Psychiatric Problems in Irish Children and Adults – From Childhood to Adulthood

A longitudinal follow up study

From Child to Adult 
A Longitudinal Study of Irish Children and their Families
Co-Author: Cleary A., Fitzgerald M., & Nixon E.
Publisher:  University College Dublin
Criterion Press Ltd.
ISBN: 1 9022 7785 6
Child to Adult Michael Fitzgerald
Free book to download on psychological problems in Irish Children and Adults. 
A follow up study of children, studied in childhood to adulthood, 21 years, showed symptom levels were high and approximately one fifth of the respondents had probable psychiatric conditions and 55% had used non prescription drugs. Behavioural deviance at age 11 was highly predictive of poor educational outcome at age 21.
A majority of mothers previously diagnosed as suffering from psychological problems when their child was 10 had now recovered. Economic disadvantage exasperated the negative outcomes.
40% of children followed up, regarded religion as important in their lives.
This book is free to download from my website.

 

Autism – Serious Diagnostic Problems – Irish Medical Times Article – 4th Nov 2016

autism-article-in-irish-medical-times-nov-2016There has been a massive broadening and evolution of the concept of autism over the past three-quarters of a century. Hans Asperger (1938, 1944) and Leo Kanner (1943) initially described autism. The prevalence of autism depends on whether you use old, narrow, out-of-date concepts of autism or new concepts of the condition. The original prevalence studies of autism in Ireland conducted by McCarthy, Fitzgerald and Smith showed a prevalence of four per 10,000 in the Eastern Health Board. Current rates as shown by the Centres for Disease Control in 2016 put the prevalence of autism at one in 68. Autism is characterised by problems in social relationships and communication, repetitive activities, narrow interests, sensory issues with an onset early in childhood but can be diagnosed at any point on the life cycle. Autism is under-diagnosed in Ireland and often comorbidities (which often co-occur), like attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, sensory issues, dyspraxia, or emotional behaviour problems are focused on and the autism spectrum disorder is missed, with serious and detrimental consequences for the child. Early diagnosis is critical for a good outcome, and there is universal agreement on the critical importance of this early diagnosis and interventions.
Guidelines
One of the problems is that the UK’s National Institute for Health and Clinical Excellence (NICE) guidelines on the diagnosis of autism, which are accepted throughout the world, are not followed. These state that there is no specific instrument recommended for a diagnosis of autism and that it is a clinical diagnosis by an experienced clinician in the diagnosis of autism. Unfortunately, in Ireland, instruments like the Autism Diagnostic Interview-R (ADI-R) are often misused as specific clinical diagnosis for autism and parents will state, “often with tears in their eyes”, that the child is, “ADI-R negative”, or does not have autism on this instrument, when it is crystal clear to the parents, teachers etc that the child has autism. This means that the child is deprived of services for children with autism, the school is deprived of extra resources, and the child becomes extremely anxious, depressed and behaviourally disordered. Prof Dorothy Bishop, Professor of Developmental Neuropsychology at the University of Cambridge, United Kingdom, told Adam Feinstein, which is reported in his book, Autism in History, that: “The main problem with the ADI-R is not just the financial cost (though that is certainly prohibitive), but also the cost in time; time for training, time for administration, and time for scoring and consensus coding,” and Bishop told Adam Feinstein that: “If it could be shown that there were real benefits in accuracy of diagnosis from adopting this lengthy procedure, then I’d be happy to say: ‘Okay.’ “But the originators of the instrument have never demonstrated that you actually need such a long process – it is really more an article of faith with them.” Faith has no place in clinical diagnosis and seems to be more a religious concept to my point of view. Bishop also told Feinstein that: “Part of the problem is that criteria for autism keep changing.”
Phenotype 
This is true, and the concept has broadened throughout the years. Today the broader autism phenotype is accepted by most professionals throughout the world, with the exception of those who use an old-fashioned, narrow-based concept of autism, or instruments focusing on narrowbased ideas of autism. I’d like to mention The International Meeting for Autism Research (IMFAR), in London in May 2008, where many of the most experienced researchers and clinicians on autism in the world attended. As reported by Feinstein in Autism in History, many of these critics “lambasted the tool (ADI-R), for missing many cases of autism”, and that this instrument was an expensive and “ineffective instrument”.
Expert clinical opinion 
Prof Bishop concluded after the use of these expensive instruments that there was often no choice but, “to seek expert clinical opinion”, which of course very often happens in Ireland but takes years to achieve, and then over all that period, the children are deprived of diagnosis and services for autism. Of course, the NICE guidelines primarily recommend expert clinical opinion anyhow. This is now a public health problem. In addition, a speech and language therapy assessment and occupational therapy assessment and possibly a cognitive psychological assessment are also necessary.
Prof Michael Fitzgerald, Department of Psychiatry, Trinity College Dublin.

 

The Mind of the Mathematician ( Female) – Ada Byron, Countess of Lovelace ( Daughter of Lord Byron)

Ada Byron
Daughter of Lord Byron
Countess of Lovelace 
           

Great female mathematicians are less common than males and are described in this book, the Mind of the Mathematician written by internationally famous mathematician Prof. Ioan James and accomplished psychiatrist Prof. Michael Fitzgerald look at the complex world of mathematics and the mind. This book discussed the brilliant female mathematician Ada Byron and her major work with Charles Babbage and his calculating machines and associated disorder that she may have suffered from. What makes mathematicians tick? How do their minds process formulas and concepts that, for most of the rest of the world’s population, remain mysterious and beyond comprehension? Is there a connection between mathematical creativity and mental illness? In The Mind of the Mathematician, together they explore the behavior and personality traits that tend to fit the profile of a mathematician. They discuss mathematics and the arts, savants, gender and mathematical ability, and the impact of autism, personality disorders, and mood disorders. These topics, together with a succinct analysis of some of the great mathematical personalities of the past three centuries, combine to form an eclectic and fascinating blend of story and scientific inquiry. What makes the mathematician tick?  How do their minds process formulas and concepts that, for most of the rest of the world’s population, remain mysteriously beyond comprehension?  Is there a connection between mathematical creativity and madness?
In the Mind of the Mathematician, internationally famous mathematician Ioan James and accomplished psychiatrist Michael Fitzgerald look at the complex world of mathematics and the mind.  Together they explore the behaviour and personality traits that tend to fit the profile of a mathematician.  They discuss mathematics and the arts, savants, gender and mathematical ability, autism and mathematicians, and the impact of personality disorders and mood disorders.  Mathematicians discussed include Gödel, Dirac, Hardy, Hadamard, Kovalevskaya, Poincare, and Gauss.
These topics, together with a succinct analysis of the great mathematical personalities of the past three centuries, combine to form an eclectic blend of story and scientific inquiry that will fascinate all those curious about how a mathematician’s mind really works.
The Mind of the Mathematician
Prof. Michael Fitzgerald
& Prof. Ioan James
Co-Author: Fitzgerald M., James I.  (2007)
Publisher:  Johns Hopkins
University Press:  Baltimore
ISBN: 978-0801885877
 
For more information about this book, click here.

Overlap: Autism and Schizophrenia – Considerable confusion surrounds the overlapping of autism and schizophrenia

Advances in Mental Health and Intellectual Disabilities

Author:   Michael Fitzgerald (Professor of Child Psychiatry, based at Department of Psychiatry, Trinity College, Dublin, UK)
Citation:  Michael Fitzgerald , (2014) “Overlap between autism and schizophrenia: history and current status”,Advances in Mental Health and Intellectual Disabilities, Vol. 8 Iss: 1, pp.15 – 23
ABSTRACT
Purpose

- Considerable confusion surrounds the overlapping of autism and schizophrenia. This has significant implications for clinicians given that correct diagnosis is critical for treatment.

Design/methodology/approach

-This paper sets out to clarify the position by reviewing the history and current status of the relationship between autism and schizophrenia. A general review was conducted using a chronological approach that focused on phenomenology, aetiology, genetic mechanisms and treatment.

Findings

- Persons with autism are far more rigid, have difficulties set shifting and get far more upset and aggressive when their routines have changed. They have far more severe theory of mind and empathy deficits than those with schizophrenia.

Research limitations/implications

- Future diagnostic refinement by means of molecular genetic studies will alter the diagnostic categories. Further studies of the conditions of autism and schizophrenia are therefore necessary.

Practical implications

- Both conditions need treatment both clinically and practically.

Originality/value

- This paper elucidates the relationship between autism and schizophrenia from a historical and current perspective. It emerges that this confusion is likely to be resolved by molecular genetic studies that will alter the diagnostic categories.

        

 

Mass Killers – Can we identify a mass killer e.g. pilot, school shooter etc. in advance?

These are extremely rare events and it is almost impossible to predict with any degree of accuracy rare events. Nevertheless, we must try but at the same time realise that many of the individual features of the profile I describe about potential mass killers are not rare in the general population. It’s the more overall picture that is relevant.

We must look at:-

  1. 1.      Medical history pattern deviating from average medical history pattern of pilots, students, military personnel etc

 

  1. 2.      Childhood history of being bullied, being a loner, being very routine bound person with special interests in death, perversions, dead animals, serial killers, mass killing, police work, military activities, horror movies, killing of animals, e.g. cats etc showing callous and unemotional trails, moodiness and showing gross lack of empathy, problems reading other people’s minds emotionally, being excessively controlling and dominating, problems with reciprocal social relationships, having sensory problems, noise, taste, touch, being significantly clumsily, being very unpopular in school but having special talents with numbers, mathematics, technology, engineering, construction and logic.

Other features would include poor eye contact, problems reading non-verbal behaviour, problems sharing emotional thoughts, problems turn taking and being very poor at group games. Many or most readers will dismiss this profile as nonsensical. The only answered to them is to ask them to produce a better alternative approach to the problem. Clearly we have to be extremely careful in labelling people inappropriately. If one is totally anti-labelling or identifying potential mass killers then one has to accept the activity of mass killers.

If one hears of a person who is in an average job and who has never performed above the average or indeed less than the average level and they state they will one day be famous and that “everyone will know my name” and they have the profile outlined above then airline management or schools managers or army commanders should ask some questions and explore the background and motive of this person a little more. If in addition to the above profile already described, a person is depressed, has recently experienced stress at his job, has had personal relationship breakup or conflict with his employers or problems with his work performance, is in a position of major responsibility e.g. airline pilot, then they should be examined further, if they make unusual and bizarre statements which could be taken as a joke if one wasn’t listening carefully.

Another scenario is a pupil (almost always male) with the profile described, who shows strange comments on his social media sites, has been bullied (or is being bullied in school), is depressed, ostracised, can’t relate to girls, is a loner, has had an academic crisis or access to guns at home or elsewhere and makes violent threats, these should be investigated by the health and safety officer in school (who should be responsible for gun attacks in school) in conjunction with the management of the school where a thorough investigation should take place. People like the readership keep Adam Lanza, Harold Shipman and Timothy McVey in mind.

 

References:

Autism Spectrum Disorders - Recent Advances - New Book Cover ’Autism and School Shooting’

by Michael Fitzgerald

has been published in April 2015 in the book ‘Autism Spectrum Disorders – Recent Advances’

by InTech Publishing in a book edited by Michael Fitzgerald.

Click here to download for free

 

young violent dangerous to know

 

Young Violent and Dangerous to Know’, a book by Michael Fitzgerald

was published by Novinka, New York in 2013 and focuses on mass killers and serial killers.

Click here for more details

 

Psychopathy -Risk Factors, Behavioural Symptoms and Treatment Options

 

A new book called “Psychopathy”

published in 2014 by Nova Science, New York, edited by Michael Fitzgerald,

has a chapter on ‘Criminal Autistic Psychopathy’ by Michael Fitzgerald, a not uncommon diagnosis in mass killers.

Click here for more details

The Mind of the Artist – Attention Deficit Hyperactivity Disorder, Autism, Asperger Syndrome & Depression

The Mind of the Artist
This is a provocative and novel investigation of the psyches of sixty artists, predominantly from the world of film, theatre and television/radio – writers, actors, producers and directors ranging from Shakespeare and Voltaire to major late-twentieth-century figures such as Spike Milligan, Sam Peckinpah and Frank Sinatra, by way of F. Scott Fitzgerald, Orson Welles and Judy Garland. Irish artists featured include Oliver St. John Gogarty, Jimmy O’Dea and Richard Harris.
The chapters, which range from quite brief vignettes to more in-depth studies, examine the background of each individual before considering their personality, social relationships and work. Professor Fitzgerald brings his expertise to bear in elucidating the psychological factors, strengths and frailties that shaped the lives and careers of these prominent creators, many of whom are regarded as geniuses.
The lives of extraordinary artists are of interest in themselves; when their stories are told from the perspective of expert psychological insight, the results are fascinating and revealing


Click here to read more or purchase this book from Nova Publishers

Did W.B. Yeats have Aspergers Syndrome?

A number of historical figures, including Eamon de Valera, WB Yeats and American artist, Andy Warhol, had Aspergers Syndrome according to Professor Michael Fitzgerald. They all showed signs of Asperger’s syndrome, a type of autism in which the person affected generally has a very high IQ, but extremely poor social and communication skills. This is explained in the following books: ‘In Autism and Creativity: Is There a Link between Autism in Men and Exceptional Ability?’ published by Brunner-Routledge and Unstoppable Brilliance, published by Liberties Press. “WB Yeats for example did very poorly at school. He failed to get into Trinity College and was described by his teachers as ‘pedestrian and demoralised’. His parents were told he would never amount to anything”, This is typical of people with Asperger’s syndrome. They do not fit in as they do not relate to others. They are often seen as odd or eccentric and may be bullied at school as a result. Many people in Ireland are thought to have Asperger’s syndrome, with males significantly more likely to develop the condition than females. unstoppable brilliance

Persons of Genius with High Functioning Autism or Asperger’s syndrome.

There are few conditions that have received as much coverage in the popular press in recent times or have been the subject of as much controversial debate as autism.  Public awareness regarding the condition has grown exponentially but many healthcare professionals may still lack confidence in making the diagnosis of autism according to Dr. Louise Gallagher who has conducted genetic research in autism at Trinity College Dublin.

 

This article aims to give an overview of the disorder of autism staring off with a clinical description and diagnostic criteria.  Theories on causation and a review of the current accepted interventions will also be outlined.

 

It can be associated with ability of genius proportions. Examples include Godel, Hans Christian Andersen, Gregor Mendel, Archimedes, and Charles Lindberg.

 

Autism is very commonly associated with low functioning and Learning Disability.  This is a false conception of the condition.  High Functioning Autism or Asperger’s syndrome can occur in persons with very high I.Q.

 

Clinical Description

 

Autism is a neuro-developmental disorder of childhood that was first described by Leo Kanner.  He described a group of children with impaired language, lack of eye contact, lack of social interaction and repetitive behaviour. In 1944, Hans Asperger published a paper describing a pattern of behaviours in several young boys who had normal intelligence and language development, but who also exhibited autistic-like behaviours and marked deficiencies in social and communication skills.  Asperger’s syndrome went largely unrecognised until the 1980s. Now it is commonly used to describe individuals with an Autistic Spectrum Disorder and normal intellectual functioning.

 

Asperger’s syndrome, and described the following difficulties in the first two years of life of children with the condition:

 

(a)       A lack of normal interest and pleasure in people around them.

 

(b)       A reduction in the quality and quantity of babbling.

 

(c)       A significant reduction in shared interests.

 

(d)      A significant reduction in the wish to communicate verbally or non-verbally.

 

(e)       A delay in speech acquisition and impoverishment of content.

 

(f)       No imaginative play or if it does occur it is confined to one or two rigid patterns.

 

Gillberg’s diagnostic criteria for Asperger’s syndrome:  social impairments; narrow interests; repetitive routines; speech and language peculiarities; non-verbal communication problems; motor clumsiness.

 

High Functioning Autism or Asperger’s syndrome is not uncommonly misdiagnosed as Schizoid, Narcissistic Borderline or Obsessive Compulsive Personality Disorder or Schizophrenia.

 

Genetic of Autism

 

Heritability estimates of over 90% have been made in relation to autism.  Louise Gallagher points out that approaches to genetic studies have involved candidate gene studies and genome-wide, affected, sib-pair linkage studies. Association studies with variants within the Serotonin transporter gene have been conducted based on the well-established findings of elevated platelet Serotonin. Findings between studies have been inconclusive to date.  Other genes, which have been studied, include UBE3A, GABRB HOXA1/B1, all of which have had conflicting reports of association.  Reelin and WNT have had initial studies reporting association but these require replication.

 

Seven genome-wide linkage studies have been published to date and a large number of regions of putative linkage have been identified.  The most convincing evidence has been found on Ch2q and 7q.  Efforts are underway to narrow these regions down to find candidate genes.

 

Interventions

 

A comprehensive management plan should be put in place once the diagnosis has been established.  Management involves a multidisciplinary approach involving the following:

 

(a)       Speech and Language Therapy.

 

(b)       Psychological assessment for appropriate school placement.

 

(c)       Education interventions.

 

(d)      Educational interventions.

 

(e)       Pharmacotherapy.

 

(f)       Theory of mind and empathy training (higher intellectual functioning).

 

Speech and Language Therapy is essential and should be provided regularly (at least once a week) for children with speech and language delay. Pharmacotherapy has limited application but Ritalin may be considered in the presence of marked hyperactivity although children with autism are reported to be more sensitive to the side effects. Risperidone has been shown to have some beneficial effects on global assessments of psychiatric morbidity but not on individual autistic symptoms.  Naltrexone has been reported to have beneficial effects on self-injury and stereotyped behaviours but well-controlled clinical trials are still required. SSRIs are widely used in the US but not in Europe. There are some reports of improvements in repetitive behaviours but randomised, controlled trials (RCTs) are required.  The use of Melatonin in sleep disorders including those associated with autism, has been reported as beneficial by a number of groups. Again there is an absence of well-controlled RCTs.

 

As mentioned above, the evidence supporting a casein and gluten-free diet is limited.  Knivsber et al. report an overall benefit in their review of the area but the studies in question have a number of methodological flaws including small sample sizes.  Secretin has not been shown to be helpful.

 

The following examples of people with High Functioning Autism or Asperger’s syndrome and contributors of genius.

 

Kurt Godel was very much a loner and a genius.  He was fascinated by mathematics and contributed greatly to it.  He was a linguist and an autodictat.  Even in junior school he was fascinated by mathematics and physics.  He was socially immature and had severe difficulties in social relationships.  He had non-verbal behaviour difficulties and had a tremendous capacity for focus on mathematical problems.  He was extremely naïve.  He suffered from severe depression.  His verbal contributions are characterised by extreme brevity. He was also quite paranoid and fearful of emissions from refrigerators.

 

Mendel was a genius who was also very much plodding in his work, hard working, and completely single minded. He proposed laws of inheritance that ultimately became the underpinning of the science of genetics.  He had severe difficulties in social relationships. He was extremely shy. In front of a class he was an extremely poor teacher. In teaching he never was fully certified and was always a substitute teacher.  He was a man of absolute routines.  He regarded his plants as his children.  He was a monk who became rather paranoid and saw his fellow monks as traitors.

 

Hans Christian Andersen was a great storyteller.  He was socially immature.  He had very significant social interactional problems.  He was very much a loner.  He never married.  He was a great writer of fairytales and showed enormous creativity in this area. He read an enormous amount of books. He was bullied and called names at school.  He was very much an outsider.  He spoke with a high pitch tone of voice.  He was extremely obsessive.  He was very ritualistic in his behaviour. He was very controlling and at meal times his food had always to be served first. He suffered very much from depression throughout his life. He had identity diffusion. He wrote endlessly and compulsively.

 

Archimedes was a great Greek mathematician and inventor. He was a loner. He was mechanically and mathematically minded.  He hyper focussed on his researches.  His interests were extremely narrow.  He would forget to eat his meals.  He was regarded as extremely eccentric.

 

Charles Lindberg was a great aviator.  He was a loner as a child.  He was painfully shy in social relationships, he was naïve in accepting an award from Hitler. He liked solitude. He was extremely logical and obsessed with aviation. He also worked on the issues in high altitude flying and on a pump that blood could be pumped if the heart was being operated upon.  This work was carried out at the Rockerfeller Institute.  His greatest achievement and one that he was well suited for was in flying solo across the Atlantic over Ireland to Paris.  The link between psychiatric disorders and genius has often been made and these are further examples of that link.

 

Autism, Asperger’s syndrome, Stalking, and other reasons for legal contact.

While most people with Asperger’s syndrome (who have higher functioning autism) are highly moral, highly ethical, a small minority get in trouble with the law.  This is probably slightly more common in those with Mild Learning Disability and Autism.  Persons with autism may get into difficulties with the law according to Denis Debbaudt an American expert on this issue because of:

 

(1)       Dangerous wandering.

 

(2)       May not respond to commands or instructions.

 

(3)       Lack of eye contact, may be misinterpreted as a sign of guilt.

 

(4)       May not recognise police uniforms, badges or vehicles.

 

(5)       Have a poor reaction to change in routine.

 

(6)       May reach for shiny objects.

 

(7)       May invade personal space of responder.

 

(8)       Inappropriate social responses.

 

(9)       Inappropriate laughing or giggling.

 

(10)      False confession or misleading statements during questioning.

 

(11)      Associated medical conditions like epilepsy.

 

(12)      Behaviour misunderstood by others resulting in calls for assistance.

 

(13)      A high pain tolerance.

 

(14)      Atypical responses during emergencies.

 

It is critical that professionals for example the police and staff working in forensic settings are aware of these features. Persons with autism are also easily led by others and as already stated misunderstand social cues.  Their obsessional thinking may have an aggressive theme. In one inpatient setting for Learning Disabled Offenders in the U.K. 12% had autism. There is insufficient training within forensic services on autism in most parts of the world.  Hopefully the Irish College of Psychiatrists, the Irish Psychiatric Association, and police authorities will deal with this matter in full. Police, parents and other professionals need to be able to identify the possibility that a person that they are interacting with may have autism or Asperger’s syndrome so that police and other contacts are less stressful for the person with autism or Asperger’s syndrome. In the U.S. research indicates that persons with developmental disabilities are approximately 7 times more likely to come into contact with law enforcement than others.  There is only a small likelihood that in the first instance the autism will be recognised either by the police or other professionals involved.

 

Persons with autism also can get involved in stalking and one of the reasons that persons with Autism Spectrum Disorders are predisposed to stalking according to Tom Berney a U.K. Psychiatrist is that they have impaired perception of social signals, misinterpretation of rules, misinterpretation of relationships, lack of awareness or concern for the outcome, and a focussed obsessive interest.  While this occurs it is not common.

 

Digby Tantum states that sexually motivated crimes are also unusual and when they occur may be a consequence of a lack of understanding on the part of the person with Asperger’s syndrome.  Persons with Asperger’s syndrome may be aggressive and commit offences against other people, but it is unclear how frequently and what proportion of people with Asperger’s syndrome are at risk of doing so. Many people with Asperger’s syndrome have a hypertrophied sense of right and wrong and are unusually conscientious and unwilling to break the law.  The Asperger’s syndrome are more likely to be victims than perpetrators.  Nevertheless even though it is uncommon persistent violence by a person with Asperger’s syndrome is a particularly difficult problem. Men with Asperger’s syndrome are over represented in a survey of one U.K. Secure Hospital.  Violence by a person with Asperger’s syndrome often has some special features.  It may be triggered by idiosyncratic stimuli nourished by rumination over past slights; displaced from provoking the person onto a safer target at a later date; and uninhibited by empathic response to the intended victims fear.  Sometimes the explanation for violence may be similar to that given by Raskolnikov in Dosteyevsky’s Crime and Punishment: that is it is of an experimental nature. It is often a wish to experience a sense of mastery and control over another person.  They may also do it to test their predictions about how others would behave in such extreme circumstances.

 

It is worth noting that Asperger’s syndrome can occur in people of talent like Casal, Kierkegaard, E. Hopper, A. J. P. Taylor, Goethe, van der Post, Columbus, O. Wells, and ‘H. G.’.