Ask Dr. Keith Roach M.D
ADD, Asperger’s and Autism: What’s the difference?
DEAR DR. ROACH: Can you tell me the difference between ADD, Asperger's and autism? -J.K.
ANSWER: Attention deficit hyperactivity disorder, sometimes still called attention deficit disorder, is a condition that begins in childhood with symptoms of inattention, hyperactivity and impulsive behavior. The DSM-5, a standard for psychiatric diagnoses, recognizes three subtypes: predominantly inattentive, predominantly hyperactive- impulsive and combined.
Asperger's syndrome is part of the spectrum of autism disorders. These disorders are characterized by deficits in social communication and social interaction, and by restricted behaviors or interests. These symptoms must impair function and begin early in life. Some people with autism have cognitive impairment, and some are cognitively normal or have superior intellect. In Asperger syndrome, there is no delay in language or cognitive development. The DSM-5 no longer recognizes Asperger as a specific entity, but those of us who have worked extensively with people with autistic spectrum disorder recognize that there is a wide variation of abilities among individuals affected. Although the diagnosis of Asperger syndrome is imprecise, it is sometimes helpful.
Diagnosis of these disorders can sometimes be difficult and may require consultation with a developmental pediatrician or psychologist.
DEAR DR. ROACH: I am an 88-year-old man with diabetes on warfarin. I have had redness under the foreskin for years, and pulling it back is getting a little hard to do. No creams or ointments have helped, and my urologist says a circumcision is the only cure. From my reading, it's not a great procedure to undergo at my age, and the urologist says it takes six weeks to heal. I would appreciate your thoughts.
ANSWER: Balanitis, inflammation of the foreskin, is a common problem in men who have not undergone circumcision, especially older men with diabetes. Many conditions may predispose a man to the development of balanitis, but infections — bacterial, viral and especially fungal — are most common. If not properly treated, it can lead to phimosis, the inability to retract the foreskin, which can in turn lead to sexual and urinary problems.
I have seen several patients who have needed circumcision, which is indeed the only option for men once the condition has significantly progressed. Circumcision in adults has a low rate of complications, but the longer you wait, the higher the risk, so I would advise you to carefully consider the advice of your urologist, who has far more information about you than I do.
Balanitis can be prevented in most men by careful control of diabetes, meticulous hygiene, avoidance of excessively forceful retraction and prompt identification and treatment of any symptoms when they occur.
DEAR DR. ROACH: I have dust mites in my home, and it complicates my psoriasis. I have asked two exterminators to rid me of them, but they said they cannot take care of mites. Do you have a solution? — M.F.
ANSWER: Dust mites are nearly ubiquitous. They colonize mattresses and bedding, sofas and carpets. Although they don't bite, they can cause allergic reactions, especially of the respiratory system, such as sneezing, runny nose and cough. They also can exacerbate asthma, and there is some evidence that they can also worsen chronic skin conditions like eczema or possibly psoriasis. They absorb water from the air and, unpleasantly, feed on shed human skin cells.
Effective methods of controlling dust mites include physical barriers (specially designed mattress and pillow covers), frequent (at least weekly) washing of bedding in hot water and vacuuming carpets and upholstered furniture with a HEPA-filter vacuum. Keeping humidity below 50 percent can be very effective if practicable.