Asperger syndrome physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]
Physical Examination
Physical, emotional, and mental tests are done to rule out other causes and look more closely for signs of this syndrome. The team that will see your child includes a psychologist, neurologist, psychiatrist, speech therapist, and other professionals who are experts in diagnosing children with Asperger syndrome.
Standard diagnostic criteria require impairment in social interaction, and repetitive and stereotyped patterns of behavior, activities and interests, without significant delay in language or cognitive development. Unlike the international standard, U.S. criteria also require significant impairment in day-to-day functioning. Other sets of diagnostic criteria have been proposed by Szatmari et al.[1] and by Gillberg and Gillberg.[2]
Diagnosis is most commonly made between the ages of four and eleven. A comprehensive assessment involves a multidisciplinary team that observes across multiple settings,and includes neurological and genetic assessment as well as tests for cognition, psychomotor function, verbal and nonverbal strengths and weaknesses, style of learning, and skills for independent living. The current "gold standard" in diagnosing ASDs combines clinical judgment with the Autism Diagnostic Interview-Revised (ADI-R)—a semistructured parent interview—and the Autism Diagnostic Observation Schedule (ADOS)—a conversation and play-based interview with the child.[3] Delayed or mistaken diagnosis can be traumatic for individuals and families; for example, misdiagnosis can lead to medications that worsen behavior. Many children with AS are initially misdiagnosed with attention-deficit hyperactivity disorder (ADHD). Diagnosing adults is more challenging, as standard diagnostic criteria are designed for children and the expression of AS changes with age.[4]
Underdiagnosis and overdiagnosis are problems in marginal cases. The cost of screening and diagnosis and the challenge of obtaining payment can inhibit or delay diagnosis. Conversely, the increasing popularity of drug treatment options and the expansion of benefits has motivated providers to overdiagnose ASD.[5] There are indications AS has been diagnosed more frequently in recent years, partly as a residual diagnosis for children of normal intelligence who do not have autism but have social difficulties. There are questions about the external validity of the AS diagnosis, that is, it is unclear whether there is a practical benefit in distinguishing AS from HFA and from PDD-NOS;[6] the same child can receive different diagnoses depending on the screening tool.
Overview
The most common clinical signs in Asperger Syndrome (AS) are impairments in social communication and repetitive behaviors.
Physical Examination
Clinical signs in Asperger Syndrome (AS) may include:[7]
- Problems in pretend play skills with persistent sensory-motor play stage.
- Preference to play with common objects (string, rocks, or sticks).
- The nature of play is usually constructive (puzzles, computer games, and blocks), ritualistic (lining objects up or sorting/matching shapes or colors) or sensory-motor (mouthing, banging, twirling).
- Atypical behaviors such as peculiar mannerisms, unusual attachments to objects, obsessions, compulsions, self-injurious behaviors, and stereotypes.
- Stereotypes are repetitive and atypical behaviors such as hand flapping, finger movements, rocking, or twirling, finger flicking, unusual eye gazing, habitual toe walking, and/or persistent sniffing and licking of nonfood items.
- The have unusual attachments for hard items; for example, ballpoint pens, flashlight, keys, action figures.
- Mild delay in speech.
- Atypical language development.
- They are verbal about a certain topic.
- They can not express feelings or recognize the feelings of others.
- Speech is overly formal (pedantic).
- Abnormal social use of language (pragmatics).
- Problems in delivery of speech (prosody) in regard to intonation, volume, rhythm and pitch.
References
- ↑ Szatmari P, Bremner R, Nagy J (1989). "Asperger's syndrome: a review of clinical features". Can J Psychiatry. 34 (6): 554–60. PMID 2766209.
- ↑ Gillberg IC, Gillberg C (1989). "Asperger syndrome—some epidemiological considerations: a research note". J Child Psychol Psychiatry. 30 (4): 631–8. doi:10.1111/j.1469-7610.1989.tb00275.x. PMID 2670981.
- ↑ Woodbury-Smith MR, Volkmar FR (2008). "Asperger syndrome". Eur Child Adolesc Psychiatry. doi:10.1007/s00787-008-0701-0. PMID 18563474.
- ↑ Tantam D (2003). "The challenge of adolescents and adults with Asperger syndrome". Child Adolesc Psychiatr Clin N Am. 12 (1): 143–63. doi:10.1016/S1056-4993(02)00053-6. PMID 12512403.
- ↑ Shattuck PT, Grosse SD (2007). "Issues related to the diagnosis and treatment of autism spectrum disorders". Ment Retard Dev Disabil Res Rev. 13 (2): 129–35. doi:10.1002/mrdd.20143. PMID 17563895.
- ↑ Klin A, Volkmar FR (2003). "Asperger syndrome: diagnosis and external validity". Child Adolesc Psychiatr Clin N Am. 12 (1): 1–13. doi:10.1016/S1056-4993(02)00052-4. PMID 12512395.
- ↑ Johnson CP, Myers SM, American Academy of Pediatrics Council on Children With Disabilities (2007). "Identification and evaluation of children with autism spectrum disorders". Pediatrics. 120 (5): 1183–215. doi:10.1542/peds.2007-2361. PMID 17967920.