Can a diagnosis of Asperger syndrome be made in very young children with suspected autism spectrum disorder?
Hold off on pinning “Asperger” on toddlers—first labels flip as kids grow.
01Research in Context
What this study did
Doctors looked at 104 toddlers who might have autism. They asked: can we sort the very young ones into Asperger syndrome? They watched each child and scored the usual checklists.
What they found
Only three toddlers truly fit the Asperger label. Repetitive play grew, but daily-routine fights shrank. The picture kept shifting, so the team called early Asperger tags “shaky.”
How this fits with other research
Barbaro et al. (2017) followed similar-aged kids for two years and saw 88 % keep their autism label. That long view backs the warning here: first labels can stick even if wrong.
Wu et al. (2021) found their T-STAT screener spots autism in 18-24-month-olds. Their positive news seems to clash, yet they test for “autism overall,” not the finer Asperger box. The two studies ask different questions.
Grigore et al. (2024) summed up 11 toddler screeners and still found “we’re not sure.” Their big review agrees with McConachie et al. (2005): tools alone don’t give solid subtypes before preschool.
Why it matters
For you at the clinic table, this means write “ASD—needs re-check” instead of “Asperger” on a two-year-old. Plan to re-test after the fourth birthday. Tell families the first name may change; it lowers later shock and keeps services open.
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02At a glance
03Original abstract
Of a cohort of 104 children with Autism, PDD-NOS or specific language disorder, recruited at age 2-3 years of age, only three appeared to meet diagnostic assessment criteria for Asperger syndrome (AS). The children were followed up at 4-5 years, and assessments at both time points included the Autism Diagnostic Interview (ADI-R), the Autism Diagnostic Observation Schedule (ADOS) and the Mullen Scales of Early Learning. The paper explores the reasons why so few children with possible AS were identified early, including problems inherent in the assessment tools and the range of normal variation within characteristics required for a diagnosis. Only 10 children altogether had first words by 24 months, and abilities in the average range, and 9 were followed up. All of these able children had varied repetitive behaviours, and these increased in terms of ADI-R algorithm score over a 13 month interval. However, items concerning resistance to change and liking of routines tended to decrease in terms of reported impact on the child and family. Repetitive behaviours seem significant in the early referral of able children for a PDD diagnosis, but identification of children with AS is more likely to occur reliably once children are older and enter school.
Journal of autism and developmental disorders, 2005 · doi:10.1007/s10803-004-1995-5