Objective: To examine the implications for research of the use of three alternative definitions for Asperger syndrome (AS). Differences across the three nosologic systems were examined in terms of diagnostic assignment, IQ profiles, comorbid symptoms, and familial aggregation of social and other psychiatric symptoms. Method: Standard data on diagnosis, intellectual functioning, comorbidity patterns, and family history were obtained on 65 individuals screened for a very high probability of having autism without mental retardation (or higher functioning autism, HFA) or AS. Diagnoses of AS were established based on three different approaches: DSM-IV, presence/absence of communicative phrase speech by 3 years, and a system designed to highlight prototypical features of AS. Results: Agreement between the three diagnostic systems was poor. AS could be differentiated from HFA (but not from PDD-NOS) on the basis of IQ profiles in two of the three systems. Differences in patterns of comorbid symptomatology were obtained in two of the three systems, although differences were primarily driven by the PDD-NOS category. Only one of the approaches yielded differences relative to aggregation of the “broader phenotype” in family members. Conclusions: Diagnostic assignments of AS based on three commonly used approaches have low agreement and lead to different results in comparisons of IQ profiles, patterns of comorbidity, and familial aggregation of psychiatric symptoms across the approach-specific resultant groups of HFA, AS, and PDD-NOS.
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References
InstitutionalAuthorNameAmerican Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders (4th ed.). (DSM-IV) American Psychiatric Association Washington, DC
InstitutionalAuthorNameAmerican Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (4th ed.), Text Revision (DSM-IV-TR) American Psychiatric Association Washington, DC
H. Asperger (1944) ArticleTitleDie ‘Autistischen Psychopathen’ im Kindesalter Archiv für Psychiatrie und Nervenkrankheiten 117 76–136
A. Bailey S. Palferman L. Heavey A. Le Couteur (1998) ArticleTitleAutism: the phenotype in relatives Journal of Autism and Developed Disorders 28 369–392
A. Bailey W. Phillips M. Rutter (1996) ArticleTitleAutism: towards an integration of clinical, genetic, neuropsychological, and neurobiological perspectives Journal of Child Psychology and Psychiatry and Allied Disciplines 37 IssueID1 89–126
P.F. Bolton A. Pickles M. Murphy M. Rutter (1998) ArticleTitleAutism, affective and other psychiatric disorders: patterns of familial aggregation Psychological Medicine 28 IssueID2 385–395
G. Bosch (1970) Infantile autism Springer-Verlag New York, NY
E.P. Bowman (1988) ArticleTitleAsperger’s syndrome and autism: the case for a connection British Journal of Psychiatry 152 377–382
D.V. Cicchetti S.S. Sparrow (1981) ArticleTitleDevelopment of criteria for establishing the Interrater reliability of specific items in a given inventory: applications to assessment of adaptive behavior American Journal of Mental Deficiency 86 127–137
D.J. Clarke C.S. LittleJohns J.A. Corbett S. Joseph (1989) ArticleTitlePervasive developmental disorders and psychoses in adult life British Journal of Psychiatry 155 692–669
G.R. DeLong J.T. Dwyer (1988) ArticleTitleCorrelation of family history with specific autistic subgroups: Asperger’s syndrome and bipolar affective disease Journal of Autism Development Disorders 18 IssueID4 593–600
S. Ehlers A. Nyden C. Gillberg A. Dahlgren Sandberg (1997) ArticleTitleAsperger syndrome, autism and attention disorders: a comparative study of the cognitive profiles of 120 children Journal of Child Psychology and Psychiatry and Allied Disciplines 38 IssueID2 207–217
R. Eisenmajer M. Prior S. Leekam L. Wing J. Gould M. Welham B. Ong (1996) ArticleTitleComparison of clinical symptoms in autism and Asperger’s disorder Journal of American Academy Child and Adolescent Psychiatry 35 1523–1531
M.B. First R.L. Spitzer M. Gibbon J.B.W. Williams (1996) Structured clinical interview for DSM-IV Axis I Disorders (Version 2.0) Biomedical Research Department, New York State Psychiatric Institute New York NY
J.M. Fletcher (1985) External validation of learning disability typologies P.B. Rourke (Eds) Neuropsychology of learning disabilities: essentials of subtype analysis. Guilford Press New York, NY 187–211
S.E. Folstein S.L. Santangelo (2000) Does Asperger syndrome aggregate in families A. Klin F.R. Volkmar S.S. Sparrow (Eds) Asperger syndrome Guilford Press New York, NY 159–171
E. Fombonne (1999) ArticleTitleThe epidemiology of autism: a review Psychological Medicine 29 769–786
M. Ghaziuddin L.Y. Tsai N. Ghaziuddin (1992) ArticleTitleBrief report: A comparison of the diagnostic criteria for Asperger Syndrome Journal of Autism Development Disorders 22 IssueID4 643–649
M. Ghaziuddin L. Tsai N. Ghaziuddin (1992) ArticleTitleComorbidity of autistic disorder in children and adolescents European Child & Adolescent Psychiatry 1 IssueID4 209–213
A. Gilchrist J. Green A. Cox D. Burton M. Rutter A. Le Couteur (2001) ArticleTitleDevelopment and current functioning in adolescents with Asperger syndrome: a comparative study Journal Child Psychology Psychiatry and Aillied Disciplines 42 227–240
C. Gillberg (1998) ArticleTitleAsperger syndrome and high-functioning autism British Journal of Psychiatry 172 200–209
C. Gillberg I.C. Gillberg M. Rastam E. Wentz (2001) ArticleTitleThe Asperger syndrome (and high-functioning autism) Diagnostic Interview (ASDI): a preliminary study of a new structured clinical interview Autism 5 57–66
C. Gillberg I.C. Gillberg S. Steffenburg (1992) ArticleTitleSiblings and parents of children with autism: A controlled population-based study Developmental Medicine and Child Neurology 34 389–398
J. Green A. Gilchrist D. Burton A. Cox (2000) ArticleTitleSocial and psychiatric functioning in adolescents with Asperger syndrome compared with conduct disorder Journal of Autism Development Disorders 30 279–293
T. Gura (1999) ArticleTitleGene defect linked to Rett syndrome Science 286 IssueID5437 27
K. Hippler C. Klicpera (2003) ArticleTitleA retrospective analysis of the clinical case records of ‘autistic psychopaths’ diagnosed by Hans Asperger and his team at the University Children’s Hospital, Vienna Philosophical Transactions of the Royal Society of London 358 291–301
P. Howlin (2000) ArticleTitleOutcome in adult life for more able individuals with autism or Asperger syndrome Autism 4 63–83 Occurrence Handle10.1177/1362361300004001005
L. Kanner (1943) ArticleTitleAutistic disturbances of affective contact Nervous Child 2 217–253
J. Kerbeshian L. Burd (1986) ArticleTitleAsperger’s syndrome and Tourette syndrome: The case of the pinball wizard British Journal of Psychiatry 148 731–6
J. Kim P. Szatmari S. Bryson D.L. Streiner F.J. Wilson (2000) ArticleTitleThe prevalence of anxiety and mood problems among children with autism and Asperger syndrome Autism 4 117–132
A. Klin A. Carter W.D. Volkmar F.R. Cohen D.J. Marans S.S. Sparrow (1997) Assessment issues in children with autism D.J. Cohen F.R. Volkmar (Eds) Handbook of Autism and Pervasive Developmental Disorders, (2nd ed.) Wiley New York, NY 411–418
A. Klin S.S. Sparrow W.D Marans A. Carter F.R. Volkmar (2000) Assessment issues in children and adolescents with Asperger syndrome A. Klin F.R. Volkmar S.S. Sparrow (Eds) Asperger syndrome Guilford Press New York, NY 309–339
A. Klin F.R. Volkmar (1996) The pervasive developmental disorders: Nosology and profiles of development S. Luthar J. Burack D. Cicchetti J. Wiesz (Eds) Developmental Perspectives on Risk and Psychopathology. Cambridge University Press New York, NY 208–226
A. Klin F.R. Volkmar (1997) Asperger Syndrome D.J. Cohen F.R. Volkmar (Eds) Handbook of Autism and Pervasive Developmental Disorders Wiley & Sons New York, NY 94–122
A. Klin F.R. Volkmar S.S. Sparrow D.V. Cicchetti B.P. Rourke (1995) ArticleTitleValidity and neuropsychological characterization of Asperger syndrome Journal of Child Psychology Psychiatry and Allied Disciplines 36 1127–1140
A. Klin F.R. Volkmar S.S. Sparrow (Eds) (2000) Asperger syndrome Guilford Press New York
R. Landa (2000) Social language use in Asperger syndrome and high-functioning autism A. Klin F.R. Volkmar S.S. Sparrow (Eds) Asperger syndrome. Guilford Press New York, NY 125–155
J.F. Leckman D. Sholomskas W.D. Thompson (1982) ArticleTitleBest estimate of lifetime psychiatric diagnosis: A methodological study Archives of General Psychiatry 32 879–883
S. Leekam S. Libby L. Wing J. Gould C. Gillberg (2000) ArticleTitleComparison of ICD-10 and Gillberg’s criteria for Asperger syndrome Autism 4 11–28
A. Lincoln E. Courchesne M. Allen E. Hanson M. Ene (1998) Neurobiology of Asperger Syndrome: seven case studies and quantitative magnetic resonance imaging findings E. Schopler G. Mesibov L.J. Kunce (Eds) Asperger syndrome or High-Functioning Autism? Plenum New York 145–166
A.J. Lincoln M. Allen A. Kilman (1995) The assessment and interpretation of intellectual abilities in people with autism E. Schopler G. Mesibov (Eds) Learning and Cognition in Autism. Plenum New York, NY 89–117
Lord, C., Rutter, M. & DiLavore, P.(1996). Autism diagnostic observation schedule – Generic (ADOS-G). Unpublished manuscript. University of Chicago, Chicago, Illinois.
C. Lord M. Rutter A. LeCouteur (1994) ArticleTitleAutism Diagnostic Interview–Revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders Journal of Autism and Developed Disorders 24 659–685
A. Martin D.K. Patzer F.R. Volkmar (2000) Psychopharmacological treatment of higher-functioning pervasive developmental disorders A. Klin F.R. Volkmar S.S. Sparrow (Eds) Asperger Syndrome. Guilford Press New York 210–230
S.D. Mayes S.L. Calhoun D.L. Crites (2001) ArticleTitleDoes DSM-IV Asperger’s disorder exist? Journal Abnorm Child Psychology 29 263–271
J.N. Miller S. Ozonoff (1997) ArticleTitleDid Asperger’s cases have Asperger Disorder? Journal of Child Psychology and Psychiatry 38 247–251
J. Miller S. Ozonoff (2000) ArticleTitleThe external validity of Asperger disorder: lack of evidence from the domain of neuropsychology Journal of Abnorm Psychology 109 227–238
M. Murphy P.F. Bolton A. Pickles E. Fombonne J. Piven M Rutter (2000) ArticleTitlePersonality traits of the relatives of autistic probands Psychological Medicine 30 1411–1424
H. Orvaschel J. Puig-Antich (1987) Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). (4th ed) Western Psychiatric Institute and Clinic Pittsburgh, PA
S. Ozonoff (2000) Neuropsychological function and the external validity of Asperger syndrome A. Klin F.R. Volkmar S.S. Sparrow (Eds) Asperger syndrome. Guilford Press New York, NY 72–96
S. Ozonoff S. Rogers B. Pennington (1991) ArticleTitleAsperger’s syndrome: evidence of an empirical distinction Journal of Child Psychology and Psychiatry 32 1107–1122
J. Piven G.A. Chase R. Landa M. Wzorek J. Gayle D. Cloud S. Folstein (1991) ArticleTitlePsychiatric disorders in the parents of autistic individuals Journal of American Academy Child and Adolescent Psychiatry 30 471–478
J. Piven P. Palmer (1999) ArticleTitlePsychiatric disorder and the broad autism phenotype: evidence from a family study of multiple-incidence autism families American Journal of Psychiatry 156 557–563
J. Piven P. Palmer D. Jacobi D. Childress S. Arndt (1997) ArticleTitleThe broader autism phenotype: evidence from a family study of multiple-incidence autism families American Journal of Psychiatry 154 185–190
M. Prior R. Eisenmajer S. Leekam L. Wing J. Gould B. Ong D. Dowe (1998) ArticleTitleAre there subgroups within the autistic spectrum? A cluster analysis of a group of children with autistic spectrum disorders Journal of Child Psychology and Psychiatry 39 893–902
B. Rourke (1989) Nonverbal learning disabilities: The syndrome and the model Guilford Press New York, NY
M. Rutter (1999) ArticleTitleThe Emanuel Miller Memorial Lecture 1998 Autism: two-way interplay between research and clinical work. Journal of Child Psychology and Psychiatry 40 169–188
M. Rutter (2000) ArticleTitleGenetic studies of autism: from the 1970s into the millennium Journel of Child Psychology and Psychiatry 28 3–14
S.L. Smalley J. McCracken P. Tanguay (1995) ArticleTitleAutism, affective disorders and social phobia American Journal of Medical Genetics 60 19–26
S. Sparrow D. Balla D. Cicchetti (1984) Vineland Adaptive Behavior Scales, Expanded Edition American Guidance Service Circle Pines, MN
P. Szatmari L. Archer S. Fisman D.L. Streiner F. Wilson (1995) ArticleTitleAsperger’s syndrome and autism: differences in behavior, cognition, and adaptive functioning Journal of American Academy Child and Adolescent Psychiatry 34 1662–1671
P. Szatmari S.E. Bryson D.L. Streiner F. Wilson L. Archer C. Ryerse (2000) ArticleTitleTwo-year outcome of preschool children with autism or Asperger’s syndrome American Journal of Psychiatry 157 1980–1987
P Szatmary (2000) Perspectives on the classification of Asperger syndrome A. Klin F.R. Volkmar S.S. Sparrow (Eds) Asperger syndrome. Guilford Press New York 403–417
D. Tantam (1988) ArticleTitleAnnotation: Asperger’s syndrome Journal of Child Psychology and Psychiatry 29 245–255
P.H. Thomsen (1994) ArticleTitleObsessive-compulsive disorder in children and adolescents: A 6–22-year follow-up study: Clinical descriptions of the course and continuity of obsessive-compulsive symptomatology European Child Adolescent Psychiatry 3 82–96
D.A. Van Krevelen (1971) ArticleTitleEarly infantile autism and autistic psychopathy Journal autism and Child Schizophrenia 1 IssueID1 82–86
F.R. Volkmar A. Klin (2002) Diagnostic issues in Asperger syndrome A. Klin F.R. Volkmar S.S. Sparrow (Eds) Asperger syndrome Guilford Press New York, NY 25–71
F.R. Volkmar A. Klin D.J. Cohen (1997) Diagnosis and Classificiation of autism and related conditions: Consensus and Issues D.J. Cohen F.R. Volkmar (Eds) Handbook of Autism and Pervasive Developmental Disorders. Wiley New York, NY 5–40
F.R. Volkmar A. Klin D. Pauls (1998) ArticleTitleNosological and genetic aspects of Asperger Syndrome Journal of Autism Development Disorders 28 457–463
F.R. Volkmar A. Klin B. Siegel P. Szatmari C. Lord M. Campbell B.J. Freeman D.V. Cicchetti M. Rutter W. Kline J. Buitelaar Y. Hattab E. Fombonne J. Fuentes J. Werry W. Stone J. Kerbeshian Y. Hoshino J. Bregman K. Loveland L. Szymanski K. Towbin (1994) ArticleTitleDSM-IV Autism/Pervasive Developmental Disorder Field Trial American Journal of Psychiatry 151 1361–1367
D. Wechsler (1992) Manual for the Wechsler Intelligence Scale for Children, (3rd ed.) The Psychological Corporation San Antonio, TX
D. Wechsler (1997) Manual for the Wechsler Adult Intelligence Scale, (3rd ed.) The Psychological Corporation San Antonio
L. Wing (1981) ArticleTitleAsperger’s syndrome: a clinical account Psychological Medicine 11 115–129
L. Wing (1986) ArticleTitleClarification on Asperger’s Syndrome (Letters to the Editor) Journal of Autism Development Disorder 16 513–515
InstitutionalAuthorNameWorld Health Organization (1992) The ICD-10 Classification of Mental and Behavioral Disorders World Health Organization Geneva
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Klin, A., Pauls, D., Schultz, R. et al. Three Diagnostic Approaches to Asperger Syndrome: Implications for Research. J Autism Dev Disord 35, 221–234 (2005). https://doi.org/10.1007/s10803-004-2001-y
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DOI: https://doi.org/10.1007/s10803-004-2001-y