How Clinicians Test for Aspergers


I am a young adult who was diagnosed with Aspergers Syndrome while in the Mental Ward at a local hospital. This diagnosis was made by a clinical Psychiatrist without any type of "testing". Just an interview about my past and present history. I read online about Asperger Symptoms and I totally agree with his diagnosis. I have hand flapping when excited, sensitivities to sounds, trouble making eye contact, difficulty understanding people's emotions, and I have an interest mainly just in music and weather and it's hard to make friends. I'm unable to get along with people well and can't hold down a job.

I told my primary Psychiatrist about the diagnosis and she kind of blows it off and says the hospital can't make a diagnosis of Aspergers without "testing" being done. What type of testing would need to be done? The Doctor at the hospital that diagnosed me said he has many patients who have Aspergers. I do not second guess his opinion. My Psychiatrist that I see regularly seems to second guess it and says it may hurt my disability case if I don't get a second diagnosis with actual "testing" done. She also claims that Psychiatrists cannot do testing because that's the job of a Psychologist. This doesn't make any sense to me.

It seems like a waste of money for me to have to go for more opinions and "testing". What types of testing is done besides IQ tests? I would think the main thing they do would be to ask questions about my childhood and present situation which already happened with my first interview and diagnosis. Do you think not getting "testing" done (plus, what type of tests?) and/or a second opinion would hurt my disability case? I have other issues besides Aspergers such as severe OCD and Panic Disorder as well, so the disability is something that was recommended to me at the hospital from being there multiple times and not holding down jobs.


Re: What type of testing would need to be done?

For the inexperienced clinician, identifying the six defining characteristics of Aspergers can be difficult. Misdiagnoses are quite common. This is further complicated by the fact that an Aspie has many of the same features found in other disorders. These features are often misinterpreted, overlooked, under-emphasized, or overemphasized. As a result, the individual may receive many different diagnoses over time from different diagnosticians.

In order to be diagnosed with Aspergers, an individual must show at least two of these symptoms:
  • Lack of appropriate social and emotional responses to others
  • Inability to spontaneously share enjoyment, interests and achievements with other people
  • Failure to make friends
  • Marked impairment regarding nonverbal social cues (e.g., doesn't make eye contact, doesn't understand others' body language, etc.)

In addition, the individual must show at least one of these behaviors:
  • Repetition of certain mannerisms (e.g., hand flapping, hair twisting, whole body movements, etc.)
  • An obsession in the parts or mechanics of objects
  • An abnormal and intense interest in one subject
  • Adherence to a strict set of rules, routines and rituals

There are several specific diagnostic tools to identify specific symptoms. The diagnostician may do the following:

1. Begin the exam with an IQ test. Since Aspies have normal or above normal IQs, that’s a good place to start.

2. Administer an assessment of adaptive skills, which tests the person’s ability to manage complex social situations.

3. If the parent is available, administer a parent interview called the Autism Diagnostic Interview Revised. Look at current functioning and early history to get a sense of the person’s skills in social, communication and behavior domains. Most adults with true Aspergers showed symptoms throughout their childhood. If a parent is not available, ask the individual to recall his childhood (e.g., “Did you have a lot of friends?” … “What did you enjoy doing?” … “Were you picked on at school a lot by your schoolmates?” …etc.). 

4. In addition, administer the ADOS Module IV. ADOS is the Autism Diagnostic Observation Schedule, and module four is for high-functioning, verbal adults. This tool allows the diagnostician to (a) look at social and communication skills and behavior, and (b) attach a grade in each domain to determine whether the person meets the criteria for Aspergers.

Another assessment tool is called the Adult Aspergers Assessment (AAA). Properties of the AAA include (1) being electronic, data-based, and computer-scorable, (2) linking with two screening instruments (the Autism Spectrum Quotient and the Empathy Quotient), and (3) employing a more stringent set of diagnostic criteria in order to avoid false positives.

Some of the Aspergers traits that are revealed during testing are included at the bottom of this article.

Often times, an individual comes into a clinic expecting an Aspergers diagnosis, but leaves with a different diagnosis. Distinguishing between social phobias/shyness and actual impairment with Aspergers can be difficult for the inexperienced clinician. Other disorders (e.g., obsessive compulsive disorder, social anxiety) can look like Aspergers.

Re: Do you think not getting "testing" done and/or a second opinion would hurt my disability case?

Not likely. Official diagnosis is necessary if one wants to apply for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). A diagnosis is needed to request “reasonable accommodations” under the ADA.

In addition to those with an MD or PhD, any professional with the credentials and expertise to diagnose any other condition may also make a diagnosis of Aspergers. Such professionals may be social workers (MSW), master’s level psychologists (MA), or other mental health professionals.

Many individuals pursue neuropsychological testing with a neuropsychologist (PhD) or a psychiatrist (MD). As a result of this testing, it may be determined that the individual has Aspergers, something related to Aspergers, or something different. This will give a fairly full picture of strengths and challenges and of how one’s brain processes information.

Neuropsychological testing is not required to get an “official diagnosis”. To apply for Social Security, one must receive the diagnosis from an MD or a PhD.

* Aspergers traits typically revealed during testing:

1. apparently inflexible adherence to specific, nonfunctional routines or rituals
2. as a child, did not enjoy playing games which involved pretending with other children
3. cannot see the point of superficial social contact, niceties, or passing time with others, unless there is a clear discussion point/debate or activity
4. can't always see why someone should have felt offended by a remark
5. can't appreciate another's viewpoint if disagrees with it
6. can't easily tell if someone is interested or bored with what they are saying
7. can't keep track of conversations in social group
8. can't pick up if someone says one thing but means another
9. can't sense when intruding
10. can't tell if someone else wants to enter a conversation
11. can't work out what other person might want to talk about
12. collects information about categories of things (e.g., types of cars)
13. consciously works out the rules of social situations
14. difficulties in understanding social situations and other people's thoughts and feelings
15. difficulty with detecting whether someone is masking their true emotion
16. difficulty with tuning in to how others feel
17. does not enjoy social chit-chat
18. does not enjoy social situations
19. does not get emotionally involved with friends' problems
20. does not spot when someone in a group is feeling awkward or uncomfortable
21. doesn't know if listener is getting bored
22. doesn't particularly enjoy reading fiction
23. doesn't think it's their problem if they offend someone
24. either lack of interest in fiction (written, or drama) appropriate to developmental level or interest in fiction is restricted to its possible basis in fact (e.g., science fiction, history, technical aspects of film)
25. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
26. failure to develop peer relationships appropriate to developmental level
27. fascinated by dates
28. fascinated by numbers
29. finds friendships and relationships difficult so tends not to bother with them
30. finds it difficult as an adult to play games with children that involve pretending
31. finds it difficult to imagine what it would be like to be someone else
32. finds it difficult to put self in someone else's shoes
33. finds it difficult to read between the lines when talking with others
34. finds it difficult to work out characters' intentions when reading a story
35. finds it difficult to work out people's intentions
36. finds it difficult to work out what someone is thinking/feeling from facial expression
37. finds it hard to know what to do in social situations
38. finds it hard to make new friends
39. finds it hard to see why some things upset people so much
40. finds making up stories difficult
41. finds self drawn more strongly to things than people
42. finds social situations confusing
43. finds social situations difficult
44. focuses more on own thoughts rather than listener's
45. frequent tendency to say things without considering the emotional impact on the listener
46. frequently finds doesn't know how to keep a conversation going
47. friends don't talk to them about problems as not considered understanding
48. gets so strongly absorbed in one thing that loses sight of other things
49. gets upset if daily routine is disturbed
50. has been told to stop talking about a particular obsessive topic because the listener is getting annoyed
51. if sees stranger in a group, thinks it's up to them to join in
52. impairments in imagination
53. inability to recognize when the listener is interested or bored
54. inability to tell, write or generate spontaneous, unscripted or un-plagiarized fiction
55. is brutally honest to the point of offending others
56. is not concerned if late when meeting a friend
57. is not good at social chit-chat
58. is not upset by seeing people cry
59. is very blunt without being intentionally rude
60. lack of showing, bringing or pointing out objects of interest
61. lack of social or emotional reciprocity (e.g., not knowing how to comfort someone and/or lack of empathy)
62. lack of spontaneous seeking to share enjoyment, interests or achievements with other people
63. lack of varied, spontaneous make believe play appropriate to developmental level
64. makes decisions without being influenced by people's feelings
65. marked impairment in the ability to initiate or sustain a conversation with others
66. 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
67. no interest in communicating his/her experience to others
68. no interest in pleasing others
69. not a good diplomat
70. not good at predicting how someone will feel
71. not good at predicting what someone else will do
72. notices patterns in things all the time
73. often described as insensitive, but can't see why
74. often finds it difficult to judge if something is rude or polite
75. often notices small sounds that others do not
76. often the last to understand the point of a joke
77. often told gone too far in driving point home in discussion
78. often told has been impolite even though they think they have been polite
79. often told keeps going on and on about the same thing in conversation
80. pedantic style of speaking, or inclusion of too much detail
81. persistent preoccupation with parts of objects/systems
82. physically awkward and uncoordinated
83. prefers to do things on own rather than with others
84. prefers to do things the same way over and over again
85. qualitative impairment in social interaction
86. qualitative impairments in verbal or non-verbal communication
87. restricted repetitive and stereotyped patterns of behavior, interests, and activities
88. sometimes told has gone too far with teasing
89. stays emotionally detached when watching movies
90. stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
91. tendency to think of issues as being black and white (e.g., in politics or morality), rather than considering multiple perspectives in a flexible way
92. tendency to turn any conversation back on to self or own topic of interest
93. tends to concentrate on talking about own experiences
94. tends to have very strong interests which gets upset about if can't pursue
95. tends to notice details that others do not
96. usually concentrates on the small details rather than the whole picture
97. usually notices car number plates or similar strings of information
98. usually notices small changes in a situation or a person's appearance
99. when talking on the phone, is not sure when it is their turn to speak
100. would rather go to a museum than the theater  

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MissMeowsic said...

Many of the characteristics listed pigeonhole those with A.S. and are more relevant to males. Females with A.S. especially older are very sensitive to other's emotions, and have learned how to make small talk and step out of their comfort zone socially, even if it leaves them feel drained afterwards. We are not all socially withdrawn and disengaged. Females learn how to adapt and mimic the neurotypical world easier than males. If professionals use these guidlines, no wonder women often go undiagnosed.

Mom said...

I agree with the last comment. My 10-year old Aspie daughter has loved fiction in the fantasy genre all her life, and loved pretending as a preschooler (although not so much now). She hates numbers and math and her special interests are in the fantasy story area, e.g., making videos with her Littlest Pet Shop toys, dragons, related book series, etc. She is very interested in making and having friends, yet social interactions tire her out, particularly in groups. She is socially slow to mature, sometimes literal, dogmatic and inflexible regarding routines, deeply obsessed with only a few things at any time, only eats a few foods, and used to be highly sensitive to noises. Because her school's ASD checklist is rooted in this male-centric view (in which obsessions are with train tables and fiction is foreign) she is not recognized as being on the spectrum.

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