3 May

Diagnosis of Asperger’s Disorder

By Lirio Sobrevinas Covey, Ph.D.

In DSM-IV (American Psychiatric Association, 1994), Asperger’s Disorder was one of four syndromes classed under the overall rubric of Pervasive Development Disorder (the others were Autistic Disorder, Rett’s Disorder, and Childhood Disintegrative Disorder).

In the recently published DSM-V (2013), autism symptoms are classed into two groups – social/communication group and the restrictive and repetitive group, all under a single overall classification labelled as Autism Spectrum Disorders (ASD). This new classification is intended to reflect the range in severity of autism symptoms, rather than to reflect a qualitative difference. Persons previously classified as AD in DSM-IV are likely to still fall under the rubric of ASD and regarded as high functioning autisms.

Asperger’s Disorder is characterized by abnormal social functioning and repetitive behaviors but not with reduced cognitive functioning, intelligence, or language ability. There is ongoing controversy regarding the validity of AD as separate from autism, in particular, “high functioning autism’’. Notably, in ICD-10 (the diagnostic classification associated with the World Health Organization), Asperger’s Disorder is classified as a subgroup of ASD.

Questionnaires specific for assessing Asperger’s Disorder have been developed. More work is required according to a review of five third-party AD rating scales that described the existing measurements as – promising but demonstrating significant weaknesses (Campbell JM, J Autism and Developmental Disorders, Volume 35, Feb, 2005). One of the five, the Krug Asperger’s Disorder Index (KADI) is considered the most sound and reliable. These instruments, although not defining of Asperger’s Disorder by themselves, can provide the diagnostic team with basic information for pursuing a more complete and intensive inquiry. Arriving at a correct diagnosis is so imperative for helping the ASD-affected individual receive appropriate clinical assistance and reach a positive life outcome.

Following are excerpts on diagnosing Asperger’s Disorder from a recent review article by FL Tarazi et colleagues from the Department of Psychiatry and Neuroscience Program, Harvard Medical School, published in Expert Reviews, 2015.

“The diagnosis of Asperger’s syndrome is complicated by the lack of a standardized diagnostic test. Asperger’s, and other ASD, are usually diagnosed as part of a two-stage process.

The first stage begins with developmental screening during physical checkups with a family doctor or physician. Interview of the child should include open-ended questions, awkward pauses, inquiring about special interests, relationship with friends and family, insight into other people’s intentions and beliefs and understanding of figurative language.

The interview should be conducted without the support of the parent. Direct observation, ideally starting in the clinic’s reception area, is essential to assess the child’s social interactions.

If any AD or ASD related symptoms are noted, the child is referred for comprehensive evaluation by a team of specialists that typically includes a psychologist, neurologist, psychiatrist, speech therapist, and additional professionals who have expertise in diagnosing children with AS and other ASD.”

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