Autismus-Spektrum-Störungen im Erwachsenenalter: klinische und neuropsychologische Befunde spätdiagnostizierter Asperger-Syndrome

Zusammenfassung

Hintergrund: Hochfunktionaler Autismus (HFA) bzw. das Asperger-Syndrom (AS) gehören zu den Autismus-Spektrum-Störungen (ASS) und sind durch seit der frühen Kindheit bestehende Störungen der sozialen Interaktion, der verbalen und nonverbalen Kommunikation sowie repetitive und/oder restriktive Verhaltensweisen gekennzeichnet. Der in den letzten Jahren zu beobachtende steigende diagnostische Bedarf jenseits des Kindes- und Jugendalters erfordert Spezialsprechstunden für ASS im Erwachsenenalter (ASS-E). Neuropsychologische Untersuchungen dieses spätdiagnostizierten autistischen Patientenklientels liegen bisher kaum vor. Methoden: Wir präsentieren eine Gruppe von 39 Patienten mit HFA/AS (mittleres Alter bei Diagnosestellung 31,1 ± 8,9 Jahre), die konsekutiv in der Spezialsprechstunde für ASS-E an der Klinik und Poliklinik für Psychiatrie und Psychotherapie an der Uniklinik Köln diagnostiziert wurden. Autistische Symptome (Autism Spectrum Quotient; AQ), depressive Symptome (Beck Depression Inventory; BDI), Intelligenz (HAWIE-R), soziale Kognition („Theory of Mind”, ToM) und Exekutiv-Funktionen (COWAT) wurden systematisch im Vergleich zu einer hinsichtlich Alter, Bildung, Geschlecht und Intelligenz parallelisierten Kontrollgruppe Gesunder (n = 39) untersucht. Ergebnisse: Patienten mit HFA/AS wiesen hohe Werte im AQ (40,4 ± 5,2) gegenüber den gesunden Kontrollen (13,5 ± 4,8) auf. Neuropsychologisch zeigten die Patienten im Vergleich zu den gesunden Kontrollen schwächere Leistungen in der sozialen Kognition, bei den Exekutivfunktionen und bei den Untertests des HAWIE-R zur sozial-sprachlichen Pragmatik und der ganzheitlichen Wahrnehmung. Diskussion: Die Diagnosestellung autistischer Störungen im Erwachsenenalter beruht im Wesentlichen auf dem klinischen Nachweis der autistischen Kernsymptome, die bei den hier untersuchten HFA/AS-Betroffenen durch hohe AQ-Werte bestätigt wurden. Das Selbstbeurteilungsinstrument AQ trennte scharf zwischen der HFA/AS-Gruppe und der gesunden Kontrollgruppe. Die autistischen Erwachsenen zeigten neuropsychologische Defizite, wie sie auch für andere Patientenpopulationen mit HFA/AS vorbeschrieben sind. Diese Befundlage spricht für eine stabile Persistenz autismusassoziierter kognitiver Verarbeitungsweisen in das Erwachsenenalter hinein, die trotz hoher sozial-adaptiver Kompensationsleistungen innerhalb dieses spätdiagnostizierten autistischen Patientenklientels nachweisbar bleiben.

Abstract

Introduction: High-functioning autism (HFA) and Aspergers syndrome (AS) are autism spectrum disorders (ASD) characterised by disturbances in social interaction, both verbal and non-verbal communication and repetitive and/or restrictive behaviour since early childhood. Symptoms appear generally during early childhood and adolescence. The increasing need to clarify diagnostic queries in advanced age led to the constitution of specialised outpatient clinics for adults involving a growing amount of HFA/AS subjects diagnosed late in life. However, thus far neuropsychological data about this group are scarce. Methods: We present a subgroup of 39 patients with HFA/AS (mean age at diagnosis 31.1 ± 8.9 years) who were consecutively diagnosed at the autism outpatient clinic at the Department of Psychiatry at the University Hospital Cologne. Autistic symptoms (autism spectrum quotient; AQ), depressive symptoms (Beck depression inventory; BDI), general intelligence (HAWIE-R), social cognition (”theory of mind”, ToM) and executive functioning (COWAT) were systematically studied in comparison to a control group matched for age, education, gender and intelligence (n = 39). Results: HFA/AS subjects presented higher AQ scores (40.4 ± 5.2) as opposed to the healthy controls (13.5 ± 4.8). Neuropsychologically, patients showed deficits in social cognition, executive functions and in subtests of HAWIE-R related to verbal comprehension and perceptual organisation as opposed to the healthy control group. Discussion: The diagnosis of autistic disorders in adulthood basically relies on the clinical assessment of autistic core symptoms which were corroborated by high AQ values. The self-rating instrument AQ was found to be highly discriminative between the HFA/AS group and the healthy control group. The neuropsychological profile of adult HFA/AS patients diagnosed late in life is compatible with that of previously investigated HFA/AS populations. These findings show that such basic autism-associated deficits persist until adulthood, although patients are able to learn social rules.

Schlüsselwörter

Asperger-Syndrom - hochfunktionaler Autismus - Neuropsychologie - Spätdiagnosen - Autismusquotient - Theory of Mind

Keywords

Asperger syndrome - high-functioning autism - neuropsychological profile - diagnosis late in life - autism spectrum quotient - theory of mind

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