Christopher Gillberg

"DAMP" redirects here. For other uses, see Damp (disambiguation).

Lars Christopher Gillberg, (born 19 April 1950) is a professor of Child and Adolescent Psychiatry at Gothenburg University in Gothenburg, Sweden. He has also been a visiting professor at the universities of Bergen, New York, Odense, St George's (University of London), and San Francisco.

Gillberg is known for his research of autism in children, Asperger syndrome. ADHD and anorexia nervosa. He is the founding editor of the journal European Child & Adolescent Psychiatry, and is the author and editor of many scientific and educational books. He is the recipient of several scientific awards, including the Philips Nordic Prize 2004 for neurological research, and he has more than 300 scientific papers listed in Medline.

Gillberg has become known internationally for his contributions to various pioneering research projects into the genetics of autism. In 2003, a French and Swedish research team at the Institut Pasteur psychiatric departments, University of Paris, led by Thomas Bourgeron, Marion Leboyer and Gillberg, made the first discovery of precisely identified genetic mutations in individuals with autism. The team identified mutations altering two genes on the X chromosome which seem to be implicated in the formation of synapses (communication spaces between neurons), in two families where several members are affected. Previous studies, such as the Paris Autism Research International Sib-Pair Study (PARIS), coordinated by Gillberg and Marion Leboyer, have more generally associated the X chromosome regions with autism. The 2003 break-through indicated the location of the mutation to be on the NLGN4 gene and the NGLN3 gene. The mutation prevents a complete protein from forming and is inherited from the mother.

In Sweden, Gillberg is also known for his concern about the confidentiality of medical records and his role in a related controversy.

Gillberg's criteria for Asperger's syndrome

Gillberg's criteria are as follows (all six criteria must be met for confirmation of diagnosis):

1. Severe impairment in reciprocal social interaction (at least two of the following)
   1. inability to interact with peers
   2. lack of desire to interact with peers
   3. lack of appreciation of social cues
   4. socially and emotionally inappropriate behavior
2. All-absorbing narrow interest (at least one of the following)
   1. exclusion of other activities
   2. repetitive adherence
   3. more rote than meaning
3. Imposition of routines and interests (at least one of the following)
   1. on self, in aspects of life
   2. on others
4. Speech and language problems (at least three of the following)
   1. delayed development
   2. superficially perfect expressive language
   3. formal, pedantic language
   4. odd prosody, peculiar voice characteristics
   5. impairment of comprehension including misinterpretations of literal/implied meanings
5. Non-verbal communication problems (at least one of the following)
   1. limited use of gestures
   2. clumsy/gauche body language
   3. limited facial expression
   4. inappropriate expression
   5. peculiar, stiff gaze
6. Motor clumsiness: poor performance on neurodevelopmental examination

(These criteria are different than those given in theDSM-IV-TR.)

DAMP, MBD, and ADHD

Gillberg played a leading role in developing the concept Deficits in Attention, Motor control and Perception (DAMP) in the 1980s. The concept was based on previous attempts to define purely diagnostic criteria for Minimal Brain Dysfunction (MBD, an obsolete name for ADHD) independent of any hypotheses about etiology.

Around 1990, DAMP had become a generally accepted diagnostic concept in two Nordic countries. However, when the DSM-IV appeared in 1994, DAMP became a redundant term, since DAMP is essentially equivalent to ADHD in combination with DCD (dyspraxia) as defined by DSM-IV. In the WHO system, this condition is classified as a hyperkinetic disorder in combination with a developmental disorder of motor function.

Gillberg began to study DAMP in the late 1970s, when it was still called MBD. Since then, he has published around 80 papers on DAMP, ADHD and related conditions. Gillberg admitted in 2003 that he and his co-workers in Gothenburg are almost the only people doing research on DAMP, and that of the "about 50" scholarly works on the topic, the "vast majority of these have either originated in the author's own clinical and research setting or have been supervised and/or co-authored by him." As far as clinical practice goes, DAMP was primarily accepted only in Gillberg's native Sweden and in Denmark, and even in those countries acceptance was limited.

In 2003, Gillberg redefined DAMP as essentially a synonym for ADHD plus DCD. His four criteria are:

• ADHD as defined in DSM-IV;
• DCD (Developmental Coordination Disorder) as defined in DSM-IV;
• Condition not better accounted for by cerebral palsy; and
• IQ higher than about 50 [Gillberg, 2003: box 1].

About half of the children with ADHD also have DCD. In clinically severe form DAMP (or ADHD+DCD) affects about 1.5% of the general population of school age children; another few per cent are affected by more moderate variants. Boys are overrepresented; girls are currently probably underdiagnosed. There are many comorbid problems/overlapping conditions, including conduct disorder, depression/anxiety, and academic failure. There is a strong link with autism spectrum disorders in severe DAMP. Familial factors and pre- and perinatal risk factors account for much of the variance. Psychosocial risk factors appear to increase the risk of marked psychiatric abnormality in DAMP. Outcome in early adult age was psychosocially poor in one study in almost 60% of unmedicated cases.

Confidentiality vs. public access controversy

One of Gillberg's early research projects, the Gothenburg study, has become the center of a heated controversy in Sweden. The controversy concerns the question to what extent the principle of public access, which in Sweden supports transparency in publicly funded activities, can be applied to sensitive data collected in medical studies involving human subjects.

Background

Beginning in 1996, pediatrician Leif Elinder criticized Gillberg's research and alleged that the numbers reported by Gillberg were made up. Elinder became associated with the sociologist Eva Kärfve at Lund University, whose research had been devoted to early witch hunts and medieval myths in Europe. They coordinated their criticism and Kärfve wrote a book, published in 2000, rejecting most of the research on DAMP, and especially Gillberg's. Other psychiatrists and neuroscientists in Sweden defended the Gillberg group and argued that Elinder and Kärfve had crossed the line from scientific criticism to personal attacks and vilification. The conflict escalated further in 2002, when Kärfve and Elinder wrote separate letters to Gothenburg University, accusing the Gillberg group of scientific misconduct. The accusations were investigated by the Ethics Council and dismissed as baseless. Elinder and Kärfve also demanded access to the original research material for the main DAMP studies. Under a section of the Swedish basic law that grants citizens access to government documents, Elinder and Kärfve were given full access to the documents by an administrative court. The University, the Gillberg group, and the participants of the study were strongly opposed to this decision, on the grounds that the material contained medical records and other sensitive information, and that the participants had been promised full confidentiality. A higher court decided that neither the participants, the researchers, nor their institution, were formally entitled to appeal the decision. When all legal avenues had been exhausted, two of Gillberg's coworkers and a university administrator destroyed the 12–27 years old research material. In the legal aftermath, Gillberg and the Rector of Gothenburg University were found guilty of "misuse of office" for not complying with the administrative court's decision.

Reaction to the ruling

The court's decision to grant the two critics access to the data was controversial. When the study participants were contacted by Gillberg and asked if they would be prepared to have the data released, all but one family refused. Because of that, and the promise given to the participants as a precondition, Gillberg and the other researchers felt obliged not to turn over the personal data. After the verdict, Johan Munch, chairman of the Central Ethical Review Board of Sweden said that in Swedish legislation, the Principle of Public Access is incompatible with these kinds of promises of absolute confidentiality, and that the Central Ethical Review Board therefore no longer approves such promises. According to Martin Ingvar of the Karolinska Institute, medical researchers in Sweden would be forced to change the current practice because of the verdict. Ingvar told media that medical studies in Sweden must now adhere to a strict anonymization encoding, even in extensive studies like Gillberg’s which contain large amounts of clinical material collected over long periods of time, in spite of the increase in cost and the larger margins of error. 267 Swedish doctors signed a letter in support of Gillberg's decision not to hand over the data. Elisabeth Rynning, a professor of Medical Law at the University of Uppsala questioned whether the court had been fully aware of the relevant laws. Access to these kinds of records may only be granted for the purpose of research or for the collection of statistics. Elinder had not stated any such purpose in his application, and Kärfve had only argued that the material would be useful for her research, not that it would actually be used in a research project. She was in fact not allowed to use the material in her research project, since that would have required a previous approval by an ethics committee. There was also the problem that Elinder and Kärfve requested the material as private citizens, while at the same time stating that they needed it in their professional capacities. If they had requested the material as representatives of their employers, the court would not have jurisdiction. Finally Rynning questioned how the court could decide that no one would be hurt, as the law requires, if Elinder and Kärfve were given full access to the data. Several participants had testified to the court that they would be deeply offended and hurt if Elinder and Kärfve could read their medical records.

Aftermath

In 2003, a bill was introduced in the Swedish parliament, Riksdagen, due to the secrecy issues raised during the trial that granted the two private individuals access to sensitive personal data. This bill did not pass. In 2004, a new law on ethical review of research involving humans was introduced. Changes were put in place in order to strengthen the protection for human subjects participating in medical research and to expand the scope of the ethical councils. Additional changes to bring the Swedish legislation closer to the European Commission directive are presently under review.

The files with the personal data collected during the Gothenburg study no longer exist. Two co-workers (one of whom was Gillberg's wife) and a university administrator shredded the files. In defense of their action, the two researchers (both chief physicians at Sahlgrenska University Hospital), referred to the promises of confidentiality that had been issued to the subjects of the study and the letters of objection that had been received from the families that they did not want their personal data used or shared with the private individuals. They argued that turning the files over would have exposed the researchers and the university to potential lawsuits from the subjects for failing to honor a written agreement. They were convicted and fined for destruction of government property.

In July 2005 the lower criminal court in Gothenburg upheld the right of Kärfve and Elinder to see any data from the Gothenburg study still held by the University. The court fined Gillberg for "misuse of office".

See further

• The Gothenburg Study of Children with DAMP

Selected publications by Gillberg

Journal Articles

• Steffenburg, Suzanne (May, 1989). "A Twin Study of Autism in Denmark, Finland, Iceland, Norway and Sweden". Journal of Child Psychology and Psychiatry and Allied Disciplines. 30 (3). The Association for Child Psychology and Psychiatry: 405–416. ISSN 0021-9630. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

• Baroncohen, Simon (December, 1992). "Can Autism Be. Detected at 18 Months? The Needle, the Haystack and the CHAT". The British Journal of Psychiatry. 161. The Royal College of Psychiatrists: 839–143. ISSN 0007-1250. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

• Ehlers, Stefan (Nov, 1993). "The Epidemiology of Asperger Syndrome - A Total Population Study". Journal of Child Psychology and Psychiatry and Allied Disciplines. 34 (8). The Association for Child Psychology and Psychiatry: 1327–1350. ISSN 0021-9630. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

• Happe, Francesca (December 20, 1996). "'Theory of mind' in the brain. Evidence from a PET scan study of Asperger syndrome". Neuroreport. 8 (1). Rapid Science Publishers: 197–201. ISSN 0959-4965. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

• Philippe, Anne (May, 1999). "Genome-wide scan for autism susceptibility genes". Human Molecular Genetics. 8 (5). Oxford University Press: 805–812. doi:10.1093/hmg/8.5.805. ISSN 1460-2083. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

• Jamain, Stéphane (31 March 2003). "Mutations of the X-linked genes encoding neuroligins NLGN3 and NLGN4 are associated with autism". Nature Genetics. 34 (1). Nature Publishing Group: 27–29. doi:10.1038/ng1136. ISSN 1061-4036. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

• Ståhlberg, Ola (July 2004). "Bipolar disorder, schizophrenia, and other psychotic disorders in adults with childhood onset AD/HD and/or autism spectrum disorders". Journal of Neural Transmission. 111 (7). Springer Wien: 891–902. doi:10.1007/s00702-004-0115-1. ISSN 0300-9564. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

• Miller, Marilyn T. (April–May 2005). "Autism associated with conditions characterized by developmental errors in early embryogenesis: a mini review". International Journal of Developmental Neuroscience. 23 (2–3). Elsevier: 201–219. doi:10.1016/j.ijdevneu.2004.06.007. ISSN 0736-5748. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: date format (link)

Books

• Gillberg, Christopher (1981). Neuropsychiatric aspects of perceptual, motor and attentional deficits in seven-year-old Swedish children. Uppsala: Uppsala University. ISBN 91-554-1212-2.

• Coleman, Mary; Gillberg, Christopher (1985). The biology of the autistic syndromes. New York: Praeger. ISBN 0-03-000834-4.{{cite book}}: CS1 maint: multiple names: authors list (link)

• Gillberg, Christopher (ed.) (1989). Diagnosis and treatment of autism. New York: Plenum Press. ISBN 0-306-43481-4. {{cite book}}: |author= has generic name (help)

• Gillberg, Christopher (1995). Clinical Child Neuropsychiatry. Cambridge University Press. ISBN 0-521-54335-5.

• Gillberg, Christopher (1997). Barn, Ungdomar och vuxna med Asperger Syndrom - Normala, geniala, nördar? (in Swedish). Gothenburg: Bokförlaget Cura AB. ISBN 91-972641-6-4.

• Gillberg, Christopher; Peeters, Theo (1998). Autism : medical and educational aspects. London: Whurr. ISBN 0-521-54335-5.{{cite book}}: CS1 maint: multiple names: authors list (link)

• Gillberg, Christopher (2002). A Guide to Asperger Syndrome. Cambridge University Press. ISBN 0-521-00183-8.

• Gillberg, Christopher;Harrington, Richard; Steinhausen, Hans-Christoph (2006). A clinician's handbook of child and adolescent psychiatry. Cambridge: Cambridge University Press. ISBN 978-0-521-81936-7.{{cite book}}: CS1 maint: multiple names: authors list (link)

External links

• Philips Prize - Information about the Philips Prize
• European Child & Adolescent Psychiatry (journal)
• The Autism Puzzle (A BBC documentary featuring Gillberg)
• An interview with Gillberg in Looking Up (an autism newsletter) 3:12, 2005.
• Kärfe, Elinder, and others defend their accusations - "Rapid responses" submitted to British Medical Journal, 2004
• Various responses to Kärfve Gothenburg University, 2001 (in Swedish)
• Riksförbundet Attention supports Gillberg Official web page in Swedish, August 21, 2005. (Riksförbundet Attention is a national Swedish association for people with neuropsychiatric disabilities.)
• Riksföreningen Autism supports Gillberg Press release in Swedish. Undated, 2006. (Riksföreningen Autism is the national Swedish association for people with autism and autism-like disorders.)
• Letter to the Swedish Chancellor of Justice The Swedish Child Neuropsychiatry Science Foundation. Letter detailing the actions by Christopher Gillberg opponents, the involvement of public figures and the media, and the legal process.
• The Gillberg Affair Review of the affair; includes English translations of main Swedish documents.