Multiple Sets of Diagnostic Criteria
The diagnosis of AS is complicated by the use of several different screening instruments. In addition to the DSM-IV and the ICD-10 criteria, other sets of diagnostic criteria for AS are the Szatmari et al. criteria and the Gillberg and Gillberg criteria.
| Partial Diagnostic Criteria for Asperger Syndrome Adapted from Mattila et al. Blank = not defined by the criteria Substantial differences between criteria listed: all sub-sections of criteria not included |
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| DSM-IV | ICD-10 | Gillberg | Szatmari | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Language delay | No | No | Maybe | |||||||||
| Cognitive development delay | No | No | ||||||||||
| Self-help skill delay | No | No | ||||||||||
| Social interaction impairment | Yes | Yes | Yes | Yes | ||||||||
| – Impaired nonverbal communication | Maybe | Maybe | Yes | Yes | ||||||||
| – Inadequate friendships | Maybe | Maybe | Maybe | Yes | ||||||||
| Repetitive, stereotyped behavior | Yes | Yes | Yes | |||||||||
| – All-absorbing interest | Maybe | Maybe | Yes | |||||||||
| – Routines or rituals | Maybe | Maybe | Yes | |||||||||
| Odd speech | Yes | Yes | ||||||||||
| Motor clumsiness | Maybe | Yes | ||||||||||
| Isolated special skills | Common | |||||||||||
| Clinically significant impairmenta | Yes | |||||||||||
| Exclusion of other disorder | Yesb | Yesc | No | Yesd | ||||||||
| a Impairment in social, occupational, or other important areas of functioning b Does not meet criteria for another pervasive developmental disorder or schizophrenia c Not attributed to pervasive developmental disorder, schizotypal disorder, simple schizophrenia, reactive and disinhibited attachment disorder, obsessional personality disorder, obsessive compulsive disorder d Does not meet criteria for autistic disorder |
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Compared with the DSM-IV and ICD-10 criteria, the requirements of normal early language and cognitive development are not mentioned by Szatmari et al., whereas language delay is allowed in the Gillberg and Gillberg criteria. Szatmari et al. emphasize solitariness, and both Gillberg and Szatmari include "odd speech" and "language" in their criteria. Although Szatmari does not mention stereotyped behaviors, one of four described stereotyped functions is required by DSM-IV and ICD-10, and two are required by Gillberg and Gillberg. Abnormal responses to sensory stimuli are not mentioned in any diagnostic scheme, although they have been associated with AS. Because DSM-IV and ICD-10 exclude speech and language difficulties, these definitions exclude some of the original cases described by Hans Asperger. According to one researcher, the majority of individuals with AS do have speech and language abnormalities, and the recent DSM–IV says that "the occurrence of 'no clinically significant delays in language does not imply that individuals with Asperger Disorder have no problems with communication' (American Psychiatric Association, 2000, p. 80)". The Gillberg and Gillberg criteria are considered closest to Asperger's original description of the syndrome; the aggression and abnormal prosody that other authors say defined Asperger's patients are not mentioned in any criteria.
The DSM-IV and ICD-10 diagnostic criteria have been criticized for being too broad and inadequate for assessing adults, overly narrow (particularly in relation to Hans Asperger's original description of individuals with AS), and vague; results of a large study in 2007 comparing the four sets of criteria point to a "huge need to reconsider the diagnostic criteria of AS". The study found complete overlap across all sets of diagnostic criteria in the impairment of social interaction with the exception of four cases not diagnosed by the Szatmari et al. criteria because of its emphasis on social solitariness. Lack of overlap was strongest in the language delay and odd speech requirements of the Gillberg and the Szatmari requirements relative to DSM-IV and ICD-10, and in the differing requirements regarding general delays. A small 2008 study of children referred with a tentative diagnosis of AS found poor agreement among the four sets of criteria, with one overlap being only 39%. In 2007 Szatmari et al. suggested a new classification system of ASD based on familial traits found by genetic epidemiology.
Read more about this topic: Diagnosis Of Asperger Syndrome
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