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Diagnostic Overview

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Asperger Syndrome and HFA are terms applied to the high functioning end of what is known as the spectrum of pervasive developmental disorders, or the autism spectrum. Asperger Syndrome is a relatively new category, as it was officially recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM) for the first time in 1994. In the future, it is possible that the DSM may combine AS and HFA into one category, as they are very similar and the treatment approaches for each are the same. Since AS/HFA shows a range or spectrum of symptom severity, many individuals who might meet criteria for that diagnosis are viewed as "unusual" or “awkward," or are misdiagnosed with other conditions such as Attention Deficit Disorder.

DSM-IV Criteria for a Diagnosis of Asperger Syndrome

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

1. marked impairments 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 of objects

C. The disturbance causes clinically significant impairment in social, occupational, 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 3 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 social interaction), and curiosity about the environment in childhood

F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia (DSM IV, p. 77)

Diagnosing Asperger Syndrome/HFA

Presently, there is no medical test for Asperger Syndrome/HFA. A diagnosis is based on observed behavior and educational and psychological testing. As the symptoms of AS/HFA vary, so do the routes to obtaining a diagnosis. You may have raised questions with your pediatrician yourself. Some children are identified as having developmental delays before obtaining a diagnosis of autism or AS and may already receive some Early Intervention or Special Education services. Unfortunately, parents’ concerns are sometimes not taken seriously by their doctor and an accurate diagnosis is delayed. Autism Speaks and other autism-related organizations are working hard to educate parents and physicians so that children with autism spectrum disorders are identified as early as possible.

Many issues can commonly arise when trying to diagnose a child with Asperger Syndrome/HFA. These difficulties can occur since children with AS/HFA are usually able to function very well in many aspects of their lives, and exhibit only a few peculiar or different behaviors. You may have noticed that your child has advanced skills in certain areas and may be very smart. These observations can make it more challenging to get an early diagnosis for your child and as a result, may delay the process of getting the help and assistance you need. As you continue to take steps toward helping your child receive the proper diagnosis, it is important to explore different options and reach out for support.

Your role as the parent is crucial in helping to diagnose your child with Asperger Syndrome/HFA, since you are the one observing your child’s growth and development on a daily basis. If certain behaviors develop, such as preoccupations, unusual habits, favorite activities, it may be a good time to visit your child’s pediatrician. If your child’s pediatrician is concerned, you will be referred to a specialist who will evaluate your child.

The specialist will usually take a very detailed history of your child, including his or her development, language skills and various aspects of their social behavior. When a doctor is trying to assess your child and investigate the possibility that your child may be on the autism spectrum, he or she will take the time to ask about social issues and development. It is important for the doctor to know if there have been problems in school, issues with making friends, or struggles with general social interactions. This evaluation will show areas where your child may struggle, but also areas where your child exhibits numerous strengths.

This experience comes with many challenges that we must surmount in order to lovingly support our children and to assimilate their acute sensory sensitivities into a world that is oftentimes overwhelmingly intolerant of diversity. But it also comes with a myriad of gifts if you can be open to seeing this perspective. Your child requires you in their life; and indeed, dozens of parents have told me they are better people than they would’ve been had they not been blessed to raise this child. Rest assured, given the proper respect, appreciation, and opportunity, your child will change the world in ways that are right and true and good and kind.

- William Stillman, Empowered Autism Parenting