Articles for the Month of November 2016

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 The prevalence of autism depends on whether you use old, narrow, out-of-date concepts of autism or new concepts of the condition.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.
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.”
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.

Is psychotherapy more than friendship?

Is Psychotherapy more than friendship?
   Is Psychotherapy more than friendship?
   We have all become familiar with psychotherapists being dubbed ‘expensive friends’ and friends ‘inexpensive therapists’ in recent years. The suggestion that psychotherapy is nothing more than high- quality friendships often provokes heated debate. Does the debate contain a ring of truth or is it far more deep-seated? What exactly do high-quality friendship and therapy have in common? Quite simply,      good communication.


Good communication makes for good relationships and is synonymous with high-quality friendship. The features of genuine friendship and therapy almost completely overlap. They include listening, empathising, sincere interest, respect, understanding, acceptance and a non-judgmental and non-critical attitude. In some respects, they sound like old-fashioned values and manners of a bygone age, which certainly can feel in short supply in the modern world.
Images of friends offloading over hedges or half-doors in some rural idyll spring to mind. Old sayings abound with the benefits of friendship: ‘A shared joy is a double joy; a shared sorrow is half a sorrow.’ The rarity of genuine friendship was summed up by 18th-century English physician Thomas Fuller, ‘If you have one true friend you have more than your share’, and equally so by American writer Sarah Orne Jewett in the character of Mrs Todd from The Country of the Pointed Firs: ‘Yes’m old friends is always best, ‘less you can catch a new one that’s fit to make an old one out of.’ Click here to read the full article

Genesis of Artistic Creativity at the National Gallery, Dublin

          Genesis of Artistic Creativity & the Yeats Family at the National Gallery, February, 2016
Friends of the National Gallery
  Prof Michael Fitzgerald presented this slide show to the friends of the National Gallery.
The main focus of this presentation is the Yeats family, Jack B Yeats and William Butler Yeats.


The Genesis of Artistic Creativity
The Genesis of Artistic Creativity
The information for the above presentation comes from this book about the nature of artistic creativity and its relationship with ‘difference’ has intrigued people for centuries. The Genesis of Artistic Creativity is a revealing exploration of the lives of 21 famous writers, philosophers, musicians and painters including William Butler Yeats and Jack B Yeats and many others, in light of the recognized criteria for diagnosis of high-functioning autism and Asperger’s Syndrome (AS).
Author: Fitzgerald M. (2005)
Publisher:Jessica Kingsley Publications: London
ISBN:  978-1843103349
The Genesis of Artistic CreativityJapanese Edition
This book was also translated and published in Japanese.

Co-Author: Fitzgerald M. (2009)

Publisher: Seiwa Shoten Pub: Tokyo
ISBN: 978-4790714392

Autism and Comedy Symposium – Comedy on the Spectrum

Comedy on the Spectrum
 A presentation by Prof Michael Fitzgerald at the “Autism and Comedy Symposium” at the University of Kent, Canterbury, UK, Jamuary 2016
Comedians with Autism
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.
Author: Fitzgerald M. (2015)
Publisher: Nova Science Publishers Inc.New York
ISBN: 978-1-63463-573-8
The Mind of the Artist and other books and free resources
Information for this presentation has come from Prof. Fitzgerald’s recent book “The Mind of the Artist”.
Information about that book along with 31 other books published, co- published and edited by Prof Fitzgerald are on his website.

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

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


-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.


– 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.


– 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.



The man who knew Infinity – Ramanujan and Hardy, both has Asperger’s Syndrome

Autism and Creativity is a stimulating study of male creativity and autism, arguing that a major genetic endowment is a prerequisite of genius, and that cultural and environmental factors are less significant than has often been claimed.
Chapters on the diagnosis and psychology of autism set the scene for a detailed examination of a number of important historical figures.
English Language Edition
Author: Fitzgerald M.  (2004)
Publisher: Brunner Routledge:  New York
ISBN: 978-1583912133
For example:
* in the Indian mathematician Ramanujan, the classic traits of Asperger’s syndrome are shown to have coexisted with an extraordinary level of creativity –
* more unexpectedly, from the fields of philosophy, politics and literature, scrutiny of Ludwig Wittgenstein, Sir Keith Joseph, Eamon de Valera, Lewis Carroll and William Butler Yeats reveals classical autistic features.


Autism and Creativity will prove fascinating reading not only for professionals and students in the field of autism and Asperger’s syndrome, but for anyone wanting to know how individuals presenting autistic features have on many occasions changed the way we understand society. This is quite simply the best book I have read on autism in history . . .

“Fitzgerald is clearly an experienced clinician and his deep understanding of the spectrum of autism conditions comes across in his writings. But he is also an exceptional scholar, and the thoroughness of his biographical research combined with his clinical acumen minimises the obvious risks inherent in historical  diagnosis. He makes a plausible case for the Autistic mind being a different – and potentially highly creative – kind of mind“.

Professor Simon Baron-Cohen, Director, Autism Research Centre, Cambridge University.

Autism & Creativity
Co-Author: Michael Fitzgerald, Yoshiki Ishisaka, Ayako Hanashima, Taki Ōta (2008)
Publisher: Seiwa Shoten Pub: Tokyo
ISBN: 978-479-11-06875

Buy it now

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.



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