Symptom Variety Complicates Asperger's Diagnosis

Article excerpt

CAMBRIDGE, MASS. - Asperger's syndrome is difficult to diagnose because symptoms are quite variable, said Dr. Daniel Rosenn, a child and adolescent psychiatrist in private practice in Wellesley, Mass.

Physicians may be hard-pressed to know when or if a child has Asperger's syndrome because "up to age 3 [years] or so, it's not easy to tell-especially if language is developing well," he said at a meeting on behavioral pediatrics sponsored by Boston University.

Asperger's syndrome is increasingly viewed as being at the high end of a continuum from high-functioning autism to severe autism. "With severe autism, patients look and act the same," said Dr. Rosenn, who is a founding member of the Asperger's Association of New England. "With Asperger's, one child doesn't look like the last or the next. They're all different."

While it's hard to get figures on Asperger's syndrome because symptoms vary so widely, it could occur in as many as 1 in 300-400 children. Down syndrome, by comparison, occurs in 1 out of 600 children.

Asperger's syndrome is four times as likely to appear in males as in females. Other characteristics seen in children with Asperger's syndrome include:

* Normal or superior intelligence.

* Clumsy poor handwriting.

* Ritual behavior such as flapping of the arms, pacing, or jumping in place, particularly when the child is excited or upset.

* A tendency to be very verbal.

* Peculiarities of speech including talking too loudly, hav-ing problems taking turns during a conversation, exhibiting poor eye contact, or having unusual variations in the pitch and rhythm of speech (for example, sounding robotic or pedantic).

* Circumscribed, often factual interest in a particular topic and a tendency to talk about it for long periods of time.

* Tendency to miss social cues.

* Becoming upset if routines or expectations are violated.

* Anxiety during transitions or when new things are encountered.

* Auditory and visual-spatial processing problems.

* Significant classroom learning disability.

Taking an extremely careful developmental history is essential, as is a good family history. Other members of the family are likely to have Asperger's syndrome as well, with 18%-19% percent of parents meeting criteria for the disorder. …