Diagnostic Criteria For Asperger's Syndrome


As a convenience to readers I'm providing in full the three most commonly used criteria for diagnosing Asperger Syndrome. I do not believe AS is a "Disorder" as such, though that has become the officially sanctioned term. It has invidious connotations which do more harm that good, so I prefer the kinder, gentler (and original) "Syndrome".

Be that as it may, here are the official texts for the three most widely used diagnostic criteria. Both DSM-IV and ICD-10 sections include related autistic conditions; they're important points of comparison to Asperger syndrome as such. Gillberg's criteria never have included other conditions and comparisons.

I've added a few notes at the end.


DSM-IV criteria:

299.00 Autistic Disorder

  1. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):
    1. 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)
    2. Qualitative impairments in communication, as manifested by at least one of the following:
      1. Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
      2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
      3. Stereotyped and repetitive use of language or idiosyncratic language
      4. Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
    3. 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
  2. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.
  3. The disturbance is not better accounted for by Rett’s disorder or childhood disintegrative disorder.

299.80 Pervasive Developmental Disorder, Not Otherwise Specified

This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific pervasive developmental disorder, schizophrenia, schizotypal personality disorder, or avoidant personality disorder. For example, this category includes "atypical autism" –presentations that do not meet the criteria for autistic disorder because of late age of onset, atypical symptomatology, or subthreshold symptomatology, or all of these.

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299.80 Asperger’s Disorder

  1. 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
  2. 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
  3. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
  4. 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).
  5. 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.
  6. Criteria are not met for another specific pervasive developmental disorder or schizophrenia.

299.80 Rett’s Disorder

  1. All of the following:
    1. Apparently normal prenatal and perinatal development
    2. Apparently normal psychomotor development through the first 5 months after birth
    3. Normal head circumference at birth
  2. Onset of all of the following after the period of normal development:
    1. Deceleration of head growth between ages 5 and 48 months
    2. Loss of previously acquired purposeful hand skills between ages 5 and 30 months with the subsequent development of stereotyped hand movements (i.e., hand-wringing or hand washing)
    3. Loss of social engagement early in the course (although often social interaction develops later)
    4. Appearance of poorly coordinated gait or trunk movements
    5. Severely impaired expressive and receptive language development with severe psychomotor retardation

299.10 Childhood Disintegrative Disorder

  1. Apparently normal development for at least the first 2 years after birth as manifested by the presence of age-appropriate verbal and nonverbal communication, social relationships, play, and adaptive behavior.
  2. Clinically significant loss of previously acquired skills (before age 10 years) in at least two of the following areas:
    1. Expressive or receptive language
    2. Social skills or adaptive behavior
    3. Bowel or bladder control
    4. Play
    5. Motor Skills
  3. Abnormalities of functioning in at least two of the following areas:
    1. Qualitative impairment in social interaction (e.g., impairment in nonverbal behaviors, failure to develop peer relationships, lack of social or emotional reciprocity)
    2. Qualitative impairments in communication (e.g., delay or lack of spoken language, inability to initiate or sustain a conversation, stereotyped and repetitive use of language, lack of varied make-believe play)
    3. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypies and mannerisms
  4. The disturbance is not better accounted for by another specific pervasive developmental disorder or by schizophrenia.

Source: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (Text Revision) 2000.

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ICD-10 criteria:

Chapter V
Mental and behavioural disorders
(F00-F99)

F84 Pervasive developmental disorders
A group of disorders characterized by qualitative abnormalities in reciprocal social interactions and in patterns of communication, and by a restricted, stereotyped, repetitive repertoire of interests and activities. These qualitative abnormalities are a pervasive feature of the individual's functioning in all situations.
Use additional code, if desired, to identify any associated medical condition and mental retardation.
F84.0 Childhood autism
A type of pervasive developmental disorder that is defined by: (a) the presence of abnormal or impaired development that is manifest before the age of three years, and (b) the characteristic type of abnormal functioning in all the three areas of psychopathology: reciprocal social interaction, communication, and restricted, stereotyped, repetitive behaviour. In addition to these specific diagnostic features, a range of other nonspecific problems are common, such as phobias, sleeping and eating disturbances, temper tantrums, and (self-directed) aggression.
Autistic disorder
Infantile:
· autism
· psychosis
Kanner's syndrome
Excludes: autistic psychopathy (F84.5)
F84.1 Atypical autism
A type of pervasive developmental disorder that differs from childhood autism either in age of onset or in failing to fulfil all three sets of diagnostic criteria. This subcategory should be used when there is abnormal and impaired development that is present only after age three years, and a lack of sufficient demonstrable abnormalities in one or two of the three areas of psychopathology required for the diagnosis of autism (namely, reciprocal social interactions, communication, and restricted, stereotyped, repetitive behaviour) in spite of characteristic abnormalities in the other area(s). Atypical autism arises most often in profoundly retarded individuals and in individuals with a severe specific developmental disorder of receptive language.
Atypical childhood psychosis
Mental retardation with autistic features
Use additional code (F70-F79), if desired, to identify mental retardation.
F84.2 Rett's syndrome
A condition, so far found only in girls, in which apparently normal early development is followed by partial or complete loss of speech and of skills in locomotion and use of hands, together with deceleration in head growth, usually with an onset between seven and 24 months of age. Loss of purposive hand movements, hand-wringing stereotypies, and hyperventilation are characteristic. Social and play development are arrested but social interest tends to be maintained. Trunk ataxia and apraxia start to develop by age four years and choreoathetoid movements frequently follow. Severe mental retardation almost invariably results.
F84.3 Other childhood disintegrative disorder
A type of pervasive developmental disorder that is defined by a period of entirely normal development before the onset of the disorder, followed by a definite loss of previously acquired skills in several areas of development over the course of a few months. Typically, this is accompanied by a general loss of interest in the environment, by stereotyped, repetitive motor mannerisms, and by autistic-like abnormalities in social interaction and communication. In some cases the disorder can be shown to be due to some associated encephalopathy but the diagnosis should be made on the behavioural features.
Dementia infantilis
Disintegrative psychosis
Heller's syndrome
Symbiotic psychosis
Use additional code, if desired, to identify any associated neurological condition.
Excludes: Rett's syndrome (F84.2)
F84.4 Overactive disorder associated with mental retardation and stereotyped movements
An ill-defined disorder of uncertain nosological validity. The category is designed to include a group of children with severe mental retardation (IQ below 35) who show major problems in hyperactivity and in attention, as well as stereotyped behaviours. They tend not to benefit from stimulant drugs (unlike those with an IQ in the normal range) and may exhibit a severe dysphoric reaction (sometimes with psychomotor retardation) when given stimulants. In adolescence, the overactivity tends to be replaced by underactivity (a pattern that is not usual in hyperkinetic children with normal intelligence). This syndrome is also often associated with a variety of developmental delays, either specific or global. The extent to which the behavioural pattern is a function of low IQ or of organic brain damage is not known.
F84.5 Asperger's syndrome
A disorder of uncertain nosological validity, characterized by the same type of qualitative abnormalities of reciprocal social interaction that typify autism, together with a restricted, stereotyped, repetitive repertoire of interests and activities. It differs from autism primarily in the fact that there is no general delay or retardation in language or in cognitive development. This disorder is often associated with marked clumsiness. There is a strong tendency for the abnormalities to persist into adolescence and adult life. Psychotic episodes occasionally occur in early adult life.
Autistic psychopathy
Schizoid disorder of childhood
F84.8 Other pervasive developmental disorders
F84.9 Pervasive developmental disorder, unspecified

Source: World Health Organization ex 11/12/2006   © Copyright WHO/DIMDI 1994/2006

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Gillberg's criteria:

All of the following six criteria must be met for confirmation of diagnosis:

  1. Severe impairment in reciprocal social interaction (at least two of the following)
    1. inability to interact with peers
    2. lack of desire to interact with peers
    3. lack of appreciation of social cues
    4. socially and emotionally inappropriate behavior
  2. All-absorbing narrow interest (at least one of the following)
    1. exclusion of other activities
    2. repetitive adherence
    3. more rote than meaning
  3. Imposition of routines and interests (at least one of the following)
    1. on self, in aspects of life
    2. on others
  4. Speech and language problems (at least three of the following)
    1. delayed development
    2. superficially perfect expressive language
    3. formal, pedantic language
    4. odd prosody, peculiar voice characteristics
    5. impairment of comprehension including misinterpretations of literal/implied meanings
  5. Non-verbal communication problems (at least one of the following)
    1. limited use of gestures
    2. clumsy/gauche body language
    3. limited facial expression
    4. inappropriate expression
    5. peculiar, stiff gaze
  6. Motor clumsiness: poor performance on neurodevelopmental examination

Source: Varied; Internet, 2007. These criteria never have had an "official" version that I know about. But there's remarkably little variation among the versions I've seen.

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Notes:
All three sets of criteria are similar, yet still different. None are meant to be definitions (there are no objective tests). All are best used only as guidelines interpreted by professionals filtering observation through their experience.

NB: All these criteria were developed in the context of evaluating children (primarily male). They do not scale very well to adults; the older the adult, the more experienced, the less well they scale!
"Older" Aspergers in particular may avoid detection entirely; undoubtedly many have.   ...As have many females of all ages.

Gillberg published the first-ever diagnostic criteria for Asperger's Syndrome in 1989, and refined them a year later. They are more true to Asperger's own first description than are any others, hence some diagnosticians prefer them over the more widely used DSM-IV and ICD-10 (above). This is more true in European countries; far less true in the United States. ...Wherein DSM-IV holds sway and mental health "professionals" are influenced greatly by prospects of commercial gain.

Note the way DSM-IV implies there's this and then that, and then we're done. ICD-10 is more relaxed, in a way, implying latitude in interpretation. I believe Gillberg's criteria, less "one-size-fits-all" but as definite (or more) as those in ICD-10 or DSM-IV is the more human of the three. Gillberg's also seem to scale rather better to adults than do the other two.

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