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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

30 "Key" Aspergers Traits

Question

I think my child has Aspergers. I know this disorder has a strong genetic factor, and my husband has been diagnosed with it. Now my son is starting to have some of the same Aspergers-like traits. Is there a test or set of criteria that will help me know if I need to have my son tested for Aspergers?


Answer

Aspergers (high functioning autism) is a neurobiological collection of behavioral differences (called a syndrome). It is classified in the DSM alongside Autistic Disorder. There is no known cause (although genetic and environmental factors are involved). It continues throughout the lifespan, but it is not a “mental illness” per say.

Here are the diagnostic criteria for Aspergers...

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 or objects
C. The disturbance causes clinically significant impairment in social, occupation, 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 2 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

These definitions were developed to determine the degree to which a youngster is “disabled” and therefore eligible to receive services; however, they may not be of much help to parents who suspect that they have an Aspergers child.

Aspergers represents a mild to significant difference in how “Aspies” process sensory input, communicate, and generally perceive social experiences from those with “neurologically typical” nervous systems. Like “neurotypicals,” Aspies have their own strengths and limitations. Unfortunately, the fact that they are “different” often makes them appear more limited and their strengths harder to perceive.

Most Aspies have one very strong learning style and may pick up very little information from other senses or teaching styles. Some may be very strong visual thinkers, very strong auditory thinkers, very strong mathematical thinkers, or very strong in their language skills.

One study found that some 70% of Aspies also met the criteria for nonverbal learning disorder. The vast majority of them have what “neurotypicals” consider weak social skills, primarily because they don’t pick up the unspoken social cues the way that “normal” people do. This difference can contribute to failures in relationships and employment, and may also lead to a high co-morbidity of depressive disorder.

Most people with Aspergers have some degree of sensory-processing dysfunction (i.e., various senses like sight, hearing, smell, touch, taste, proprioception, and vestibular may be over-or-under sensitive to stimuli in comparison to those without Aspergers). Synaesthesia (i.e., mixing of sensory information like smelling sounds) may also be present.

What some view as “limitations” can also be viewed as strengths.

Below is a fairly comprehensive list of Aspergers traits. If most of these seem to fit your son, then it might be helpful to get a comprehensive psychiatric evaluation from a Child and Adolescent Psychiatrist who specializes in Aspergers:

1. a determination to seek the truth
2. ability to pursue personal theory or perspective despite conflicting evidence
3. ability to regard others at “face value”
4. acute sensitivity to specific sensory experiences and stimuli (e.g., hearing touch, vision and/or smell)
5. advanced use of pictorial metaphor
6. advanced vocabulary and interest in words
7. avid perseverance in gathering and cataloging information on a topic of interest
8. clarity of values/decision making unaltered by political or financial factors
9. conversation free of hidden meaning or agenda
10. encyclopedic or “CD-ROM” knowledge of one or more topics
11. exceptional memory and/or recall of details often forgotten or disregarded by others (e.g., names, dates schedules, routines)
12. fascination with word-based humor (e.g., puns)
13. free of sexist, “age-ist”, or cultural-ist biases
14. frequent victim of social weaknesses of others
15. increased probability over general population of attending university after high school
16. interested primarily in significant contributions to conversation
17. knowledge of routines and a focused desire to maintain order and accuracy
18. listening without continual judgment or assumption
19. often takes care of others outside the range of typical development
20. original/unique perspective in problem solving
21. peer relationships characterized by genuine loyalty and dependability
22. persistence of thought
23. prefers to avoid “small talk” or socially trivial statements and superficial conversation
24. seeking an audience or friends capable of enthusiasm for unique interests and topics, consideration of details, spending time discussing a topic that may not be of primary interest
25. seeking sincere, positive, genuine friends with an unassuming sense of humor
26. “social unsung hero” with trusting optimism
27. speaking one’s mind irrespective of social context or adherence to personal beliefs
28. steadfast in the belief of the possibility of genuine friendship
29. strength in individual sports or games, particularly those involving endurance or visual accuracy (e.g., rowing, swimming, bowling, chess)
30. strong preference for detail versus the “big picture”

The Aspergers Comprehensive Handbook

Understanding Theory of Mind Deficits in Autistic Children: Misbehavior or Misunderstanding?

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