Question:
Should the criterion established for diagnosing Asperger’s Disorder (Syndrome) be assessed for clarification?
Discussion:
The DSM- IV-TR uses the same diagnostic code of 299.80 for both Asperger’s Disorder (AD) and for Pervasive Developmental Disorder (NOS) even though they are considered as separate disorders. This already depicts an overlap between the two diagnoses that could create subjective confusion in diagnostic accuracy. The criterion also closely resembles the 299.0 diagnosis of Autistic Disorder, each with very similar characteristics defining criterion. The confusion can potentially affect the diagnosis and subsequent treatment for individuals with these characteristic symptoms, their families and clinicians. All are clinical disorders identified on Axis1 in the DSM-IV-TR. (American Psychiatric Association, 2000).
In a study done by Thomas Carlson, Christi McGeorge and Sarah Halverson (2007), the ability of Marriage and Family Therapists’ to diagnose AD was explored. The clinicians were given a vignette, including specific AD criteria symptoms ,and asked to make a diagnosis.
Four topics of relevance were presented as a background to the study. The first outlined a brief history of AD. Most notable was the similar and simultaneous findings of both Hans Asperger (AD founder) and Leo Kanner (Infantile Autism founder). Many people do not recognize a difference between the high functioning Autism criteria and the AD criteria (Volkmar, Klin, Schultz, Rubin, & Bronen).
There are those who point to a specific difference between the two diagnoses. The language development framework is differential in that the AD criterion specifies that no language process delay be present, while it is present for an Autistic diagnosis. The dissenting opinion is that of an encompassing Autism diagnosis including AD characteristics on its high functioning spectrum (Eisenmajer, Prior, Leekam, Wing, Gould, Welham, & Ong, 1996). Another topic explored the notion that the disorder may not exist at all. That it is simply a societal rejection of behaviors, which are contrary to social norms (Baron-Cohen, 2002).
A person commonly diagnosed with AD has difficulty with three factors. They experience difficulty with external stimulus; they exhibit unusual patterns of object organization and focus, and very specifically have communication breakdowns with other persons. Diagnosis of AD most often does not occur before age 11 or later even though parents report characteristic concerns at about age 3 (Portway & Johnson, 2002). One can only imagine the number of problems that might arise for the patient and family of a misdiagnosed person. It is very often that a person with AD has been given a number of different diagnoses prior to the AD diagnosis. These might include, but are not limited to, Attention Deficit Hyperactivity Disorder, Bipolar Disorder, Obsessive-Compulsive Disorder, Conduct Disorder, Depression, or Schizophrenia. (Tsai, 2000). These diagnoses are more commonly known to clinicians, and due to the characteristic similarities with AD, might be prematurely chosen as a diagnosis.
The study found that 4 out of 5 Marriage and Family Therapists were not able to identify the AD diagnosis when given a vignette with the specific criteria for diagnosis included (Carlson et al., 2007). While the scope of this critique does not permit detailed outlining of the specific overlapping criteria found between these clinical diagnoses, the implications of the diagnostic failure in the study indicates a need for further clarification.
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, D.C.: Author.
Baron-Cohen,S. (2002). Is asperger syndrome necessarily viewed as a disability? Focus on Autism and other developmental disabilities, 17(3), 186-191.
Carlson, T.S., McGeorge, C.R., Halverson, S. (2007) Marriage and Family Therapists’ Ability to Diagnose Asperger’s Syndrome: A Vignette Study. Contemporary Family Therapy, 29 (2), 25-37.
Eisenmajer, R., Prior, M., Leekam, S., Wing, L., Gould, J., Welham, M., & Ong. B. (1996). Comparison of clinical symptoms in autism and asperger’s disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 35(11), 1523-1531.
Portway, S., & Johnson, B., (2002). Supporting families of a child with asperger syndrome. Community Practitioner, 75(9), 338-342.
Tsai, L. (2003). Diagnostic confusion in asperger disorder. Retrieved March 6, 2008 from http://www.med.umich.edu/psych/child/dd/sum2002nwsltr.ttm.
Volkmar, F.R., Klin, A., Schultz, R.T., Rubin, E., & Bronin, R. (2000). Asperger’s disorder. The American Journal of Psychiatry, 157, 262-267.
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