Asperger Syndrome Differential Diagnoses

Updated: Feb 13, 2018
  • Author: James Robert Brasic, MD, MPH, MS, MA; Chief Editor: Caroly Pataki, MD  more...
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Diagnostic Considerations

Although normal language and cognitive development differentiate Asperger syndrome from other developmental disorders, the social impairment associated with this condition is also a characteristic of the following disorders:

  • Developmental learning disability of the right hemisphere

  • Nonverbal learning disability

  • Schizoid personality disorder

  • Schizotypal personality disorder

  • Semantic-pragmatic processing disorder

  • Social-emotional learning disabilities

The Autism Screening Checklist (see the image below) is helpful in identifying children with characteristics of autism spectrum disorder (ASD) and in differentiating children with these disorders from children with schizophrenia and other psychoses.

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 ASD (including Asperger syndrome). Some children with ASD demonstrate normal development for the first couple of years or so and then demonstrate a regression with loss of language skills.

Children with ASD may or may not speak; thus, they may score either “no” or “yes” on item 4. Children with Asperger syndrome develop speech at the usual age. They may display oddities of speech characteristic of ASD. A score of “yes” on items 2 and 11 occurs in healthy children, not in children with ASD (including Asperger syndrome and other pervasive developmental disorders).

A score of “no” on items 2 and 11 coupled with a score of “yes” on items 5, 6, 7, 8, 9, 10, 12, and 13 occurs in some children with ASD (including Asperger syndrome). 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, the more likely the presence of ASD (including Asperger syndrome).

A score of “yes” on items 14, 15, 16, 17, 18, and 19 occurs in children with schizophrenia and other disorders but not in children with Asperger syndrome and other forms of ASD. A score of “no” on item 2 and “yes” on item 12 may occur in people with Asperger syndrome.

In making a differential diagnosis, it is important to consider comorbid movement disorders. Appropriate rating scales, when used regularly, help identify and differentiate among various movement disorders. (For more information on instruments for assessing movement in children with Asperger syndrome and related conditions, see Tardive Dyskinesia.)

In addition to the conditions listed in the differential diagnosis, other disorders to consider include the following:

  • Basic phonologic processing disorder

  • Catatonia [2, 3, 4, 58]

  • Dyslexia

  • Hearing impairment

  • Hyperlexia

  • Nonverbal learning disability

  • Personality disorder

  • Physical abuse

  • Pragmatic language disorder

  • Right cerebral hemisphere damage or dysfunction

  • Schizoid personality

  • Semantic-pragmatic processing disorder

  • Sensory integration disorder

  • Triple X syndrome

  • Endocrine disorders

  • Audiovisual disorders

  • Collagen disorders

Differential Diagnoses