Clinical characteristics of seven patietns with Asperger’s disorder not attending school in adlescence *
The aim of this study was to research the cause and treatment for the maladjustment, especially school non-attendance, of adolescents with Asperger's disorder who have grown up without any precise diagnosis and adequate treatment and care. Twenty-three patients were referred to the Department of Psychiatry at Kawasaki Medical School Hospital because of school non-attendance between June 2005 and January 2006. Seven of these patients were diagnosed as having Asperger's disorder according to the DSM-Ⅳ-TR. Child and adolescent psychiatrist asked the patients about their mental states. The author questioned their mothers about their developmental history and evaluated the patients using the Autism-Spectrum Quotient（AQ）for children alone and the High-Functioning Autism Spectrum Screening Questionnaire（ASSQ-R）for their mothers. Then, a clinical psychologist conducted the Wechsler Intelligence Scale for Children（WISC-Ⅲ）. The mental states and developmental history of the patients were as follows. 1）The specific causes of school non-attendance were found in all patients. 2）All of the patients experienced impairment of development of social interaction and imagination in early childhood. 3）Medical examinations at one year and six months old and at three years old did not reveal any problems in any of the patients. 4）All of the patients were characterized by a sense of incongruity with other persons. 5）Peculiar and rigid thinking was encountered in six patients. 6）All of patients had been bullied. 7）The time slip phenomenon was present in six patients. 8）Two patients were hypersensitive in the past and five presently were hypersensitive. Psychological testing 1）As for the AQ for children, six patients had high points over 20. 2）Regarding the ASSQ-R, six mothers had low points below 19. 3）As for the WISC-Ⅲ, IQ score for all patients were over 80. The possible factors and treatment are as follows. 1）The gap between the high AQ of the children and the low ASSQ-R of the mothers indicates a different recognition of the patients' mental status by patients and by their mothers. Their sense of incongruity with other persons during pre-adolescence strengthens their isolated feelings. It is important for the patients and their parents to understand the characteristics of Asperger's disorder. 2）The patients' peculiar and rigid thinking makes it difficult for them to have a good relation with their friends in adolescence. This will change gradually through good experiences in their lives. 3）The memory of being bullied is recalled through the time slip phenomenon. This strengthens the fear of personal relations. It is important for both parents and teachers to understand the time slip phenomenon. 4）The hypersensitivity of the patients makes it difficult for them to stay in a classroom full of stimulations. If their environment can be made less stimulating, they will become calm and stable. (Accepted on April ５，2006)
