Confusion and inconsistency in diagnosis of Asperger syndrome: a review of studies from 1981 to 2010.
DSM-IV Asperger criteria overlap so much with autism that reliable differential diagnosis is questionable—plan interventions for symptom profiles, not labels.
01Research in Context
What this study did
Sharma et al. (2012) read 69 papers written between 1981 and 2010. They looked at how doctors used DSM-IV rules to split Asperger syndrome from classic autism.
The team compared checklists, IQ scores, and language reports. They wanted to see if the two labels pointed to truly different groups.
What they found
The rules overlapped so much that no clear line appeared. Kids who met Asperger criteria also met autism criteria and vice versa.
Because the checklists were almost identical, reliability was poor. The review says the Asperger label added more confusion than clarity.
How this fits with other research
Eisenmajer et al. (1998) hinted at this problem fourteen years earlier. They warned that genetic studies could not separate the groups until stricter rules arrived.
Ghaziuddin et al. (2004) found one small clue: average verbal IQ was higher in Asperger cases. Yet scores still overlapped, so IQ alone could not decide the diagnosis.
Edgin et al. (2017) later showed DSM-5 fixed some issues but missed many former Asperger clients. Their data extend the 2012 worry into everyday clinics today.
Why it matters
Stop planning goals around a shaky label. Watch the child’s real skill pattern—social interest, language style, sensory needs—and teach to those targets. Keep one set of programs that flex; they work whether the chart says autism, Asperger, or ASD level 1.
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02At a glance
03Original abstract
This paper presents a review of past and current research on the diagnosis of Asperger syndrome (AS) in children. It is suggested that the widely used criteria for diagnosing AS in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV are insufficient and invalid for a reliable diagnosis of AS. In addition, when these diagnostic criteria are applied, there is the potential bias of receiving a diagnosis towards the high-functioning end of the autism spectrum. Through a critical review of 69 research studies carried out between 1981 and 2010, this paper shows that six possible criteria for diagnosing AS (specifically, the age at which signs and symptoms related to autism become apparent, language and social communication abilities, intellectual abilities, motor or movement skills, repetitive patterns of behaviour and the nature of social interaction) overlap with the criteria for diagnosing autism. However, there is a possibility that some finer differences exist in the nature of social interaction, motor skills and speech patterns between groups with a diagnosis of AS and autism. These findings are proposed to be of relevance for designing intervention studies aimed at the treatment of specific symptoms in people with an autism spectrum disorder.
Autism : the international journal of research and practice, 2012 · doi:10.1177/1362361311411935