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asperger's syndrome information and features

         

Definition Overlap Procedure Tests Reasons Reactions Spectrum Disclosure

Introduction

National Autistic Society definition

ICD 10 World Health Organisation Diagnostic Criteria

DSM IV Diagnostic Criteria
Szatmari Diagnostic Criteria
Gillberg Diagnostic Criteria
T. Attwood & C. Gray Discovery Criteria
Summary of the diagnostic criteria
Introduction

If you are reading this page you probably want to know exactly what Asperger's Syndrome is. One quick glance at the complicated lists of diagnostic criteria below and you may feel more confused than anything.

The way I think of it is that the diagnostic criteria are the skeleton of Asperger's Syndrome... they give it strength, form, and structure. In order to put some meat on those bones you need to read about real people's lives and experiences, and only then does it all start to come together and make sense.

Though there are many different versions of the diagnostic criteria, they all describe the same things, but with just slightly different wording. So why bother with them all? One of the reasons is that diagnosing a condition like Asperger's Syndrome isn't an exact science, but in order to get people to take it seriously you need something universal and consistent to refer to. That way a diagnosis of Asperger's Syndrome in Japan will mean the same thing as a Diagnosis of Asperger's Syndrome in France and so on. Even at this present moment in time though this isn't really the case. Even just a few miles apart, in the next state or county, town or city, specialists can vary in what they consider to be adequate evidence for a diagnosis. Some barely even acknowledge there is such a thing as high functioning autism while others are far more generous. As long as this remains a problem people will keep generating subtly different versions of the diagnostic criteria in the hope that theirs will be the one that will catch on.

Definition of Asperger's Syndrome from the National Autistic Society in the UK

Social Communication

People with AS may be very good at basic communication and letting people know what they think and feel. Their difficulties lie in the social aspects of communication. For example:

They may have difficulty understanding gestures, body language, and facial expressions.
They may not be aware of what is socially appropriate and may have difficulty choosing topics to talk about.
They may not be socially motivated because they find communication difficult, so they may not have many friends and they may choose not to socialise very much.

Some of these problems can be seen in the way people with AS present themselves. For example, classic traits include:

Difficulty making eye contact.
Repetitive speech.
Difficulties expressing themselves, especially when talking about emotions.
Anxiety in social situations, and resultant nervous tics.

Social Understanding

Typical examples of difficulties with social understanding include:

Difficulties in group situations, such as going to the pub with a group of friends.
Finding small talk and chatting very difficult.
Problems understanding double meanings, for example, not knowing when people are teasing you.
Not choosing appropriate topics to talk about.
Taking what people say very literally.

You might want to back this up with specific examples of the kind of social situations you find difficult.

Imagination

This can be a slightly confusing term. People often assume it means that people with AS are not imaginative in the conventional use if the word, for example, they lack creative abilities. This is not the case, and many people with AS are extremely able writers, artists and musicians. Instead, lack of imagination in AS can include difficulty imagining alternative outcomes and finding it hard to predict what will happen next. This frequently lead to anxiety. This can present as:

An obsession with rigid routines and distress if routines are disrupted.
Problems with making plans for the future and having difficulties organising your life.
Problems with sequencing tasks, so that preparing to go out can be difficult because you can't always remember what to take with you.

Some people with AS over compensate for this by being extremely meticulous in their planning, and having extensive written or mental checklists.

Secondary Traits of Asperger's Syndrome

Besides the triad of impairments, people with AS tend to have difficulties which relate to the triad but are not included within it. These can include:

Obsessive compulsive behaviours. Often these are severe enough to be diagnosed as Obsessive Compulsive Disorder or OCD.
These can also be linked to obsessive interest in just one topic, for example they might have one subject about which they are extremely knowledgeable which they want to talk about with everyone they meet.
Phobias. Sometimes people with AS are described as having a social phobia, but they may also be affected by other common fears such as claustrophobia and agoraphobia.
Acute anxiety, which can lead to panic attacks and a rigid following of routines.
Depression and social isolation. This is especially common among adults.
Clumsiness, often linked dot a condition known as dyspraxia. This includes difficulties with fine motor coordination, such as difficulties writing neatly, as well as problems with gross motor coordination, such as ungainly movements, tripping and falling a lot, and sometimes appearing drunk as a result.

Not having these associated problems does not mean you do not have AS, but if you have any of them you might want to describe it in order to back up your case.

ICD 10 (World Health Organisation 1992) Diagnostic Criteria

A. A lack of any clinically significant delay in language or cognitive development.

Diagnosis requires that single words should have developed by two years of age or earlier and that communicative phrases be used by three years of age or earlier. Self-help skills, adaptive behaviour and curiosity about the environment during the first three years should be at a level consistent with normal intellectual development. However, motor milestones may be somewhat delayed and motor clumsiness is usual (although not a necessary diagnostic feature). Isolated special skills, often related to abnormal preoccupations, are common, but are not required for diagnosis.

B. Qualitative impairments in reciprocal social interaction (criteria as for autism).

Diagnosis requires demonstrable abnormalities in at least 3 out of the following 5 areas:

  1. Failure adequately to use eye-to-eye gaze, facial expression, body posture and gesture to regulate social interaction;

  2. Failure to develop (in a manner appropriate to mental age, and despite ample opportunities) peer relationships that involve a mutual sharing of interests, activities and emotions;

  3. Rarely seeking and using other people for comfort and affection at times of stress or distress and/or offering comfort and affection to others when they are showing distress or unhappiness;

  4. Lack of shared enjoyment in terms of vicarious pleasure in other people's happiness and/or a spontaneous seeking to share their own enjoyment through joint involvement with others;

  5. A lack of socio-emotional reciprocity as shown by an impaired or deviant response to other people's emotions; and/or lack of modulation of behaviour according to social context, and/or a weak integration of social, emotional and communicative behaviours.

C. Restricted, repetitive and stereotyped patterns of behaviour, interests and activities. (Criteria as for autism; however it would be less usual for these to include either motor mannerisms or preoccupations with part-objects or non-functional elements of play materials).

Diagnosis requires demonstrable abnormalities in at least 2 out of the following 6 areas:

  1. An encompassing preoccupation with stereotyped and restricted patterns of interest;

  2. Specific attachments to unusual objects;

  3. Apparently compulsive adherence to specific, non-functional, routines or rituals;

  4. Stereotyped and repetitive motor mannerisms that involve either hand/finger flapping or twisting, or complex whole body movement;

  5. Preoccupations with part-objects or non-functional elements of play materials (such as their odour, the feel of their surface/ or the noise/vibration that they generate);

  6. Distress over changes in small, non-functional, details of the environment.

D. The disorder is not attributable to the other varieties of pervasive developmental disorder; schizotypal disorder; simple schizophrenia; reactive and disinhibited attachment disorder of childhood; obsessional personality disorder; obsessive compulsive disorder.

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Diagnostic 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 behaviours 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 (eg: 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 behaviour, 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, non-functional routines or rituals;
  3. Stereotyped and repetitive motor mannerisms (eg: 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 (eg: 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 behaviour (other than social interaction), and curiosity about the environment in childhood.
 
F. Criteria are not met for another specific Pervasive Developmental Disorder, or Schizophrenia.

You can read the full DSM-IV entry for pervasive developmental disorders, which includes Autism and Asperger's Syndrome, by following this link.

Diagnostic Criteria For Asperger's's Disorder (Szatmari, Et Al. 1989)

A. Solitary, as manifested by at least two of the following four:

    1. No close friends.

    2. Avoids others.

    3. No interest in making friends.

    4. A loner.

B. Impaired social interaction, as manifested by at least one of the

   following five:

    1. Approaches others only to have own needs met.

    2. A clumsy social approach.

    3. One-sided Reactions to peers.

    4. Difficulty sensing feelings of others.

    5. Detached from feelings of others.

C. Impaired non-verbal communication, as manifested by at least one

   of the following seven:

    1. Limited facial expression.

    2. Unable to read emotion from facial expressions of child.

    3. Unable to give messages with eyes.

    4. Does not look at others. 

    5. Does not use hands to express oneself.

    6. Gestures are large and clumsy.

    7. Comes too close to others.

D. Odd speech, as manifested by at least two of the following six:

    1. abnormalities in inflection.

    2. talks too much.

    3. talks too little.

    4. lack of cohesion to conversation.

    5. idiosyncratic use of words.

    6. repetitive patterns of speech.

E. Does not meet criteria for Autistic Disorder.

Gillberg (1991) Diagnostic Criteria

A. Severe impairment in reciprocal social interaction as manifested by at least two of the following four:

  1. Inability to interact with peers.
  2. Lack of desire to interact with peers.
  3. Lack of appreciation of social cues.
  4. Socially and emotionally inappropriate behaviour.

B. All-absorbing narrow interest, as manifested by at least one of the following three:

  1. Exclusion of other activities.
  2. Repetitive adherence.
  3. More rote than meaning.

C. Speech and language problems, as manifested by at least three of the following five:

  1. Delayed development of language.
  2. Superficially perfect expressive language.
  3. Formal, pedantic language.
  4. Odd prosody, peculiar voice characteristics.
  5. Impairment of comprehension, including misinterpretations of literal/implied meanings.

D. Non-verbal communication problems, as manifested by at least one of the following five:

  1. Limited use of gestures.
  2. Clumsy/gauche body language.
  3. Limited facial expression.
  4. Inappropriate expression.
  5. Peculiar, stiff gaze.

E. Motor clumsiness, as documented by poor performance on neurodevelopmental examination.

Discovery Criteria by T. Attwood and C. Gray

A qualitative advantage in social interaction, as manifested by a majority of the following:

  • Peer relationships characterized by absolute loyalty and impeccable dependability
  • Free of sexist, "age-ist", or culturalist biases; ability to regard others at "face value"
  • Speaking one’s mind irrespective of social context or adherence to personal beliefs
  • Ability to pursue personal theory or perspective despite conflicting evidence
  • 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
  • Listening without continual judgment or assumption
  • Interested primarily in significant contributions to conversation; preferring to avoid "ritualistic small talk" or socially trivial statements and superficial conversation.
  • Seeking sincere, positive, genuine friends with an unassuming sense of humour.

Fluent in "Asperger'sese", a social language characterized by at least three of the following:

  • A determination to seek the truth
  • Conversation free of hidden meaning or agenda
  • Advanced vocabulary and interest in words
  • Fascination with word-based humour, such as puns
  • Advanced use of pictorial metaphor

Cognitive skills characterized by at least four of the following:

  • Strong preference for detail over gestalt
  • Original, often unique perspective in problem solving
  • Exceptional memory and/or recall of details often forgotten or disregarded by others, for example: names, dates, schedules, routines
  • Avid perseverance in gathering and cataloguing information on a topic of interest
  • Persistence of thought
  • Encyclopaedic or "CD ROM" knowledge of one or more topics
  • Knowledge of routines and a focused desire to maintain order and accuracy
  • Clarity of values/decision making unaltered by political or financial factors

Additional possible features:

  • Acute sensitivity to specific sensory experiences and stimuli, for example: hearing, touch, vision, and/or smell
  • Strength in individual sports and games, particularly those involving endurance or visual accuracy, including rowing, swimming, bowling, chess
  • "Social unsung hero" with trusting optimism: frequent victim of social weaknesses of others, while steadfast in the belief of the possibility of genuine friendship
  • Increased probability over general population of attending university after high school
  • Often take care of others outside the range of typical development

Summary of the Diagnostic Criteria

In very brief summary I would describe Asperger's syndrome as:

  • At least average intelligence.
  • Normal language development.
  • Different style of communication and interaction, with social problems likely as a result.
  • Different style of thinking, with learning difficulties and/or unusual gifts likely as a result.
  • Different style of perceptions, with non-typical behaviours and reactions likely as a result.

I think the big dilemma with diagnostic criteria is that they only exist in the first place because they are designed to identify the existence of a problem, so they are bound to be quite negative and focusing on the bad rather than the good. After all, doctors don't have time to diagnose people with being OK... they are there to help people who need it. People with Asperger's syndrome usually need help, because it can be very disabling and traumatic being different, but the experience is different for everybody...

  • Some people need help just to cope with life at all.
  • Some people struggle because they lack the support and understanding that others take for granted.
  • Some people are lucky enough to have the support and understanding they need and cope about as well as anybody.

There are three ways of looking at that... either some people are more mildly 'Asperger's' than others OR having Asperger's syndrome itself is not a problem, but the consequences of it sometimes can be and often are, (possibly depending on your personality and circumstances), OR it could be a combination of both. I'll leave you with that to think about anyway because I don't know what I think yet.

Further reading available from Amazon.com  or Amazon.co.uk

Definition Overlap Procedure Tests Reasons Reactions Spectrum Disclosure
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