Asperger's Disorder Health Article

Diagnosis

Currently, there are no blood tests or brain scans that can be used to diagnose AS. Until DSM-IV (1994), there was no "official" list of symptoms for the disorder, which made its diagnosis both difficult and inexact. Although most children with AS are diagnosed between five and nine years of age, many are not diagnosed until adulthood. Misdiagnoses are common; AS has been confused with such other neurological disorders as Tourette's syndrome, or with attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), or obsessive-compulsive disorder (OCD). Some researchers think that AS may overlap with some types of learning disability, such as the nonverbal learning disability (NLD) syndrome identified in 1989.

The inclusion of AS as a separate diagnostic category in DSM-IV was justified on the basis of a large international field trial of over a thousand children and adolescents. Nevertheless, the diagnosis of AS is also complicated by confusion with such other diagnostic categories as "high-functioning (IQ higher than 70) autism" or HFA, and "schizoid personality disorder of childhood." Unlike schizoid personality disorder of childhood, AS is not an unchanging set of personality traits—AS has a developmental dimension. AS is distinguished from HFA by the following characteristics:

• Later onset of symptoms (usually around three years of age)
• Early development of grammatical speech; the AS child's verbal IQ (scores on verbal sections of standardized intelligence tests) is usually higher than performance IQ (how well the child performs in school). The reverse is usually true for autistic children
• Less severe deficiencies in social and communication skills
• Presence of intense interest in one or two topics
• Physical clumsiness and lack of coordination
• Family is more likely to have a history of the disorder
• Lower frequency of neurological disorders
• More positive outcome in later life

DSM-IV-TR criteria for Asperger's disorder

The DSM-IV-TR specifies the following diagnostic criteria for AS:

• The child's social interactions are impaired in at least two of the following ways: markedly limited use of nonverbal communication (facial expressions, for example); lack of age-appropriate peer relationships; failure to share enjoyment, interests, or accomplishment with others; lack of reciprocity (turn-taking) in social interactions.
• The child's behavior, interests, and activities are characterized by repetitive or rigid patterns, such as an abnormal preoccupation with one or two topics, or with parts of objects; repetitive physical movements; or rigid insistence on certain routines and rituals.
• The patient's social, occupational, or educational functioning is significantly impaired.
• The child has normal age-appropriate language skills.
• The child has normal age-appropriate cognitive skills, self-help abilities, and curiosity about the environment.
• The child does not meet criteria for another specific PDD or schizophrenia.

To establish the diagnosis, the child psychiatrist or psychologist would observe the child, and would interview parents, possibly teachers, and the affected child (depending on the child's age), and would gather a comprehensive medical and social history.

Other diagnostic scales and checklists

Other instruments that have been used to identify children with AS include Gillberg's criteria, a six-item list compiled by a Swedish researcher that specifies problems in social interaction, a preoccupying narrow interest, forcing routines and interests on the self or others, speech and language problems, nonverbal communication problems, and physical clumsiness; and the Australian Scale for Asperger's Syndrome, a detailed multi-item questionnaire developed in 1996.

Brain imaging findings

Current research has linked only a few structural abnormalities of the brain to AS. Findings include abnormally large folds in the brain tissue in the left frontal region, abnormally small folds in the operculum (a lid-like structure composed of portions of three adjoining brain lobes), and damage to the left temporal lobe (a part of the brain containing a sensory area associated with hearing). The first single photon emission tomography (SPECT) study of an AS patient found a lower-than-normal supply of blood to the left parietal area of the brain, an area associated with bodily sensations. Brain imaging studies on a larger sample of AS patients is the next stage of research.

Treatment team

The treatment team needed for a child with Asperger's syndrome will vary based on the specifics and the severity of the child's disabilities. Pediatricians, developmental pediatricians, neurologists, and child psychiatrists can all play a part in the diagnosis and the treatment planning for a child with Asperger's syndrome. Physical therapy, occupational therapy, speech and language therapy, individual and group behavioral therapy, and psychoeducational planning are all crucial to helping a child with Asperger's syndrome progress optimally.

Treatments

There is no cure for AS and no prescribed treatment regimen for all AS patients. Specific treatments are based on the individual's symptom pattern.