SCREENING & DIAGNOSIS OF ASPERGER SYNDROME

]Asperger's 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 other children.

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.[24] Developmental screening during a routine check-up by a general practitioner or pediatrician may identify signs that warrant further investigation.[1][4] The diagnosis of Asperger syndrome is complicated by the use of several different screening instruments.[4][17] 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.[1]

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,[6] U.S. criteria also require significant impairment in day-to-day functioning.[12] Other sets of diagnostic criteria have been proposed by Szatmari et al.[40] and by Gillberg and Gillberg.[41]

Diagnosis is most commonly made between the ages of four and eleven.[1] A comprehensive assessment involves a multidisciplinary team[2][4][42] that observes across multiple settings,[1] 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.[4] Delayed or mistaken diagnosis can be traumatic for individuals and families; for example, misdiagnosis can lead to medications that worsen behavior.[42]

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).[1] Diagnosing adults is more challenging, as standard diagnostic criteria are designed for children and the expression of Asperger syndrome changes with age.[43] 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 disorder,[42] Tourette syndrome ,[16] stereotypic movement disorder and bipolar disorder.[24]

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.[44] 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;[45] the same child can receive different diagnoses depending on the screening tool.[4]

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 Intervention page.

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 level
(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 or rituals
(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 functioning.

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 Syndrome, Childhood 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 as well.

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 syndrome are:
• 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 or high-functioning 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 vice versa.

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.

References

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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). ISBN 0890420254.
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. PMID 2766209.
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. PMID 2670981.
42. Fitzgerald M, Corvin A (2001). "Diagnosis and differential diagnosis of Asperger syndrome". Adv Psychiatric Treat 7 (4): 310–8.
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.

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