDDs either, "Asperger syndrome is one of the five pervasive developmental- (PDD) or autism spectrum disorders (ASD), which are characterized by widespread abnormalities of social interaction and communication, restricted interests and repetitive behavior.[7] " and a main article link to PDDs should be ample. Then cut back the AS/HFA stuff.

While we're on the subject, I don't see the need for two articles on the subject: why can't Diagnosis of Asperger syndrome be merged with Controversies about functioning labels in the autism spectrum? It's essentially the same topic.

No, Sandy was right, it is very necessary to have the Diagnosis of Asperger syndrome article, not least because it is about (or was, last time I checked) the diagnosis and diagnostic schema, and entirely different topic to Controversies about functioning labels in the autism spectrum...It should be the opposite if anything, there shouldn't be any element of controversy in it.

Perhaps one can be the controversy page for the other, much as Vaccine controversy is the controversy page for Vaccine. But the two pages are essentially on the same topic, even if one attempts to be noncontroversial, and if they are kept distinct then the good stuff from one should be migrated to the other and vice versa. Eubulides 22:47, 6 September 2007 (UTC)

To my mind the entire purpose of the Diagnosis of Asperger syndrome article is to describe the nature and process of diagnosis of AS fully, whether good, bad or indifferent. Think of it as a cake recipe...it just tells you how the cake is made, not how good it tastes, or how many calories it has, or whether it is a good or a bad thing.

Szatmari's name is dropped here unnecessarily; the text should be rewritten to avoid the namedropping. The article should concentrate on ideas, not personalities.

I think dropping Satzmari is an obvious part of dropping the belaboring of PDDs, I take it he is mentioned in the PDD article?

It's also part of the more general principle that we should keep researchers' names out of the main text unless the researchers themselves are the subject, which Szatmari is not. This issue is independent of whether he's mentioned in the PDD article (he's not currently mentioned). Eubulides 22:47, 6 September 2007 (UTC)

I don't want to give a blanket agreement, but you seem to have a pretty good grasp of where names should be left out.

OK, I've edited "Classification" along the lines of the above discussion. Further comments welcome. Eubulides 08:14, 11 September 2007 (UTC)

Characteristics

This section drops names too often as well, and also mentions affiliations. It should get rewritten so as not to mention Kasari, UCLA, Yale, McPartland, etc. There is too much repetition here about speech and other issues; the text needs to be rewritten to summarize each issue once rather than repeating them.

The section's lead is too long; most of this stuff should be moved into subsections.

Well we could discuss THAT all night without covering it all and I suspect we would agree on most of it, so let's start working towards that?

I have started working on it by making this change to the lead for this section. This change moves much of the repetitive material into subsections, where it can be trimmed later. I did remove yet another reference to the HFA vs AS diagnostic problem; it doesn't need to be repeated here. Eubulides 17:14, 11 September 2007 (UTC)

That seems fine up to the point of writing.--Zeraeph 17:51, 11 September 2007 (UTC)

Social interaction

The first paragraph is poorly worded and I first interpreted it to claim that people with AS have less empathy than people with HFA. Please try to avoid phrases like "confirmed in a controlled study" unless they're really needed (which they aren't here); people can find out that kind of detail by following the references.

The emotional-attachment sentence at the end of the 2nd parpgraph (citing Attwood twice) made little sense to me. Perhaps it should be removed since it seems pretty wishy-washy.

I liked the last paragraph; I thought it read well and made good points.

No major dissention, except I think the last paragraph could flow better too, maybe?

I made these changes to improve the section and remove some repetition. I hope the flow in the last paragraph is better now. Further suggestions welcome. Eubulides 18:50, 11 September 2007 (UTC)

Repetitive behaviors and restricted interests

"Typically unusual"? And that sentence says "unusual" too much.

I thought I had got rid of "Typically unusual"? Well I have now, that half of the sentence made no real sense. Let's have a fuller "unusual" purge some time soon?

I disagree that interest in (say) "members of congress" is a distinguishing feature of children with AS. Neurotypical children often develop interests in topics that most adults would find obscure or trivial. The key notion here is the intensity of preoccupation and the lack of common-sense understanding, not the particular subject matter.

EXACTLY...and of course, anecdotally, trains and dinosaurs regularly wipe the board as AS "special interests" so the wording is misleading, I think we need to work on that section in a serious way

I disagree that preoccupation is typically "at the expense of their developing typical peer relationships". Peer relationship problems typically come from the social-interaction feature of Asperger, not from crowding out by preoccupation. I couldn't find this phrase in the cited sources, but perhaps I didn't search for it correctly. Anyway, I suggest removing or rewording it.

No argument here...I wanted to do that days ago but flu to bad and head not work.

"tics and stims". The word "stim" here is out of place: it refers to a particular theory for stereotypy that may or may not apply. Is it really supported by the citation? (I don't have access to the first one.) If so, you might want to look at that citation a bit more skeptically.

"Tics" may be well out of place too, let's really work that part over and see how it winds up?

There is a dangling reference to a "RapinTS" citation.

Let's *undangle* him

OK, this subsection's problems are fixed, I hope, partly by this change. Eubulides 07:57, 12 September 2007 (UTC)

Speech and language

I found this section amusing, since (like much of the rest of the article) it goes on and on, and repeats itself in various ways, on the subject of verbosity and repetition! As usual, I assume much of this will be copyedited away. This particular section is too long by a factor of two, maybe more.

Remove "According to Klin,". The article should focus on AS, not on AS researchers.

The part about "incoherence" and "thought disorder" is over the top. Indication of possible thought disorder is quite rare (Klin says "a very small number of cases") and is not worth emphasizing so much here. I'd remove it.

I'd lose the "Is Paul there?" example. Without further context, it's not much of a distinguishing example between AS and neurotypical behavior.

If only for fun you might also want to see Humor #Evolution and humor and doi:10.1016/j.tics.2005.06.008. Eubulides 05:31, 10 September 2007 (UTC)

I made changes along the lines described above. Eubulides 22:02, 11 September 2007 (UTC)

Other

The 2nd paragraph contains sentences that seem to contradict each other, with no mention of the contradiction. I would trust Rogers & Ozonoff over Brasic in this area.

I think it needs a makeover till the contradictory sources make some kind of sense?

More name-dropping; the article shouldn't have to say "McPartland and Kim" in the main text here. The 3rd paragraph in particular seems too long and speculative.

Totally, that can be dropped without a weasel, or an *immutable law of nature* in sight --Zeraeph 22:05, 6 September 2007 (UTC)

This is as far as I got in my review so far. More later as I have time. Eubulides 20:05, 6 September 2007 (UTC)

I think you mean September 6th. The 9th is on Sunday and hasn't happened yet. Simply south 20:09, 6 September 2007 (UTC)

Thanks, I fixed the section title. Eubulides 22:35, 6 September 2007 (UTC)

Just wanted to applaud Eubulides recent work towards consensual progress ... CeilingCrash 05:45, 7 September 2007 (UTC)

Me too, suddenly this looks like a real discussion about content, and, on this level, it is surprising how many changes we already seem to agree about. (can I whip out all those "unusuals" yet? Or is anyone attached to them?) --Zeraeph 10:46, 7 September 2007 (UTC)

Please do remove all of the references to specific researchers; at some point since the 4th, the text picked up a lot of weasly statements ("it has been found that", etc.) and overattribution to specific researchers. That's as far as I can get. SandyGeorgia (Talk) 02:34, 11 September 2007 (UTC)

OK, I've made a series of edits along the lines suggested above. I retitled the section to "Other symptoms" since "Other" by itself was a bit ambiguous. Eubulides 19:45, 12 September 2007 (UTC)

Diagnosis

The first sentence is terribly unsatisfying. Please summarize the six main criteria rather than tantalize the reader by saying there are six without saying what they are. It is OK to paraphrase DSM-IV so long as the paraphrase is not too close.

In the 2nd paragraph, it is not immediately obvious that the ICD-10 criteria are broader than DSM-IV's. Please reword to make this clearer.

An IDEA...how about summarising the ICD10 criteria then explain how the DSM differs? That way we can be really close to specific text without the APA being subject to the slightest temptation to send persons with baseball bats round to reason with us on an intellectual level. Also remember, AS is essentially a condition with origins and a longer bhistory in the German speaking world, so the DSM is not as relevant as the ICD10 --Zeraeph 03:43, 8 September 2007 (UTC)

This section briefly alludes to screening, but WP:MEDMOS suggests that there be a separate section for screening. More material is needed here. You can steal from Autism #Screening as well as from other sections in Asperger syndrome.

Diagnostic instruments like ADOS should be mentioned. This is bread-and-butter stuff: not exciting, but it should be in there.

Even MORE so in Diagnosis of Asperger syndrome I would have thought?--Zeraeph 03:43, 8 September 2007 (UTC)

Avoid phrases like "is claimed to be". In an article like this, if something needs that kind of disclaimer, then it's probably best omitted.

Omit phrases like "It has been found that".

The trouble is, particularly in the area of diagnosis, there is such a diversy of approach, resources, attitude and opinions that you cannot say "This is so" about so many things without misleading in the "grievous" range.--Zeraeph 03:43, 8 September 2007 (UTC)

"diagnosis is not made on average until the age of 11" cites Foster & King, but they merely cite Wing & Potter for this, perhaps we should cite Wing & Potter here instead?

This section does not say much about differential diagnosis (except for screwups); it should.

Ah but THAT is what Diagnosis of Asperger syndrome is for, expanding on the summary, better to refer to it here and go into it at length in the main article than to bloat the summary by naming conditions?

What is the typical delay between first mention of parental concern to the primary care physician, and official diagnosis? This affects the notion that early intervention is important. If early intervention is a big deal but diagnosis isn't typically until age 11, then how in the world can one intervene early?

The problem of underdiagnosis and overdiagnosis (for nonmedical reasons) should be mentioned. At least, I assume they're both problems; they are in autism.

Perhaps mention any problems or separate features of diagnosis in adulthood?

Now you mention it that IS noticeable in it's absence, isn't it? Here something fun to run down. Anecdotallly (and common sensically) one of the biggest problem in adult diagnosis is that diagnosis often requires the presence and co-operation of a parent or similar, and that many specialists STILL refuse to diagnose without this. Quite apart from the obvious offensiveness of refusing to diagnose an adult unless "mummy comes too" there are other problems. The parents may no longer be living, there may be unhelpful family dynamics, *other*...I wonder, is there any work in this area? Anything we can use? --Zeraeph 03:43, 8 September 2007 (UTC)

Again, there's too much repetition but I assume a later copyedit can fix this. Eubulides 00:24, 8 September 2007 (UTC)

Everything I didn't specifically answer I thoroughly agree with. :o) --Zeraeph 03:43, 8 September 2007 (UTC)

~~It seems there's been some recent repair, but~~ as of a few days ago, Diagnosis was in bad shape. Important information had been deleted (leaving dangling sources throughout the article), and unsourced text had been added. The last reliably sourced version prior to those changes was here. The DSM criteria was dropped in some misunderstanding about paraphrasing from reliable sources, and an unsourced, inaccurate statement that doctors "often" picked up AS was added (I have no idea where that statement came from). In other words, I'm concerned that this section will need a thorough going over. I suggested the daughter article on Diagnosis only because this article was giving undue weight to non-standard diagnostic schemes that really didn't belong here. I am not tied to Diagnosis of Asperger syndrome and agree that controversial aspects can find a better home elsewhere while the relevant information should stay here; there are too many forks in autism articles already. Screening has been lacking here for a long time and a Screening section is needed per WP:MEDMOS. It hasn't been added because some editors object to medical info being added to the article. SandyGeorgia (Talk) 02:30, 11 September 2007 (UTC)

Oops, I see Diagnosis hasn't been completely repaired yet; the unsourced (and as far as I can tell inaccurate) statement is still there: "Signs suggestive of AS are often noted by a general practitioner or pediatrician during a routine developmental check up." I've seen no indication of this anywhere in the sources; the Sept 4 reliably sourced version did not have this text, and it didn't come from the sources mentioned. I don't know where this statement came from. Further, the next sentence is attributed to NIH but sourced to McPartland; that wasn't in the Sept 4 version either. I haven't carefully reviewed other sections, but in Diagnosis, the text has deteriorated from the sourced version; a revert to the last RVS of Sept 4 and a rewrite from there may be the fastest way to repair this section. SandyGeorgia (Talk) 02:48, 11 September 2007 (UTC)

Double oops, struck my comment above about recent repair; I had several windows open and was viewing the Sept 4 version. The description of the DSM criteria hasn't been restored either (it is not a copyvio to paraphrase the main criteria). Diagnosis needs a lot of repair; text can be found in the last sourced version. SandyGeorgia (Talk) 03:01, 11 September 2007 (UTC)

Please get permission from Chad Thompson of the APA for transcription of DSM IV criteria and post it to copyrights before restoring it. Also, you will be finding a lot of text that "does not appear in sources" in future because from now on we will actually be writing the article not paraphrasing it from source material, as you did, any more. --Zeraeph 03:48, 11 September 2007 (UTC)

I disagree on both points. First, we do not need permission from the APA to paraphrase crucial elements of AS criteria. The APA has a copyright on their criteria, not a patent on them. Second, the article needs to stay true to reliable sources; wording should not stray far from what the sources say. Eubulides 05:15, 11 September 2007 (UTC)

First all you need to do is to email cthompson@psych.org and get confirmation of your theory and you can replace the criteria. Second, nobody suggested anything should "stray too far" from reliable sources, just that it should never again skate on the edge of plagiarising them. --Zeraeph 06:00, 11 September 2007 (UTC)

Sorry, we'll just have to disagree on this one. There is neither plagiarism nor copyright violation here, and there is no need to bother cthompson with email. Eubulides 06:26, 11 September 2007 (UTC)

That is only your opinion, not fact. As a matter of FACT I have already mailed cthompson for permission (as is both policy AND the law) to use DSM criteria or transcription on another article and had it absolutely refused, and you are quite correct, there is no longer even a suggestion of plagiarism in the diagnosis section, let's keep it that way? --Zeraeph 06:32, 11 September 2007 (UTC)

We are not talking about transcribing the criteria or making copies of them; we are talking about summarizing them. We do not need permission from cthompson to summarize them. A properly attributed summary is neither plagiarism nor copyright infringement. Eubulides 06:36, 11 September 2007 (UTC)

Unfortunately for you, Chad Thompson and the APA have never, hitherto, shown the least sign of sharing your opinion, and it is THEIR call, not yours. It is them, not me that you must persuade, and if you try to do so (an email costs nothing) you will have my fullest support. I cannot however, in all conscience support you in presenting you incorrect assumptions as fact. --Zeraeph 06:42, 11 September 2007 (UTC)

It is not their call. That is not how copyright law works. We do not need to ask their permission to summarize diagnostic criteria, any more than the editors of Harry Potter and the Philosopher's Stone #Plot needed to ask Rowling's permission to summarize her plot. Copyright protects expression of an idea, not the idea itself. Eubulides 07:09, 11 September 2007 (UTC)

Correct; APA certainly has copyright issues when their content is transcribed directly, but they don't own the rights to paraphrasing summaries of the criteria. This has been discussed before on Wiki; everyone understands we can't include direct copies of DSM, but we can summarize. The e-mail is unnecessary, as this is not a call the APA makes; they don't own a patent on paraphrased words. The content can go in, with no problem. If Z continues to oppose, an outside request for comment may help her understanding of copyright, "plagiarism" and sticking closely to reliable sources, but we need to get this content back for comprehensiveness. SandyGeorgia (Talk) 22:51, 11 September 2007 (UTC)

I've applied this change to address the above issues, except for the "typical delay" issue, which I could not find a reliable source for. I'd like to thank SandyGeorgia for coming up with the first draft of a shorter "Diagnosis" section, which this is derived from. Eubulides 19:55, 13 September 2007 (UTC)

Causes

I would lose most of the mention of specific chromosomes. First, the vast majority of readers won't know what they are and won't care either. Second, the science is still waaay too unsettled in this area; nobody really knows much about chromosomes and AS even if people are publishing papers like crazy about them. Just say that genetics are crucial, that the chromosomes are being studied, and then maybe mention one relatively solid genetics finding as an example.

AMEN TO THAT...that stuff swims in front of my eyes and reforms as chinese script. --Zeraeph 03:47, 8 September 2007 (UTC)

The environmental factors paragraph is too strong; it claims no environmental cause has been confirmed for ASD, but several teratogens such as thalidomide have been associated with ASD; see Causes of autism #Teratogens. The studies aren't large, but they're suggestive, e.g., PMID 10882750. Visit scholar.google.com and search for "teratogen asperger". Eubulides 02:18, 8 September 2007 (UTC)

An interesting idea--Zeraeph 03:47, 8 September 2007 (UTC)

That brings up something that's been weighing on my mind: the distinction between various points on the autism spectrum. An Australian research team wrote a paper on how they wanted to do a study on AS, but couldn't, because they couldn't find enough people with AS to make a decent sampling (they had wanted 60). And I think that's a common problem, you see a lot of studies where they do it on the whole spectrum at once, although if you read the figures that may mean 40 autistics, 20 PDDs, and 4 aspies (I'm not making those numbers up, there is a study I read recently which was very much like that). It's as if you wanted a study on pygmies, but came up with a study on Africans, and most of the sampling were Zulus... you end up concluding that the pygmies are a remarkably tall and warlike people. That makes me VERY leery of taking studies on mixed autism spectrum spectrum subjects and trying to say that the results apply to a subset, particularly to a subset that may have been significantly under-represented in the sampling. It seems like the sort of situation where Jimbo's "zero information is preferred to misleading or false information" might come into play, so I would be a lot more comfortable with avoiding the use of papers like that, absent a very compelling reason to do otherwise. Poindexter Propellerhead 19:14, 8 September 2007 (UTC)

I agree with you in general, but PMID 10882750 started with 57 children exposed to certain teratogens before birth, and found that two of them (3.5%) were diagnosed with AS, well above the typical prevalence rate. It's just one study, as I said, but I'm sure there are others (you can do the search I mentioned…). The evidence certainly could be stronger, but as far as I know nobody seriously disputes the claim that certain teratogens are strongly associated with AS and with other ASD forms. Eubulides 19:32, 8 September 2007 (UTC)

I did go to Google Scholar and PubMed and try that out, what I got was one peer-reviewed study matching "teratogen" and "asperger,"[[1]] which said "Epidemiologic studies indicate that environmental factors such as toxic exposures, teratogens, perinatal insults, and prenatal infections such as rubella and cytomegalovirus account for few cases." I don't think anyone doubts that taking valproic acid during pregnancy can increase the chance of having an autistic kid, but only a tiny percentage of mothers will ever do that. Which didn't make me feel like this is a situation where the lack of clinical studies on teratogens and AS (per se) really must be overlooked. We're short enough on space in this article that my feeling is that we'd probably be best off saving the space we have for things which have a clear relationship to a significant number of AS cases. Poindexter Propellerhead 21:23, 8 September 2007 (UTC)

Odd; I can find other stuff. For example, doi:10.1016/j.reprotox.2004.08.004 says that PMID 10882750 has been followed by other studies and that "Autism and Asperger syndrome have been described in several other children exposed to VPA." The point of mentioning environmental factors is not that a high percentage of AS is caused by teratogens (it's not, at least, not that we know); it's that (1) it does appear to be the case that some cases of AS are caused by environmental factors, and that AS is therefore not purely an genetic condition, and (2) the environmental factors that we know about operate within the first 8 weeks after conception, which is a strong hint about other AS causes and the AS mechanisms. Eubulides 21:56, 8 September 2007 (UTC)

I guess it depends on how one looks at genetics. While valproic acid has never been thought of as a very strong mutagen in the classical sense, the evidence I've seen points to it working by modifying DNA through oxidatative processes.[[2]] So we're still talking genetics as the mechanism, aren't we? Poindexter Propellerhead 22:35, 8 September 2007 (UTC)

You're correct that to some extent this is a definitional issue, but exposure to a chemical after conception is generally considered to be an environmental factor, not a genetic one, even if the chemical operates by causing damage to DNA. See, for example, PMID 16835036, which considers valproic acid to be an environmental factor. I've never seen any reliable source call it a genetic one. Eubulides 00:05, 9 September 2007 (UTC)

Concur with Eubulides; I dropped in as much reliably sourced text as I could from the reviews, and paring it down is welcome as long as needed content isn't lost (as it was last week in Diagnosis). SandyGeorgia (Talk) 02:24, 11 September 2007 (UTC)

OK, I made this change to implement the above suggestions. Eubulides 20:45, 13 September 2007 (UTC)

Mechanism

This section starts off with the phrase "Brain imaging techniques have revealed…" which is a bad way to start an encyclopedia section. The section should start off with a brief summary of the mechanism of AS, as far as it is known. How this knowledge was obtained is secondary. The rest of this paragraph is fine; good job.

The 2nd paragraph is an enormous grab-bag of pieces of mechanism in seemingly random order, referring to many primary studies. Better would be a briefer summary of the major areas of proposed mechanism, and how they're related to each other and to the rest of the article. Readers want to see the big picture here, not a recitation of little results. Not all those results need be cited, surely. Also, in the 2nd paragraph there is no mention of the mirror neuron system (e.g., PMID 15048895) or of the underconnectivity theory (e.g., PMID 16961948). Sorry, these are just random studies; I hope that a review article somewhere talks about this better, but the point is that these theories are fairly popular these days as possible explanation of the pathophysiology of AS.

The 3rd paragraph focuses almost entirely on Simon Baron-Cohen's theories to the exclusion of other important neuropsychological theories for AS, namely executive function theory (a bit long in the tooth but still being researched, e.g., see PMID 16977495) and weak central coherence theory (e.g., see PMID 17501729). Again, sorry, these are just random primary studies, but what's really need is a review. Eubulides 01:22, 9 September 2007 (UTC)

Eubulides, unless you are able to rewrite this portion, I don't think anyone else will. I've been begging everyone I could find for several weeks. Again, this is the sort of refinement that is needed to make this article attain featured status; if not, we've got a good article, but so far, no one else has come forward who is able to rewrite this section. SandyGeorgia (Talk) 02:22, 11 September 2007 (UTC)

OK, I took a first cut at a rewrite, as follows. This makes the section both higher-level and briefer. Eubulides 23:22, 14 September 2007 (UTC)

Excellent. SandyGeorgia (Talk) 23:30, 14 September 2007 (UTC)

Treatment

The main part of this section is impressive. My only thought is that, when you trim, it'd be better to trim the medications part, since they are targeted at comorbid conditions rather than at AS itself. Eubulides 05:47, 10 September 2007 (UTC)

Comorbids that occur at a very high rate; we've pared medication down to a manageable size, and considering the high rate of comorbids, I'd not like to lose too much more. SandyGeorgia (Talk) 02:19, 11 September 2007 (UTC)

OK, I limited myself to a very light trim (mostly just adjusting it to the standard criteria for core features), here. I still think it's a bit too detailed but am running low on editing time and there are bigger problems to tackle. Eubulides 23:37, 14 September 2007 (UTC)

It looks good (I can't believe I wrote 1-day). SandyGeorgia (Talk) 23:43, 14 September 2007 (UTC)

The change that moved the treatment of comorbid anxiety disorders to this section also changed it's meaning considerably, changing it from treatment options like CBT and medication for anxiety disorders to behavioral therapy for all comorbid disorders. I am not so sure that moving treatment of comorbid disorders to Treatment improves the readability of the article and it might confuse readers to think that some of the treatments for comorbid disorders are usefull for AS. --Fenke 22:25, 18 September 2007 (UTC)

Thanks for catching that. It wasn't intended to have that meaning. "Treatment" already mentions that behavioral interventions can be effective in combination with medication for anxiety, depression, inattention and aggression, so I attempted to fix the problem by moving the text in question next to that part of "Treatment". Eubulides 22:54, 18 September 2007 (UTC)

Shift in view

This subsection does not belong under "Treatment". It has very little to do with treatment. "History" would be a better home for it. Or maybe "Cultural aspects" or "Classification".

Again, let's lose the researcher's names in the main text. There is no need to directly quote Attwood here; a paraphrase should suffice. Eubulides 18:28, 10 September 2007 (UTC)

Casliber wanted it in Treatment. I'd concur with moving it back to Cultural aspects, where it was before. SandyGeorgia (Talk) 02:18, 11 September 2007 (UTC)

I moved it back to "Cultural aspects". Some editing still needs to be done to "Cultural aspects" to merge this moved text. I'd prefer not having a subsection, since it's odd to have a section with just one subsection. Eubulides 23:53, 13 September 2007 (UTC)

I missed this, both since it's quite a ways up the page, and also because I'm fairly busy with other things still, but I (still) agree with the placement of it in treatment, which I believe all then-active editors agreed to a couple of weeks ago. Poindexter Propellerhead 00:28, 15 September 2007 (UTC)

It's in Archive 13, Casliber argued the content was about Treatment and wanted to move it up, I concurred, there was no other agreement (I don't think), and now I don't see anything in that para about treatment. SandyGeorgia (Talk) 01:00, 15 September 2007 (UTC)

At that time, editors were not hesitating to express disagreement with anything they had a problem with, so I read the relative silence as acquiescence; you are reading it as "no other agreement," I guess there are arguments for either interpretation. Like Cas, I do see it as treatment related, since it raises the question of whether treatment is necessary or appropriate. I also wonder if WP:NPOV#Fairness_of_tone might not apply to shifting most of the non-pathological perspective to the very end of the article. Poindexter Propellerhead 01:37, 15 September 2007 (UTC)

The end of the article is far more prominent than the middle, so are you concerned that the current placement overpromotes the difference-not-disability argument? Anyway, I disagree that the shift-in-view section is more appropriate for "Treatment". Sure, shift-in-view raises the question of whether treatment is necessary or appropriate; but it also raises the question of whether diagnosis is necessary or appropriate so it equally belongs in "Diagnosis". Likewise for "Screening". Likewise for "Prognosis". And the shift-in-view section applies even more strongly to "Classification", to "Characteristics", and to "Cultural aspects" than it does to any of those other sections. "Treatment" is way down on the list as to where shift-in-view arguments should go. Eubulides 07:19, 16 September 2007 (UTC)

I removed the "Shift in view" subsection title, since it's weird to have a single subsection of a section, and did some other editing to try to make "Cultural aspects" hang together. Here's the change I made. It could use further improvement. Eubulides 07:22, 16 September 2007 (UTC)

Prognosis

I am skeptical of the claim that AS symptoms can at some point "fade to normal", with the implication that this is common enough to note. That claim is cited by a news article, not by a medical review article. On the contrary, the relatively later diagnosis of AS as compared to autism suggests that AS is less likely to "fade" than autism is. Here is a quote from a refereed continuing professional journal article suggesting the opposite: "the symptoms of Asperger syndrome may only become obvious with the social and functional demands of adolescence". Incidentally we may want to cite this latter article in a few other places too, as it is freely available and does not require a subscription. Berney T (2004). "Asperger syndrome from childhood into adulthood". Adv Psychiatr Treat. 10 (5): 341–51. Eubulides 19:41, 10 September 2007 (UTC)

Concur; other editors were attached to the Moran article, and I tried to preserve some of that text, but I would prefer we stick to more reliable sources. SandyGeorgia (Talk) 02:17, 11 September 2007 (UTC)

If you'd like a peer-reviewed reference, here's one.[[3]][[4]] They found that kids who were fairly bright and not too odd had their symptoms improve over time, on their own. Learning, I suppose. Poindexter Propellerhead 07:06, 17 September 2007 (UTC)

Thanks for the refs; I add them here and modified the text to match these more-reliable sources. Eubulides 20:19, 17 September 2007 (UTC)

I should mention that on rereading I found that the Berney reference didn't add much, and has so much opinion and so few citations that I am uncomfortable referring to it here. Eubulides 05:11, 18 September 2007 (UTC)

Epidemiology

If someone has access to Fombonne's latest (I don't, except for what Google Books tells me) they might want to fold in its new stuff as compared to the older Fombonne stuff cited here. Here's a citation: Fombonne E (2007). "Epidemiological surveys of pervasive developmental disorders". In Volkmar FR (ed.). Autism and Pervasive Developmental Disorders (2nd ed ed.). Cambridge University Press. pp. 33–68. ISBN 0521549574. {{cite book}}: |edition= has extra text (help)

"A computerized registry in Denmark indicates an annual incidence of 1.4 per 10,000 for AS." I don't have the cited reference (Baskin et al.) but this figure looks wrong to me. Perhaps the reference is talking about the prevalence, not the incidence? Or, if it is the incidence rate, what age group and time period are we talking about here? It's hard to believe that this is the overall annual incidence rate for AS in Denmark. Can you give the primary source for this claim, as opposed to the review article's summary? Eubulides 20:15, 10 September 2007 (UTC)

I can supply this when I'm home; I also thought it looked wrong so stared at it a number of times, and I recall another source was in the same ballpark, so I convinved myself it wasn't an error. Perhaps you'll be able to sort it out. SandyGeorgia (Talk) 02:15, 11 September 2007 (UTC)

Sorry, I forgot I owed you this:

Baskin, pp. 2–3:

Incidence, Prevalence, and Potential Etiologies

Several studies have investigated the incidence and prevalence of AS. Studies from Denmark, where nationwide computerized registries of psychiatric admissions have existed since 1969, allowed a thorough assessment of change in occurrence of PDD from 1971 to 2000.7 Over 2 million children were followed with 2061 cases of autism spectrum disorders identified. No increases in incidence were found until 1990, but a significant increase occurred from 1990 through 2000. An annual incidence of 1.4/10,000 for AS was reported. Although an overall increase in incidence cannot be ruled out, it was concluded that this more accurately reflects heightened awareness and diagnosis of the condition.

7. Lauritsen M, Pedersen C, Mortensen P. The incidence and prevalence of pervasive developmental disorders: a Danish population-based study. Psychol Med. 2004;34:1339-1346. —Preceding unsigned comment added by SandyGeorgia (talk • contribs) 23:48, 14 September 2007 (UTC)

Thanks for the reference to Lauritsen et al. They were talking about administrative incidence for children under 10, which is quite different from epidemiological incidence for the population at large. By "administrative incidence" I mean a count of people being referred, as opposed to actually going out to see who has AS and who doesn't. These counts are known to be inaccurate for ASD, and explaining all this didn't seem to be worth the trouble, especially as most people talk about prevalence not incidence for ASD (for good reason; see Autism #Epidemiology), so I removed the claim and the citation. Eubulides 05:15, 18 September 2007 (UTC)

Comorbidities

This section has material about treatment that belongs under "Treatment", not "Comorbidities". It also has material about misdiagnosis that belongs under "Diagnosis".

The word "comorbid" should be defined or briefly explained. The phrase "presenting in clinical settings" should be reworded into plain language. The long list of comorbid conditions can be trimmed or summarized.

This section should make the point that comorbidity does not necessarily imply the presence of multiple conditions, but instead can reflect our current inability to supply a single diagnosis that accounts for all symptoms. Here's a general citation about this but most likely you can cite the same point to one of the existing AS citations: First MB (2005). "Mutually exclusive versus co-occurring diagnostic categories: the challenge of diagnostic comorbidity". Psychopathology. 38 (4): 206–10. doi:10.1159/000086093. PMID 16145276. Eubulides 20:15, 10 September 2007 (UTC)

Seems fair enough suggestion to me. IMHO a even a waterfall shuffle would probably make some of those section more pertinent and relevant than they are now. They are so jumbled that I go cross-eyed whenever I look at them. --Zeraeph 20:55, 10 September 2007 (UTC)

Eubulides, can you be more specific here? I'm not seeing a long list that needs to be pared, and I'm not clear on what needs to be moved to Diagnosis and Treatment. SandyGeorgia (Talk) 02:13, 11 September 2007 (UTC)

On further thought, I kept almost all of the material, though a good chunk of it got moved to other sections. There is still a bit too much non-epidemiology stuff in epidemiology (e.g., an explanation of where anxiety comes from has no business in that section) but I guess it's good enough for now. I did remove extensive coverage of the 1993 Swedish study, which I felt did not make the cut (this is supposed to summarize, not to highlight one study), and I trimmed down the way-too-much detail in the male-to-female ratio. I also dropped Muris et al 1998 as its results disagreed with McPartland's 65% figure and it seemed a bit old and was just one study. I wish we had a stronger source than Dasari, but someone can do that later. Eubulides 23:32, 18 September 2007 (UTC)

I moved the remaining non-epidemiological stuff (about anxiety and depression) to "Prognosis". Eubulides 19:09, 19 September 2007 (UTC)

History

As with many other sections, this one is too long and repetitive and I assume will be copyedited down. I think this section is too long by a factor of two, maybe more. Here are suggestions for removal:

Nationality is mentioned too often. Austria should be mentioned at most once. Wing's nationality isn't that relevant (her language is, her nationality is not).

We don't need to know here that Kanner was Austrian and emigrated to the U.S. in 1924.

There is too much about Bosch. We don't need to know here that he worked at Frankfurt from 1951 to 1962. We don't need to know about the 1970 translation of his 1962 German monograph. Wing's work was the seminal paper that caused AS to be recognized as a separate disorder. I doubt whether it's worth worrying much here about earlier work in English, but if we do want to go that route, then Wing herself wrote, "Asperger's work was introduced to English readers not by me but by Van Krevelen (1971), whose paper, arguing for the separation of the syndrome from Kanner's autism, appeared in the first inssue of this journal." She is referring to van Krevelen 1971 (PMID 5172442). She also wrote about Bosch's work in the same letter so she clearly knew about it and did not consider it to be in the same class as van Krevelen. Here's the citation: Wing L (1986). "Clarification on Asperger's syndrome". J Autism Dev Disord. 16 (4): 513–5. doi:10.1007/BF01531716.

"American psychiatry"? Shouldn't that be "English-language psychiatry"?

The last paragraph unnecessarily recapitulates the dispute about diagnostic validity, which was already covered in "Classification".

Eubulides 19:08, 10 September 2007 (UTC)

Apart from the fact that Wing's nationality most certainly IS relevant to the specifically European focus of AS, and MUST stay, and that I really think that Lorna Wing's autistic daughter is relevant too, that all seems good. Bosch only got so much attention because myself got too deep into it one day. He can go. --Zeraeph 21:07, 10 September 2007 (UTC)

Concur with all of Eubulides' points (Bosch and some of the other text got worked in there simply because this article incorrectly stated for five years that Wing was the first to use the term). Eubulides, when you say, "assume will be copyedited down", I hope you're willing to do it; I'm counting on it, since 1) prose is not my forte, 2) I don't have many of those sources, and 3) you have the comprehensive sources and background to be able to bring this article to featured status—otherwise, we've only got a good article here. I'm working my way up from the bottom through your comments and may not get to all of them today. SandyGeorgia (Talk) 02:09, 11 September 2007 (UTC)

Question: if the feeling is that History is too long, would it be beneficial to create a daughter article, History of Asperger syndrome, similar to History of Tourette syndrome, and summarize it back to this article with summary style? If it's decided that this section is too long, I hate to lose sourced text on History, and wonder how others feel about dumping some of the text to a daughter article. SandyGeorgia (Talk) 11:47, 12 September 2007 (UTC)

- I think a daughter article would be fine. There's a lot of history there. How about calling it History of autism instead, though? It would be better to cover all the autism-related conditions at once, I think. particularly in a few years after the criteria get revised again. We can steal from Autism #History for the autism part. Eubulides 15:32, 12 September 2007 (UTC)
  - Fine with me; I just don't want to lose text that has been written when it can be placed elsewhere. SandyGeorgia (Talk) 15:43, 12 September 2007 (UTC)

I know it's a LONG title, but might it be History of autistic spectrum disorders or History of Autistic Spectrum. Many with AS really hate to be lumped with autism, so I always like autism spectrum even though the brain studies (the ones I've read that date from 2002, that is) are showing the same brain areas and same basic type of things going on. Just IMHO. Kiwi 19:37, 12 September 2007 (UTC)

I would favor keeping it to the history of AS, and letting Kannerian autism have its own history article if needed. Poindexter Propellerhead 01:40, 15 September 2007 (UTC)

I'm partial towards History of Asperger syndrome, since there's enough info out there to write a comprehensive, stand-alone article, but would still like to hear Eubulides' thoughts. Eubulides, do you want to have a go at chopping this down, or should I? SandyGeorgia (Talk) 16:26, 16 September 2007 (UTC)

Please chop away. And it's also fine with me if you write the AS history article, since you have the material. Eubulides 05:47, 17 September 2007 (UTC)

I created the daughter article, History of Asperger syndrome and summarized it to here; we're now at 31KB readable prose. SandyGeorgia (Talk) 06:37, 17 September 2007 (UTC)

Thanks, I proofread and copyedited the new summary of this section. Eubulides 19:47, 19 September 2007 (UTC)

Cultural aspects

The second paragraph (about the Wired article) is not at all supported by its sources. The sources talk about the claim in the context of all of ASD, but the 2nd paragraph's claims are mostly about AS. As far as I know, the theory of assortative mating for ASD (not just AS) stems from speculation by Simon Baron-Cohen (PMID 16519981) that has not been confirmed. The simplest fix for this somewhat messy situation is to remove that paragraph. Eubulides 22:31, 9 September 2007 (UTC)

Far from it, the simplest fix would be to expand and correct it, citing Simon Baron Cohen...Eubulides, though I am happy to support you in tidying syntax and word forms without discussion, please remember that one editor does NOT a consensus make? --Zeraeph 22:52, 9 September 2007 (UTC)

No, the Wired article's point about assortative mating is about ASD, not AS: the exact quote is "One provocative hypothesis that might account for the rise of spectrum disorders in technically adept communities like Silicon Valley, some geneticists speculate, is an increase in assortative mating." The TIME article is completely off the point: it says only that AS has a tendency to "run in families", which is an entirely different thing from assortative mating. I have the feeling that the TIME article is there only because of recent editing botches. Getting back to the main point, Baron-Cohen's hypothesis (PMID 16519981) is explicitly about the combination of Autism and Asperger syndrome; it is not just AS itself. The current text completely misrepresents Baron-Cohen's hypothesis. Correcting the text would mean we'd have to move the text to Autism spectrum, and out of Asperger syndrome. Personally I am not sure assortative mating makes the cut even for Autism spectrum, as it's sheer speculation now. Eubulides 23:21, 9 September 2007 (UTC)

As is,Time is hardly reliable sources for the statement "It posited that AS may be the result of assortative mating by geeks in mathematical and technological areas." The wired sentence seems OK, but the 'Time' section could do with a real reference. In addition, I can't find a reference to assortive mating in the Time article, what page is it on? It may be as Eub. says, it's an editing oopsie; the alternative is someone putting in a spurious reference. Also, if only SBC thinks that it's due to assortive mating, it could at best be a qualified reference as a minority point as per WP:RS and WP:FRINGE. WLU 23:49, 9 September 2007 (UTC)

I found a reliable source for the theory of assortative mating and ASD, and reworked the text to match the source. It still seems to me that this text does not belong in Asperger syndrome, as it is so speculative. Autistic culture would be a better spot for it. Eubulides 04:49, 10 September 2007 (UTC)

While your fix is better than what was there before, I also agree that this content could find a better home elsewhere. SandyGeorgia (Talk) 02:04, 11 September 2007 (UTC)

OK, I made these changes to do the above suggestions, as well as improve the quality of the citations and omit a few redundant words. Eubulides 21:25, 13 September 2007 (UTC)

External links

Most of the links in this section don't meet the criteria of WP:MEDMOS #External links. This is not the place for random articles or radio programs. We should restrict ourselves to just a few directories of information about AS. I suggest either deleting this section, or replacing it with the following short list of links:

{{dmoz|Health/Mental_Health/Disorders/Neurodevelopmental/Autism_Spectrum/Asperger%27s_Syndrome|Asperger's Syndrome}}
Autism, Asperger's & related disorders
National Dissemination Center for Children with Disabilities (NICHCY) connections to Asperger syndrome

Eubulides 19:33, 10 September 2007 (UTC)

I do not honestly see how two POV links and Dmoz could possibly be an improvement on the current links. I used to object strenuously to Domz for the simple reason that the AS section was under the control of an editor who was more than capable of deploying the entire entry to reflect his ongoing war with Wikipedia, but he is now gone. Still PP used to be a Dmoz editor and he feels it is FAR too unaccountable and POV to use.

Shall we, rather, be WP:BOLD and strip off the external links altogether?--Zeraeph 21:06, 10 September 2007 (UTC)

I concur with Eubulides' list; this article needs to comply with WP:EL, WP:RS, and WP:NOT. If other articles are significant, they should be added to DMOZ. SandyGeorgia (Talk) 02:02, 11 September 2007 (UTC)

I just now checked Dmoz and it didn't seem either great or terrible to me. Perhaps if someone can suggest a better link directory that isn't full of ads or POV? In the meantime this is the best one I know of, so I put it in for now. The other option is to remove "External links" entirely, which I've of two minds about; perhaps we can get other opinions on that? Eubulides 19:18, 11 September 2007 (UTC)

Please could you actually WAIT for consensus? Not just "a green light from User:SandyGeorgia". There are other editors who each have equal weight with her. --Zeraeph 19:40, 11 September 2007 (UTC)

Of the three who have commented, nobody has disagreed that the current link set is bad. I have removed it pending further discussion about the proposed replacements. I don't see the POV problems in the proposed links; by and large they reflect mainstream medical and scientific opinion, which is where this article is supposed to be. If you prefer a different set of links could you please suggest it? Eubulides 19:55, 11 September 2007 (UTC)

Completely eliminating EL does an injustice to our readers; we need to add it back in a way that conforms with WP:EL, WP:RS and WP:NOT. DMOz allows readers to find anything they want, and is the most common open directory. SandyGeorgia (Talk) 22:53, 11 September 2007 (UTC)

Oh, I shouldn't think so, not considering the abysmal quality of the links that remained. DMOZ allows readers to find the links DMOZ wants them to find (under heaven knows what system of accountability) it is actually Google et al that provide readers with access to *anything* they want to find. But if we are going to put it back, it had better conform to WP:NPOV and WP:RS as well. --Zeraeph 23:01, 11 September 2007 (UTC)

What specific problems are there in the three proposed external links? So far the only criticism I've seen is "POV", which is too vague. As far as I can tell, the three links have about the same POV as the Wikipedia article is supposed to, namely a relatively neutral point of view in the mainstream. What am I missing? Eubulides 00:09, 12 September 2007 (UTC)

I'm OK with DMOZ, since they are usually sort of screwed up, but in a random fashion, so at least their errors and biases average out over time. The other couple of links I'm content to do without, I didn't see that they really added any different perspectives or info than what is already in the article. Poindexter Propellerhead 01:15, 12 September 2007 (UTC)

That sounds like a reasonable compromise (those sources could also be added to DMOZ anyway, if they're not already there). SandyGeorgia (Talk) 01:18, 12 September 2007 (UTC)

OK, done. Eubulides 04:35, 12 September 2007 (UTC)

New lead

I've been working on the lead, attempting to meet the criticisms I expressed on the 4th of this month, and also take account of other comments. I have not added any new sources, and worked within the references that were already in the lead. I've tried to remove duplication and expanded on some definitions to bring them closer to the sources. I've also tried to make it easier to read, using some simpler language, as well as restricting paragraph length, and trying to restrict each paragraph to one topic. In all it is about 30 words shorter than the lead I'm replacing. Given the issues here, I don't expect it to last long, but hope it is at least helpful in moving towards a better article. --Michael Johnson 06:05, 7 September 2007 (UTC)

There is one word of it I'd like to question: "five." That's the number of PDDs listed by DSM-IV, but not by ICD-10 (or DSM-III, the place we got "high functioning autism" from, for that matter). I had started working towards a more manual-agnostic approach to the matter until I ran into it again in the Criteria section, and was intending to come here and bring that up. Other than the one word, I'm generally happy with it. Poindexter Propellerhead 08:15, 7 September 2007 (UTC)

It all seems good to me, since I tweaked the "five" back to "several" (probably just from working on an older version?). I wonder if we can start bringing the whole article into line? --Zeraeph 10:38, 7 September 2007 (UTC)

Yep I was working from the version of the 2nd Sep. Although I do note that most other references on Wikipedia, including the ASD article itself, only refer to 5. However several is fine. I'm happy to keep working on the rest when I have time. --Michael Johnson 13:10, 7 September 2007 (UTC)

Just in passing, here's a comparison of DSM-IV and ICD-10 categories.[[5]] I suspect that the historical emphasis on DSM is due to our having a disproportionate number of American editors, and falls under this statement: "This Wikipedia project has a systemic bias that grows naturally out of the demographic of its contributors and manifests itself as imbalanced coverage."[[6]] I don't see it as a key issue, just a minor evil which we might as well avoid as long as we're doing a complete rewrite anyway. Poindexter Propellerhead 18:08, 7 September 2007 (UTC)

I wondered about that myself, given the ICD-10 category was earlier. However by introducing Laura Wing I figured I had introduced enought trans-Atlantic balance. --Michael Johnson 22:42, 7 September 2007 (UTC)

Historical (speculated) aspies

Just noticed that an anon came along and inserted a section on people speculated to have had AS; it was unsourced, and, not surprisingly, reverted within the hour. I've never worked on the past sections which have existed on this topic, or had any especially strong feeling about them (as long as they were reliably sourced), but am thinking that it might be best to re-add a couple of sentences on the subject, if only to stop people from cruising by and inserting unsourced stuff. Does anyone have any objection? Does anyone have any preference as to which section it goes in? Poindexter Propellerhead 20:30, 7 September 2007 (UTC)

For what it's worth, Tourette syndrome mentions Samuel Johnson and Mozart in its "Cultural reference" pages. There is a good case for mentioning Johnson. The Mozart claim is dubious and personally I'd omit that claim (or at least pare it down to one sentence) but that's more SandyGeorgia's call. Autism lacks such a section entirely, and doesn't even bother to Wikilink directly to List of people on the autistic spectrum. The claims that Newton and Einstein had AS are also dubious. I'd devote at most one sentence to them, and perhaps it's better to stick with zero. This page will get drive-bys no matter what's in it. Eubulides 20:46, 7 September 2007 (UTC)

I was thinking two sentences, one of which would be "of course people are going to speculate, and there's no way to know for sure," the other sentence being a list of those whose names have come up in at least two papers or books, which would have to be written by people with solid academic credentials, and peer-reviewed in most cases. No exceptions unless the person is living and has stated that they have been professionally diagnosed. Sound reasonable? Poindexter Propellerhead 21:00, 7 September 2007 (UTC)

A couple of sentences down at the bottom can do no harm...just a little lighter touch to round things off? Like the end of a News Broadcast? Incidentally, I have always been told Mozart had AS. Which brings me to something very missing in the article...the special relationship between Aspies and music, it used to be almost a diagnostic criterion in europe. It's connected to auditory training. Has anyone got any academic sources for that?--Zeraeph 21:16, 7 September 2007 (UTC)

I dunno, I think mentioning living people would lead to a huge can of worms. It would be far better to focus on one or two major historical figures that there is good evidence for. Ideally something like Samuel Johnson and Tourette's. However, I think it unlikely that we'll get anything that good. It's too difficult to remotely diagnose AS and distinguish it from autism or PDD-NOS or the broader autism phenotype. See, for example, the recent paper "John Couch Adams's Asperger syndrome and the British non-discovery of Neptune" doi:10.1098/rsnr.2007.0187, a paper that, despite its title, admits in its body that the authors don't know and don't care whether Adams had AS or some other ASD. Asperger syndrome will be stronger if it leaves this stuff out. Eubulides 21:33, 7 September 2007 (UTC)

I think that the can of worms you fear would be pretty small; although a number of living persons have said things which suggested that they might have AS, only one that I know of has flat out said that he has it, and has been professionally diagnosed, and that would be Vernon Smith.[[7]] He has done multiple interviews on the subject of his AS, which (short of putting his doctors under oath) would seem about as solid as one could ever get. I see no reason to consider any iffier cases than that.

As for Mozart, he wouldn't make the cut under my suggested guidelines. Michael Fitzgerald nominated him in a book, but the book was not peer reviewed, and as far as I have found, Mozart has not been named by any other RS. The only musical figures who I know to have the backing of two academics are Erik Satie and Glenn Gould. Poindexter Propellerhead 22:05, 7 September 2007 (UTC)

Have a look at what WP:MEDMOS has to say on this and feel free to comment on that talk page you have an opinion. I wrote that part of MEDMOS as a compromise between those who hate such lists and those who maintain them. I've worked on lists for epilepsy, hepatitis C and polio (but have no intention on working on the ASD lists). I recommend you keep such lists/speculation out of this article. We already have List of people on the autistic spectrum (basic but reasonably sourced) and People speculated to have been autistic (a mess). I think the former should be linked in the "See also" section. Any such additions to this article can be removed and the editor directed towards the standalone list. The problem with AS is that it has no history, so any historical figures really are 100% speculation. From my work on the epilepsy list, I'd say that most of this speculation is complete bollocks, but that doesn't stop respectable journals publishing the stuff. Be aware that such articles may not be subject to the same rigorous review as research papers, even if published in a so-called "peer-reviewed journal".

Poindexter, you should probably contribute your ideas/sources over at the two lists I mention. Move any unsourced material to the talk pages (or if there are WP:BLP concerns, delete). It would be good if someone cleaned up those lists, but it won't be me. Colin°^Talk 22:14, 7 September 2007 (UTC)

OK, just spent a few hours citing People speculated to have been autistic, it's still got some ways to go, but at least it has maybe 45 cites to a dozen or so books and papers now, rather than zero. I also chopped out a bunch of reference-tagged OR. Of course it's still speculative, I can't change that, but it's a lot less bad than it was. That done, I'm going to ponder the situation a while. Poindexter Propellerhead 05:51, 8 September 2007 (UTC)

Vernon L. Smith would indeed overcome my can-of-worms objection, but eminent as he is, most of our readers have never heard of him; would he really add much to the article? I mentioned John Couch Adams but on thinking about it again, even he is not famous enough for this purpose (even apart from the dubious diagnosis). Eubulides 22:20, 7 September 2007 (UTC)

There are reasonable sources for a number historical figures, but, quite justifiably, they don't go beyond "showed signs of". Personally I don't think it adds much, sort of fame by association. Perhaps it becomes relevent if someone comes up wth a "cure" to AS, then we might question, is the species loosing something? --Michael Johnson 22:58, 7 September 2007 (UTC)

Broken refs

Refs #32 and #36 are broken.--Rmky87 17:48, 9 September 2007 (UTC)

Thanks for reporting that; I fixed them. Eubulides 19:14, 9 September 2007 (UTC)

It's a constant battle with this article; text that contains named refs is deleted without checking and repairing the subsequent occurrences. They were all correct in the last reliably sourced version (LRSV), which was back on September 4th. I have limited access and am only slowly working my way up through commentary here as I have time; did diagnosis get repaired? It had some unnecessary deletions and unsourced inaccurate additions the last time I checked a few days ago. (PS, Eubulides, I will check that source for stims vs. stereotypies as soon as I'm home, but I suspect it should be stereotypy and the wrong term was used before you straightened out stimming and stereotypy (psychiatry). I have the full text at home.) SandyGeorgia (Talk) 01:57, 11 September 2007 (UTC)

Simon Baron-Cohen image

Very kindly provided by Simon Baron-Cohen, who is nice he even ran down the photographer for permission. It is Non-free but with permission for fair use.

Image can be resized, moved, cropped and upload as second image (with same permissions) whatever, but thought I'd better pop it up before it gets deleted as an orphan. --Zeraeph 19:06, 9 September 2007 (UTC)

It's not an orphan, since Simon Baron-Cohen points at it. I'd really rather not have this image in Asperger syndrome, for reasons already discussed. This article already highlights SBC's theories too much, at the expense of other theories that are just as respectable; including his image and omitting other eminent contemporary researchers make the article look more like a puff piece than it did already. Eubulides 19:17, 9 September 2007 (UTC)

He actually gave it for this article, so let's try and see what the consensus is? There is no reason why you shouldn't get images of other "eminent contemporary researchers" as well to balance? --Zeraeph 22:34, 9 September 2007 (UTC)

Other editors, such as SandyGeorge, have complained about a lack of images in this article. Delete this one and there is only one small image of Asperger. Zeraeph is right, get more images to balance it, don't just delete. --Michael Johnson 22:48, 9 September 2007 (UTC)

Getting more images of other eminent researchers would "balance" the article only in that it would be better to have images of Ehlers, Frith, Gillberg, Happé, Klin, Ozonoff, Rogers, Volkmar, Wing, etc., than having just Baron-Cohen. But this would be changing the article in the wrong direction (not to mention being a source of further disputes). Asperger syndrome should focus on AS, not on AS researchers. With the exception of Asperger himself and maybe Wing, who were instrumental in the history of the disorder, the other researchers just don't make the cut. Rather than head in this direction, the article would be better off stealing the images from Autism. If you take a look at the images in Autism, all but one are far more relevant to AS than this image of Baron-Cohen is. Eubulides 23:06, 9 September 2007 (UTC)

I agree with Eubulides. SBC is already over-represented, and the suggestion of increasing focus on the researchers themselves is unnecessary. Maybe a secondary linked article could be created for a 'who's who gallery' of AS researchers (for those attached to this idea). Soulgany101 11:26, 10 September 2007 (UTC)

I agree with Eubulides and Soulgany101. Yes, we need images, and there are images that could be used to illustrate AS; SBC isn't one of them, and gives undue weight to one researcher's views. His image should be used in his article, where anyone curious about him can find it (but the right hand side shoulod be cropped off). SandyGeorgia (Talk) 01:44, 11 September 2007 (UTC)

So are you saying that you have changed your mind about the SBC image since this edit? [8] --Zeraeph 03:59, 11 September 2007 (UTC)

Right after that edit, another editor explained that the image wouldn't be appropriate. I believe it was Casliber, but perhaps you want to review. SandyGeorgia (Talk) 00:19, 12 September 2007 (UTC)

Aside from the desirability of using it in this article, I think the SBC image fails the fair use criteria, specifically clause 1. If you are in contact with SBC and/or his photographer, you should attempt to obtain a completely free image that meets one of the acceptable licences. Ideally, this should be loaded onto Commons rather than English WP. There is stuff on Commons about boilerplate letters you can send folk when asking for images.

"Fair use" isn't something SBC/photographer can give you, it is something you claim in the absence of permission. WP/Commons rules are very restrictive. It isn't acceptable, for example, to give permission only for WP or only for non-profit usage. Colin°^Talk 12:05, 11 September 2007 (UTC)

Unfortunately Simon Baron Cohen could not get GFDL permission from the photographer, only permission for use in Wikipedia as described.

At the end of the day there is only so much of pestering public figures one can do. Simon Baron Cohen is a very sweet and helpful man, but not my oldest and dearest friend! --Zeraeph 13:29, 11 September 2007 (UTC)

Let's wait to see the consensus among the regular editors shall we? My personal feeling was that, if the article needs images, best they be AS related images that people are genuinely curious about, and I know In was very curious about Simon Baron-Cohen. Having found out what a sweet man he is, who went to immense trouble to get the image cleared for THIS article (the bio article was an afterthought on my part), I really would like to use it. I am not sure what other "images of AS" we could use?

Certainly no "minority brain scans"...Fionajade (well known UK lady Aspie) in Burlesque and Corsets? Happy Dublin Aspies invading the gay pubs (as they do)? Other? Because THOSE are honest images of AS. --Zeraeph 11:53, 10 September 2007 (UTC)

Getting silly

I think this is becoming a little silly, obviously SandyGeorgia is determined to revert and object to any edit or suggestion I make, whatever it is, and now OTHER people's edits are also getting caught in the crossfire.

I have decided that I have better things to do (and HOW :o) ) than sit here playing this game with her. I also feel she will behave a lot more reasonably if I am not here, so rather than get into a childish edit war I am taking a Wikibreak. 'bye --Zeraeph 00:53, 12 September 2007 (UTC)

Missing clarification: I tagged unsourced and confusing statements, and added back dropped, dangling references. The reverts were Zeraeph's, although these items have been well discussed on talk. SandyGeorgia (Talk) 01:59, 12 September 2007 (UTC)

We're back to two dangling refs, as Z removed my attempts to repair them. I added several tags for clarification which were also removed. Multiple problems in Diagnosis section. There is a mention that physicians "often" detect AS which is unsupported by any of the sources I've read and the citation supplied, a dangling sentence which doesn't define the DSM criteria, and mention thoughout Diagnosis of other sets of criteria which aren't defined anywhere in this article. There is also a statement attributed to NINDS but sourced to McPartland, as well as a lot of overattribution of common concepts to individual authors. I suggest the only way to repair the issues in Diagnosis is to get back to the reliably sourced version and begin to pare it down from there. This is a reliable, comprehensive version, although screening is still missing. SandyGeorgia (Talk) 01:04, 12 September 2007 (UTC)

The text, before you left, was "Developmental screening during a routine check-up by a general practitioner or pediatrician may identify signs that warrant further investigation." That got changed to "Signs suggestive of AS are often[40][not in citation given] noted by a general practitioner or pediatrician during a routine developmental check up." If it's a big deal to you, I'm sure that, rather than tag it, you could just change "are often" back to "may be" and nobody would mind. Poindexter Propellerhead 01:48, 12 September 2007 (UTC)

You sure about that? :-) Minor corrections aren't getting through; at any rate, I still think we're better off to rework the entire thing, paring it down from the original version in a way that we don't leave any dangling, unexplained or unsourced text. It doesn't make sense to mention other sets of diagnostic criteria that aren't defined anywhere else in the article, and there are too many munged references and overattribution of authors. (By the way, I removed the "rage" word from the subarticle, since you earlier objected that only one source used that particular word, the other sources all referred to aggression, so I left that word instead.) SandyGeorgia (Talk) 01:56, 12 September 2007 (UTC)

First, I find "may be" as bad as "are often" - is that a kinda weasely thing or not? Kiwi 02:06, 12 September 2007 (UTC)

The NIH exact words are "Most doctors rely on the presence of a core group of behaviors to alert them to the possibility of a diagnosis of AS." If you want to more closely paraphrase those words, take care; you may be accused of plagiarism :-) At any rate, there is no mention anywhere in any of the literature I read as to how reliably doctors "often noted" AS in routing screening; there is not a clear answer on how over- or underdiagnosed AS is, and how good routine screening is, at least in the sources I read, while there are several mentions that it's not often diagnosed until age 11, even though parents can trace signs to early infancy. The reason we stick closely to what the sources say is so we don't inadvertently introduce error. SandyGeorgia (Talk) 02:24, 12 September 2007 (UTC)

There is no doubt that GPs, Family Practitioners or Pediatricians notice aspie traits in kids from time to time, but that they don't always do it. There aren't very many ways to express that, but I wouldn't consider most wording choices to be weasely. It's not as if anyone had a worldwide percentage figure that they were avoiding, or as if any likely wording favored some POV. Poindexter Propellerhead 02:37, 12 September 2007 (UTC)

But we can't say anything happens "often" unless a reliable source gives us that. In fact, the sources I read imply the opposite. The word "may" is not weasly IMO; it's often used in the sources, and is not singled out at WP:AWW or WP:WTA. SandyGeorgia (Talk) 03:09, 12 September 2007 (UTC)

Minor reverting & need for reality check

Referring to two editors in an edit war, I replaced them myself for in my reading of the text and my need to understand what is being talked about, the clarify requests were greatly needed.

I have done this to let anyone who drops by to read the article see where work is needed, for very seldom do readers check out the talk page, even when they decide to make edits. This is far more common than not all over Wiki. If it's not on the article page, no one will be clued in - and who would want to wade through this long hard to load page?

As to Sandy's suggestion that perhaps the earlier version of that segment be used to replace the section, in toto, is clearly up for discussion and ultimate decisions of both those who have access to journals and texts and also those actually wanting to tackle the rewrite to work out here. May I suggest everyone print out both and read them both to make informed comments and have decisive dialogue? Kiwi 02:06, 12 September 2007 (UTC)

I have not suggested in toto; I've suggested we use it as an accurate starting place from which to pare down. I'd like to see what Eubulides can do with it, since he's very well versed in autism research. The problem is the current version is too munged to provide a good starting place. SandyGeorgia (Talk) 02:14, 12 September 2007 (UTC)

Sandy especially and all involved editors -- that term was not meant to suggest what it apparently ended up doing. I had truly meant, as you had, to use it as a starting point. If my printers weren't already disconnected and packed, I'd have tried it myself - regardless, I'm not expert in either Wikipedia fine-tuning editing nor in the Asperger Syndrome. Just someone with an Aspie nephew, now in 3rd year college, but still terribly socially disabled. Kiwi 02:28, 12 September 2007 (UTC)

No problem; I was just clarifying for general readership purposes. SandyGeorgia (Talk) 02:29, 12 September 2007 (UTC)

By the way, Kiwi, what "two editors in an edit war"? I added tags, Zeraeph reverted them (improperly, with no discussion, even though the issues had already been raised on talk, something you should never do). I don't edit war. SandyGeorgia (Talk) 02:41, 12 September 2007 (UTC)

(giggles) That was a reference to an explanation of leave-taking. The reason I did it on my own was so there could be no finger-pointing and saying SEE? Sorry, that is probably against WP politeness? If so I will delete this. Kiwi 02:51, 12 September 2007 (UTC)

Again, no problem; just keeping the record straight, so some unsuspecting new reader doesn't come along a year from now and think I was edit warring :-) SandyGeorgia (Talk) 02:57, 12 September 2007 (UTC)

(outdent)The article was, and still is, longer than it should be; it spends a lot of time caught up in more detail than is needed for our audience, the average layperson. So Diagnosis was pared back, and the full content removed to a daughter article. I think that the failure to mention any of the criteria is a mistake -- we should probably give ICD-10's (the international standard, as well as less touchy as regards copyright). But, beyond that, much clarification is likely to mean starting to lengthen the article again. I think we should probably try for giving ICD's criteria, plus maybe a paragraph of general explanation, and let people look at the daughter article if they want more. I don't see any advantage to trying to do that with any version, past or present, of this article, since none of them are either short or ICD-based; from scratch would probably be easier. Poindexter Propellerhead 03:37, 12 September 2007 (UTC)

I disagree that the article is too long overall, although a redistribution of readable prose is in order. Some sections are too verbose and redundant; others are not well developed or missing completely (e.g.; Screening). I see Diagnosis ending up more or less the same size after restoration, but we can't just drop in mention of Szatmari and Gillberg without somehow defining those. SandyGeorgia (Talk) 04:12, 12 September 2007 (UTC)

Hi, Poindexter. I spent a lot of time researching the help desk and such early this year about this "article length" thingie and found that it was a valuable guideline in the past when most people were dial-up (now most dial-ups are in the States, the rest of the world having gone Hi-Speed internet). Anyway, there is complete consensus that length is not etched in stone.

And as for the ICD's criteria vs the DSM, it is very valuable to include the paraphrased DSM because of the many Americans (who seem to be having the huge autism explosion) who are out there looking. It is IMPORTANT for them to SEE the criteria that THEIR doctors used to make the diagnosis. Be sure to include How Many must be present to adopt the diagnosis (same with ICD). One just can't list a bunch of things and alarm people unnecessarily.

It is ALSO necessary to point out (as the DSM does) that these aren't things that are there just sometimes - but that are a prominent part of the child's/adult's pattern of relating to the environment and others. One thing an article like this should not do is lead people to jump the gun and start self-diagnosing and diagnosing others.

And by the way, there are dozens (possibly scores) of psychology and psychiatry articles at wiki that have paraphrased DSM-IV criteria included. It is totally accepted all over the web. Kiwi 04:31, 12 September 2007 (UTC)

I'm just going by WP:SIZE; when that gets rewritten, I'll follow the new version. Until then, I try to honor the guideline that's in place.

We're well within WP:SIZE guidelines, even though numerous FAs exceed the recommended 50KB readable prose. SandyGeorgia (Talk) 11:09, 12 September 2007 (UTC)

Other featured articles for your review: Byzantine Empire (65KB readable prose, 120KB overall), B movie (63KB readable prose, 96KB overall), Ketuanan Melayu (84KB readable prose, 110KB overall), Campaign history of the Roman military (74KB readable prose, 121 KB overall) and there are others that I can't recall. All of these exceed 60KB readable prose; AS will likely end up in the mid-40s or less. For a comparable topic, Schizophrenia is at 43KB readable prose. SandyGeorgia (Talk) 11:36, 12 September 2007 (UTC)

As for DSM vs ICD, no US parent would be confused by reading the ICD criteria, because the DSM criteria were based on them; they are very, very similar. ICD is also used in the US, the US even has its own special edition of it, ICD-10-CM, to take into account regional differences. So it's not as if using ICD would mislead anyone, it just gives a nod towards the international perspective, and at the same time avoids trouble with the APA, whose reputation in the intellectual property domain is similar to Disney's or Scientology's. I hope that clarifies the reasoning behind my preference. Poindexter Propellerhead 06:00, 12 September 2007 (UTC)

There is no APA problem; this is a red herring that was introduced along with a general misunderstanding about public domain text and "plagiarism". SandyGeorgia (Talk) 11:09, 12 September 2007 (UTC)

The "Diagnosis" section is the weakest in the article, and it's fine with me to rewrite it by starting with Diagnosis of Asperger syndrome and condensing it down. There's still a lot of work to be done elsewhere too. Talk:Asperger syndrome #Eubulides review of Sept. 6 version indicates that work is still needed in the lead, in "Repetitive behaviors and restricted interests", and all sections from "Other" through "Cultural aspects". SandyGeorgia, if you have the time, perhaps you could work on "Diagnosis"? I'm assuming it should be cut down to a couple of paragraphs, deferring most of the detail to Diagnosis of Asperger syndrome. You might also want to look at Autism #Diagnosis for stuff to steal. I can look at the sections other than "Diagnosis". Eubulides 05:41, 12 September 2007 (UTC)

I'll put something up later today in my Sandbox for Diagnosis. SandyGeorgia (Talk) 11:09, 12 September 2007 (UTC)

After Eubulides' beautiful rework of Diagnosis and addition of Screening, current readable prose size (per WP:SIZE as measured by Dr pda's script) is 36KB (vis-a-vis recommended 30–50KB). SandyGeorgia (Talk) 22:36, 13 September 2007 (UTC)

Another archive?

The talk page is now at 237KB; can we archive everything before Eubulides review section (that is, the top 16 sections)? SandyGeorgia (Talk) 11:41, 12 September 2007 (UTC)

Sounds good to me! Kiwi 13:31, 12 September 2007 (UTC)

Regarding Autistic-Spectrum Diagnostic Acumen of Pediatricians

Someone with access to this journal might add depth to the issue of a physician's ability to detect Autistic Spectrum disoders including AS. My grandson was detectable by 18 months (by his parents). He is either HFA or AS (more likely) as his speech problems are due to motor difficulties to his lips, mouth and tongue.

Source: University of Oregon Date: September 12, 2007 The study appeared in the August issue of the Journal Pediatrics. Note: adapted from a news release issued by University of Oregon.

Pediatricians May Miss Developmental Delays, But Parents Can Help: full article HERE-Science Daily; Science Daily — blurb - 53 (parent-led referrals) of the 78 overall referrals could not have been made without the Ages & Stages Questionnaires (ASQ) filled out by parents. 38 of the overall 78 underwent further evaluation and qualified for federally funded early intervention services, and 44 of those 78 became eligible for additional monitoring.; The ASQ (the parent fill-out form used hin this study) -- is already recommended by the American Academy of Pediatrics for other targeted age groups and has been in use for about 20 years. You can take it for free (and confidential) here [9]

courtesy Kiwi 13:31, 12 September 2007 (UTC)

A PMID 17671065 is helpful; news releases aren't usually as reliable. SandyGeorgia (Talk) 13:45, 12 September 2007 (UTC)

Also, you can just give the link to the article in Science Daily so you don't have to violate their copyright by copying the entire article here. Fair Use allows for excerpts of articles for educational purposes. SandyGeorgia (Talk) 13:51, 12 September 2007 (UTC)

Hi, Sandy - while I kept all interview quotes intact and properly attributed, I deleted lots of content, compressed and reordered data and paraphrased, too, so I didn't realize I was still violating copyright. I did forget, though, to post the link so I thank you. I know this article cannot serve as a Wiki encyclopedia resource - my intent was to point people towards the paper, mention the studies cited in the article, just thinking that someone might be curious and lucky enough to read the article itself. Abstracts establish existence, but even full abstracts fall short of citations editors can check out. Kiwi 15:10, 12 September 2007 (UTC)

Whenever you have a URL, no need to post the text; takes up space on the talk page, and runs into copyright issues. When you don't have a URL, you can summarize only enough for educational purposes, per Fair Use. SandyGeorgia (Talk) 15:17, 12 September 2007 (UTC)

Understood, Sandy - cleaned up what I said extensively and made sure the free assessment instrument url was mentioned. Thanks for explaining - won't happen again. Kiwi 19:28, 12 September 2007 (UTC)

Article title

Something I wondered about, when I first read this article, was why it was titled "Asperger Syndrome" instead of the more commonly used "Asperger's Syndrome." "Asperger's Syndrome" also happens to be the official name in ICD-10, and WP:MEDMOS discusses resolving multiple-name issues by going with ICD's. Does changing it sound OK to everyone, or is there some reason for the current name that I've overlooked? Poindexter Propellerhead 22:25, 12 September 2007 (UTC)

See WP:MEDMOS and convention in medical circles about the improper use of possessive eponyms, widely publicized issue, convention to *not* use possessive eponyms in medical writing. ICD-10 is behind on this (and just about everything else). (If you suggest to the Down syndrome folk they should be Down's syndrome, they'll bite your head off.) SandyGeorgia (Talk) 23:07, 12 September 2007 (UTC)

List of eponymous diseases #Punctuation mentions PMID 46972, which argues against the possessive, but it also says "Medical journals, dictionaries and style guides remain divided on this issue." English medical articles in refereed journals remain split on this issue, my impression is that about half of recent articles use "Asperger's" and half "Asperger". I see little point in changing the article's name, though the naming issue might be worth mentioning in a subarticle like the proposed History of autism. Eubulides 23:46, 12 September 2007 (UTC)

OK... WP:MEDMOS#Naming_conventions warns against using "a historical eponym that has been superseded," but "Asperger's Syndrome" has not been superseded, and the relatively up-to-date DSM-IV-TR uses "Asperger's" as well. Just thought I'd bring it up, since "Asperger Syndrome" is not the official name, and it seemed like MEDMOS wanted the official name... oh, well. Poindexter Propellerhead 01:11, 13 September 2007 (UTC)

Moving "Causes" and "Mechanism" up

Currently the article puts "Screening" and "Diagnosis" after "Causes" and "Mechanism". I propose putting them after. The typical course of a syndrome is that it is caused by something that creates a internal mechanism, which is then detected via screening and then diagnosed. Reordering the sections in this way will put the presentation in temporal order, which (all other things being equal) is a good thing. Eubulides 20:12, 13 September 2007 (UTC)

If you can make the text flow that way, it works for me. SandyGeorgia (Talk) 22:33, 13 September 2007 (UTC)

Yes, that makes a more sense in terms of order. Soulgany101 22:51, 13 September 2007 (UTC)

OK, thanks, done. Eubulides 23:50, 13 September 2007 (UTC)

Other symptoms

Inserted study by Uta Frith (which was removed with 'letters to the editor' material) in order to clinically substantiate claim that alexithymia appears in AS. I'm assuming we want verification of claims. Soulgany101 22:17, 13 September 2007 (UTC)

We want validation of claims, but I'm afraid these claims may not be worth citing in the article. Frith's lecture merely cites PMID 15162941 as an upcoming study, but the paper that was actually published for that study does not justify Asperger syndrome's claim that "at least half of the Asperger syndrome subjects in a study obtained scores that indicate severe impairment". The study's subjects had either AS or HFA, and the study's paper explicitly does not report a separate breakdown for those with AS due to the small study size. Frith's lecture does have the claim, but as the lecture cites only the study to support the claim, it's a pretty weak claim. Furthermore, Frith's lecture does not say that alexithymia "overlaps" AS, as the Wikipedia article says; the lecture merely reports the over-half result. A claim of overlap is much stronger than one of association. Surely there's better support for these claims somewhere, in more recent literature? If not, we should drop them. Eubulides 23:43, 13 September 2007 (UTC)

I do remember reading in that paper by Frith an explicit reference to over half of those with "AS" (not HFA) having "severe alexithymic impairment". I think thats worth citing to show the prevelance. I have not read the entire article to which Frith refers, but assume that if the explicit reference to AS is not mentioned, then Frith is privy to some of the unpublished micro data. Nevertheless I'll go over the paper later and get back here, as it is now published in full text online. Soulgany101 00:18, 14 September 2007 (UTC)

In Frith's words: “the Asperger syndrome group obtained such extreme scores on the Toronto questionnaire that they would have been classified as severely impaired.” Soulgany101 00:25, 14 September 2007 (UTC)

OK, I've read the study to which Frith refers. The study does differentiate between HFA and AS in its subject groups: "The adults with ASDs had all received a formal diagnosis of either Asperger syndrome (n = 20) or [HFA]autism (n = 7)". Secondly, Uta Frith is in fact one of the three who conducted the study, so I take it for granted that if Frith says “the Asperger syndrome group obtained such extreme scores on the Toronto questionnaire that they would have been classified as severely impaired”, it is correct, although you are correct in stating that she does not break this down in the summary of the study. As Frith authored both papers, I'm satisfied with the credibility of Frith's statement, and think it should be included here as it clarifies the oft asked question of prevalence. I'm happy for the mention to go or stay based on editor consensus, of course. Soulgany101 01:03, 14 September 2007 (UTC)

I don't see what this has to do with the prevalence of AS; can you please explain?

Frith is referring to the prevalence of alexithymia in AS, and to the level of elevation as "severe". Others refer to an 'overlap'. Soulgany101 06:26, 14 September 2007 (UTC)

I read both papers too, which is why I raised this issue. The study paper (PMID 15162941) says that it does not break down the figures due to statistical unreliability, saying "These data were not subjected to further analysis given the small sample size of the groups." A plausible explanation for the seeming disagreement between Frith's lecture and the study paper is that Frith discovered after delivering the lecture that the study's results were not statistically significant if AS subjects only were considered.

The "after delivering the lecture..." is your conjecture. As the lecture was delivered after the study was completed I doub't your conjecture is plausible. Soulgany101 06:26, 14 September 2007 (UTC)

The lecture says that the report of the study is "in press", which means it wasn't in final form. There are other disagreements between the review and the study report: for example, the review says the study covered 19 individuals with AS, but the study itself says 20. This is another indication that we cannot rely on the review to accurately report details about a study that was still in press. Eubulides 18:06, 14 September 2007 (UTC)

The phrase you quote "These data were not subjected to further analysis..." refers not to the prevalence of alexithymia in AS, but to "The responses of each group to the three components of emotion processing assessed by the TAS-20". In other words the sub-factor scores of the scale were not subject to further analysis. This in my reading posits no "unreliability" regarding the sample size of over half of the 20 Asperger's subjects (ie. 10+) who reached a high score on the TAS-20, qualifying as "severely" impaired. Soulgany101 06:41, 14 September 2007 (UTC)

I disagree with that interpretation. The quoted phrase is talking about te data in Table III of the paper. That table's rows are the group responses; its columns are the groups (ASD adults, normal adults, ASD relatives). An obvious "further analysis" is to break the columns into smaller groups (e.g., AS adults). There is other further analysis that could be done: the rows could be broken down, along the lines that you suggested. But there's a strong implication that the study was so small that breaking it down either way would have generated questionable results. If they could have reported separate results for AS, they would have. Eubulides 18:06, 14 September 2007 (UTC)

WP:MEDRS says that an article like this should be based on reliably secondary sources whenever possible, and that primary sources should be used with great care. Here, we have a paragraph about alexithymia and AS that cites only (a) a primary source about one small study, (b) a claim about the study in a review by one author (a coauthor of that study) that is not supported by the primary source, and (b) letters to the editor. The author in question (Frith) is reliable, but I'm afraid that the alexithymia paragraph as it stands is placing undue weight on a theory with relatively little scientific evidence to back it. Compare this paragraph to the other two paragraphs in the body of the section, each of which is supported by what must be dozens of studies and by a multiple-author review.
The simplest way to fix the problem is to remove the paragraph about alexithymia entirely.

That is an interesting way to fix a problem, though I would opt to keep a mention in the article somewhere. As you say, the connection has merit, and this according to a growing body of researchers. Soulgany101 06:26, 14 September 2007 (UTC)

Better, I think, would be to condense the point about alexithymia into a single sentence and combine it into one of the earlier paragraphs, most likely the lead paragraph of the section. I write all this without pleasure, as I think the alexithymia-and-AS connection has merit; but my personal opinion of the theory is irrelevant.

Eubulides 04:39, 14 September 2007 (UTC)

This topic has been a long-standing bone of contention between Zeraeph and Soulgany101, including a blanking and edit warring spree at Alexithymia that I tried to mediate; let's please not get too sidetracked on one sentence, or it could derail the significant work we still have to address. Soulgany, Alexithymia covers the info you want to convey; do we really need it all in this article? Eubulides, can we find an intermediate compromise? I don't want to see us go down an already contentious path, when we have so much to do still. SandyGeorgia (Talk) 18:26, 14 September 2007 (UTC)

Yes, there were three main areas of contention, one that there was a completely inaccurate, unreferenced (and unreferenceable) claim which Z did not want to delete, and secondly there was a Christian rock band who were promoting their song 'Alexithymia' on the page, which I did not feel was useful in the article. Thirdly, Z also went on an irrational blanking spree to wipe out what she thought were unreferenced claims, but which were in fact referenced (she didn't understand the referencing system). I can't really see any of that happening here. But I agree it also is not worth sweating over here as the alexithymia page covers the issues sufficiently. After now discussing the material by Frith I'm happy for Eubulides to make of it what he/she will. Soulgany101 21:55, 14 September 2007 (UTC)

It made it into this article only because Baskin (an independent review) mentioned it; I'll go to my other computer where I have the Baskin article and add his text here, so you can have a look. SandyGeorgia (Talk) 04:43, 14 September 2007 (UTC)

From Baskin, p. 5 (references Tani et al):

Difficulty in relating socially may be considered similar to a lack of awareness of one’s own internal state. Sifneos conceived the term “alexithymia” to describe the difficulty of distinguishing emotional feelings from bodily sensations.[26] Tani and colleagues[27] noted the similarity between AS and alexithymia and the potential involvement of the limbic system and prefrontal cortex in both. They found that the conditions also shared a common disruption of sleep, specifically in initiation and continuity. Using the Toronto Alexithymia Scale and Basic Nordic Sleep Questionnaire, they compared 20 AS adults with 10 healthy controls. As postulated, AS subjects were significantly more alexithymic and reported poorer sleep quality.

26. Sifneos PE, Apfel-Savitz R, Frankel FH. The phenomenon of “alexithymia.” Observations in neurotic and psychosomatic patients. Psychother Psychosom. 1977;28:47-57.

27. Tani P, Lindberg N, Joukamaa M, et al. Asperger syndrome, alexithymia and perception of sleep. Neuropsychobiology. 2004;49:64-70. PMID 14981336

SandyGeorgia (Talk) 04:48, 14 September 2007 (UTC)

The text already refers to the Tani et al. paper. I see now that the Tani et al. paper also talks about sleep problems, which are another symptom worth mentioning. Both secondary sources about alexithymia refer to just one primary source, so in this particular case let's omit them; they're not that good as reviews. Also, the letters to the editor cover one of the primary sources sufficiently well so we need not refer to the primary source there either. I tracked down a more-recent study that reports association between alexithymia and AS, and rewrote that paragraph to mention both sleep problems and alexithymia, using the Tani et al. paper to tie it together. Hope this suffices. Eubulides 19:35, 14 September 2007 (UTC)

I think the new paragraph is in line with the direction the rest of the article is trending; given that the entire article is becoming more brief and succinct, it doesn't seem necessary to have 3 sentences about one trait where causality isn't clear. SandyGeorgia (Talk) 19:55, 14 September 2007 (UTC)

Yes, it works for me too, though it seems unnecessarily short. Soulgany101 21:55, 14 September 2007 (UTC)

That's a very refreshing response; it's nice to encounter a moderate editor here :-) A lot of this article is becoming short—Alexithymia isn't alone—and I don't think that's necessarily a bad thing. SandyGeorgia (Talk) 22:17, 14 September 2007 (UTC)

Newly-arrived graphic

I know this is going to come up again (since only a few days ago there was objection to using a graphic of a brain scan), so I thought I'd ask about the image of a brain scan that's been added to the article. The caption says "Functional magnetic resonance imaging provides some evidence for both underconnectivity and mirror neuron theories of AS." I am assuming, perhaps incorrectly, that the basis for the caption is the work of Dapretto et al., Kana et al., and Just et al., but those papers were all done on patients who had been diagnosed with autistic disorder, rather than AS. So I was wondering, are there papers that I've overlooked which dealt with AS patients? Poindexter Propellerhead 01:55, 15 September 2007 (UTC)

Thanks for catching that. You're right, those papers were not about AS. I removed the "of AS" from the caption. I also added a cite to a study (Nishitani et al.) that provided evidence linking AS to the MNS theory. That study used MRI, not fMRI, though, so the caption was indeed wrong. Eubulides 06:05, 15 September 2007 (UTC)

I'd like to make a suggestion, if I might. I'm sure that there will be objections to the graphic, since one was made in advance, but I admit that finding graphics which will be considered worthy by all is a daunting task. I noticed that some graphics-related debates happened on the autism pages, but that everybody liked the pictures of kids doing things which were typical of autism. I happen to have a kid with AS who would be happy to help Wikipedia out, and I'm a pretty decent photographer. Would there be any objection, in principle, to using something like that instead? Poindexter Propellerhead 07:10, 15 September 2007 (UTC)

I think that's what we've been hoping for; that is, that someone would actually *do* something to get images (such as design a brain image specific to AS only). But what would you photograph him or her doing that could be captured on film as typifying somthing written about in the AS article ? And you realize you'd then be releasing the photo to worldwide, netwide, whatever; that is, you'd have no control at all over where the photo ended up? SandyGeorgia (Talk) 14:41, 15 September 2007 (UTC)

I have been trying to do something to obtain images from elsewhere, but haven't found anything suitable. I do realize that I'd be releasing the photo without restriction, forever. As for what I'd depict, he has some special interests that he puts a lot of time into, and plays in ways that no NT kid would play. For example, if you give an NT kid a set of Magnetix to play with, they will build various sorts of things... if you give my son a set of Magnetix, he will start using them to design things like polymer molecules, using the different colors to represent various sorts of bonds between the atoms. And he will not tire of this, he will happily construct dozens or hundreds of molecules without ever building anything else. If that doesn't suit everyone, we could probably think of something else to use, but I thought it a pretty good example of a behavior you'd never see in an NT 8-9 year old, kind of the aspie analog to the autistic toddler with their size-sorted toys. Poindexter Propellerhead 18:20, 15 September 2007 (UTC)

That sounds good. PP, I'd personally be very reluctant to put out a kid's picture on the 'net, not knowing where it may end up ten years from now (or how he may feel about it when he's 20). If you decide to do this, I hope you'll take care to get a side shot or not too much of his face, OK? SandyGeorgia (Talk) 18:53, 15 September 2007 (UTC)

When he's 20 he'll probably be a biochemist like his sister, and like the pic, but I took side shots just to be safe. I have a couple which are pretty good, and will post their locations, so that people can pick a favorite, as soon as I've figured out how to upload them. Poindexter Propellerhead 22:26, 15 September 2007 (UTC)

Well, that was easy! They are here and here. Poindexter Propellerhead 22:35, 15 September 2007 (UTC) (Links deleted to orphan the images. Poindexter Propellerhead 18:10, 16 September 2007 (UTC) )

I like the first one, as it shows a head tilt suggesting absorption in the project. The second does not show that (to my eye). I really great shot, and I hope the other editors like it as much as I do, and vote to include it. Soulgany101 04:31, 16 September 2007 (UTC)

Very interesting. I' prefer it if the child was looking more away from the camera, maybe so only the back of his head was visible with him facing the molecule away from us. I feel a bit uneasy with a kid's face on WP. Great idea for a pic though. I am happy with the general idea and hte more de-identified the better. cheers, Casliber (talk · contribs) 05:26, 16 September 2007 (UTC)

I still have this concern. PP, are you aware that the porn industry crops (splices, whatever the word id) children's faces onto bodies to extend the number of images they can offer? Take great care, pls; I'd feel better if less face was showing. SandyGeorgia (Talk) 14:52, 16 September 2007 (UTC)

In deference to concerns about privacy and image abuse, I selected the photo which shows less of his face (sorry, Soulgany, I liked the other one a little better, too), and cropped it a bit to increase anonymity. I also reduced the resolution, and raised the jpeg compression high enough to make it a poor candidate for Photoshop manipulation; with almost 50 million pictures on images.google.com which match "boy," it shouldn't be a leading candidate for abuse. The new version is here,[[10]] I'll orphan the old ones and let the bot delete them. Poindexter Propellerhead 18:10, 16 September 2007 (UTC)

I like the idea of pictures like this too. The two child photos in Autism greatly humanize the page. Eubulides 06:20, 16 September 2007 (UTC)

Nobody objected to this particular image with its revised caption, so I it back in for now. The article greatly needs images, even if they're not perfect. I hope any concerns can be addressed by rewording the caption. Eubulides 19:56, 19 September 2007 (UTC)

WTF?

...can have both positive and negative effects... Excuse me? What positive effects could there be? I'm pretty sure even Prader-Willi Syndrome is less detrimental for a given person than Asperger's. Take it from someone diagnosed with it. User:Gmeric13@aol.com —Preceding signed but undated comment was added at 00:45, 16 September 2007 (UTC)

Well, to quote one of our references,[[11]]

"Individuals with Asperger disorder have normal or even superior intelligence, and they may make great intellectual contributions... Published case reports of men with Asperger disorder suggest an association with the capacity to accomplish cutting-edge research in computer science, mathematics, and physics. While the deficits manifested by those with Asperger disorder are often debilitating, many individuals experience positive outcomes, especially those who excel in areas not dependent on social interaction. Persons with Asperger disorder have exhibited outstanding skills in mathematics, music, and computer sciences. Many are highly creative, and many prominent individuals demonstrate traits suggesting Asperger syndrome. As an example, biographers describe Albert Einstein as a person with highly developed mathematical skills who was unaware of social norms and insensitive to the emotional needs of family and friends."

That's a brief summary, but I hope that it answers your question. A lot of us aspies wouldn't want a cure if they could invent one. Poindexter Propellerhead 01:28, 16 September 2007 (UTC)

I have Asperger's, and I feel it is the reason why I have such a logical mind- which is why I excel rather typically at mathermatics, computer science, physics and music. Basically, I'm confirming the above. 77.96.223.11 21:52, 20 September 2007 (UTC)

Perhaps I was wrong. Not definitely, but perhaps. Another thing - while the average person with Asperger's may be especially good at mathematics, I was always terrible at word problems. Every night in elementary school for a very long time, my parents would have to sit down for 3 hours and go over the problem with me and I still wouldn't understand. It's that way once again today, when it doesn't look like I will pass a required course to graduate from high school. Maybe something's wrong with me because I don't think this is a good thing. User:Gmeric13@aol.com

I don't think the self-diagnosed much appreciate any hint that Asperger's is related to anything less than super-genius levels of intellect. 160.62.4.10 (talk) 14:25, 27 May 2008 (UTC)

Tweak needed to Diagnosis

Eubulides, I think (not sure?) the previous versions avoided the use of the word "should" per Wikipedia is not an instruction manual or textbook and should not include instructions, advice (legal, medical or otherwise) or "how-to"s. WP:NOT#HOWTO. Can you tweak this Diagnosis sentence in a way that works around the word "should" and eliminates the double use of the word "include"?

A multidisciplinary team[2][4][38] should observe across multiple settings[1] and include neurologic and genetic assessment that includes tests for cognition, psychomotor function, verbal and nonverbal strengths and weaknesses, style of learning, and skills for independent living.

I'd do it myself, except my prose stinks. SandyGeorgia (Talk) 19:35, 16 September 2007 (UTC)

How about saying "would"? Meaning that ideally, a multidisciplinary team would do all that? Circeus 20:39, 16 September 2007 (UTC) Circeus 20:39, 16 September 2007 (UTC)

I just checked Diagnosis of Asperger syndrome and it has "should" (oops). Another option, ... multidisciplinary team typically observes across ... but don't know how to fix the double "include". SandyGeorgia (Talk) 20:44, 16 September 2007 (UTC)

I fixed the wording this way. Perhaps someone else could do something similar for Diagnosis of Asperger syndrome? Eubulides 05:45, 17 September 2007 (UTC)