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.

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

Adrenal Hypoplasia
Attachment Disorders
Birth Trauma
Child Abuse & Neglect: Posttraumatic Stress Disorder
Child Sexual Abuse
Cognitive Deficits
Conduct Disorder
Dissociative Identity Disorder
Fetal Alcohol Syndrome
Fragile X Syndrome
Hearing Impairment
Pediatric Generalized Anxiety Disorder
Pediatric Intellectual Disability
Pediatric Obsessive-Compulsive Disorder
Rett Syndrome

Workup

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Autism screening checklist.

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Author

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

James Robert Brasic, MD, MPH, MS, MA is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Neurology, International Parkinson and Movement Disorder Society, Society for Neuroscience, Society of Nuclear Medicine and Molecular Imaging

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Johns Hopkins University School of Medicine; New York City Health and Hospitals/Bellevue, New York University Langone Health<br/>Serve(d) as a speaker or a member of a speakers bureau for: Society of Nuclear Medicine and Molecular Imaging, Maryland Regional Council of Child and Adolescent Psychiatry<br/>Received research grant from: National Institutes of Health, Johns Hopkins University School of Medicine, Intellectual & Developmental Disabilities Research Center (U54 HD079123) at the Kennedy Krieger Institute<br/>Received income in an amount equal to or greater than $250 from: Gerson Lehrman Group; Guidepost<br/>Received royalty from Medscape for other.

Coauthor(s)

Farzaneh Farhadi, MD Postdoctoral Research Fellow, Johns Hopkins Hospital

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

Hongzhu Deng, MD, PhD Associate Professor, Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University of Medical Sciences, China

Disclosure: Nothing to disclose.

Gregory N McKay Johns Hopkins University School of Medicine

Disclosure: Nothing to disclose.

Acknowledgements

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.