Listed below are the three main categories of impairments in Aspergers. Under each category are several possible characteristics. Indicate with a Yes or No whether each characteristic listed is indicative of Aspergers.
1. Impairment in Social Interaction:
a. Odd facial expressions
b. Difficulty judging social distance
c. Overly friendly
d. Inappropriate responses to approaches of others
2. Impairment in Communication:
a. Inappropriate questions/comments
b. May be non-verbal
c. Good at thinking abstractly
d. Delay in development of language
3. Restricted and/or Repetitive Patterns of Behavior, Interests and Activities:
a. Inflexibility regarding routines
b. Severe self-abuse
c. Stereotyped motor mannerisms
d. Little to interest them
Aspergers or Not?
Below are three vignettes, each describing an individual with certain difficulties. Indicate whether you believe the paragraph describes an individual with Aspergers.
Charlie was a boy in his mid-teens. He attended a school for students with special needs. He was verbal, but at times difficult to understand, partly because of his articulation and partly because his sentences were often constructed incorrectly. He rarely initiated conversations, unless to talk about his interest in movies. He was not particularly interested in his peers, although it did not seem to matter to him that he had no real friends. He was fairly accomplished in math, but was reading at a 3rd grade level at age 14. His full-scale I.Q. was 68.
Robert, a man in his mid-twenties, complained he felt uncomfortable around people. He had decided he had Aspergers. He worked as an accountant and was competent at his job. He did not feel particularly depressed, although complained of feeling anxious when forced to interact with others.
Mark, an eleven year old in the public school system, frequently got into serious trouble with his teachers. He was clearly bright, but often refused to do his work, saying he did not have to if he did not want to. He was a computer whiz, able to fix problems with the computer even his teacher could not solve. In fact, his interest in computers seemed to overshadow nearly all aspects of his life. He tended to interact poorly with other kids, misreading their social cues, and becoming very angry if they tried to interfere with his use of the computer.
Answer Key—
1. Impairment in Social Interaction:
a. Yes
b. Yes
c. No
d. Yes
2. Impairment in Communication:
a. Yes
b. No
c. No
d. No. However, this is somewhat of a trick question. The DSM IV indicates there can be no delay in the development of language to qualify for an Aspergers diagnosis. On the other hand, Attwood indicates a significant percentage of Aspergers kids do have delayed language, although they are speaking fluently by age 5.
3. Restricted and/or Repetitive Patterns of Behavior, Interests and Activities:
a. Yes. Inflexibility can occur in Aspergers, but is not required for the diagnosis. Restricted patterns of behavior, interests and activities, however, are quite common.
b. No. There can sometimes be self-injurious behavior, but severe self-abuse is much more likely to be indicative of autism.
c. Yes. Stereotyped motor mannerisms can occur in Aspergers, although serious problems in this area occur more often in autism.
d. No
Aspergers or Not?
The extent of Charlie’s language difficulties and his cognitive difficulties rule out the diagnosis of Aspergers. A more appropriate diagnosis would be autism, albeit fairly high-functioning.
This case is more complicated. Although Robert may qualify for an Aspergers diagnosis, there is not enough information in the vignette to substantiate this. His feelings of discomfort around people might suggest Aspergers, but they might just as well be indicative of another disorder, such as schizoid personality. Additional information about such issues as his use of language and any problems with perspective taking would help in formulating the diagnosis.
Mark has Aspergers. His refusal to do school work stems from his difficulty recognizing the social rules, i.e., kids are in school to work, as well as his inability to recognize the importance of restraint in his remarks. Computers and computer games are his area of special interest.