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What Are the Diagnostic Criteria for Asperger Syndrome?

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Updated March 13, 2009

Question: What Are the Diagnostic Criteria for Asperger Syndrome?
What are the diagnostic criteria for Asperger syndrome? How do the criteria for Asperger syndrome differ from the criteria for other autism disorders?
Answer: The Diagnostic and Statistical Manual, Fourth Edition (DSM-IV), most recently published in 2000, is the official diagnostic manual for mental disorders. It contains specific diagnostic criteria for Asperger disorder (also called Asperger syndrome), along with information about associated issues.

For the first time, it includes some mention of anxiety and sensory disorders associated with Asperger syndrome, though those disorders are not required for diagnosis.

The DSM-IV does describe distinct differences between Asperger syndrome and other autism spectrum disorders, stating that:

    "The essential features of Asperger's Disorder are severe and sustained impairment in social interaction... and the development of restricted, repetitive patterns of behavior, interests, and activities .... The disturbance must cause clinically significant impairment in social, occupational, or other important areas of functioning. In contrast to Autistic Disorder, there are no clinically significant delays or deviances in language acquisition (e.g., single non-echoed words are used communicatively by age 2 years, and spontaneous communicative phrases are used by age 3 years)...although more subtle aspects of social communication (e.g., typical give and take in conversation) may be affected.

While these sound like significant differences in diagnosis, the truth is that, in the words of Asperger syndrome expert Dr. Tony Attwood, "the difference between high-functioning autism and Asperger syndrome is mostly in the spelling."

This is particularly the case as children grow up and differences in language ability at the age of three become irrelevant. By the time people with Asperger syndrome or high-functioning autism are teens, those distinctions have essentially disappeared, making it very difficult to distinguish between the two diagnoses.

The following criterion are from the DSM-IV. Asperger's disorder is one of five specific "Pervasive Developmental Disorders" listed:

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

  • 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
  • failure to develop peer relationships appropriate to developmental level
  • 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)
  • 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:

  • encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity of focus
  • apparently inflexible adherence to specific, nonfunctional routines or rituals
  • stereotyped and repetitive motor mannerisms (e.g., 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 e.g., single words used by age two years, communicative phrases used by age three 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.

Sources:

American Psychiatric Association. (2000). Diagnostic criteria for Asperger’s disorder. In Diagnostic and statistical manual of mental disorders (Fourth edition---text revision (DSM-IV-TR). Washington, DC: American Psychiatric Association, 84.

Interview with Dr. Tony Attwood, May, 2007.

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