**6. Tics, obsessive compulsive disorder and ASD**

Canitano et al. [31] showed that 22% of ASDs presented with tic disorder, but there was a "difficulty in discriminating complex tics and OCD symptoms, and ASD symptoms". Nevertheless, the overlap between neurodevelopmental disorders is consistent. This equates with clinical experience and clinical reality. Maybe we need a subcategory called ASD plus tics and another category ASD without tics, another category with tics with ADHD and another category tics without ADHD, tics without OCD, etc. Stein [32] notes the overlap between autism, tics and stereotypic movement disorder. There is considerable neurobiological data in relation to OCD spectrum disorder. Stein [32] again emphasises the "possibly overlapping phenomenological and neurobiological features". Stein [32] points out that "there is increasing evidence that a sub-set of OCD may be genetically related to Tourette's Disorder, manifests with tics or OCD and involving both the serotonin or dopamine systems and the basal ganglia". Meir et al. [33] showed that "individuals diagnosed with OCD displayed a nearly four-fold higher risk to be diagnosed with ASD in later life" and that "the high co-morbidity sequential risk and shared familial risks between OCD and ASD's are suggestive of partially shared etiological mechanism". It would appear then that some neurosis (OCD) could be neurodevelopmental in origin, at least partly. This again shows the lack of sharp delineation between psychiatric diagnoses.

**7**

**Asperger syndrome (DSM-IV) diagnostic criteria**

**Failure to develop peer relationships to develop-**

**Lack of spontaneous seeking to share enjoyment**

**Lack of social and emotional reciprocity**

**Inflexible adherence to specific non- functional routines or rituals**

**Stereotyped and repetitive motor mannerisms**

**Clinically significant impairment in social or occupational functioning**

**No clinically significant delay in language development**

**No clinically significant delay in cognitive development or self-help skills**

**Persistent pre- occupation with parts of objects**

Yes

Yes

Yes

**pre-**

**Impairment in use of eye-to-eye gaze, facial expression, body postures**

 **mental level**

**occupation with one or more stereotyped pattern of interest**

Yes

Yes

Yes

Yes

Yes

Schizoid personality in

childhood

Obsessive

Yes, often

Yes, often

Yes

Yes

Yes

Yes

Yes

compulsive

personality

disorder

Schizotypal

Yes

Yes

Yes

Yes,

Yes Yes

Yes

Yes

Yes

Yes

sometimes

disorder

Avoidant

Yes

Yes

Yes

Yes

Yes

personality

disorder

**Table 1.** *Differential diagnosis of neurodevelopmental disorders (Asperger's syndrome).*

*The Future of Psychiatry and Neurodevelopmental Disorders: A Paradigm Shift*

*DOI: http://dx.doi.org/10.5772/intechopen.88540*

*The Future of Psychiatry and Neurodevelopmental Disorders: A Paradigm Shift DOI: http://dx.doi.org/10.5772/intechopen.88540*

> **Table 1.**

 *Differential diagnosis of neurodevelopmental disorders (Asperger's syndrome).*

*Neurodevelopment and Neurodevelopmental Disorder*

schizophrenia, bipolar disorder, etc. in their family histories.

**6. Tics, obsessive compulsive disorder and ASD**

shows the lack of sharp delineation between psychiatric diagnoses.

**4. Prevalence**

1/37 males [30].

**5. Differential diagnosis**

See **Table 1** attached.

Kanner [26] was correct when he pointed out that "the extreme isolation from people … infantile autism bears so close a resemblance to schizophrenic withdrawal that the relationship between the two conditions deserves serious consideration". Of course other times, he described them as very separate. Asperger [27] pointed out that "the schizophrenic patient seems to show progressive loss of contact, the children we diagnose (now called Asperger's syndrome), lack contact from the start". The problem here is that some of the patients with autism do follow this pattern, but others have regressive autism, where they develop normally and then regress with loss of language, etc. I've seen this occurring up to 3 or 4 years of age. Rutter [11] states that "the social class of parents of autistic children is most unlike that of the parents of schizophrenics. A high proportion of the parents of autistic children are of above average intelligence and superior socio-economic states". This is incorrect, as shown by Gillberg and Schumann [28]. In my clinical practice, I constantly see patients from every social class with autism and observe

Using narrow criteria of autism ADI-R, etc., Baird et al. [29] found a prevalence

of 25 per 10,000, but when the broader autism spectrum criterium was used, a prevalence of 116 per 10,000 was found. This unfortunately means that over three quarters of the persons with autism in the community have what I would call "real" autism or clinical autism (autism spectrum disorder) and were missed by these narrow-based instruments. Currently, the prevalence of autism is 1/59 CDC and

Canitano et al. [31] showed that 22% of ASDs presented with tic disorder, but there was a "difficulty in discriminating complex tics and OCD symptoms, and ASD symptoms". Nevertheless, the overlap between neurodevelopmental disorders is consistent. This equates with clinical experience and clinical reality. Maybe we need a subcategory called ASD plus tics and another category ASD without tics, another category with tics with ADHD and another category tics without ADHD, tics without OCD, etc. Stein [32] notes the overlap between autism, tics and stereotypic movement disorder. There is considerable neurobiological data in relation to OCD spectrum disorder. Stein [32] again emphasises the "possibly overlapping phenomenological and neurobiological features". Stein [32] points out that "there is increasing evidence that a sub-set of OCD may be genetically related to Tourette's Disorder, manifests with tics or OCD and involving both the serotonin or dopamine systems and the basal ganglia". Meir et al. [33] showed that "individuals diagnosed with OCD displayed a nearly four-fold higher risk to be diagnosed with ASD in later life" and that "the high co-morbidity sequential risk and shared familial risks between OCD and ASD's are suggestive of partially shared etiological mechanism". It would appear then that some neurosis (OCD) could be neurodevelopmental in origin, at least partly. This again

**6**
