Asperger Syndrome

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Annotated Information

Classification and Resources

ID 124
ICD-10 ICD10CM:F84.5;
ICD-9-CM
OMIM OMIM:300494;OMIM:300497;OMIM:608631;OMIM:608638;OMIM:608781;OMIM:609954;
SNOMED-CT
Orphanet
MeSH MSH:D020817;
DO

Defination

Asperger syndrome (AS), also known as Asperger's syndrome, Asperger disorder (AD) or simply Asperger's, is an autism spectrum disorder (ASD) that is characterized by significant difficulties in social interaction and nonverbal communication, alongside restricted and repetitive patterns of behavior and interests It differs from other autism spectrum disorders by its relative preservation of linguistic and cognitive development Although not required for diagnosis, physical clumsiness and atypical (peculiar or odd) use of language are frequently reported The diagnosis of Asperger's was eliminated in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-) and replaced by a diagnosis of autism spectrum disorder on a severity scale~The syndrome is named after the Austrian pediatrician Hans Asperger who, in , studied and described children in his practice who lacked nonverbal communication skills, demonstrated limited empathy with their peers, and were physically clumsy The modern conception of Asperger syndrome came into existence in and went through a period of popularization, becoming standardized as a diagnosis in the early s Many questions and controversies remain about aspects of the disorder There is doubt about whether it is distinct from high-functioning autism (HFA); partly because of this, its prevalence is not firmly established~The cause of Asperger's is unknown Although research suggests the likelihood of a genetic basis, there is no known genetic cause, and brain imaging techniques have not identified a clear common pathology There is no single treatment, and the effectiveness of particular interventions is supported by only limited data Intervention is aimed at improving symptoms and function The mainstay of management is behavioral therapy, focusing on specific deficits to address poor communication skills, obsessive or repetitive routines, and physical clumsiness Most children improve as they mature to adulthood, but social and communication difficulties may persist Some researchers and people with Asperger's have advocated a shift in attitudes toward the view that it is a difference, rather than a disease that must be treated or cured Globally Asperger's is estimated to affect million people as of ~

Synonyms

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Etiology

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Diagnosis

Standard diagnostic criteria require impairment in social interaction and repetitive and stereotyped patterns of behavior, activities and interests, without significant delay in language or cognitive development Unlike the international standard, the DSM-IV-TR criteria also required significant impairment in day-to-day functioning; DSM- eliminated AS as a separate diagnosis in , and folded it into the umbrella of autism spectrum disorders Other sets of diagnostic criteria have been proposed by Szatmari et al and by Gillberg and Gillberg~Diagnosis is most commonly made between the ages of four and eleven A comprehensive assessment involves a multidisciplinary team that observes across multiple settings, and includes neurological and genetic assessment as well as tests for cognition, psychomotor function, verbal and nonverbal strengths and weaknesses, style of learning, and skills for independent living The "gold standard" in diagnosing ASDs combines clinical judgment with the Autism Diagnostic Interview-Revised (ADI-R)—a semistructured parent interview—and the Autism Diagnostic Observation Schedule (ADOS)—a conversation and play-based interview with the child Delayed or mistaken diagnosis can be traumatic for individuals and families; for example, misdiagnosis can lead to medications that worsen behavior Many children with AS are initially misdiagnosed with attention deficit hyperactivity disorder (ADHD) Diagnosing adults is more challenging, as standard diagnostic criteria are designed for children and the expression of AS changes with age; adult diagnosis requires painstaking clinical examination and thorough medical history gained from both the individual and other people who know the person, focusing on childhood behavior Conditions that must be considered in a differential diagnosis include other ASDs, the schizophrenia spectrum, ADHD, obsessive–compulsive disorder, major depressive disorder, semantic pragmatic disorder, nonverbal learning disorder, Tourette syndrome, stereotypic movement disorder, bipolar disorder, and social-cognitive deficits due to brain damage from alcohol abuse~Underdiagnosis and overdiagnosis are problems in marginal cases The cost and difficulty of screening and assessment can delay diagnosis Conversely, the increasing popularity of drug treatment options and the expansion of benefits has motivated providers to overdiagnose ASD There are indications AS has been diagnosed more frequently in recent years, partly as a residual diagnosis for children of normal intelligence who are not autistic but have social difficulties~There are questions about the external validity of the AS diagnosis That is, it is unclear whether there is a practical benefit in distinguishing AS from HFA and from PDD-NOS; the same child can receive different diagnoses depending on the screening tool The debate about distinguishing AS from HFA is partly due to a tautological dilemma where disorders are defined based on severity of impairment, so that studies that appear to confirm differences based on severity are to be expected~

Symptoms

Standard diagnostic criteria require impairment in social interaction and repetitive and stereotyped patterns of behavior, activities and interests, without significant delay in language or cognitive development Unlike the international standard, the DSM-IV-TR criteria also required significant impairment in day-to-day functioning; DSM- eliminated AS as a separate diagnosis in , and folded it into the umbrella of autism spectrum disorders Other sets of diagnostic criteria have been proposed by Szatmari et al and by Gillberg and Gillberg~Diagnosis is most commonly made between the ages of four and eleven A comprehensive assessment involves a multidisciplinary team that observes across multiple settings, and includes neurological and genetic assessment as well as tests for cognition, psychomotor function, verbal and nonverbal strengths and weaknesses, style of learning, and skills for independent living The "gold standard" in diagnosing ASDs combines clinical judgment with the Autism Diagnostic Interview-Revised (ADI-R)—a semistructured parent interview—and the Autism Diagnostic Observation Schedule (ADOS)—a conversation and play-based interview with the child Delayed or mistaken diagnosis can be traumatic for individuals and families; for example, misdiagnosis can lead to medications that worsen behavior Many children with AS are initially misdiagnosed with attention deficit hyperactivity disorder (ADHD) Diagnosing adults is more challenging, as standard diagnostic criteria are designed for children and the expression of AS changes with age; adult diagnosis requires painstaking clinical examination and thorough medical history gained from both the individual and other people who know the person, focusing on childhood behavior Conditions that must be considered in a differential diagnosis include other ASDs, the schizophrenia spectrum, ADHD, obsessive–compulsive disorder, major depressive disorder, semantic pragmatic disorder, nonverbal learning disorder, Tourette syndrome, stereotypic movement disorder, bipolar disorder, and social-cognitive deficits due to brain damage from alcohol abuse~Underdiagnosis and overdiagnosis are problems in marginal cases The cost and difficulty of screening and assessment can delay diagnosis Conversely, the increasing popularity of drug treatment options and the expansion of benefits has motivated providers to overdiagnose ASD There are indications AS has been diagnosed more frequently in recent years, partly as a residual diagnosis for children of normal intelligence who are not autistic but have social difficulties~There are questions about the external validity of the AS diagnosis That is, it is unclear whether there is a practical benefit in distinguishing AS from HFA and from PDD-NOS; the same child can receive different diagnoses depending on the screening tool The debate about distinguishing AS from HFA is partly due to a tautological dilemma where disorders are defined based on severity of impairment, so that studies that appear to confirm differences based on severity are to be expected~

Treatment

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References

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