حساب شرح حال سنجش در سیندروم اسپرگر و اوتیسم با عملکرد بالا

Sensory experiences in Asperger syndrome (AS) or high-functioning autism (HFA) were explored by qualitative content analysis of autobiographical texts by persons with AS/HFA. Predetermined categories of hyper- and hyposensitivity were applied to texts. Hypersensitivity consists of strong reactions and heightened apprehension in reaction to external stimuli, sometimes together with overfocused or unselective attention. It was common in vision, hearing, and touch. In contrast, hyposensitivity was frequent in reaction to internal and body stimuli such as interoception, proprioception, and pain. It consists of less registration, discrimination, and recognition of stimuli as well as cravings for specific stimuli. Awareness of the strong impact of sensitivity is essential for creating good environments and encounters in the context of psychiatric and other health care.

PROBLEMS WITH MODULATION of sensory input, “lack of responsiveness or an exaggerated reaction to sensory stimuli” (Ornitz, 1973, p. 26), have continuously been noticed since the first descriptions of the autistic spectrum. The characteristics of the autistic spectrum are limitations in social interaction, communication, and imagination, together with narrow repetitive behaviors (Wing, 1997). In Asperger syndrome (AS) or high-functioning autism (HFA), intellectual ability is average or high. The difference between AS and HFA is delayed childhood development in language or cognitive functions in HFA, but not in AS. Early descriptions noticed sensory modulation problems, for example, in relation to sound and touch (Asperger, 1991 and Wing, 1969). Sensory impairments are not diagnostic criteria in the American Psychiatric Association's (APA, 1994) fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). In the forthcoming DSM-V, sensory “hyper- and hypo-reactivity” ( APA, 2010) are proposed as subcriteria (to the criteria-fixated interests and repetitive behavior) for autism spectrum disorder. Another proposed change is to include AS in the concept autism spectrum disorder. Sensory phenomena have been reported clinically, but little research has been devoted to them (Happé & Frith, 2006). There are theoretical assumptions about the causes of sensory differences in autism, but there is no theoretical model that fully explains them (Gerrard & Rugg, 2009 and Rogers & Ozonoff, 2005). The categories of hyper- and hyposensitivity broadly defined as over- and underresponsiveness, based on empirical ground, are used in scales developed to measure the phenomena. Scales are mainly parent report (Baranek et al., 2006, Dunn, 1999 and Talay-Ongan & Wood, 2000) or parent interview scales (Leekham, Nieto, Libby, Wing, & Gould, 2007). Dunn (1997) developed a theoretic generic model for sensory processing that is not specific to AS/HFA or autism. Low sensory thresholds are supposed to interact with behavioral responses and cause sensory avoidance or sensory sensitivity. Similarly, high sensory thresholds interact with behavioral responses and cause low registration or sensation seeking. Two scales for assessment based on this model were developed (Brown & Dunn, 2002 and Dunn, 1999). High frequencies of modulation problems in children with autism compared with nonautistic children were found in research with parent report scales, and the same was seen in children with AS/HFA (Ben-Sasson et al., 2009 and Dunn et al., 2002). To the best of our knowledge, there is only one published quantitative study on the occurrence of sensitivity in adults with AS/HFA using self-report scale data and a nonautistic control group (Crane, Goddard, & Pring, 2009). This study showed the same pattern of high frequency of hyper- and hyposensitivity compared with controls as studies concerning children with autism and AS/HFA. Sensory descriptions and measurements are mostly based on observation of childhood behaviors, and sensory modulation problems are inferred from these behaviors (Baranek et al., 2006 and Talay-Ongan & Wood, 2000). Experiences that are verbally expressed and representative for the high-functioning group are sometimes referred to, but are often reported anecdotally, and systematic investigation is scarce. Two previous qualitative studies about sensory phenomena described by adults with AS/HFA have been conducted. One study analyzed Internet-based self-accounts by persons with AS/HFA (Jones, Quigney, & Huws, 2003), and one study analyzed published autobiographical material (Chamak, Bonniau, Jaunay, & Cohen, 2008). These studies provided examples of sensory and perceptual features, but there were not systematic analyses of different types of sensory reactions. It is important to take into account verbal descriptions from high-functioning persons. According to Billstedt, Gillberg, and Gillberg (2007), sensory and perceptual problems together with social interaction difficulties are the shortcomings most likely to persist into adulthood for persons diagnosed with autism in childhood. The aim of this study was to explore and describe hyper- and hyposensitivity in the context of verbal expressions of high-functioning persons with AS/HFA.

Sensory experiences and sensory environments both have a potentially strong positive and negative impact on people with AS/HFA. Furthermore, if reduced or heightened sensitivity is present in the individual, it can have diagnostic implications. Coexisting mental health problems and contacts with psychiatric services are common in this group (Hofvander et al., 2009). Encounters with mental health services can easily elicit strong negative sensory reactions. Hypersensitivity makes the person vulnerable to environmental circumstances, and a busy environment can cause disorientation and extreme stress. To create a calm milieu, avoiding too many stimuli is a crucial first step. Elimination of background auditory and visual stimuli, use of soft or natural lighting, taking extra care in physical examination, and organization of the environment in clear and logical ways can prevent discomfort and hypersensitive reactions. It is helpful that the staff are able to understand the way of sensing and perceiving in the autism spectrum. It can, for example, seem very strange not to feel pain when injured, whereas experience pain when being gently touched. Without knowledge about sensory experiences in people with AS/HFA, it is difficult to understand such reactions. It is also important to be aware of possible problems in the processing of information because of hypersensitivity to distracting noises in the environment and too many things happening at the same time. A nonautistic person is required to be highly focused, receptive, and able to adapt when communicating with a person with AS/HFA. It is important to be alert to which sensory channel and way to communicate that work best for the autistic person. It can, for example, be too much to receive information from two sensory channels simultaneously and to make eye contact and listen to what is being said at the same time. There are many things taken for granted in the nonautistic world that can be confusing for the autistic person. The sensory and perceptual world in the autism spectrum is different from the nonautistic as has been shown in many studies. Therefore, to have an atmosphere where it is acceptable to ask questions about how things have been understood, on the autistic and the nonautistic part, is essential because the risk for misunderstandings is very high.