How Aspergers is Diagnosed?

Question

How can professionals tell if someone has Aspergers …and is it possible to have something in addition to Aspergers?

Answer

Aspergers (high functioning autism) is usually diagnosed when all other disorders have been ruled out. Individuals who have, or suspect they have, Aspergers may have been previously diagnosed with:

• Attention Deficit Disorder

• Autistic Disorder, High Functioning

• Developmental Coordination Disorder

• Nonverbal Learning Disorder

• Pervasive Developmental Disorder, Not Otherwise Specified

• Right Hemisphere Learning Disorder

• Schizoid Personality Disorder

• Semantic Pragmatic Language Disorder

• Traumatic Brain Injury (if one has a medical history that includes a past head injury)

There are several disorders that are frequently co-morbid with Aspergers (i.e., occurs along with Aspergers). These include:

• Attention Deficit Hyperactive Disorder

• Depressive Disorder

• Dysthymia Disorder

• Obsessive Compulsive Disorder

• Seizure Disorder/Epilepsy

• Sensory Integration Dysfunction

• Tourette’s Syndrome

The diagnosis of Aspergers is usually the result of a comprehensive psychiatric evaluation by a Child and Adolescent Psychiatrist. In most cases, the evaluation will involve the following components:

• communication and psychiatric assessments
• history
• parental conferences
• psychological assessment
• recommendations
• further consultation if needed

Aspergers involves delays and deviant patterns of behavior in multiple areas of functioning that often require the input of therapists with different areas of expertise, especially overall developmental functioning, neuropsychological features, and behavioral status. Thus, the clinical assessment of people with Aspergers should be conducted by an experienced interdisciplinary team.

It is very important that parents participate in the psychiatric evaluation. Evaluation findings should be translated into a single coherent view of the child. Recommendations should be easily understood, detailed, concrete, and realistic. When writing reports, therapists should express the implications of their findings to the client’s day-to-day adaptation, learning, and vocational training.

As Aspergers (high functioning autism) becomes a more well-known diagnostic label, it is possible that it is becoming a trendy concept used in a needless manner by therapists who intend to convey only that their patient is currently experiencing difficulties in social interaction and in peer relationships. The label “Aspergers” is meant as a serious and debilitating developmental disorder impairing the individual’s capacity for socialization – not a temporary or mild condition. Thus, moms and dads should be briefed about the current knowledge-base of Aspergers and the common confusions around this disorder that currently exist in the mental health field. Clinicians should clarify any misconceptions and establish a consensus about the client’s abilities and disabilities, which should not be simply assumed under the use of the diagnostic label.

Specific areas of evaluation include the following:

1. A careful history should be obtained, including information related to pregnancy and neonatal period, early development and characteristics of development, and medical and family history.

2. A review of previous records including previous evaluations should be performed and the information incorporated and results compared in order to obtain a sense of course of development.

3. Several other specific areas should be directly examined (e.g., a careful history of onset/recognition of the problems, development of motor skills, language patterns, and areas of special interest).

4. Particular emphasis should be placed on social development, including past and present problems in social interaction, patterns of attachment of family members, development of friendships, self-concept, emotional development, and mood presentation.

5. Other specific areas should be examined and measured including:

• academic achievement (i.e., performance in school-like subjects)
• adaptive functioning (i.e., degree of self-sufficiency in real-life situations)
• neuropsychological functioning (i.e., motor and psychomotor skills, memory, executive functions, problem-solving, concept formation, visual-perceptual skills)
• personality assessment (i.e., common preoccupations, compensatory strategies of adaptation, mood presentation)

6. A fairly comprehensive neuropsychological assessment should be conducted, including:

• concept formation (both verbal and nonverbal)
• executive functions
• facial recognition
• gestalt perception
• measures of motor skills (i.e., coordination of the large muscles as well as manipulative skills and visual-motor coordination, visual-perceptual skills)
• parts-whole relationships
• spatial orientation
• visual memory

7. Particular attention should be given to demonstrated or potential compensatory strategies (e.g., individuals with significant visual-spatial deficits may translate the task or mediate their responses by means of verbal strategies or verbal guidance). Such strategies may be important for educational programming.

8. A communication assessment to obtain both quantitative and qualitative information regarding the various aspects of the client’s communication skills should be performed. The assessment should examine:

• content, coherence, and contingency of conversation
• non-literal language (e.g., metaphor, irony, absurdities, and humor)
• nonverbal forms of communication (e.g., gaze, gestures)
• pragmatics (e.g., turn-taking, sensitivity to cues provided by the interlocutor, adherence to typical rules of conversation)
• prosody of speech (melody, volume, stress and pitch)

This assessment should go beyond the testing of speech and formal language (e.g., articulation, vocabulary, sentence construction and comprehension), which are often areas of strength.

9. Lastly, the psychiatric evaluation should include observations of the client during more and less structured periods (e.g., while interacting with parents and while engaged in assessment by members of the assessment team). Specific areas for observation and inquiry should include:

• ability to infer other’s intentions and beliefs
• ability to intuit other’s feelings
• ability to understand ambiguous non-literal communications (e.g., teasing and sarcasm)
• anxiety
• capacities for self-awareness
• coherence of thought
• depression
• development of peer relationships and friendships
• level of insight into social and behavioral problems
• panic attacks
• perspective-taking
• problem behaviors that are likely to interfere with treatment should be noted (e.g., aggression).
• quality of attachment to family members
• social and affective presentation
• the client’s patterns of special interest and leisure time
• the presence of obsessions or compulsions
• typical reactions in novel situations

It is possible for some individuals to have some Asperger tendencies, but not have full-blown Aspergers per say. A diagnosis of Aspergers simply reflects the severity of the differences between those with the diagnosis and those without. Current research suggests that there are 10-15 genes related to Aspergers. The severity of differences may relate to how many genes are affected and/or other inherited traits, environmental exposures, and life experiences.

The inability to clearly define the difference between Autism and Aspergers is why researchers consider both to be part of an “Autism Spectrum” (Aspergers representing the higher-functioning of the spectrum). Those with Aspergers have normal to above normal intelligence and fewer limitations in their use of speech and ability to communicate than those diagnosed with Autism. Significant delays in the development of speech and communication, beyond the age of 2 years, are considered characteristic of Autism.

People that do develop speech but continue to have difficulties in communication and/or performing daily living activities are often classified as having “high functioning autism.” This is a description that many grown-ups on the Autism Spectrum dislike because it suggests that people with more severe difficulties in communicating and performing daily living activities are “low functioning.” The false assumption is that Autistics are mentally retarded, and as a result, they are not given the mental and academic stimulation they need to achieve their full potential. Yet many “low functioning” Autistic people are very intelligent once the environmental and/or biochemical stresses interfering with their ability to communicate or perform daily living activities are lessened.

Because of high verbal skills, the expectations are often just the opposite for Aspies. The assumption is that Aspies are intelligent enough to do more than they demonstrate and are just not trying hard enough. But the truth is that they are “passing” for close to “normal” only because they are trying so hard, and in most cases, can’t function better than they do. Therefore, it is important for the Aspie to develop some “self-advocacy skills” to clearly communicate to others just what he/she can and cannot do.

The Aspergers Comprehensive Handbook