What is Aspergers Syndrome?

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What is Asperger's Syndrome?

The answer to that question is more complicated than most people would like it to be. There is some controversy about exactly what constitutes Asperger's Syndrome (or Asperger's Disorder per the DSM-IV). When the criteria for AS were put into the DSM-IV the folks that do traditional Autism saw AS people as having no language problems. The problem with that is that the folks that work with AS people every day generally disagree and argue that there are commonly issues with pragmatics and social language evident. That is merely one area of contention in the field - and that doesn't even bring in what the people with AS themselves have to say on the topic. Here is another area to be careful of when looking at Asperger's - many claim that above average intelligence is a hallmark of AS. The problem is that there is no research supporting this claim. The requirement, at least in some diagnostic systems, is for intelligence in the average to above average range (which means not in the intellectually delayed or mentally retarded range). So, be careful of anyone that says things as if they have the only right answer when it comes to issues around Asperger's.

Inconsistencies in the way the term Asperger's has been used and the lack, until the 1990's, of recognized official definitions has made it difficult to interpret the research available on Asperger's. Even today, some professionals will use the term to refer to people with autism who have IQs in the normal range, or to adults with autism, or to PDD-NOS. All this despite recent official definitions that emphasize differences from autism, e.g. in terms of better communication (particularly verbal) skills.

Criteria

Attwood
DSM-IV
Gillberg 1991
ICD-10 1992
Szatmari 1989

Attwood "Discovery" Criteria

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 "Aspergerese", 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

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Diagnostic Criteria - from the American Psychiatric Association

A. Qualitative impairment in social interaction, as manifested by at least two of the following:

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;
Failure to develop peer relationships appropriate to developmental level;
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);
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:

Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus;
Apparently inflexible adherence to specific, non-functional routines or rituals;
Stereotyped and repetitive motor mannerisms (eg: hand or finger flapping or twisting, or complex whole-body movements);
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.

Gillberg (1991) Diagnostic Criteria

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

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

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

Exclusion of other activities.
Repetitive adherence.
More rote than meaning.

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

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

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

Limited use of gestures.
Clumsy/gauche body language.
Limited facial expression.
Inappropriate expression.
Peculiar, stiff gaze.

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

ICD 10 Diagnostic Criteria (World Health Organization 1992)

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:

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

An encompassing preoccupation with stereotyped and restricted patterns of interest;
Specific attachments to unusual objects;
Apparently compulsive adherence to specific, non-functional, routines or rituals;
Stereotyped and repetitive motor mannerisms that involve either hand/finger flapping or twisting, or complex whole body movement;
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);
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.

Szatmari's (1989) Diagnostic Criteria

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 responses 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.

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