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Featured article review

Lovely, the article was FAR'd. OK, the person who submitted it set up the files all wrong, so I'll go about correcting and archiving them now. SandyGeorgia (Talk) 01:38, 21 August 2007 (UTC)

Comorbidities

Here is a proposed comorbid section in my sandbox. I deleted a couple of sentences from the article which were about autism and PDD but not specific to AS. Is this OK to go ? SandyGeorgia (Talk) 05:17, 21 August 2007 (UTC)

Looks good to me.cheers, Casliber (talk · contribs) 05:27, 21 August 2007 (UTC)

Bedtime here; if anyone else concurs, go ahead and pop that in from my sandbox. On the table I generated from the four sets of diagnostic criteria from Mattila, also in my sandbox, I did only partial info in the hopes it won't violate copyright. What do you all think? It helps me see the differences (and it looks like Szatmari is talking about a whole 'nother condition). SandyGeorgia (Talk) 05:33, 21 August 2007 (UTC)

Does the info about psychosocial factors (peer victimization) go in comorbids, prognosis, or what? Does the info about medical anamolies go in comorbids or diagnosis? SandyGeorgia (Talk) 05:36, 21 August 2007 (UTC)

Safest to leave it as comorbid - as soon as you get either backwards into causation or forwards into prognosis, disputes start about what is related to what and how strong the evidence is for causation etc.cheers, Casliber (talk · contribs) 05:57, 21 August 2007 (UTC)

OK, I'll wait a bit to see if there is other input before adding this to the article. SandyGeorgia (Talk) 15:19, 21 August 2007 (UTC)

Cultural aspects

I have a bad habit of working from the bottom up, because the text at the top is harder to work on :-) In the first paragraph of Cultural aspects, the first sentence is original opinion, not supported by the source (which is a demonstrably inaccurate source anyway, since the author misstates the AS diagnostic criteria), and the second part of the paragraph delves into personality type theory, which is straying from a tight focus on the topic at hand. Can we lose that paragraph or find a way to rephrase and cite the first sentence to a reliable source (which could also be included in the second sub-section, eliminating the need for subsectioning and resulting in a cleaner table of contents per no. 2 ? SandyGeorgia (Talk) 15:19, 21 August 2007 (UTC)

In fact, we already have a reliable source for reworking the first sentence at PMID 11014749 . Can we re-do that sentence and merge it into one Cultural aspects section, losing the sub-section and the personality types? SandyGeorgia (Talk) 15:47, 21 August 2007 (UTC)

The Cultural aspects section needs to be reconciled with text that was moved to the bottom of Treatment; it's basically saying the same thing, and I'm not sure some of it shouldn't go back to Cultural aspects from Treatment. Cas, can you have a look at the two blobs of text sourced to Baron-Cohen (which I've now read) and figure out where and how to merge/reconcile them? I felt badly deleting the marginally sourced text from Cultural aspects without adding something back, but it turns out I spent a lot of time re-inventing the wheel, as that Baron-Cohen text is pretty much already in Treatment. SandyGeorgia (Talk) 01:50, 22 August 2007 (UTC)

Missing section, Screening

See WP:MEDMOS, this article is missing a section on Prevention or Screening. And before editors whack me with you can't prevent, pls review how I handled this section in Tourette syndrome (screen for comorbids, etc.) Are there reliable screening instruments for AS? SandyGeorgia (Talk) 15:31, 21 August 2007 (UTC)

Better to go oblique and call it "Early Intervention"? Because although you cannot prevent or screen, you can significantly alter the prognosis by early identification and intervention. Surely that is more appropriate to context, and equivalent? --Zeraeph 16:48, 21 August 2007 (UTC)

That might generate conflict in the article; there was extended debate in the autism article rewrite as it seems there isn't good evidence backing the notion that early intervention helps. Do you object to calling it screening, and working in some text about early intervention? SandyGeorgia (Talk) 16:58, 21 August 2007 (UTC)

My problem with screening (and I would see this as applying to TS to the same extent) is that it DOES imply a view to prevention, rather than identifying an immutable reality. I am not saying that as something to be debated, but rather something to be honestly sat back and thought about...I am not even sure "early intervention" is right, maybe just "intervention" or "other"? --Zeraeph 17:20, 21 August 2007 (UTC)

Allright, will wait and see what others think. Maybe as we start typing up that text, a solution will emerge. There's text in the reviews that needs to go somewhere. SandyGeorgia (Talk) 17:29, 21 August 2007 (UTC)

This text (currently in Epidemiology):

• The prevalence of AS in adults is not well understood, but Baron-Cohen et al. documented that 2% of adults score higher than 32 in his Autism Spectrum Quotient (AQ) questionnaire, developed in 2001 to measure the extent to which an adult of normal intelligence has the traits associated with autism spectrum conditions. All interviewed high-scorers met at least 3 DSM-IV criteria, and 63% met threshold criteria for an ASD diagnosis; a Japanese study found similar AQ Test results.

is not about epidemiology. It's about a screening instrument, the AQ. If we start a Screening section, something could be included there, but I don't see the connection to Epidemiology. SandyGeorgia (Talk) 16:27, 23 August 2007 (UTC)

Putting this here so we don't forget it; this text was in Causes, but it's not about Causes, it's Screening:

• Research on infants points to early differences in reflexes, which may be able to serve as an "early detector" of AS and autism.

SandyGeorgia (Talk) 20:27, 24 August 2007 (UTC)

Treatment

I don't understand why editors here have accepted a Section heading called "Treatment" for a condition that doesn't always need to be "treated"; in TS, I opted for the alternate section heading of "Management", recognizing that not everyone wants or needs "treatment", but may need to "manage" tics or life with tics. Can we change the section heading to Management, per WP:MEDMOS option? SandyGeorgia (Talk) 15:34, 21 August 2007 (UTC)

Of course it's a REALLY good idea...and SO OBVIOUS! :o) --Zeraeph 16:44, 21 August 2007 (UTC)

Well, I suggested it during the last FAR and got nowhere :-) I just typed up a massive and complicated analysis of the Mattila article and the four sets of diagnostic criteria and lost it all in edit conflict. Argh. It will take some motivation for me to type all of that again; maybe I'll work in my sandbox. SandyGeorgia (Talk) 17:00, 21 August 2007 (UTC)

OW!! Maybe we can use the "editor at work" template on talk here as a special case? :o)--Zeraeph 17:22, 21 August 2007 (UTC)

I don't think that will help; it's my computer. Don't know why I lose stuff even when I preview it. Argh. It was a ton of typing. I'll do it again later. SandyGeorgia (Talk) 17:27, 21 August 2007 (UTC)

I prefer treatment as it makes it sound a bit more pro-active than management; regardless of milder/higher functioning end people, the fact remains that there are people who are impaired at the bottom end, and the treatments which work are behavioural treatments targeted at deficits. management to me suggests status quo whereas treatment is about improving. If no treatment is necessary in any given condition then it is not needed. That's just my take on it - cheers, Casliber (talk · contribs) 02:16, 22 August 2007 (UTC)

I suppose the fundamental difference with Tourette's is that impairment in functioning is not part of the diagnostic criteria, and most need no treatment. SandyGeorgia (Talk) 03:58, 22 August 2007 (UTC)

A break

As I suggested yesterday, I have run out of time that I can put into this article for the moment... I will be leaving on a trip tomorrow, and have a number of errands and preparations to make before I go, and things to tend to when I get back. I believe that Zeraeph is in a similar situation, with house guests requiring attention, as well as some less pleasant schedule demands over the next few days. Though sketchy on the details, I believe that CC has some near term restrictions on his time as well. There have also been concerns that attempts to reach consensus have been more effective at reducing productivity than they have at creating unity. A couple of days ago, for example, we spent so much time disputing on the talk page that very little else got done, a scenario where everyone loses. So, both because we have to take a break, and because it's probably the most efficient approach, our participation in the editing of this page will be negligible for a little while. You may go ahead and do as you see fit, without worrying about us.

This also ends any need for mediation, I'll ask CC to verify that personally, since he was the one who requested it. Poindexter Propellerhead 21:02, 21 August 2007 (UTC)

Yes, i no longer feel mediation is needed. CeilingCrash 21:54, 21 August 2007 (UTC)

I'm going to be pretty busy as well over the next month, but will have sporadic openings where I'll try to do as much as I can. For example, I'd like to finish up comorbids, finish up Diagnosis (which I've started in my sandbox) and work on Management and other straightforward things as available in the new reviews. It strikes me that the lead is the most contentious area, so it's best left til we're all available to iron it out. Is it OK if I proceed with the other areas, as long as I develop text in my sandbox and give folks a few days to check it out? Are you Ok with comorbids so far, and the other section heading changes I've proposed above ? SandyGeorgia (Talk) 21:08, 21 August 2007 (UTC)

Don't worry about our viewpoints. I'm in the process of packing, and I don't think the others are even as available as I am. You're free to change the lead, or anything else, however you wish. As you've noted, we work at a measured and deliberate pace, making our work habits, through no fault of anyone, difficult to mesh with yours. So, have at it, without hesitation, there's no risk of stepping on our toes, because they will be elsewhere. Poindexter Propellerhead 21:47, 21 August 2007 (UTC)

I absolutely concur, of course, being me, I will be popping in to "watchdog" a few articles I usually do, but I just don't have the kind of time it takes to give this article the necessary attention (after all, I only usually "watchdog" it for vandalism and the lunatic fringe, which REALLY isn't called for at present). --Zeraeph 22:11, 21 August 2007 (UTC)

Well, this is reassuring, but no one has said if they're content with my writing so far, and I'd hate to have it all reverted if I'm on the wrong track :-) (Currently working on Diagnosis in my sandbox.) SandyGeorgia (Talk) 22:46, 21 August 2007 (UTC)

I don't know enough about opinions on details of every edit to be able to comment; in fact, I think it's safe to say that nobody knows, because we have not reviewed every edit. Personally, I've been extremely happy with some of the text, less so with other. But you have no need whatsoever to worry about reversion. If we come back later and agree that any improvement can be made, we will address it through our usual, gradual, consensus-driven polishing process. Poindexter Propellerhead 23:08, 21 August 2007 (UTC)

Diagnosis section

OK, pending a later copyedit by Tony, I've done all I can do. Please review the version in my sandbox and let me know if it's close enough to go into the article (recognizing that copyediting, tweaking, and correct wikifying will still be needed later). There are many screening instruments mentioned in the journal reports, so I still suggest we add a section on that later. SandyGeorgia (Talk) 01:30, 22 August 2007 (UTC)

The only thing I'd add up top is that it should be (is?) diagnosed by a specialist whose area of expertise covers the condition, namely a psychiatrist, child psychiatrist, pediatrician or child psychologist - and that pediatric medical review is essantial to rule out an organic condition. cheers, Casliber (talk · contribs) 02:20, 22 August 2007 (UTC)

Seems straightforward, but I've not yet read that in any text, so I need to find a source. Did you see the multidisciplinary evaluation bit at the bottom? All of my friends with AS children tell me that's the crucial part; that most often, it takes a multidisciplinary approach, so I thought it important to get that in. Feel free to operate in my sandbox if you find anything; otherwise, I'll look tomorrow. SandyGeorgia (Talk) 02:30, 22 August 2007 (UTC)

Yep - saw the multidisciplinary bit and agree it is vital in terms of assessing functionality WRT strengths and weaknesses, but still need to mention who actually makes diagnosis; my bit above can be introduced there. I'll see if I can figure how.cheers, Casliber (talk · contribs) 03:52, 22 August 2007 (UTC)

I added some new text on this that may satisfy your concerns; it's all I could find. SandyGeorgia (Talk) 17:06, 22 August 2007 (UTC)

Sorry - a bit fuzzy-headed at the moment as I have a cold/fluey thingy - I just noticed:

The diagnosis of AS is a two-stage process. The first stage begins with developmental screening during a routine check-up with a family doctor or pediatrician. The second stage is a comprehensive team evaluation to either rule in or rule out AS.

- the first bit seems a bit wordy - would you be happy with

The diagnosis of AS is a two-stage process; Initially, developmental screening during a routine check-up may pick up some signs that the family doctor or pediatrician feels may warrant further investigation. This will require a comprehensive team evaluation to either confirm or rule out a diagnosis of AS.

Lemme know what you think. (don't much like 'rule in' as a verb here) cheers, Casliber (talk · contribs) 03:04, 23 August 2007 (UTC)

Perfect, I completely cribbed that from the NIH public domain, so a rewrite is in order. I'll put that in. SandyGeorgia (Talk) 03:08, 23 August 2007 (UTC)

could probably even leave out 2 stage bit. I'm picking up Tony's stuff on redundancies...cheers, Casliber (talk · contribs) 03:34, 23 August 2007 (UTC)

Copyediting

Tony, thanks for the excellent copyedit of the History section. Responding:

• I'm not concerned about the over-reliance on "What'sSpecial"; there was nothing there that wasn't duplicated in bits and pieces in numerous other sources, and none of it seems controversial. That article has the advantage that the full text is available online.
• I was intentionally vague here, and I'm not sure how to resolve this. I've found a number of sources saying AS was added to ICD in 1992, and others saying 1993. Maybe someone can resolve (I see I used the 92 date later in the text).
• You changed:
  • "Kannerian autism", characterized by significant cognitive and communicative deficiencies, including delays in language development or complete lack of language. (Kanner, L (1943). "Autistic Disturbances of Affective Contact". Nervous Child, 2;217–250.) ... to:
  • characterized by significant cognitive and communicative deficiencies, including delays in language development or a complete absence of the capacity for language.

• I don't have that source, and I'm not certain if that's a change in meaning; can someone else please check and correct ?

Better would be: "Kannerian autism", characterized by significant cognitive and communicative deficiencies, including delayed or absent language development. (Kanner, L (1943). "Autistic Disturbances of Affective Contact". Nervous Child, 2;217–250.) cheers, Casliber (talk · contribs) 03:10, 24 August 2007 (UTC)

• You changed:
  • unlike Kanner autism, there is no history of language or general developmental delay in Asperger's ... to
  • unlike Kanner autism, there is no history of linguistic or cognitive developmental delay in Asperger's.

• The source says, "Like autism, it is considered to be a developmental condition of early onset. But unlike Kanner-type autism, there is no history of language delay or general developmental delay." I'm not sure if there's a change in meaning there; can someone review ? SandyGeorgia (Talk) 15:04, 22 August 2007 (UTC)

Thanks, Sandy. Best to be safe, I guess, but it is a problem when the sources are unsatisfactorily vague. What does "general" development mean? Perhaps the wider context of that article clarifies this. I think I went back to the DSCM IV text, subconsciously. I do see WP as being able to exercise a role in providing clarity to a subject by clarifying fuzzy prose in the sources it draws on, but we do, of course, need to be confident that we're not misinterpreting the "known" facts. Tony 15:28, 22 August 2007 (UTC)

Thank you; since Cas is a practicing professional, he should be able to clear up those remaining items. Hello, Casliber :-) SandyGeorgia (Talk) 15:39, 22 August 2007 (UTC)

I'd agree with Tony - cognitive is a better fit than general (though the underlying concept is vague, as are all definitions of "normal"..) cheers, Casliber (talk · contribs) 03:11, 24 August 2007 (UTC)

Prognosis

I'm working next on Prognosis in my sandbox; there is a lot of text to incorporate. I've downloaded the full Coplan study, and it simply is not about Asperger's. Considering the study limitations and that the paper is more about a predictive model than outcome in AS per se, I'm not sure if any of it is relevant. Coplan states that larger studies are needed to validate the model, so it also suffers from recentism. SandyGeorgia (Talk) 17:55, 22 August 2007 (UTC)

Please review Prognosis in my sandbox; I worked in the Baron-Cohen ASQ statements, as well as everything I found in both the Baskin and McPartland reviews. SandyGeorgia (Talk) 23:39, 22 August 2007 (UTC)

Images

Does Image:Autismbrain.jpg used in Autism also apply to AS? Can we use it? SandyGeorgia (Talk) 03:36, 23 August 2007 (UTC)

Regarding the removal of this image, the peer-reviewed literature states that

• "Differences in brain volumes—such as enlarged amygdala and hippocampus—have been linked to autism; the most robust findings are of the reduced size of the corpus callosum and rapid brain growth and increased brain volume in early childhood that normalizes in mid-childhood. "

so this image has useful info to convey. The problem we have is that there are few useful images, no one has found and inserted anything that is free use in the four months since I first raised this, and I'm concerned that we may lose the two Asperger images, as they don't have good free use rationals. We need something; unless someone can find something, the brain image and risperdal may be the best we have. Hopefully careful use of image captions will render the use of these images effective. SandyGeorgia (Talk) 15:08, 26 August 2007 (UTC)

Fair Use issues raised on the FAR; we need to look at these, and may need to bring back the brain image. I don't really speak Fair Use, but it did appear the Asperger images weren't in the clear, which is why I moved in the brain and risperdal images, which have no problems. SandyGeorgia (Talk) 14:20, 27 August 2007 (UTC)

Alexithymia

The Baskin (2006) review mentions Alexithymia and provides context and leads to other research. I've incorporated everything from Baskin, the other articles, and our article on alexithymia in a rewrite in my sandbox. I suggest:

1. The extra detail in Asperger syndrome about who named it, discovered it, when etc. is too much detail for this article; that sort of detail is more appropriately explored in the alexithymia article, so I've left it out.
2. Alexithymia is not identified as a core characteristic of AS; mediating factors and causality are not clear, so the text belongs more correctly in Comorbids.
3. The statement that 85% of people with ASDs have alexithymia doesn't belong in an article about AS, but could find a home in the autism spectrum article. SandyGeorgia (Talk) 16:22, 23 August 2007 (UTC)

Unless anyone disagrees, I'll incorporate the text from my sandbox into the Comorbidities section, removing it from Characteristics. SandyGeorgia (Talk) 15:50, 23 August 2007 (UTC)

The sandbox version is accurate, and I agree it can be placed under comorbidity. There was some original concern that comorbidity referred only to the co-presence of disorders, and that alexithymia is not labeled a disorder (it is presently called a syndrome, condition, trait, or state). A further study of "comorbidity" revealed it can apply to two or more conditions (which alexithymia is), meaning there should be no problem with placing it in that section. Soulgany101 21:22, 23 August 2007 (UTC)

A bit of a quandary as Alexithymia isn't a condition like depression, anxiety as such but sits in a bit of a twilight zone as an observed (or reported) characteristic. I'd have trouble with it in comorbidities and lean slightly toward characteristics though recognize the problem....I'm not too fussed reallycheers, Casliber (talk · contribs) 22:11, 23 August 2007 (UTC)

I agree, it can be placed in the characteristics section. I'm happy with either placement.Soulgany101 22:23, 23 August 2007 (UTC)

PS. If it is going to be left in the characteristics section it should be moved out of the 'social differences' heading as this is a poor category in which to place a predominately psychological issue. Maybe 'Other differences'? Soulgany101 00:26, 24 August 2007 (UTC)

I'll park the text in Other for now, and we can rework those kinds of details in the final runthrough. (Casliber, I left a few things for you to resolve from Tony's copyedit; see the Copyediting section a few sections up.) SandyGeorgia (Talk) 00:39, 24 August 2007 (UTC)

A look ahead

I'm plodding forward on Treatment in my Sandbox; not sure yet how to deal with ABA and would love some help from Eubulides. I don't anticipate a problem with Causes, except that I don't have the knowledge/background to deal with neuroanatomical findings, brain imaging, etcetera, and I'm hoping either Cas, Tim or Eubulides will write that piece (there's ample info in all of the reviews, but it's over my head). I'm really hoping Eubulides will rework Epidemiology, as that's his thing (and AQ is a screening instrument, doesn't belong in Epidemiology). Looking ahead, Classification shouldn't be hard, but every time I glance at Characteristics, I find it daunting. Too much of what is there isn't well sourced (too much Attwood and others), and I'm a little concerned about how to best tackle that section. Ideas ? I hope no one is concerned yet about uneven wikilinking; I'd much rather review for wikilinking and possible redundant info between sections when we're really really almost done and in the final ce phase. SandyGeorgia (Talk) 00:58, 24 August 2007 (UTC)

Treatment (sandbox)

In my sandbox; good enough to move in to the article, knowing that we may need to smooth things over in the end??? Gettin' tired SandyGeorgia (Talk) 01:45, 24 August 2007 (UTC)

Sorry, I wanted to highlight why meds are controversial - necessary at times but tricky too. trying to think of a word between frequent and uncommon....Otherwise very well done - looks greatcheers, Casliber (talk · contribs) 01:55, 24 August 2007 (UTC)

I'll work on citing that unless someone else gets to it first; that's common info, so it shouldn't be hard. SandyGeorgia (Talk) 02:33, 24 August 2007 (UTC)

Ok, I'm confused; I don't know what those {{ref}} thingies are that you added. Help? SandyGeorgia (Talk) 02:37, 24 August 2007 (UTC)

d'OH (slaps forehead) - i meant tags...cheers, Casliber (talk · contribs) 02:41, 24 August 2007 (UTC)

That makes more sense; I'll look for citations :-) SandyGeorgia (Talk) 02:44, 24 August 2007 (UTC)

I found some citations, but without free journal access, I can't be certain they're the best; would you mind having another look? SandyGeorgia (Talk) 03:28, 24 August 2007 (UTC)

Knowing who they are and where they're published I'm satisfied. They are unlikely to be challenged and there would be alot of others to back them up. cheers, Casliber (talk · contribs) 01:25, 25 August 2007 (UTC)

I have limited time to review, but just now started to look at Asperger #Treatment, and here is my first comment. Currently Asperger #Treatment says "Because no two children with AS are alike, intervention is tailored to the individual needs of the child based on multidisciplinary assessment." and cites Foster & King (PMID 14508298). This evidently refers to Foster & King's remark on page 493, "No two children with AS are alike, and treatment must be individualized. Multimodal interventions are the rule and may include individual psychotherapy, family counseling, social skills training, speech and language interventions, occupation and physical therapy, vocational training, and medication." Foster & King cite one source for this (uncontroversial) claim, namely Blackshaw et al. doi:10.1177/1362361301005002005. But Blackshaw et al. have nothing to do with this claim. The citation to Blackshaw et al. appears to be an error in Foster & King, and casts some doubt on using Foster & King to back up the claim in Misplaced Pages. Can you come up with a better citation? (As must be apparent by now, I'm picky about citations, perhaps even too picky.…) One other thing: I get the impression that intervention is supposed to be tailored, but is not always tailored enough in practice; perhaps the sentence could be reworded to not imply that individuation always occurs. Eubulides 00:02, 25 August 2007 (UTC)

Ugh. That level of problem is irritating in a journal report. I doubt that I would be successful in citing it with the resources I have, so if no one else can cite it, we'd best just delete it. SandyGeorgia (Talk) 00:18, 25 August 2007 (UTC)

Regarding Because no two children with AS are alike, intervention is tailored to the individual needs of the child based on multidisciplinary assessment. - we could lose the first clause - we know what it means but it is fairly self-evident and adds little - rather just say that "treatment is customised to address a child's particular deficits." or something similar and leave it at that. cheers, Casliber (talk · contribs) 01:27, 25 August 2007 (UTC)

I fixed the wording and added a citation. Eubulides 04:27, 25 August 2007 (UTC)

Causes

I've started on Causes. What I'm finding as I go through out current text is that very little of the text and studies there are specific to AS; most of it is general to autism spectrum disorders, so is in the wrong article, while AS per se is neglected. I'm going back to the peer-reviewed journal articles and starting over, building info specific to AS in my Sandbox. Thoughts? SandyGeorgia (Talk) 20:32, 24 August 2007 (UTC)

I'm finished with Causes in my sandbox. Will others please go through it with extra care? It's mostly Greek to me, and I've only regurgitated what the sources say. SandyGeorgia (Talk) 22:29, 24 August 2007 (UTC)

Looks good - done a good job treading the line between jargon and clear english without losing meaning (though I'm probably not the best person to call on this aspect). cheers, Casliber (talk · contribs) 01:34, 25 August 2007 (UTC)

Tim tweaked it as well, so I went ahead and moved it in. SandyGeorgia (Talk) 03:47, 25 August 2007 (UTC)

AS vs. HFA

Next I'm going to tackle this piece (because I'm afraid to take on Characteristics just yet, since it needs huge amounts of work). The question of AS/HFA is mentioned in almost every article I've read, and is significant. It belongs in Classification, right? (Somebody start giving Eubulides cookies and milk, beer and pretzels, or scotch and pate, whatever it takes to get him to write Epidemiology :-)) I'm starting to get dizzy, and I hope others are seriously checking and scrutizing my work :-) SandyGeorgia (Talk) 01:48, 25 August 2007 (UTC)

I looked briefly at this but am short of time right now. You're right, Characteristics is going to need lots of work: I barely scratched the surface by rewriting its 1st paragraph. The question of AS versus HFA does belong in Classification. One idea: read Autism #Classification, particularly near the area where it cites Asperger syndrome or high-functioning autism? (ISBN 0306457466). It's not likely you'll be able to grab that book (other than snippets in Google Books) but here's another idea. I recently found a good short intro to this area (which also happens to be free, which is a big plus) in Klin 2006 (PMID 16791390). Don't be fooled by its Pubmed summary: the article is in English. Klin makes two good points about HFA vs AS. First, most recent research in this area does not focus on differential diagnosis (i.e., are HFA and AS different?) but rather on what might cause one versus the other (i.e., what predicts the differences in phenotypic presentation?). Second, in practice the typical needs and challenges faced by individuals with these conditions are often best described/analyzed without paying much attention to the specific diagnostic label. Eubulides 04:47, 25 August 2007 (UTC)

I just took my first indepth look at Characteristics, and I can't find anything salvageable. If there is anything in there that is well-sourced to high quality sources and is worthy of saving, can someone point it out? A bit frustrated, feeling a blank slate will be needed there. SandyGeorgia (Talk) 03:32, 26 August 2007 (UTC)

The 1st sentence, and the 2nd sentence up through the first semicolon should be OK so far as they go, since they're based on Klin 2006. But you're right, most of the section is quite bad, and a good rewrite of that section may well need to lose the 1st two sentences as well. Eubulides 04:05, 26 August 2007 (UTC)

Have a look at what I did there to make the other diagnostic schemes work (I have to someone pave the way for Gillberg and Szatmari, which are discussed in Diagnosis). I've gone line by line through that section, and now that I've read all these journal articles, I'm pretty sure it will be much easier to start from scratch. If anyone sees any sentence that is well-sourced and of particular value anywhere in Characteristics, please scream. SandyGeorgia (Talk) 04:25, 26 August 2007 (UTC)

Thanks so much, Eubulides; I'll work on those items later today, after I get through Tony's latest inline queries—a couple of them pertain to text I cribbed from autism on ABA, so you might want to have a look and resolve those two. SandyGeorgia (Talk) 13:51, 25 August 2007 (UTC)

Re treating people WRT problems and symptoms rather than labels - actually true for most of psychiatric conditions. It is only for the fact that there is a keenness to pigeonhole these things that we even have this dilemma, but never mind - the essential difference is the whole speech thing - the $64 question is whether there is a demarkation or "zone of rarity" between HFA and AS.....cheers, Casliber (talk · contribs) 13:57, 25 August 2007 (UTC)

That diagnostic label thingie is another reason I've kept Roger Freeman's blog around on TS. When we first dove in to this, the AS/HFA dilemma was mentioned sporadically throughout the article, but never clearly delineated, so left a person unfamiliar with AS in a fog. We need to write a serious paragraph or two in Classification, and reduce the fog in the lead. I'll try to pound this out this afternoon if no one else gets to it sooner, but you professional types will have to seriously scrutinize my work :-) SandyGeorgia (Talk) 14:02, 25 August 2007 (UTC)

Size check

The article is currently at 49KB readable prose, within WP:SIZE guidelines, but we haven't yet tackled the rewrite of Characteristics. If the readable prose in Characteristics grows a lot, we may need to consider areas for summary. Based on precedents already set numerous times at WP:FAC and WP:FAR, we should certainly have no problem going up to 55KB on readable prose, but we shouldn't go beyond that. SandyGeorgia (Talk) 15:12, 25 August 2007 (UTC)

Now at 48KB after I moved around some redundant text and removed text that isn't likely to be cited. So, the question is whether Epidemioloy can be rewritten to a similar size, and Characteristics can grow no more than 5 KB. If so, we'll be fine on size. SandyGeorgia (Talk) 15:31, 25 August 2007 (UTC)

Now at 46 KB after removal of several paragraphs that were undue weight or not specific to AS, so we should end up fine on size after rewrite of Characteristics. SandyGeorgia (Talk) 12:51, 26 August 2007 (UTC)

After rewrite of three out of four sections in Characteristics, now at 49KB; rewrite of Speech and language and Classificiations pending. It should not be difficult to justify slightly passing 50KB prose per WP:SIZE considering there are several dozen FAs that were passed with over 60KB of readable prose. SandyGeorgia (Talk) 00:49, 29 August 2007 (UTC)

New lead incorporated, prose size at 52KB; that size will pass FAR or FAC these days, but we should take care that the article doesn't grow. Hopefully the final ce will reduce size a bit by identifying redundant prose. SandyGeorgia (Talk) 13:29, 31 August 2007 (UTC)

Re-working the lead

Not close to doing this yet but want people to start thinking about it. We need to write a compelling, stand-alone summary of the article per WP:LEAD.

• The lead should be capable of standing alone as a concise overview of the article, establishing context, summarizing the most important points, explaining why the subject is interesting or notable, and briefly describing its notable controversies, if there are any. The emphasis given to material in the lead should roughly reflect its importance to the topic according to reliable, published sources. ... the lead section should briefly summarize the most important points covered in an article in such a way that it can stand on its own as a concise version of the article. It is even more important here than for the rest of the article that the text be accessible, and consideration should be given to creating interest in reading the whole article (see news style and summary style). The first sentence in the lead section should be a concise definition of the topic unless that definition is implied by the title (such as 'History of …' and similar titles). ... In general, specialized terminology should be avoided in an introduction. Where uncommon terms are essential to describing the subject, they should be placed in context, briefly defined, and linked. The subject should be placed in a context with which many readers could be expected to be familiar. In general, the relative emphasis given to material in the lead should reflect its relative importance to the subject according to reliable sources. Significant information should not appear in the lead if it is not covered in the remainder of the article, although specific facts, such as birthdates, titles, or scientific designations will often appear in the lead only.

By the time we get to writing the lead, the article should be comprehensive, covering everything that needs to be said, so we can choose what to summarize back to the lead.

Leads of similar articles

• The 40% substance use (hard data) in the lead should be cited, so it should be five.

Summarizing sentences don't necessarily require citation in the lead if the cites are provided in the article, but hard data, quotes, or items that surprise or may be challenged do need to be cited in the lead. (I'm not a fan of over-cited leads as they are sometimes an indication of too much detail, not enough summary, or too much controversy in the lead, but each article is different.)

Can each person start a section, proposing what they'd like to include in the lead ? SandyGeorgia (Talk) 20:52, 25 August 2007 (UTC)

SandyGeorgia

Four paragraphs, no less than 14 sentences-no more than 16, minimal citations (6 or less if possible). I am particularly struck that almost every article I have read mentions the diagnostic confusion in the lead or abstract, as well as the AS/HFA issue, so I believe those need to be in the lead. I also think it will be hard to understand the issues if that framework (as well as the recent-ness of the codification of the condition) isn't laid out early on. I also think Hans needs to be in the lead to provide context for discussion of him throughout the article. This is my initial idea; it will probably change. In terms of detail, the lead of the last featured version seems about right (although the exact content might not be the same as that one).

1. Definition, introduction, (three sentences). Define the condition, how it relates to other ASDs or PDDs (one to two sentences), and basic characteristics (one sentence).
2. History, (two sentences). Introduce Hans and History next, to provide context for next para, where diagnostic confusion is introduced. Explain that it is a recently defined condition.
3. Diagnosis, Causes, Treatment , (four sentences to six). Multiple sets of criteria, diagnostic confusion, AS/HFA issue, DSM-IV/ICD-10 issues, and some detail on how it's diagnosed, one sentence summarizing causes (unknown but could include x, y and z) and treatment (no single teratment but x, y and z are used).
4. Epidemiology, Prognosis, Culture (four to six sentences). How many have it (unclear because of diagnostic confusion) and how they do with it, ending on emerging autistic culture (as done in Autism).

SandyGeorgia (Talk) 20:52, 25 August 2007 (UTC)

My first shot at a lead: four paragraphs, six refs, fifteen sentences. SandyGeorgia (Talk) 23:37, 29 August 2007 (UTC)

Comments on Sandy's lead:I'd scrap all the alternate names in brackets and relegate somewhere - history maybe or classification - never heard it called Asperger Disorder and others where apostrophe and 's' are added are fairly self explanatory. I'd also remove "on the continuum of autistic spectrum disorders (ASD);" as that is still being debated, also Retts disorder is not on a continuum with anything I thought. more to come —Preceding unsigned comment added by Casliber (talk • contribs) 02:36, August 30, 2007 (UTC)

I do like my line - "aim of intervention is to ameliorate symptoms and improve function" - a succinct point that needs to be made at the beginning of a treatment section of lead. As it's what I wrote below I'll wait to see what others think. cheers, Casliber (talk · contribs) 02:39, 30 August 2007 (UTC)

OK. I'll delete the continuum (even though it's the word McPartland uses), and add your "aim of intervention" to my version. Asperger's disorder is the offical name in the DSM; we can't get away from that. I'm really opposed to leaving off all of the alternate names for three reasons: 1) Asperger's disorder is the official DSM name, 2) it's good for google to use all the names, and 3) per WP:LEAD, variations are given in the lead. Otherwise, readers are confused as they encouter different names in refs, etc. SandyGeorgia (Talk) 02:45, 30 August 2007 (UTC)

A new look? My aim was to incorporate your "aim of intevention" and lose the continuum, but I think we have to keep the alternate names in the lead per WP:LEAD and WP:MOSBOLD—"In the first paragraph of any article, put the article name and any synonyms (including acronyms) in boldface." SandyGeorgia (Talk) 02:53, 30 August 2007 (UTC)

Good points (slaps hand on forehead)...wow, DSM wrote that? thanks for highlighting that synonym thingy. Go for it - it's a big lead but I think it's about as succinct as it can be. cheers, Casliber (talk · contribs) 02:56, 30 August 2007 (UTC)

Yep, it's also officially "Tourette's disorder", which really bugs me. Anyway, if others think it's close enough, I'll ask Tony1 to work his copyedit magic on it before I move it in. SandyGeorgia (Talk) 02:58, 30 August 2007 (UTC)

Eubulides comments.

• Change "—also referred to as Asperger's syndrome, Asperger's disorder, Asperger's, or AS—" to "(also Asperger's syndrome, Asperger's disorder, Asperger's, or AS)".

•  Done

• The first couple of sentences mention both ASD and PDD and this will confuse the reader. Just stick to one of these two notions in the lead. You can explain the details later. I suggest standardizing on ASD.

•  Done (will need to recheck use of PDD in article).

• The current wording makes it sound like AS might differ from other ASDs in that it is "characterized by difficulties in social communication, interaction and reciprocity". Please reword to avoid this possible misinterpretation.

•  Done (I hope, pls check.)

• In "speech and language delay and motor clumsiness are not mentioned in most diagnostic criteria", change "most" to "standard".

•  Done

• There's way too much history in the lead, and it's too early. The average reader doesn't care about the history of a syndrome; they just want to know what Asperger is. There's no need for the lead to mention Lorna Wing or her 1981 paper or Asperger's two occupations or exactly when the DSM recognized Asperger's or the English speaking world or eponyms or that sort of detail. One sentence on Hans Asperger ought to be enough. Zero sentences would be acceptable. Any history should be at the end.

•  Done, reduced detail, left his name, but I left date DSM recognized AS, as recentness of diagnosis needs to be understood as one reads the article

• Change "Less than two decades after the widespread introduction of AS to English-speaking audiences" to "Less than two decades after the standardization of AS as a diagnosis".

•  Done

• "the diagnostic validity of Asperger syndrome is tentative, there is little consensus among clinical researchers about the usage of the term Asperger's syndrome, there is lingering doubt about the distinction between AS and high-functioning autism (HFA), and there are questions about the empirical validation of diagnostic criteria". There is a good deal of duplication here. Please summarize more concisely. Perhaps "The diagnostic validity of AS is disputed."? Or perhaps I'm missing another point here?

•  Done (you're not missing anything, I'm trying to satisfy others :-)

• "The deficits associated with AS may be debilitating and lifelong, but individuals who are able to excel in areas less dependent on social interaction may experience positive outcomes. Reports suggest that people with AS may accomplish innovative research in fields such as computer science, mathematics, and physics and that the condition need not be an obstacle to achievement." This seems duplicative; please combine the two sections. "Reports" is a bit strong: this is just Baron-Cohen's group, right? Has it been confirmed by other groups?

• Nope, it's only him, but I feel obligated to include this in the lead for consensus, so tried to fix and combine to one thought.

• The last sentence isn't cited and is a bit dubiously worded. The "shift in view" was originally due to Frith, right? Does Frith have AS?

• Tony reworded anyway. SandyGeorgia (Talk) 12:57, 30 August 2007 (UTC)

Eubulides 06:18, 30 August 2007 (UTC)

• Thanks, Eubulides, good stuff. I see Tony ce'd after your comments, so I'll look at everything today, merge and fix, and ping you when I've addressed the list. SandyGeorgia (Talk) 12:01, 30 August 2007 (UTC)

• Done, pls recheck? SandyGeorgia (Talk) 12:57, 30 August 2007 (UTC)

My final comment on lead (or is that comment on final lead?) - the content is fine - I am a little concerned about the flow and how it reads but given the amount of material summarised it is tricky how it could be done otherwise. If everyone else is happy with how it reads then I'm not fussed....cheers, Casliber (talk · contribs) 13:39, 30 August 2007 (UTC)

I suspect we'll need to fix a lot of flow issues once we have all the text in the article, stabilized, and can stand back and review with a fresh perspective. If that's your only concern, and if Eubulides is satisfied, I propose that we move it in, stand back a few days (do the wikilinking in the meantime) and then begin to look at the big picture in terms of how the entire thing flows, if it's comprehensive, if there is redundancy, etc. SandyGeorgia (Talk) 13:45, 30 August 2007 (UTC)

That is, if it's close enough to move in, we can untag the article, which is good for Wiki and Wiki readers :-) SandyGeorgia (Talk) 13:56, 30 August 2007 (UTC)

Cas - trial lead - play here

Asperger Syndrome is a psychiatric or pediatric diagnosis describing a syndrome of abnormal behaviours/abnormalities typified by impaired social function and repetitive or stereotypic behaviour. It is one of five neurobiological syndromes classified as Pervasive developmental disorders (PDD), along with the similar condition autism. Symptoms are often evident from early childhood, though diagnosis is not often made until several years later. and standard language development. The diagnosis is complicated by the lack of a standard diagnostic screen, and the use of several different screening instruments and sets of diagnostic criteria. The exact cause of AS is unknown and the prevalence is not firmly established, due partly to the use of differing sets of diagnostic criteria.

Asperger syndrome was named in honor of Hans Asperger, an Austrian psychiatrist and pediatrician, by researcher Lorna Wing, who first used the eponym in a 1981 paper. In 1994, AS was recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as Asperger's Disorder.

Asperger Syndrome is a lifelong condition and intervention is aimed at ameliorating symptoms nad improving function; the mainstay of treatment is behaviour therapy focussing on specific deficits - poor communication skills, obsessive or repetitive routines, and physical clumsiness. Most individuals with AS can learn to cope with their differences, but may continue to need support to maintain an independent life. —Preceding unsigned comment added by Casliber (talk • contribs) 04:40, August 27, 2007 (UTC)

EQ SQ

Why is EQ SQ theory even mentioned in this article considering this text at our Wiki article:

• The concept of differing types of intelligence in males and females is controversial, and remains largely speculative. Baron-Cohen claims to have based his ideas on a study on a small group of infants he did in 2000, but according to Harvard researchers the study lacked critical controls, has never been replicated and the results were not published in a peer-reviewed journal, and there is a large body of literature which contradicts Baron-Cohen's ideas.

There is no mention of this theory as relevant in any of the journal reviews, it looks like undue weight to a fringe theory, and Baron-Cohen seems to be the only proponent. I'd like to delete it if others agree. SandyGeorgia (Talk) 00:37, 26 August 2007 (UTC)

That text focuses on the "extreme male brain" variant of the theory, a variant that flopped. Baron-Cohen has more recently altered and rebadged it as "hyper-systemizing", but so far the new name has been rarely cited by papers outside of Baron-Cohen's own research group. Autism #Neuropsychology gives the theory two sentences, which is perhaps too much; one would do. Giving it zero is not out of the question, though that seems a bit (ahem) extreme. One must be careful to distinguish the sales pitches ("extreme male brain", "hyper-systemizing") from the actual theory. Eubulides 03:47, 26 August 2007 (UTC)

Thanks, Eubulides; I'll crib something useful from autism then. SandyGeorgia (Talk) 04:07, 26 August 2007 (UTC)

Superior spatial skills, memory, focus

I removed the uncited statement about superior spatial skills per PMID 16328713, PMID 10895561, PMID 12199132 and the lack of mention of this in the journal reviews. The "fulfilling careers" hasn't yet been verified anywhere. The reviews don't mention excellent memory and that isn't cited to peer-reviewed literature. It doesn't appear that any of that sentence can be reliably sourced. I can't find any mention of excellent memory, but do find mention of memory impairments (PMID 17088272, PMID 16874561). If someone has those quotes from Attwood, or any idea of the origin of this text, they would give us leads for tracking down peer-reviewed sources. Enhanced mental focus doesn't jive with the high rate of comorbid ADHD, and I can't find any mention. If anyone has anything, it would help. McPartland says:

• Klin and colleagues compared individuals with AS with individuals with HFA on a variety of neuropsychologic measures and determined that individuals with AS exhibited deficits in fine and gross motor skills; visual motor integration; visual-spatial perception; nonverbal concept formation; and visual memory with preserved articulation, verbal output, auditory perception, vocabulary, and verbal memory. Individuals with AS have been reported to exhibit stronger verbal abilities relative to performance abilities, with particular weakness in visual-spatial organization and graphomotor skills .

SandyGeorgia (Talk) 01:48, 26 August 2007 (UTC)

Promoted to spark research

I'm trying to understand why the article gives space to one person's hypothesis of a financial motivation for the diagnosis. Is this undue weight to a fringe theory or is there other literature of substance to back this up? SandyGeorgia (Talk) 04:22, 26 August 2007 (UTC)

• Peter Szatmari suggests that AS was promoted as a diagnosis to spark more research into the syndrome: "It was introduced into the official classification systems in 1994 and has grown in popularity as a diagnosis, even though its validity has not been clearly established. It is interesting to note that it was introduced not so much as an indication of its status as a 'true' disorder, but more to stimulate research ... its validity is very much in question." (Stoddart, K. P. (Editor) (2005). "Children, Youth and Adults with Asperger Syndrome: Integrating Multiple Perspectives". London: Jessica Kingsley Publishers. ISBN 1-84310-268-4. p. 239.)

This kind of the non-peer-reviewed published info seems marginal. SandyGeorgia (Talk) 04:22, 26 August 2007 (UTC)

I'd lose that info. AS was introduced as a diagnosis at the same time as Rett's and CDD, and with the same level of consensus required. They did literature reviews, data reanalyses, and a field trial. (See PMID 8923221.) There is certainly some controversy over AS as a diagnosis, but any extraordinary claim that AS was introduced as a diagnosis "more to stimulate research" requires more substantiation than this. Eubulides 06:06, 26 August 2007 (UTC)

Almst all psych diagnoses have some issue with validity, AS is no worse than many others, agree with preceding. cheers, Casliber (talk · contribs) 06:24, 26 August 2007 (UTC)

Dysgraphia and other text not needed ?

Supposedly PMID 15473168 can verify dysgraphia in AS; does anyone have access and if so, can you provide the quote? SandyGeorgia (Talk) 04:56, 26 August 2007 (UTC)

I have access. I can't find any mention of dysgraphia in that citation, other than the quote "Reading/writing disorders and/or dyscalculia had been reported in the relatives of 32 patients" which seems a bit of a stretch for a claim of dysgraphia in AS. The "32 patients" are 32 of 100 patients with AS. Eubulides 05:44, 26 August 2007 (UTC)

I've never heard of any significance being attached to the finding of dysgraphia in AS. Interesting yes but I'm not sure of the clinical relevance. cheers, Casliber (talk · contribs) 09:13, 26 August 2007 (UTC)

Well, it's very discouraging that I'm finding almost nothing salvageable in Characteristics. The good news is that McPartland covers it well, but I'm now concerned about rewriting the entire section to one source and diversification of sources. Can anyone who has access to full-text journals suggest another good review article that fully describes characteristics, signs and symptoms of AS, in the interest of diversifying sources ? Also, it appears that mindblindness is also a pop psych construct; is there any peer-reviewed research in this area that would help us keep that in the article? To what extent should we cover things that are part of all ASDs (tics, echolalia, palilalia come to mind)? To what extent do we cover sensory integration when it's allegedly part of all ASDs and subject to controversial findings and no studies verifying efficacy of treatment modalities? In other words, if McPartland doesn't cover something, how much effort do we put into finding sources to verify some of this text, or do we completely start over, sticking to peer-reviewed sources only? By searching within the books, I'm finding most of the Attwood text not useful, although I do like his examples of language—used purely as examples it seems OK. SandyGeorgia (Talk) 12:47, 26 August 2007 (UTC)

Briefly:

• In English you might look at Khouzam et al. (PMID 15124148, already cited) and Frith's Emanuel Miller lecture (PMID 15056300, already cited). McPartland is better as an overall review, but these could serve as useful checks. If you could get Klin et al. 2000 (ISBN 1572305347) that would be great but I'm probably dreaming, right?
• The more-respectable name for mindblindness is "theory of mind". I haven't read up on its applicability to AS but the idea was originally aimed at autism (or maybe ASD), not AS; for AS it does seem to be a bit dated and questionable. Please see PMID 1378848 for one study.
• For individual symptoms it's best to focus on those most-common of AS, or those which best distinguish AS from other ASD.
• You should be able to cover sensory integration in a sentence or two. See PMID 16313426.
• McPartland is a good guide; nobody's infallible but at this stage I wouldn't put a lot of effort into second-guessing him.

Eubulides 16:02, 26 August 2007 (UTC)

Wonderful leads; thanks Eubulides. I've also found useful text in Kasari, Klin, and Baskin, so I think I'm OK now on diversity of sources. I'm starting to work in my Sandbox. SandyGeorgia (Talk) 16:17, 26 August 2007 (UTC)

This is all based on Attwood, self-published, and also is true for many other conditions: do we need this and is there anything peer reviewed to support this concept and its relevance?

• Even among those who feel that the differences between AS and HFA are significant, it is common for diagnoses to be influenced by non-technical issues, such as availability of government benefits for one condition but not the other. (Attwood (1997), pp. 150–51 and Attwood, Tony (2003). Is There a Difference Between Asperger's Syndrome and High Functioning Autism? (PDF). Sacramento Asperger Syndrome Information & Support. Retrieved on 2007-08-15.)

SandyGeorgia (Talk) 14:47, 26 August 2007 (UTC)

The basic point sounds right to me. Even though it's true for many other conditions, we can't assume the reader has read about the other conditions, so I think it's relevant here. I agree it'd be better to get a peer-reviewed citation for it. You might try Shattuck & Grosse (PMID 17563895). Eubulides 17:01, 26 August 2007 (UTC)

Shattuck looks like an excellent source, but I don't want to fork out $25 to answer one question (a journal review I can use to cite numerous statements is a whole 'nother story—I don't mind having invested thousands of dollars into TS books and reports, but AS is a hobby :-). Since the text is worth keeping, I've rephrased it to better clarify what the source says, and moved incoporated it into the right section (Classification) in the article. I guess it's OK to cite this to Attwood until I can get to a medical library. SandyGeorgia (Talk) 19:01, 26 August 2007 (UTC)

Not FA-worthy

I have Aspergers. And after reading this article, not only did I not think it was FA worthy, but, actually, I left looking for other sites to explain it better. AR Argon 05:32, 26 August 2007 (UTC)

Thanks for your input - if you read above this you can tell there is a rewrite happening at the moment; letting us know which bits you felt let it down and giving us some specifics would be great. cheers, Casliber (talk · contribs) 09:12, 26 August 2007 (UTC)

Well, to be honest, the introduction was rather off putting. But I see you guys are rewriting it as we speak, so... there should be no huge concern here. I'm sorry for being kind of uncivil, I was just in a terrible mood at the time. AR Argon 09:49, 27 August 2007 (UTC)

No worries - the introduction has been recognised as needing a workover and will be reworked post-haste. Feedback after its done will be good. cheers, Casliber (talk · contribs) 10:33, 27 August 2007 (UTC)

Argon, just to bring you up to speed, everything has been rewritten except the lead and Characteristics, and Classification isn't quite done yet. Also, we're leaving wikilinking and correct definitions of all the acronyms until the text is nailed down. If you have comments on the other sections of the article, that would help. Also, have a look at the To Do list at the head of the talk page, where I'm striking items as we complete them. SandyGeorgia (Talk) 13:44, 27 August 2007 (UTC)

Cool, I think I want to contribute. Have you seen the category for Wikipedians with Aspergers Syndrome? Lots of them, that's all I can say. I'm still fairly new here, but I'll do my best. Right now, I'm gonna take a break. See ya when I get back! AR Argon 19:44, 27 August 2007 (UTC)

OK, what sections could use tweaking, and what are the guidelines to articles like this, such as the order of things and stuff like that? AR Argon 20:40, 30 August 2007 (UTC)

The next step is to move the lead from my sandbox to the article (now approved by several editors, but waiting for more), and then begin to check the article for consistency, redundancy, comprehensiveness and flow. We're at the size limit, so if we're going to add anything, we need to delete something. I think I've gotten all the wikilinking. The order of sections is correct now, per WP:MEDMOS and everything else per WP:MOS should be correct. FA guidelines are at WP:WIAFA; we've got all guidelines covered but are short on images (Tony1, Eubulides, Tim, Casliber and I have written many featured articles between us). Tony1 has copyedited each section, but an overall copyedit for flow will be needed at the end. Really, the next step is to get all the text into the article and then sit on it a few days, read through it, make sure it hangs together, flows well, covers everything, etc. We need free use images. I'm waiting for several others to approve the lead, per Talk:Asperger_syndrome#Re-working_the_lead, and then I'll move it in. SandyGeorgia (Talk) 21:18, 30 August 2007 (UTC)

I'll see what I can do, though I am inexperienced with uploading images. What kind of image would you need? AR Argon 21:44, 30 August 2007 (UTC)

The problem is, if you're unfamiliar with the whole business of image policy (or afraid of it, as I am :-) it's hard to do. Images have to be GFDL free. I really don't speak that language, but you can look at the image section on this page for the image which Zeraeph doesn't like - click on it and you'll see that it's in the clear, and compare it to the Hans image, which isn't. It's over my head; I hate dealing with images. Argon, you can probably help a lot by printing out the article after we bring the lead in and reading it word by word to watch for anything that's off. SandyGeorgia (Talk) 21:47, 30 August 2007 (UTC)

PS, if you follow the links under #3 (Images) at WP:WIAFA, you can learn about Wiki policy (that is, if you're smarter than I am :-) SandyGeorgia (Talk) 22:00, 30 August 2007 (UTC)

The image "Zeraeph objects to" relates specifically to Autism not AS, a rational you have personally used for excluding no end of soures. You can't pop in "any old GFDL thing", regardless of relevance, to "jazz up the article"! Aslo, as an illustration it gives undue weight to idea that are only "suggested" in terms of the cause of Autism itself, let alone AS. It's almost as bad as those quoteboxes some wag put in earlier "billboarding" the most negative and derisory quotes on AS that they could find. --Zeraeph 23:28, 30 August 2007 (UTC)

Ho, hum. What's a wag? I'm not sure I like being called one. You're entitled to your opinion on the quotes and the image, but I don't share them and I don't consider neurological differences "derisory"; there's just ... differences. By the way, if someone is able to come up with an image that specifically highlights the brain areas implicated in AS, will that work for you? Your objection seems to be the way the other image was labeled. I guess. For example, TimVickers put together the brain image used at TS, so I thought we could ask him, unless you plan to object, then I don't want to take his time. SandyGeorgia (Talk) 00:24, 31 August 2007 (UTC)

No, my objection is to the use of the image at all, it gives WP:UNDUE to a notion of neurology that is only SUGGESTED in connection with Autism let alone AS. I'm not going back over histories, but you are NOT SERIOUSLY asking me to believe that a good solid NPOV editor like you, would put those blatantly negative, derisory, POV quoteboxes that distorted the appearance of the entire article to the point of actively stigmatising AS? NEVER, I refuse to believe you would do that. Apart from anything else, the article would fail FAR in that state, which would be the LAST thing you would wish to do...which brings me neatly to the meaning of "wag", it is an old (British Regency I think?) term for a prankster.

Incidentally, how is the inclusion of the Dahmer piece coming along? --Zeraeph 02:39, 31 August 2007 (UTC)

Epidemiology

Can this be verified to a reliable source (and is it worth keeping, or is it outdated)?

• Gillberg estimates that 30–50% of all persons with AS are undiagnosed. (Bauer S. Asperger Syndrome. The Source (2000). Retrieved 7 July 2006)

SandyGeorgia (Talk) 13:08, 26 August 2007 (UTC)

That number probably comes from Gillberg's 2002 book, which I do not have easy access to right now. However, I would be leery of those numbers. They are most likely relative to some particular context (Sweden circa 2000?) and shouldn't be taken out of that context. It's probably better just to say something like "many cases go undiagnosed". I imagine that one of your existing sources can be cited for the more-vague claim. Eubulides 20:46, 26 August 2007 (UTC)

I don't recall coming across anything general–vague, but I'll be on the lookout for it now. SandyGeorgia (Talk) 21:25, 26 August 2007 (UTC)

Found and added; Klin says it has become a "residual diagnosis", I've not yet encountered any mention of underdiagnosis in a review. The underdiagnosis statement was from 1993 (!!!) so I removed it (AS wasn't even in the DSM then). SandyGeorgia (Talk) 13:13, 29 August 2007 (UTC)

You have to wonder how you find the undiagnosed ones...cheers, Casliber (talk · contribs) 13:23, 29 August 2007 (UTC)

There's been solid work in this area on other similar diagnoses, for example, Tourette syndrome. Every look at a broad population (for example, thousands of school-age children in a given community) has determined that the majority of TS they picked up in the look at a broad population was previously undiagnosed; parents, teachers and clinicians alike were unaware of common tics. I haven't seen such statements or studies on AS. SandyGeorgia (Talk) 13:33, 29 August 2007 (UTC)

Quality of repetitive behaviors

Eubulides or Cas or anyone, are you able to access the second journal article to reconcile these two? I'm familiar with the first, but not the second:

1. A questionnaire returned by 92 parents found that, relative to a group of children with Tourette syndrome, the strong, repetitive interests of children with AS typically focus on the mechanical (how things work) as opposed to the psychological (how people work), suggesting impaired “folk psychology” in children with AS and superior “folk physics”. PMID 10789283
2. PMID 15909401 The parent(s) of 61 children and adolescents (19 with AS, 21 with HFA, and 21 TD) completed two interviews focused specifically on lifetime and current repetitive behavior symptoms. No reliable differences in repetitive behavior between AS and HFA children were found. Results suggested that circumscribed interests differ in developmental course from the three other DSM-IV-TR categories of repetitive behavior. Internal consistency among the four DSM-IV-TR categories of repetitive behavior was high, alpha = .84, providing evidence for a unitary repetitive behaviors factor. The importance of expanding research in the repetitive behavior domain is highlighted as part of the necessary integration of behavioral and neurobiological approaches to understanding the etiology of autism.

What other 3 DSM-IV-TR categoreis are they referring to, and what were the behaviors investigated relative to the first study? SandyGeorgia (Talk) 22:25, 26 August 2007 (UTC)

The 4 categories were B.1 through B.4 of Diagnostic criteria for 299.80 Asperger's Disorder. But before delving into this too deeply, shouldn't we be looking at review articles for this sort of thing rather than slogging through the primary literature? There must be at least a dozen studies in this area, e.g., doi:10.1007/s10578-007-0052-y, doi:10.1007/s10803-006-0332-6, doi:10.1007/s10803-006-0286-8. Eubulides 23:44, 26 August 2007 (UTC)

I happened across it when I was looking for something else, and wasn't sure if it refuted the first result, which was only a parent questionnaire and deals with quality of obsessions rather than the AS/HFA dilemma. I'm sticking with the review articles on AS/HFA :-) If they don't mention this topic, I'm steering clear! Do you feel the first questionnaire isn't worthy of mention? The obsessions in AS are different than the obsessions in TS, which are different than the obsessions in OCD, is the idea there ... SandyGeorgia (Talk) 02:19, 27 August 2007 (UTC)

I wouldn't mention the 1st questionnaire (PMID 10789283) either. As far as I know, that study hasn't been replicated and it is rarely mentioned (other than in papers by Baron-Cohen). Eubulides 02:44, 27 August 2007 (UTC)

I had not previously focused on the fact that it was a questionnaire, which troubles me. I've just started rewriting Characteristics in my Sandbox, and will lose that part. SandyGeorgia (Talk) 02:49, 27 August 2007 (UTC)

I think a review article is the best way to go -just the bits above don't fill me with confidence (I feel questionnaires are a poor substitute for a clinician assessment..) - I wasn't near a hospital today and yesterday got snowed under...cheers, Casliber (talk · contribs) 13:22, 29 August 2007 (UTC)

Characteristics rewrite

I've started User:SandyGeorgia/Sandbox2#Characteristics; it's very rough going and the prose is going to need work. I hope to finish the next two sections tonight or tomorrow. I can't use a lot of what's there now as most of it isn't verified, but there is a lot of new info in the new journal reports. SandyGeorgia (Talk) 04:17, 27 August 2007 (UTC)

I've incorporated everything I could find in 3 of the 4 sections of Characteristics, in my Sandbox, and asked Tony and Eubulides to have a look. That's as far as I can get today. I haven't yet tackled Speech and language because the amount of info in that area is voluminous and it will take me some time to get through it all. I'm struck by how much is written about something that isn't part of the DSM-IV diagnostic criteria—almost double what is written on Social interaction and Repetitive behaviors—which seems to speak to the issues with the diagnostic criteria. SandyGeorgia (Talk) 12:55, 27 August 2007 (UTC) PS, I haven't even attempted wikilinking yet because that can be done after the text is nailed down. SandyGeorgia (Talk) 12:59, 27 August 2007 (UTC)

Tony has copyedited the three sections there, so I'm ready to move them in unless anyone disagrees. I can write speech and language over the next day or so, and Classification after that. SandyGeorgia (Talk) 00:10, 29 August 2007 (UTC)

Looks good - great job on that section and am happy for move - point taken about lead. cheers, Casliber (talk · contribs) 00:31, 29 August 2007 (UTC)

PS: DSM can be quite reductionistic/minimalist about conditions - this varies across the range of diagnoses. cheers, Casliber (talk · contribs) 00:32, 29 August 2007 (UTC)

OK, I'll move those three sections in, and if no one comes up with a broad defining quote from across the pond, I'll look for that after I finish speech and language (tomorrow or the next day). SandyGeorgia (Talk) 00:38, 29 August 2007 (UTC)

By the way, there are summary statements that broadly define the AS Characteristics from Yale, Harvard and UCLA researchers at the introduction to the section; we need one or two similar broadly defining sentences (hopefully introducing something new and different than what is already there and contributing to the lead-in summary of the characteristics) from Gillberg or Szatmari or Baron-Cohen to balance the section with the US centric view. SandyGeorgia (Talk) 13:50, 27 August 2007 (UTC)

I am really striking out on finding recent (post 2000 would be best) statements from Szatmari, Gillberg or Baron-Cohen that broadly define the characteristics of AS. Will list what I found here, for consideration:

• "hildren with ASD ... live in a mysterious world of direct perception and immediacy; they see a world without metaphors". SandyGeorgia (Talk) 17:36, 29 August 2007 (UTC)
• This one might be usable, since Gillberg's criteria includes motor clumsiness, and motor skills haven't yet been mentioned in the introduction: "Children with autism spectrum disorders, notably those with Asperger syndrome, have long been reported to suffer from the kind of motor clumsiness currently subsumed under the DCD label". PMID 14640308 SandyGeorgia (Talk) 17:52, 29 August 2007 (UTC)

• I added Gillberg so we could balance DSM vs. other criteria and US-centric vs. across the pond, and because the summary hadn't mentioned motor skills, which figure prominently in journal reviews. SandyGeorgia (Talk) 21:48, 29 August 2007 (UTC)

Speech and language done in my sandbox, pending Tony copyedit. SandyGeorgia (Talk) 16:53, 29 August 2007 (UTC)

Unclear

What does this sentence mean? "Sometimes, the opposite problem occurs: the person with AS is unusually affectionate to significant others; and misses or misinterprets signals from the other partner, causing the partner stress." KBry 15:05, 27 August 2007 (UTC)

That entire section is being rewritten, see entry above. SandyGeorgia (Talk) 15:08, 27 August 2007 (UTC)

External link review

Now that the article is more comprehensive, I'm taking a new look at the External links per WP:EL, WP:RS; the inclusion of any link should be justified. Anything that is already in the DMOZ link, or used elsewhere in the article, need not be in External links.

1. Per WP:RS, why do we have http://www.autism-help.org/ ? This should be a DMOZ link.
2. Why do we include MedlinePlus when MedlinePlus is a standard link in the Infobox?
3. Why do we use http://www.cdc.gov/ncbddd/autism/actearly/autism.html when it deals more with autism than Asperger's? Isn't there something more specific to Asperger's?
4. BBCs h2g2 already discussed above (see Talk:Asperger_syndrome#Everybody_happy_now.3F); I'm Opposed to its inclusion because it's not a reliable source, but won't fight it. SandyGeorgia (Talk) 14:32, 29 August 2007 (UTC)

Archive ?

This page is over 200KB; can we archive everything down to the point that the article was submitted at FAR, so that our next archive will be discussions during the FAR? SandyGeorgia (Talk) 18:03, 29 August 2007 (UTC) (That is, the first 22 sections.) SandyGeorgia (Talk) 18:04, 29 August 2007 (UTC)

I was thinking the same thing but had held off due to not being one of the main inputters. I'd agree. cheers, Casliber (talk · contribs) 20:30, 29 August 2007 (UTC)

I'll wait a bit to see if anyone disagrees, but it will be nice to have a clean archive of the FAR period. SandyGeorgia (Talk) 21:12, 29 August 2007 (UTC)

If the agreement of someone who hardly has time to read this count, FOR HEAVEN'S SAKE ARCHIVE IT :o) --Zeraeph 21:23, 29 August 2007 (UTC)

Image and box removal

Zeraeph, our edits got crossed up when you were removing quote boxes and images. On the quote boxes, I have no problem losing them if you don't like them. I was trying to kill two birds with one stone; cover for the fact that we don't have images while reducing readable prose size. I reverted your edits because you removed the boxes partially without restoring the previous version, and then I removed them correctly.

On the image, I'm not understanding why you keep removing Image:Autismbrain.jpg saying that it's based on a "maybe". The image was published in Strock by the NIMH, and I don't see the "maybe". We need images because we are lacking free images; why should we bypass a public domain, free use image? If it's a problem with the wording, we should work with the image caption. SandyGeorgia (Talk) 00:59, 30 August 2007 (UTC)

I can give you a lot of personal pics with free GFDL licence AND my AS DX attached, doesn't mean you should use 'em in the article to spruce it up :o). Seriously, you wrote the section and should know better than I do that the idea it represents is only a "maybe" yet. (There is NO WAY you would realise this, you are "too close to the wall" as they say about painting a room). When I scanned the article this morning, the presence of the image REALLY bounced out as some kind of "be all and end all" that you do not intend it to be. It's NOT a good idea...if you want more pics why not put back the lovely one of Hans Asperger with a little boy? --Zeraeph 01:14, 30 August 2007 (UTC)

PS also, HOW is "Autismbrain.jpg" specifically AS related? Like so many other thing you rejected for inclusion it is, in fact generic to autism. —Preceding unsigned comment added by Zeraeph (talk • contribs) 01:16, August 30, 2007 (UTC)

As indicated on the FAR, the image of Hans with the little boy had Fair Use issues; the souced text in the article doesn't seem to indicate a strong "maybe" on the items captioned for the image, so I'm still not understanding. If we have no images, we have no images I guess, but it's still strange to lose one that's valid. SandyGeorgia (Talk) 01:49, 30 August 2007 (UTC)

I don't think it's valid, it is just one hypothesis of the AUTISTIC brain given WP:UNDUE by illustration...I'm not being funny, it really JUMPED at me as such this AM...now...if you REALLY need to present "the illustrated Asperger Syndrome" at all costs I have two AS related Yorkshire terriers ready to pose like supermodels. GFDL, full color. :o) --Zeraeph 01:54, 30 August 2007 (UTC)

Risperidone Image and POV Creep

That REALLY needs to go...after lots of thinking...what on earth is the point in having it there? Just "jazzing up the article"? For the casual reader, the IMPRESSION is that somehow Risperidone is "insulin for Aspies", or some kind of major "treatment" or "cure" for AS, in truth, more people with AS take valium. It's like putting JUST an illustration of Seretide in the COPD article. It distorts the impression of the reader, and provides heavy connotations of mental illness. There are trials, a few people respond to it. Most people with AS do not take any medication. In addition far more have atypical reactions to certain meds such as SSRIs, which nobody has mentioned at all, and there must be sources, than ever even consider taking, or are offered, Risperidone. WHY was the image of Risperidone not discussed on the talk page BEFORE inclusion?

I am very concerned that the article has developed a really alarming POV creep. Not sure why or how that is happening. But I am sure that I honestly do not have time to have every word I say, and source I suggest, dismissed out of hand for, often spurious, reasons, as has happened to other editors here. I stopped editing to avoid the stress of the constant arguments here, honestly believing the article was in safe hands, so what the heck? I pop back to look and find that there are illustrations giving WP:UNDUE to one, unproven neurological theory of Autism (not even AS) and an anti-psychotic that is occasionally prescribed, and quoteboxes that highlight ONLY the most negative and disparaging quotes about AS, completely distorting the impression given to any casual reader of the nature of the condition and those who have it. The Tourette syndrome article, for example, has never had similar quoteboxes.--Zeraeph 07:50, 31 August 2007 (UTC)

As I explained earlier, I was trying to use the quoteboxes to make up for the lack of images while lowering the readable prose size at the same time, since we're pushing up against size limits on text. You hated them, they're gone, end of story. But to answer your questions. I think TS has at least six free, public domain images, and two of them are of drugs that I had a very hard time (haldol, for gosh sakes!) accepting when more images were requested at FAC, but standards are standards. NO ONE takes Haldol anymore for TS, it's a HORRID drug, but it remains an important part of the TS story, so I acquisced to the image because I understood I could draw attention to the correct info via the image caption, so I could use the image to combat misinfo about TS and haldol. And, I was also very upset when I came home from a trip one day to find that someone unbeknownst to me had submitted TS to GAC (I'm not a fan of GA and hadn't planned to submit it), and the kind GA reviewer had inserted brain images which I did not like. That was TimVickers; I had never heard of him then and I was not happy being saddled with an image that implied something was "wrong" with ticcers' brains. That was then, this is now. I now understand we have to give our readers something visual to hold their interest in the text that we want them to read, and we can correct misperceptions by carefully chosen captions. And the fact remains that science has identified brain differences. I hope this helps you see that I do understand the concern. WRT the quote boxes, TS didn't need anything else to break up the text, since it already had images; many readers have a hard time taking on large blocks of text without something visually pleasing. I also didn't view the quotes as being at all derisory; first, because I don't think of descriptions of the condition as derisory any more than I think of descriptions of tics as derisory (it's about acceptance), and second, is this really "derisory" or negative: "One of the most striking features of individuals with AS is their passionate pursuit of specific areas of interest" ?? I didn't think so. As to mentions of other drugs, two things. I've read dozens of reviews now, and it's risperdal that's mentioned. That also completely fits with my experience with children with AS in the US, Canada and Australia, so it didn't surprise me. Perhaps it's different wherever you are, but valium just wouldn't be prescribed here, and SSRIs aren't that common either, since CBT has somewhat supplanted them. Risperdal is standard treatment for AS, although newer atypicals like abilify are now being used even more, but they're not yet mentioned in the literature, probably because they're not approved. We can only say what reliable sources say, and in this case, it jives with the experience I have of knowing hundreds of children (few adults) who take atypical neuroleptics, primarily risperdal, for symptoms associated with AS. I'm still unclear why you believe the brain image is undue weight, so I really don't know how to answer that; it's well established in all the literature. I hope this helps you better understand so we can all come to consensus together, SandyGeorgia (Talk) 08:16, 31 August 2007 (UTC)

Correction, TS has eight images. SandyGeorgia (Talk) 08:56, 31 August 2007 (UTC)

Sandy, I am having a tough enough time coming to terms with the fact that YOU were the person who put up those quoteboxes - I honestly thought you were kidding. Why did you choose to put such negative and prejudicial quotes in them , as text we want them to read? Is that what you (certainly not we) want people to read about AS when you could have chosen positive, balanced or neutral quotes just as easily? Is that how you see people with AS? As cold blooded, single minded people without verbal skills or grace who are brain damaged and need medication? Because that was the subliminal message created by the quoteboxes and images, in sequence.

For the record, that makes me very sad, particularly as you are personally a big part of the reasons why I have found it easy to adapt to and accept TS in someone I know, without prejudice, or even making a big deal of it.

I take your point about images, and Haldol, BUT, unfortunately, Risperidaone is NOT "an important part of the AS story" (can I see a source for "Risperdal as standard treatment for AS" please, because I have never heard of ANY standard drug treatment for AS), and it is, rather, an insignificant piece of optional punctuation, as are the suggested neurological features of Autism, so it becomes misleading to use them. If you feel images are so important, why not think a little creatively? I know I am personally curious (for all the wrong reasons) to see what "Borat's Cousin" Simon Baron-Cohen, looks like? You don't like him, but at least he is directly relevant? What about the other sources you find significant? There must be pictures of them? --Zeraeph 12:24, 31 August 2007 (UTC)

Z, I firmly have the message that you didn't like the quoteboxes, they are gone, I'm not asking to bring them back, I didn't consider them negative, I don't view them as you do, I don't see anything in those quotes reflecting "cold blooded" or "brain damaged", they are summations of what reliable sources say about the diagnostic Characteristics, I don't consider "passionate pursuit of specific areas of interest" derogatory: please consider the idea of quoteboxes closed as you so clearly don't want them; that's not a problem for me and I'm not suggesting bringing them back. The reliably sourced statements about risperdal are already in the article and it is one of few meds proven effective for symptoms associated with AS; do you see the advantage in having an image of the med to draw attention to the full paragraph in the article describing its side effects, so some mom won't blindly and automatically give it to kiddo because Doc said so? I'm glad you're seeing that images will improve the article; I've been pretty hard at work on the other aspects of this article, and it would be stupendous if others could chip in and find free or public domain images (I hate image work anyway, as I don't fully understand the free use policies). (edit conflict: I see Eubulides has a good data source we can use; does that help resolve this?) SandyGeorgia (Talk) 12:53, 31 August 2007 (UTC)

In this section, there seem to be differing opinions on the subject of which medications are prescribed for AS. I suggest the following reference to help resolve disputes in this area: Oswald DP, Sonenklar NA (2007). "Medication use among children with autism spectrum disorders". J Child Adolesc Psychopharmacol. 17 (3): 348–55. doi:10.1089/cap.2006.17303. PMID 17630868. Its statistics are for ASD, not AS, but they're the best I know of in the open literature. The statistics were taken from year-2002 MedStat databases of 5.7 million patients, of which 2390 were ASD patients aged 21 or less, which formed the group being studied. Sample statistics: 57% received some sort of psychotropic or anticonvulsant agent. The most common classes of drugs prescribed for those with ASD were antidepressants (32.1%), stimulants (26.9%), and antipsychotics (23.5%). Risperidone was the most frequently prescribed antipsychotic. If you limit yourself to children aged 8 years and up, about 70% received some sort of psychoactive medication in a given year. These statistics were in line with other surveys, though there is some indication that the use of drugs is increasing with time. Eubulides 12:51, 31 August 2007 (UTC)

Sorry but this is another Autism source that is not AS specific. Are those now acceptable as sources, because, if so, the whole article will need re-writing AGAIN to included all the text previously dismissed because the sources were not "AS specific"?

Even so, the study shows that Risperidone the greatest (unspecified) portion of 7.6% of the study group of whom only an unspecified portion have AS is hardly evidence of Risperidone as "standard treatement for AS" as you claimed.

A mother, just scanning, without the education to understand the academic terms of the text, sees a pretty photo she CAN understand, says "WOW!! Those pills will fix my kid" and goes out and gets them.

It seems to me that, as an illustration, Borat (cousin of Simon Baron Cohen) himself would be equally relevant and far less misleading --Zeraeph 13:07, 31 August 2007 (UTC)

Do you have a means of obtaining a GFDL image of Baron-Cohen? For example, are gov't websites in the UK subject to "public domain" use as they are in the US, and would there be an image on a gov't website? I've already searched on US gov't sites and came up with nothing. SandyGeorgia (Talk) 13:10, 31 August 2007 (UTC)

For what it's worth, I don't like the idea of either the risperidone pills or Simon Baron-Cohen as images for this article. SBC is not so much more preeminent than everyone else in Asperger's that we should have a picture of him. If anything, the photo should be of Wing. Second, I agree that putting images of pills in the article is offputting. My own impression (I still don't have time to read the article carefully) is that the coverage of drug treatment is too extensive in the article, out of proportion to its importance. Sorry, gotta run. Eubulides 14:12, 31 August 2007 (UTC)

Eubulides, you have better access to sources; will you be available any time over the next month to help smooth this out, or should we muddle forward? FAR is a long process; now that we have basic text in place, we don't have to hurry on the tweaks. SandyGeorgia (Talk) 14:16, 31 August 2007 (UTC)

By the way, we have three sentences summarizing pharmacotherapy, and eight sentences on side effects and dangers of meds ! SandyGeorgia (Talk) 14:20, 31 August 2007 (UTC)

And there's even more above that; I agree with Eubulides (it's grown too much), and the section needs to be gelled down to a more manageable summary, but I'd like to wait for Casliber, since he wanted some of that text. SandyGeorgia (Talk) 14:30, 31 August 2007 (UTC)

I have no idea about UK copyrights so I just mailed him at Cambridge, let's see what he says. Probably on vacation though, this is the week of the UK Bank Holiday, so it will take a while. --Zeraeph 13:21, 31 August 2007 (UTC)

Good start, but be aware that him simply giving permission isn't enough. There's all sorts of hoops that have to be jumped through to satisfy GFDL, and I don't fully understand it all or even know where to find the info. SandyGeorgia (Talk) 13:22, 31 August 2007 (UTC)

As long as he gives permission and that can be stated it is fine, I have gone through that before, however, I personally agree with Eubulides, I don't REALLY think the article needs ANY more pictures, if none automatically occur, I just prefer Simon Baron-Cohen (or Lorna Wing) to a drug used by an unspecified portion of 7.6% of people with ASDs of whom a portion MAY have AS called Risperidone. --Zeraeph 14:37, 31 August 2007 (UTC)

I've read numerous accounts of Fair Use free use problems where the author saying it's fine isn't enough; they need to release it to something related to GFDL via an e-mail or something to WikiFoundation. I think, anyway. Maybe B-C has access to a free use image of Lorna Wing ... would you be up to asking? That would be an excellent resolution of the image dilemma, and we could stop devoting all this space to discussion of this issue. SandyGeorgia (Talk) 15:08, 31 August 2007 (UTC)

• Zeraeph, I find it hard to work out why you're interpreting those quotes as "cold-blooded" and negative. They seem to me to be merely expressions of scientific research. Tony 13:53, 31 August 2007 (UTC)

• They are not representative, balanced, neutral "expressions of scientific research" representative of all facets of Asperger Syndrome, they are confined to the negative aspects. Let me help you work it out. How would you feel if those particular quotes were chosen, from an huge body of varied research, as the most significant aspects of who you are? I would definately be happy to go as far as arbcom over those quoteboxes. I am also deeply saddened by them, and any attitude which would feel comfortable with them. --Zeraeph 14:29, 31 August 2007 (UTC)

• Shall I repeat again that the quoteboxes are gone and no one is asking to bring them back? And that I disagree that "passionate pursuit of specific areas of interest" and other descriptive statements are negative? I also agree with Eubulides that the amount of space dedicated to pharmacotherapy is excessive, and that we should work with Casliber to reduce it, but having sourced text to pare down is a good problem; it's a lot easier to gel text down than to build it up. This is the kind of tweaking that needs to be done, but I'd like to wait for Casliber. SandyGeorgia (Talk) 14:59, 31 August 2007 (UTC)

OK - My view on images is the same as Zeraeph's; I agree that I don't think the image of risperidone or any medication is warranted and agree it may send the wrong information. Images do speak louder than words and they are prescribed enough as it is - no medications are specific for AS per se and are generally only helpful for some troublesome symptoms. However, they do need to have some discussion in the article as the fact remains they are widely used and this needs to be addressed with some form of discussion in the article. As far as the quoteboxes I hadn't much of an opinion either way really. The fact remains that the diagnosis as per Asperger and DSM is one where those with ASD manifest significant symptoms/deficits - criterion C The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning. - this is what is used in research - DSM is the lingua franca of psychiatry and psychiatric pediatrics. The question would then be if there were people who didn't qualify for criterion C then under DSM they wouldn't have AS - maybe this will change in DSM V I don't know but that is how it stands at present. More than this I can't say as I can really see this opening up a can of worms - sorry. Overall I think the article is a vast improvement which I wouldn't have believed possible 3 weeks ago. cheers, Casliber (talk · contribs) 15:07, 31 August 2007 (UTC)

PS: Scratching my head over possible images - Wing & Baron Cohen for sure..no meds..artwork by someone with AS highlighting some characteristic detail etc. maybe? Very difficult. I'm off to bed and will muse on it anon....(1am here)..zzzzzzzzzzzzz. cheers, Casliber (talk · contribs) 15:10, 31 August 2007 (UTC)

OK, I'll remove the risperal image. I'll copy all the pharmacotherapy section into Sandbox so we can gel it down to a more compact version. SandyGeorgia (Talk) 15:11, 31 August 2007 (UTC)

Rework pharmacotherapy portion of Treatment

I copied the text into User:SandyGeorgia/Sandbox2#Pharmacotherapy_portion_of_Treatment_section so we can begin to gel it down to a more compact version. Sounds like Casliber is off for the day, so this may not get done today. SandyGeorgia (Talk) 15:20, 31 August 2007 (UTC)

Pls have a look; I haven't done the adverse effects yet (second paragraph), but on the basics of pharmacotherapy, I took the text from the previous 3 paragraphs and gelled it to four sentences in one paragraph:

1. No specific medications and limited research into efficacy
2. Important to treat comorbids
3. Atypicals
4. SSRIs

SandyGeorgia (Talk) 15:35, 31 August 2007 (UTC)

I also worked on cutting down the adverse effects paragraph. It's now six sentences:

1. Problems with medication, ignored in literature
2. SSRI adverse effects
3. Risperidone adverse effects
4. Olanzapine adverse effects
5. Ramifications for school children
6. May be harder for people with AS to tolerate side effects

It's a bit more compact and less redundant now; is there anything else we can lose? SandyGeorgia (Talk) 15:45, 31 August 2007 (UTC)

I wouldn't want it any shorter than this - whether treatment is appropriate or not the meds are used alot and it is extremely worthwhile providing a summary. cheers, Casliber (talk · contribs) 21:54, 31 August 2007 (UTC)

Wikification

I've caught all the wikilinks I could, but I may have missed some. Per WP:MOSLINK and WP:CONTEXT, the first occurrence of technical, important or relvant terms should be linked, and common terms known to most English speakers shouldn't be linked. Overlinking should be avoided. Because there's a lot of jargon in this article, I've linked a couple of words not only on the first occurrence, but also on a few subsequent instances. If fresh sets of eyes can check the wikilinking, that would be great. SandyGeorgia (Talk) 13:34, 31 August 2007 (UTC)

Something I think I should say

I just had time to go over the current article properly, I only got half way down when I realised I have no option but to delink it from several AS related websites where I had, previously (for a couple of years), trusted the article to present a balanced, informed view of AS. I preferred it to actually creating a definition because I felt that the participation of several different editors, with several viewpoints made the article, fairer and more objective.

As it stands today, the article has arrived at a point where the current, overall negative bias sets back the understanding and acceptance of actual people with AS by several years. I can no longer use it.

I would take the quoteboxes that symbolised the negative bias all the way to arbcom if Sandy had not had the consideration to withdraw them as she did. But there is no way I have the time or resources to do that with the whole article. So, instead, I am going to try and trust the community of Misplaced Pages and say please remember, this article has always been regarded as a significant source of objective (rather than agenda driven) information on Asperger syndrome. Real people, human beings like yourselves, have to live with the consequences of the contents.

I wish I could bring them here and show them to you. Intelligent adults with the same passions ands feelings as anyone else who have been raised conditioned to see themselves as perpetual and defective children who will never be able to fall in love, have children, drive cars or even be entitled to the same basic rights as any other human being. This conditioning is born of a lethal cocktail of misinformation, exploitative agenda and the ordinary human aversion to "difference".

I don't ask that this article be biased in favor of those young people, that would be wrong, and against everything Misplaced Pages stands for, and I happen to REALLY believe in, but I do not think it should be biased against them in this way.

To give you the best idea I can of the nature and extent of the problem, I would be happy if the article were reverted to the last featured version with the changes to "History" incorporated. That version had no particularly negative bias and more accessible text, not everybody in need of the information has third level education after all.--Zeraeph 15:30, 31 August 2007 (UTC)

Unfortunately, that version wasn't entirely accurate, comprehensive, neutral, up to date, and didn't make use of more recent high-quality reliable sources. Attwood published his book ten years ago, only three years after the diagnosis was recognized, so it wasn't possible for him to reflect the current state of knowledge about AS. That version relied very heavily on Attwood and other self-published sources. The good news is that the people who want to read Attwood's views only can still get his book. SandyGeorgia (Talk) 15:57, 31 August 2007 (UTC)

By the way, to my best recollection, we have included every source that you and CeilingCrash have requested (even in the lead, and even giving undue weight to individual researcher's opinions), and we've deleted the images and quoteboxes you disliked. Is there any reliable source that isn't accounted for, according due weight? SandyGeorgia (Talk) 15:59, 31 August 2007 (UTC)

You recollection is faulty, because I did not particularly suggest any sources, I just requested some to review if I got a chance. Sources were suggested by CC and PP, I supported them in some and you in others.

My primary problem is not with the sources, it is with the pervasive, negative spin in the text that presents them. My second problem is with the escalating inaccessibility of the language in which the article is presented. At this stage it is unlikely to be comprehensible to any neurotypical person with less than a third level education and understanding.

In the last FAR you said this: Presenting accurate medical facts is not incompatible with presenting the view that AS need not be considered a "disorder": it is possible to cover both medical facts and advocacy for acceptance in one article. I concur. So, why is that not the end result here? --Zeraeph 16:36, 31 August 2007 (UTC)

I certainly don't see any "pervasive negative spin" other than Z's spin on Sandy's efforts. The effort looks balanced to me in its present state of progression. Soulgany101 22:58, 31 August 2007 (UTC)

Yeah, well we already recognise that you are "agenda driven" so just about ANYTHING negative about AS would suit you. --Zeraeph 23:06, 31 August 2007 (UTC)

I don't get it - what in particular are you concerned about? How is describing deficits and treatment negative?cheers, Casliber (talk · contribs) 01:00, 1 September 2007 (UTC)

Really? I should have thought common sense would be helpful there? No matter...visualise with me...imagine you are an autonomous adult with AS, just trying to make it through the night, like anyone else, intelligent, honest, honorable, hurting from the anomie, marginalisation, and general only-being-accepted-or-assisted-as-long-as-you-accept-and-embrace-the-role-of-a demented-child...THEN read the article...

If you have enough empathy you should IMMEDIATELY spot, not only the selective use of sources to present only the negatives (even where the sources actually reference positives), but ALSO the inaccessible language, that a mother, in middle America, or Milton Keynes, cannot make head nor tail of, EVEN THOUGH she lives at the coal face, dealing with a child who seems to be from another planet...

Is there a problem? I am a fully (Micheal Fitzgerald, no less) dx'ed Aspie, I surely have "no empathy"...if I can "get it" why can't you, an NT shrink, get it too? --Zeraeph 01:14, 1 September 2007 (UTC)

Nope, I don't get it either, Zeraeph. I can imagine that some of the NPOV, objective scientific facts in this difficult area might be confronting to me if I were emotionally connected with the syndrome, but I'd try to maintain a distance from them. Our readers want clear balanced information, and for all of the research and professional/practitioner activity over the past few decades, the literature is fragmented. This is a place where that literature can be presented in a cohesive way, and Sandy has been doing a fine job, IMV. I don't see negative spin—quite the opposite, just the facts for our readers to interpret. Let's support her and you, Zeraeph, in finishing this task. Everyone is benefiting. Tony 01:20, 1 September 2007 (UTC)

I do maintain distance, it is my job (and vocation) to do so, which is why, unbeknownst to her, Sandy had my full confidence for so long, however, I find it impossible to accept selective negatives and the total omission of positives from THE SAME SOURCES as objectivity. For the very simple reason that it is *not* objectivity, by the standards of any reasonable man, and all the semantic gymnastics in the world will not make it so.

"Everyone" certainly does NOT benefit from the prejudicial and selective presentation of information. Misplaced Pages does not benefit, as such a stain appears on it's overall standard of objectivity. People with AS do not benefit, as selective negatives headline google where there SHOULD be objectivity.

I am, equally, not at all sure that I agree with your assumption that Sandy is soley responsible, she is usually a very neutral editor (evidenced by her last, near single handed revision, of this article last year with totally different, and far more objective, emphasis). --Zeraeph 01:33, 1 September 2007 (UTC)

PS, I cannot for the LIFE of me understand why you do not get the issue of inaccessible language WHATEVER your viewpoint?

• (outdent) You need to provide examples of "inaccessible language" and, indeed, of negative spin, if you believe that they exist. I'm unconvinced, and think our time is better spent on finishing the task. Tony 01:43, 1 September 2007 (UTC)

I think you are an experienced enough editor to see inaccessible language without me patronising you by pointing out specifics. The whole article needs rewriting for accessibility.

As for selective representation, the article manages to cite, McPartland J, Klin A (2006). "Asperger's syndrome". Adolescent medicine clinics 17 (3): 771–88; abstract xiii, thus: Although motor clumsiness and the delayed acquisition of language capacity are not mentioned in standard diagnostic criteria, odd speech, language peculiarities and motor skills difficulties are frequently reported features of AS. yet fails to even refer to "Asperger’s initial description optimistically predicted positive outcome based on the presence of intact cognitive ability and the potential application of special skills for gainful employment. Compared with individuals with lower functioning ASDs, a more positive outcome can be expected." from the same source. I could sit here all week listing similar comparisons, I do not have that kind of time available.

That is only one example...but, to be honest, I feel I am going up against heavy duty admins here, and nobody but me really cares if the article is balanced and objective or not. It doesn't matter whether I am right or wrong, I won't win, and will probably attract a community ban for trying, so my smart move now would be a Wiki-break. I am taking my smart move. But I would ask ALL of you to consult your consciences about your comfort level in supporting a POV article with the level of potential significant affect on attitudes and real people's lives as this one. --Zeraeph 02:07, 1 September 2007 (UTC)

OK - I have found and tweaked a little - it is tricky as many words considered jargon have specific meanings that it can be a challenge to put in simpler words without losing meaning. And, yes, as I work in the area I can let alot slip by without recognising it as a problem for those outside the medical profession. This is one reason I like bluelinks so that folk can click on and find out what a particular concept or word means. In any case I for one am happy to try rephrasing specific problem bit you want to point out.

As far as POV - the article highlights the symptoms and treatment and discusses deficits....you want it to go over the sterngths (?)....but then you write about how difficult it is for you? Isn't that the point of the article who might want to read about it? What else do you want covered? Diagnosing dead people or otherwise high functioning people without interviewing them clinically I feel is speculative at best. —Preceding unsigned comment added by Casliber (talk • contribs) 02:54, 1 September 2007 (UTC)

I am sorry, I do not believe I have ever written about "how difficult it is" for me in terms of AS, to the contrary, I always feel it is unwise to go into too many details of one's weaknesses online. Such personal "sharing" is far too open to abuse. You must have mixed me up with someone else.

However, for the record, this is what I think. AS is a condition that makes many ordinary, everyday things others take for granted into exhausting ordeals, but conversely it gives an alternative focus that can, if appropriately applied, make many things more "normal" people would find difficult, or even impossible, come quite easily to the ASpie.

AS can only be understood by accepting it as a combination of strengths and limitations. Strategies that target only the limitations and overlook the strengths are just destructive to the unfortunate human being "inside the ASpie suit", not least because, by determinedly ignoring his considerable strengths you are offering him a modality that, of it's nature, conditions him to seek safety and functionality in undermining himself. Anecdotally, as I understand it, this increases his risk of co-morbidity, substance abuse and suicide to alarming levels. Hardly effective, or helpful.

However, to the rest of your point, no matter how benignly intentioned (that is what you are trying to imply? If not, please clarify?) the exclusion, or how "uninteresting" you feel the "strengths" to be, excluding those strengths, as at present, is not in compliance with WP:NPOV. --Zeraeph 11:16, 1 September 2007 (UTC)

I agree that this article have been turned into a pro-defective POV of view. This have been an ongoing change ever since the last FAR. The main problem is Sandy's and others propositions that only published research can be put into the article, and basically all published research has a negative bias (for obvious reasons). I also agree that the best would be a revert, as it would take way to much work to reformulate all the negative bias, and most of it would probably be reverted by the defect-lobby anyway. --Rdos 09:53, 1 September 2007 (UTC)

I strongly disagree with this line that what is reportage of the science is a negative spin. I dispute that a revert is appropriate. Tony 10:44, 1 September 2007 (UTC)

Hi Rdos, Tony, you are actually both half wrong and half right...there is absolutely nothing wrong with Sandy's insistence on only published research, I support that myself on this and many other articles (and if you knew the kind of nonsense I use that rationale to keep out I bet you would support it too). However, only using the negatives from published research and ignoring the positives in the same sources (there are plenty RDos, do mail me if you would like copies to see for yourself) as at present, is a "negative spin" and POV. --Zeraeph 11:16, 1 September 2007 (UTC)

As it stands, DSM IV has as criterion C - "C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning." - thus if someone does not have this criterion then they do not have AS - some may be described as having Asperger traits but they do not qualify for the diagnosis. This is what the medical and legal world understands as AS. Of course DSM may change in future (V, VI etc.) this is how it is currently. Under these criteria high functioning people with no significant deficit do not qualify for the diagnosis cheers, Casliber (talk · contribs) 11:20, 1 September 2007 (UTC)

True, but the fact that the significant deficit is accompanied by equally significant strengths does not cancel out the deficit, nor render the accompanying strengths into irrelevance or non-existance. The only way any strategy can be effective is by acknowledging and learning how to use our strengths to compensate for our deficits, something that is unlikely to be possible to execute through blanket denial of the existance of those same strengths. --Zeraeph 11:32, 1 September 2007 (UTC)

PS. Just making coffee I remembered one more pertinent thing. This article is called Asperger syndrome, the DSM classification is Asperger Disorder and is, technically, only a subset of Asperger syndrome. If maintaining a DSM Focussed article with an exclusively negative bias seems so important why not RENAME this (FA status and all) as Asperger disorder the DSM category, and move any superfluous information from it to a new, more generic article called Asperger syndrome? It seems to me that would make everybody happy, you would have your exclusive DSM focus, Sandy would have her FA status and a relaxing of size constraints. Everybody would be happy, and the article title would be a lot more honest. Think on't --Zeraeph 11:56, 1 September 2007 (UTC)

efficacy vs effectiveness

Recent edit summary: (efficacy refers to studies, effectiveness refers to practice)

Here's my convenient desk-top Encarta (not the final authority, though):

• efficacy |ˈefikəsē| noun the ability to produce a desired or intended result : there is little information on the efficacy of this treatment. ORIGIN early 16th cent.: from Latin efficacia, from efficax, efficac- (see efficacious ).

• effective |iˈfektiv| adjective 1 successful in producing a desired or intended result : effective solutions to environmental problems. • (esp. of a law or policy) operative : the agreements will be effective from November. 2 fulfilling a specified function in fact, though not formally acknowledged as such : the companies were under effective Soviet control. • assessed according to actual rather than face value : an effective price of $176 million. • impressive; striking : an effective finale. Tony 02:47, 1 September 2007 (UTC)

Frustrating. I am googling to try and find a succinct page on it somewhere but failing - googling does show ample evidence of the definitions, that is, does the efficacy of an intervention in a controlled environment (which is how it is defined in Evidence Based Medicine) translate into effectiveness in the community. This is how we were taught in medicine WRT trials etc. I'll keep looking.....cheers, Casliber (talk · contribs) 11:01, 1 September 2007 (UTC)

Try this, the efficacity of a trained attack dog in deterring burglars is beyond question, but the EFFECTIVENESS of keeping a trained attack dog to deter burglars in an house where all are allergic to dogs might be a little less clear. --Zeraeph 11:19, 1 September 2007 (UTC)

1. ^ Cite error: The named reference Baron-Cohen was invoked but never defined (see the help page).
2. Wakabayashi A, Tojo Y, et al. "" Japanese. Shinrigaku Kenkyu. 2004 Apr;75(1):78–84. PMID 15724518
3. Teitelbaum O, Benton T, Shah PK, et al. "Eshkol-Wachman movement notation in diagnosis: the early detection of Asperger's syndrome." Proc Natl Acad Sci U S A. 2004 10 August;101(32):11909–14. Epub 2004 28 July. PMID 15282371 Full text.
4. Cite error: The named reference emed was invoked but never defined (see the help page).
5. Wing, Lorna. Asperger syndrome: a clinical account. Retrieved 2 July 2006.
6. BehaveNet® Clinical Capsule™. DSM-IV & DSM-IV-TR: Asperger's Disorder (AD). Retrieved 28 June 2006.
7. NINDS (May 11, 2006). Asperger Syndrome Fact Sheet. Retrieved 2 July 2006.

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