Asperger Syndrome Differential Diagnoses

  • Author: James Robert Brasic, MD, MPH; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Jul 20, 2011
 
 

Diagnostic Considerations

Although normal language and cognitive development differentiate Asperger syndrome from other developmental disorders, the severe social impairment associated with this condition overlaps with disorders, such as high-functioning autism (HFA).

De Spiegeleer and Appelboom have pointed out that Asperger syndrome is an autism spectrum disorder.[1] For clinical management purposes, Asperger syndrome and HFA may be considered equivalent. Impaired social skills are associated with several other conditions (eg, developmental learning disability of the right hemisphere, nonverbal learning disability, schizoid personality disorder, semantic-pragmatic processing disorder, social-emotional learning disabilities).

The Autism Screening Checklist is helpful in identifying children with characteristics of autism spectrum disorders. It differentiates children with autism spectrum disorders from children with schizophrenia and other psychoses. The checklist is seen below.

Go to Pervasive Developmental Disorder and Autism for complete information on these topics.

Autism screening checklist. Autism screening checklist.

A score of "yes" on items 1, 3, and 4 of the Autism Screening Checklist occurs in healthy children and in children with autism spectrum disorders, including Asperger syndrome. Some children with autism and other autism spectrum disorders demonstrate normal development for the first couple of years or so and then demonstrate a regression with loss of language skills. Children with autism may or may not speak. Therefore, children with autism may score “no” or “yes” on item 4. Children with Asperger syndrome develop speech at the usual age. They may display oddities of speech characteristic of autism and Asperger syndrome. A score of "yes" on items 2 and 11 occurs in healthy children, not in children with autism spectrum disorders and other pervasive developmental disorders.

A score of "no" on the Autism Screening Checklist items 2 and 11 and a score of "yes" on items 5, 6, 7, 8, 9, 10, 12, and 13 occurs in some children with autism spectrum disorders. The higher the score for "no" on items 2, 4, and 11 and for "yes" on items 5, 6, 7, 8, 9, 10, 12, and 13 on the Autism Screening Checklist, the more likely the presence of an autism spectrum disorder. A score of "yes" on items 14, 15, 16, 17, 18, and 19 occurs in children with schizophrenia and other disorders, not in children with Asperger syndrome and other autism spectrum disorders. A score of "no" on item 2 and "yes" on item 12 may occur in people with Asperger syndrome.

Consider comorbid movement disorders in making a differential diagnosis. Various rating scales, when used regularly, help to identify and differentiate among various movement disorders. For more information, see Tardive Dyskinesia.

Disorders to consider, aside from those in the next section, in the differential diagnosis of Asperger syndrome include the following:

  • Basic phonological processing disorder
  • Callosal dysgenesis
  • Catatonia
  • Cerebellar dysfunction
  • Dyslexia
  • Fahr syndrome
  • Head trauma
  • Hearing impairment
  • Human immunodeficiency virus infection
  • Hyperlexia
  • Interventricular hemorrhage
  • Leukodystrophy
  • Multiple sclerosis
  • Nonverbal learning disability
  • Personality disorder
  • Physical abuse
  • Pragmatic language disorder
  • Psychosocial dwarfism
  • Reactive attachment disorder
  • Right cerebral hemisphere damage or dysfunction
  • Schizoid personality
  • Semantic-pragmatic processing disorder
  • Sensory integration disorder
  • Substance abuse
  • Toxicant-induced encephalopathy
  • Traumatic brain injury
  • Triple X syndrome

Differential Diagnoses

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Contributor Information and Disclosures
Author

James Robert Brasic, MD, MPH  Assistant Professor, Division of Nuclear Medicine, Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine

James Robert Brasic, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Neurology, and Movement Disorders Society

Disclosure: Taylor and Francis Royalty Independent contractor; Wolters Kluver/Lippincott Williams & Wilkins Royalty Independent contractor; National Alliance for Research on Schizophrenia and Depression Grant/research funds Other; National Institutes of Health Grant/research funds Other

Specialty Editor Board

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

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