How Aspergers is Diagnosed?

Question

How can professionals tell if someone has Aspergers …and is it possible to have something in addition to Aspergers?

Answer

Aspergers (high functioning autism) is usually diagnosed when all other disorders have been ruled out. Individuals who have, or suspect they have, Aspergers may have been previously diagnosed with:

• Attention Deficit Disorder

• Autistic Disorder, High Functioning

• Developmental Coordination Disorder

• Nonverbal Learning Disorder

• Pervasive Developmental Disorder, Not Otherwise Specified

• Right Hemisphere Learning Disorder

• Schizoid Personality Disorder

• Semantic Pragmatic Language Disorder

• Traumatic Brain Injury (if one has a medical history that includes a past head injury)

There are several disorders that are frequently co-morbid with Aspergers (i.e., occurs along with Aspergers). These include:

• Attention Deficit Hyperactive Disorder

• Depressive Disorder

• Dysthymia Disorder

• Obsessive Compulsive Disorder

• Seizure Disorder/Epilepsy

• Sensory Integration Dysfunction

• Tourette’s Syndrome

The diagnosis of Aspergers is usually the result of a comprehensive psychiatric evaluation by a Child and Adolescent Psychiatrist. In most cases, the evaluation will involve the following components:

• communication and psychiatric assessments
• history
• parental conferences
• psychological assessment
• recommendations
• further consultation if needed

Aspergers involves delays and deviant patterns of behavior in multiple areas of functioning that often require the input of therapists with different areas of expertise, especially overall developmental functioning, neuropsychological features, and behavioral status. Thus, the clinical assessment of people with Aspergers should be conducted by an experienced interdisciplinary team.

It is very important that parents participate in the psychiatric evaluation. Evaluation findings should be translated into a single coherent view of the child. Recommendations should be easily understood, detailed, concrete, and realistic. When writing reports, therapists should express the implications of their findings to the client’s day-to-day adaptation, learning, and vocational training.

As Aspergers (high functioning autism) becomes a more well-known diagnostic label, it is possible that it is becoming a trendy concept used in a needless manner by therapists who intend to convey only that their patient is currently experiencing difficulties in social interaction and in peer relationships. The label “Aspergers” is meant as a serious and debilitating developmental disorder impairing the individual’s capacity for socialization – not a temporary or mild condition. Thus, moms and dads should be briefed about the current knowledge-base of Aspergers and the common confusions around this disorder that currently exist in the mental health field. Clinicians should clarify any misconceptions and establish a consensus about the client’s abilities and disabilities, which should not be simply assumed under the use of the diagnostic label.

Specific areas of evaluation include the following:

1. A careful history should be obtained, including information related to pregnancy and neonatal period, early development and characteristics of development, and medical and family history.

2. A review of previous records including previous evaluations should be performed and the information incorporated and results compared in order to obtain a sense of course of development.

3. Several other specific areas should be directly examined (e.g., a careful history of onset/recognition of the problems, development of motor skills, language patterns, and areas of special interest).

4. Particular emphasis should be placed on social development, including past and present problems in social interaction, patterns of attachment of family members, development of friendships, self-concept, emotional development, and mood presentation.

5. Other specific areas should be examined and measured including:

• academic achievement (i.e., performance in school-like subjects)
• adaptive functioning (i.e., degree of self-sufficiency in real-life situations)
• neuropsychological functioning (i.e., motor and psychomotor skills, memory, executive functions, problem-solving, concept formation, visual-perceptual skills)
• personality assessment (i.e., common preoccupations, compensatory strategies of adaptation, mood presentation)

6. A fairly comprehensive neuropsychological assessment should be conducted, including:

• concept formation (both verbal and nonverbal)
• executive functions
• facial recognition
• gestalt perception
• measures of motor skills (i.e., coordination of the large muscles as well as manipulative skills and visual-motor coordination, visual-perceptual skills)
• parts-whole relationships
• spatial orientation
• visual memory

7. Particular attention should be given to demonstrated or potential compensatory strategies (e.g., individuals with significant visual-spatial deficits may translate the task or mediate their responses by means of verbal strategies or verbal guidance). Such strategies may be important for educational programming.

8. A communication assessment to obtain both quantitative and qualitative information regarding the various aspects of the client’s communication skills should be performed. The assessment should examine:

• content, coherence, and contingency of conversation
• non-literal language (e.g., metaphor, irony, absurdities, and humor)
• nonverbal forms of communication (e.g., gaze, gestures)
• pragmatics (e.g., turn-taking, sensitivity to cues provided by the interlocutor, adherence to typical rules of conversation)
• prosody of speech (melody, volume, stress and pitch)

This assessment should go beyond the testing of speech and formal language (e.g., articulation, vocabulary, sentence construction and comprehension), which are often areas of strength.

9. Lastly, the psychiatric evaluation should include observations of the client during more and less structured periods (e.g., while interacting with parents and while engaged in assessment by members of the assessment team). Specific areas for observation and inquiry should include:

• ability to infer other’s intentions and beliefs
• ability to intuit other’s feelings
• ability to understand ambiguous non-literal communications (e.g., teasing and sarcasm)
• anxiety
• capacities for self-awareness
• coherence of thought
• depression
• development of peer relationships and friendships
• level of insight into social and behavioral problems
• panic attacks
• perspective-taking
• problem behaviors that are likely to interfere with treatment should be noted (e.g., aggression).
• quality of attachment to family members
• social and affective presentation
• the client’s patterns of special interest and leisure time
• the presence of obsessions or compulsions
• typical reactions in novel situations

It is possible for some individuals to have some Asperger tendencies, but not have full-blown Aspergers per say. A diagnosis of Aspergers simply reflects the severity of the differences between those with the diagnosis and those without. Current research suggests that there are 10-15 genes related to Aspergers. The severity of differences may relate to how many genes are affected and/or other inherited traits, environmental exposures, and life experiences.

The inability to clearly define the difference between Autism and Aspergers is why researchers consider both to be part of an “Autism Spectrum” (Aspergers representing the higher-functioning of the spectrum). Those with Aspergers have normal to above normal intelligence and fewer limitations in their use of speech and ability to communicate than those diagnosed with Autism. Significant delays in the development of speech and communication, beyond the age of 2 years, are considered characteristic of Autism.

People that do develop speech but continue to have difficulties in communication and/or performing daily living activities are often classified as having “high functioning autism.” This is a description that many grown-ups on the Autism Spectrum dislike because it suggests that people with more severe difficulties in communicating and performing daily living activities are “low functioning.” The false assumption is that Autistics are mentally retarded, and as a result, they are not given the mental and academic stimulation they need to achieve their full potential. Yet many “low functioning” Autistic people are very intelligent once the environmental and/or biochemical stresses interfering with their ability to communicate or perform daily living activities are lessened.

Because of high verbal skills, the expectations are often just the opposite for Aspies. The assumption is that Aspies are intelligent enough to do more than they demonstrate and are just not trying hard enough. But the truth is that they are “passing” for close to “normal” only because they are trying so hard, and in most cases, can’t function better than they do. Therefore, it is important for the Aspie to develop some “self-advocacy skills” to clearly communicate to others just what he/she can and cannot do.

The Aspergers Comprehensive Handbook

30 "Key" Aspergers Traits

Question

I think my child has Aspergers. I know this disorder has a strong genetic factor, and my husband has been diagnosed with it. Now my son is starting to have some of the same Aspergers-like traits. Is there a test or set of criteria that will help me know if I need to have my son tested for Aspergers?

Answer

Aspergers (high functioning autism) is a neurobiological collection of behavioral differences (called a syndrome). It is classified in the DSM alongside Autistic Disorder. There is no known cause (although genetic and environmental factors are involved). It continues throughout the lifespan, but it is not a “mental illness” per say.

Here are the diagnostic criteria for Aspergers...

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

1. 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
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 (e.g. 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 behavior, 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, nonfunctional routines or rituals
3. stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
4. persistent preoccupation with parts or objects

C. The disturbance causes clinically significant impairment in social, occupation, or other important areas of functioning

D. There is no clinically significant general delay in language (e.g. single words used by age 2 years, communicative phrases used by age 2 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

These definitions were developed to determine the degree to which a youngster is “disabled” and therefore eligible to receive services; however, they may not be of much help to parents who suspect that they have an Aspergers child.

Aspergers represents a mild to significant difference in how “Aspies” process sensory input, communicate, and generally perceive social experiences from those with “neurologically typical” nervous systems. Like “neurotypicals,” Aspies have their own strengths and limitations. Unfortunately, the fact that they are “different” often makes them appear more limited and their strengths harder to perceive.

Most Aspies have one very strong learning style and may pick up very little information from other senses or teaching styles. Some may be very strong visual thinkers, very strong auditory thinkers, very strong mathematical thinkers, or very strong in their language skills.

One study found that some 70% of Aspies also met the criteria for nonverbal learning disorder. The vast majority of them have what “neurotypicals” consider weak social skills, primarily because they don’t pick up the unspoken social cues the way that “normal” people do. This difference can contribute to failures in relationships and employment, and may also lead to a high co-morbidity of depressive disorder.

Most people with Aspergers have some degree of sensory-processing dysfunction (i.e., various senses like sight, hearing, smell, touch, taste, proprioception, and vestibular may be over-or-under sensitive to stimuli in comparison to those without Aspergers). Synaesthesia (i.e., mixing of sensory information like smelling sounds) may also be present.

What some view as “limitations” can also be viewed as strengths.

Below is a fairly comprehensive list of Aspergers traits. If most of these seem to fit your son, then it might be helpful to get a comprehensive psychiatric evaluation from a Child and Adolescent Psychiatrist who specializes in Aspergers:

1. a determination to seek the truth

2. ability to pursue personal theory or perspective despite conflicting evidence

3. ability to regard others at “face value”

4. acute sensitivity to specific sensory experiences and stimuli (e.g., hearing touch, vision and/or smell)

5. advanced use of pictorial metaphor

6. advanced vocabulary and interest in words

7. avid perseverance in gathering and cataloging information on a topic of interest

8. clarity of values/decision making unaltered by political or financial factors

9. conversation free of hidden meaning or agenda

10. encyclopedic or “CD-ROM” knowledge of one or more topics

11. exceptional memory and/or recall of details often forgotten or disregarded by others (e.g., names, dates schedules, routines)

12. fascination with word-based humor (e.g., puns)

13. free of sexist, “age-ist”, or cultural-ist biases

14. frequent victim of social weaknesses of others

15. increased probability over general population of attending university after high school

16. interested primarily in significant contributions to conversation

17. knowledge of routines and a focused desire to maintain order and accuracy

18. listening without continual judgment or assumption

19. often takes care of others outside the range of typical development

20. original/unique perspective in problem solving

21. peer relationships characterized by genuine loyalty and dependability

22. persistence of thought

23. prefers to avoid “small talk” or socially trivial statements and superficial conversation

24. 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

25. seeking sincere, positive, genuine friends with an unassuming sense of humor

26. “social unsung hero” with trusting optimism

27. speaking one’s mind irrespective of social context or adherence to personal beliefs

28. steadfast in the belief of the possibility of genuine friendship

29. strength in individual sports or games, particularly those involving endurance or visual accuracy (e.g., rowing, swimming, bowling, chess)

30. strong preference for detail versus the “big picture”

The Aspergers Comprehensive Handbook

Aspies in the Workplace: 25 Tips for Employers

Aspergers awareness has made employers more sensitive to the needs of "Aspies." More employers know how to approach an interview with an Aspie as well as how to create a workplace environment for them. As awareness increases, more employers recognize the value of Aspergers employees, and some even offer special job training to help these employees adjust to the workplace.

The social and communication problems inherent in people with Aspergers (high functioning autism) create challenges in job-hunting and in sustaining long-term employment. Common social and communication problems that can affect a job include:

• Sensory processing issues (e.g., responds in an unusual manner to certain sights, sounds, smells or tastes)
• Repetitive and obsessive behavior (e.g., rocking back and forth, skin picking or hand flapping)
• Problems understanding the emotions of others, and as a result, may react inappropriately
• Needs a structured routine and may get extremely upset by routine changes
• May not work well with others
• Inability to understand verbal instructions
• Difficulty maintaining a two-way conversation

Some of these symptoms may create misunderstandings with co-workers and make it difficult for Aspergers employees to fit into the workplace environment. Here are 25 tips for employers who are considering hiring – or have already hired – an individual with Aspergers:

1. Adjust your evaluation process. During the interview, be aware that the positive “body language” and “non-verbal cues” you might expect to see may not be forthcoming from someone with Aspergers.

2. Allowances should be made for the Aspie’s idiosyncrasies (e.g., giving “progress updates” may not be seen as particularly important by the Aspie, so managers may need to ask for them as a matter of course).

3. Aspies can handle jobs that deal with facts or logic (e.g., computer science, software design, engineering, research, and math). So if there is a particular job task that deals with some of these areas directly or indirectly, it might be a good fit for the Aspie.

4. Be very precise in the job description. A prospective applicant with Aspergers is likely to take words and phrases literally.

5. Many Aspies have a desire to help people – but they also lack social skills. Thus, a task where the Aspie can assist others “indirectly” (i.e., not face-to-face) may be a good fit (e.g., delivering supplies).

6. Because of their interest in fairness and justice, job tasks that require honesty and trustworthiness are good (e.g., depositing money, writing company checks).

7. Don't force Aspergers employees into social gatherings or events without full consent.

8. Don't force employees with Aspergers to take part in unnecessary team-working processes that add nothing to how well something gets done.

9. Draw on shared experience. Take advice from support groups and listen to all parties during recruitment and beyond, including care-givers and the employee him/herself.

10. Ensure that the Aspergers employee has an advocate. A line-manager is probably not the best person because his/her management role may conflict with a supporting and caring role.

11. For multi-step plans, give your Aspergers employee a clear written list of steps to follow …or, if he has trouble seeing how all the steps relate to each other, then treat each one as a separate task.

12. Individuals with Aspergers don't always do well with open-ended questions. So instead of saying, “What job task would you like to do today?” …say "We have these three tasks that need to be done (then specify what they are), which would you like to do?"

13. It can take time for an Aspergers employee to settle into the workplace, so whether it's a job in a high-powered professional environment or at a more administrative or vocational level, initial reactions from co-workers and managers will greatly influence whether or not it works out. Thus, one role of the mentor can be to explain the Aspie’s shyness and/or hesitancy in social contact to others.

14. It is beneficial for the person with Aspergers to have someone to go to for advice and answers if he/she thinks something at work does not seem right.

15. Know that hypothetical scenarios, much used by interviewers as a way to test a candidate's problem-solving skills, are unlikely to draw the best from an Aspie, because most are not very good at projecting themselves into imaginary situations.

16. Know that most Aspergers employees tend to work better alone. Thus, if there is a job assignment that does not require a group effort per say, it might be best suited for the Aspie. Consider tasks where the Aspie can work individually, rather than on a team.

17. Make reasonable adjustments. If the Aspie is over-sensitive to bright office lights, background chatter, or prefers to work at home – do what you can.

18. Make regular performance checks. Even if things are going well, review the Aspie’s progress regularly. This is crucial if the Aspergers employee's behavior changes. If so, find out why the behavior change is occurring, and consider what can be done to help.

19. Most Aspergers employees are less likely to get bored with repetition since they tend to find comfort in routines, so they can be better able to handle repetitive jobs that require attention to detail.

20. People with Aspergers are more likely to be bullied or taken advantage of in the workplace. For example, some assume that whatever the supervisor tells them is true, so they do not question it, which makes it very easy for a supervisor to abuse them. Thus, it may be beneficial for the Aspie to know the basics of employment law, so that if a supervisor tells him something different, he knows better.

21. Telephone order taking or survey taking can work for some Aspies because they have scripts and do not require face-to-face interaction. If something like this is available – consider it.

22. The Aspergers employee should be assigned a mentor, and there should be training for staff who will be working with the Aspie. If managed well, the highly developed analytical skills exhibited by people with Aspergers can give companies a valuable competitive edge.

23. Think about the recruitment policy. Standard job ads and selection processes are unlikely to encourage someone with Aspergers to apply for posts they may be qualified for. For example, look at the emphasis placed on communication skills. Does the role really need those skills?

24. Understand that some Aspies are very set in their own ways of doing things, and as a result, they may question everything the supervisor says.

25. Perhaps most importantly, remember that each individual with Aspergers is different, so there aren't any “one-size-fits-all” tips. Every person with Aspergers is an individual, and some will manage well in the workplace with small interventions. Companies need a better awareness of the condition, because there's a lot they can do quite easily that will help.

The Aspergers Comprehensive Handbook

Aspies Get a Bad Rap!

In working with Aspergers (high functioning autism) children and teens – as well as their parents – I can say categorically that it’s not uncommon for individuals with Aspergers to get a “bad rap.” It’s not fair – it’s not right – but it’s reality. Aspies are generally seen as a little strange (or extremely strange). As a result, they often get ostracized, ridiculed, and bullied.

Many Aspies are disrespected in elementary and middle school, ostracized in high school, rejected in the workplace, and rendered as the “odd Aspie out.” Why? Because different equals bad …different equals dorky …different equals derision …and different equals social rejection.

Aspergers is often called the “Geek Syndrome” because Aspies act so different from the social norm and have excessive knowledge and obsession with different things. For example, they may obsess about things like Robin Hood, the Peanuts gang, maps, trains, baseball cards, and Civil War history. This is not seen as normal to many people, and these obsessions help contribute to the ostracism and rejection.

Here are a few more reasons why Aspies do not get the acceptance they deserve:

1. Most Aspergers children and teens are smart, they study hard, and they respect authority – but this isn’t cool. What’s cool is using school-time as an opportunity to socialize, disrespecting authority, and getting into trouble.

2. Most Aspies are gentle and somewhat passive. NOT COOL! However, it is cool to be tough or "hard" and to fight.

3. Most Aspies are talented – but being a clarinet player in the school band is viewed as dorky. To be in sports is cool though (even though you don’t use your brain much).

4. Most Aspies have a child-like innocence (a bad trait to have if you don’t want to get your head knocked off). This is not cool. To be cool, you act older than your age and go around playing tricks on, and making jokes about, other people.

5. Most Aspies can make amazingly loyal friends – but how goofy is that?! The cool thing to do is to have a bunch of peers to hang-out with and to take advantage of as many of them as possible.

You want some more examples of ‘GEEK’ behavior? O.K. Here they are...

Most Aspies:

• adhere unvaryingly to routines
• are able forgive others
• are accepting of others
• are honest
• are not bullies, con artists, or social manipulators
• are not inclined to steal
• are perfectly capable of entertaining themselves
• don’t discriminate against anyone based on race, gender, age, etc.
• don’t launch unprovoked attacks, verbal or otherwise
• don’t play head games
• don’t take advantage of other’s weaknesses
• enjoy their own company and can spend time alone
• have exceptional memories
• have no interest in harming others
• notice fine details that others miss
• prefer talking about significant things that will enhance their knowledge-base rather than “shooting the bullshit”
• will not go along with the crowd if they know that something is wrong

Too often, the Aspie is told, “Something is wrong with you.” And sooner than later, he/she unconsciously absorbs this negative statement and begins to believe it. It has been well documented that those with Aspergers are vulnerable people who will face certain difficulties. These are often highlighted by individuals who see only the negatives rather than the positives such differences could represent. This lack of positive awareness, combined with an inconsistency of knowledge, can lead to inaccurate stereotyping and resultant interventions that are far more harmful than helpful.

We hear so many negative things about children and teens with Aspergers – and so much about what can NOT be helped. Maybe we need to take another look and see what kind of positive traits are found. I believe there are a lot of traits in the Aspergers personality that the non-Aspergers person can afford to implement into his/her own life.

Like everyone on the face of the earth, we are people, with a mix of strengths and weaknesses. Aspies are different – but they are not defective. The world needs all different kinds of minds – including the Aspergers minds. The way Aspies think should be regarded as a positive attribute, which the rest of society can learn from. When their differences are embraced, the positives definitely outweigh the negatives.

What's your opinion?  If you have one, feel free to express it.  Click on the comment button below.

The Aspergers Comprehensive Handbook