SCREENING & DIAGNOSIS
OF ASPERGER SYNDROME
syndrome is characterized by delays in a child's social interaction,
language as used in social communication, or symbolic or imaginative
play. A possible diagnosis
of Asperger's syndrome would normally involve these characteristics
across a range of situations.
A child may not look at the other person's face when spoken to,
and appear uninterested in communicating with others. It may be
very difficult to get their attention, or get them to return a smile.
Aspergers syndrome can lead to repetitive
behaviors and obsessions with certain objects. Early signs of
this may be constant rocking movements or flapping of the hands.
Attachments to particular objects and eating only certain foods
may appear to be much more intense than with those exhibited by
Emotional outbursts can appear to have no cause and the child may
not respond to hugs and reassurances. There can be an extreme sensory
sensitivity to touch and sounds, and a tendency not to play
with other children. A child may only play with a limited number
of toys, and may concentrate on only part of the toy.
Screening of Asperger's syndrome
Parents of children with Asperger syndrome can
typically trace differences in their children's development to as
early as 30 months of age. Developmental screening during a
routine check-up by a general practitioner or pediatrician may identify
signs that warrant further investigation. The diagnosis of
Asperger syndrome is complicated by the use of several different screening instruments.
None have been shown to reliably differentiate between Asperger syndrome and other
Autism Spectrum Disorders. The current "gold standard" in diagnosing Autism Spectrum Disorders uses
the Autism Diagnostic Interview-Revised (ADI-R)—a semistructured
parent interview—and the Autism Diagnostic Observation Schedule
(ADOS)—a conversation and play-based interview with the child.
Diagnosis of Asperger syndrome
Standard diagnostic criteria require impairment
in social interaction, and repetitive and stereotyped behaviors
and interests, without significant delay in language or cognitive
development. Unlike the international standard, U.S. criteria
also require significant impairment in day-to-day functioning.
Other sets of diagnostic criteria have been proposed by Szatmari
et al. and by Gillberg and Gillberg.
Diagnosis is most commonly made between the ages
of four and eleven. A comprehensive assessment involves a multidisciplinary
team that observes across multiple settings, and includes
neurological and genetic assessment as well as tests for cognition,
psychomotor function, verbal and nonverbal strengths and weaknesses,
style of learning, and skills for independent living. Delayed
or mistaken diagnosis can be traumatic for individuals and families;
for example, misdiagnosis can lead to medications that worsen behavior.
procedure of diagnosing Asperger syndrome
Developmental screening during a routine check-up
by a general practitioner or pediatrician may identify signs that
warrant further investigation. This will require a comprehensive
team evaluation to either confirm or exclude a diagnosis of Aspergers syndrome.
This team usually includes a psychologist, neurologist, psychiatrist,
speech and language pathologist, occupational therapist and other
professionals with expertise in diagnosing children with Aspergers syndrome. Observation
occurs across multiple settings; the social disability in Aspergers syndrome may
be more evident during periods when social expectations are unclear
and children are free of adult direction. A comprehensive evaluation
includes neurological and genetic assessment, with in-depth cognitive
and language testing to establish IQ and evaluate psychomotor function,
verbal and nonverbal strengths and weaknesses, style of learning,
and skills for independent living. An assessment of communication
strengths and weaknesses includes the evaluation of nonverbal forms
of communication (gaze and gestures); the use of non-literal language
(metaphor, irony, absurdities and humor); patterns of speech inflection,
stress and volume; pragmatics (turn-taking and sensitivity to verbal
cues); and the content, clarity and coherence of conversation. Testing
may include an audiological referral to exclude hearing impairment.
The determination of whether there is a family
history of autism spectrum conditions is important. A medical practitioner
will diagnose on the basis of the test results and the child’s developmental
history and current symptoms. Because multiple domains of functioning
are involved, a multidisciplinary team approach is critical; an
accurate assessment of the individual's strengths and weaknesses
is more useful than a diagnostic label. Delayed or mistaken diagnosis
is a serious problem that can be traumatic for individuals and families;
diagnosis based solely on a neurological, speech and language, or
educational attainment may yield only a partial diagnosis.
misDiagnosis & underdiagnosis of Asperger syndrome
Many children with Asperger syndrome are initially misdiagnosed
with attention-deficit hyperactivity disorder (ADHD). Diagnosing
adults is more challenging, as standard diagnostic criteria are
designed for children and the expression of Asperger syndrome changes with age.
Conditions that must be considered in a differential diagnosis include
other Autism Spectrum Disorders, the schizophrenia spectrum, ADHD, Obsessive
compulsive disorder, depression, semantic pragmatic disorder, nonverbal learning
syndrome , stereotypic movement disorder
Underdiagnosis and overdiagnosis are problems
in marginal cases. The cost of screening and diagnosis and the challenge
of obtaining payment can inhibit or delay diagnosis. Conversely,
the increasing popularity of drug treatment options and the expansion
of benefits has motivated providers to overdiagnose Autism Spectrum
Disorder. There are indications Asperger syndrome has been diagnosed
more frequently in recent years, partly as a residual diagnosis
for children of normal intelligence who do not have autism but have
social difficulties. There are questions about the external validity
of the Asperger syndrome diagnosis, that is, it is unclear whether
there is a practical benefit in distinguishing Asperger syndrome
from high-functioning autism and from PDD-NOS; the same child can receive different
diagnoses depending on the screening tool.
Importance of early diagnosis and intervention in asperger's
As Asperger's syndrome is a developmental disorder,
it is important to minimize the delays in a child's development.
Early diagnosis and intervention
reduce the impact of Asperger's on a child's life so if you suspect
your child may have autism, contact your local autism association,
family doctor or a pediatrician. For more information, see the Early
Official diagnostic process of asperger syndrome
Some of the Pervasive Developmental Disorders
are increasingly known as Autism Spectrum Disorders, due to the
ongoing debate over classification
and diagnosis. There are various diagnostic frameworks for Pervasive
Developmental Disorders. By far the most common one is the Diagnostic
and Statistical Manual of Mental Disorders (DSM-IV).
Aspergers syndrome correlates with Asperger’s
Disorder defined in section 299.80 of the DSM-IV by six main criteria:
A. Qualitative impairment in social interaction,
as manifested by at least two of the following:
(1) marked impairment in the use of multiple nonverbal
behaviors such as eye-to-eye gaze, facial expression, body postures,
and gestures to regulate social interaction
(2) failure to develop peer relationships appropriate to developmental
(3) a lack of spontaneous seeking to share enjoyment, interests,
or achievements with other people (e.g., by a lack of showing, bringing,
or pointing out objects of interest to other people)
(4) lack of social or emotional reciprocity
B. Restricted repetitive and stereotyped patterns
of behavior, interests, and activities, as manifested by at least
one of the following:
(1) encompassing preoccupation with one or more
stereotyped and restricted patterns of interest that is abnormal
either in intensity or focus
(2) apparently inflexible adherence to specific, nonfunctional routines
(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger
flapping or twisting, or complex whole-body movements)
(4) persistent preoccupation
with parts of objects
C.The disturbance causes clinically significant
impairment in social, occupational, or other important areas of
D. There is no clinically significant general
delay in language (e.g., single words used by age 2 years, communicative
phrases used by age 3 years).
E. There is no clinically significant delay in
cognitive development or in the development of age-appropriate self-help
skills, adaptive behavior (other than in social interaction), and
curiosity about the environment in childhood.
F. Criteria are not met for another specific Pervasive
Developmental Disorder or Schizophrenia.
Aspergers syndrome is also known as Asperger syndrome,
or AS for short. It is a Pervasive Developmental Disorder, one of
five neurological conditions characterized by difference in language
and communication skills, as well as repetitive or restrictive patterns
of thought and behavior. The other four related disorders or conditions
are autism, Rett
Disintegrative Disorder, and
PDD-NOS (Pervasive Developmental Disorder Not Otherwise Specified).
There is an increasing move to seeing Asperger's
syndrome as being part of the autism spectrum, hence is often known as an Autism Spectrum Disorder
Other screening instruments for asperger syndrome
The diagnosis of Aspergers syndrome is complicated by the use of
several different screening instruments. The diagnostic criteria
of the Diagnostic and Statistical Manual are criticized for being
vague and subjective. Other sets of diagnostic criteria for Aspergers
• ICD 10 World Health Organization Diagnostic Criteria
• Szatmari Diagnostic Criteria
• Gillberg Diagnostic Criteria
• Attwood & Gray Discovery Criteria.
The ICD-10 definition has similar criteria to
the DSM-IV version. Asperger’s syndrome had at different times been
called Autistic psychopathy and Schizoid disorder of childhood,
although those terms are now understood as archaic and inaccurate,
and therefore no longer accepted in common use.
Debate over Aspergers & high functioning autism
Some doctors believe that Aspergers syndrome is
not a separate and distinct disorder, referring to it as High
Functioning Autism (HFA). The diagnoses of Asperger’s syndrome
autism are used interchangeably, complicating prevalence estimates:
the same child can receive different diagnoses, depending on the
screening tool the doctor uses, and some children will be diagnosed
with high-functioning autism instead of Asperger’s syndrome, and
Many experienced clinicians apply the early onset on High Functioning
Autism or the regressive pattern of development as the distinguishing
factor in differentiating between Asperger’s syndrome and high-functioning autism. The
current classification of the Pervasive Developmental Disorders
(PDDs) is unsatisfying to many parents, clinicians, and researchers,
and may not reflect the true nature of the conditions.
Peter Szatmari, a Canadian researcher of Pervasive Developmental
Disorders, feels that greater precision is needed to better differentiate
between the various Pervasive Developmental Disorders diagnoses.
The DSM-IV and ICD-10 focus on the idea that discrete biological
entities exist within Pervasive Developmental Disorders, which leads
to a preoccupation with searching for cross-sectional differences
between Pervasive Developmental Disorders subtypes, a strategy which
has not been very useful in classification or in clinical practice.
1. McPartland J, Klin A (2006). "Asperger's
syndrome". Adolesc Med Clin 17 (3): 771–88. doi:10.1016/j.admecli.2006.06.010.
2. Baskin JH, Sperber M, Price BH (2006). "Asperger syndrome
revisited". Rev Neurol Dis 3 (1): 1–7. PMID 16596080.
4. National Institute of Neurological Disorders and Stroke (NINDS)
(2007-07-31). Asperger syndrome fact sheet. Retrieved on 2007-08-24.
NIH Publication No. 05-5624.
6. ^ a b World Health Organization (2006). "F84. Pervasive
developmental disorders", International Statistical Classification
of Diseases and Related Health Problems, 10th ed. (ICD-10).
12. American Psychiatric Association (2000). "Diagnostic criteria
for 299.80 Asperger's Disorder (AD)", Diagnostic and Statistical
Manual of Mental Disorders, 4th ed., text revision (DSM-IV-TR).
16. ^ a b Rapin I (2001). "Autism spectrum disorders: relevance
to Tourette syndrome". Adv Neurol 85: 89–101. PMID 11530449.
17. Ehlers S, Gillberg C (1993). "The epidemiology of Asperger's
syndrome. A total population study". J Child Psychol Psychiat
34 (8): 1327–50.
24. Foster B, King BH (2003). "Asperger syndrome: to be or
not to be?". Curr Opin Pediatr 15 (5): 491–4. PMID 14508298.
40. Szatmari P, Bremner R, Nagy J (1989). "Asperger's syndrome:
a review of clinical features". Can J Psychiatry 34 (6): 554–60.
41. Gillberg IC, Gillberg C (1989). "Asperger syndrome—some
epidemiological considerations: a research note". J Child Psychol
Psychiatry 30 (4): 631–8. doi:10.1111/j.1469-7610.1989.tb00275.x.
42. Fitzgerald M, Corvin A (2001). "Diagnosis and differential
diagnosis of Asperger syndrome". Adv Psychiatric Treat 7 (4):
43. Tantam D (2003). "The challenge of adolescents and adults
with Asperger syndrome". Child Adolesc Psychiatr Clin N Am
12 (1): 143–63. PMID 12512403.
44. Shattuck PT, Grosse SD (2007). "Issues related to the diagnosis
and treatment of Autism Spectrum Disorders". Ment Retard Dev
Disabil Res Rev 13 (2): 129–35. doi:10.1002/mrdd.20143. PMID 17563895.
45. Klin A, Volkmar FR (2003). "Asperger syndrome: diagnosis
and external validity". Child Adolesc Psychiatr Clin N Am 12
(1): 1–13. PMID 12512395.
Click here to go to the
home page www.autism-help.org
This autism information is under copyright of
www.autism-help.org and requests to reproduce this information should
be sent to the webmaster. Contact details are available here.