Part II review of: Fred R. Volkmar, Matthew State, Ami Klin (2009). Autism and autism spectrum disorders: diagnostic issues for the coming decade Journal of Child Psychology and Psychiatry, 50 (1-2), 108-115 DOI: 10.1111/j.1469-7610.2008.02010.x

Much controversy and confusion remains about the differences between high functioning autism and Asperger’s syndrome. As the authors described, there are many areas of overlap as well as differences between the original Asperger’s proposal and autism.

Several aspects of Asperger’s original (1944) report suggest areas of overlap (social disability/autism) and difference from autism, e.g., preserved language ability, high rate of similar difficulty in family members, unusual fact-based special interests.

Yet, researchers, clinicians, and parents often note that such differences are not always clear cut. For example, many kids with HFA show unusual fact-based interests. In addition, according to the DSM-IV-TR, the most notable difference between HFA and AS is the presence or absence of language delay. For a diagnosis of HFA there must be a history of language delays, while for a diagnosis of Asperger’s language development must be fairly intact. But most clinicians would agree that it is very common to see kids with all the typical signs of Asperger’s (including intact language skills at the time of assessment) but with a documented history of language delays, which technically calls for a diagnosis of autism. Furthermore, new research has suggested that people with AS also show language impairment, but these impairments are not easily noted by parents or even trained clinicians. For example, last year I discussed Saalasti et al. (2008) article on this issue showing impairments in comprehension and phonological processes among children with Asperger’s.

Another issue proposed by the authors as potentially relevant was the possible differences between Asperger’s and autism in their neuropsychological functioning. Two issues are worth discussing. First, unfortunately the data on neuropsychological profiles of kids with Asperger’s and HFA are not consistent, as many studies have failed to find differences in cognitive functioning between these groups (see this review for example). Second, the most relevant question parents often ask me is “then what?” What do we gain by knowing that these two profiles differ (or not) in their neurocognitive functioning? What if AS and HFA are just variations of the same thing?

The authors respond to this question:

To simply designate ‘high-functioning autism’ as Asperger’s adds relatively little; what would be of much greater interest would be whether there is some evidence for the utility of AS as a diagnosis based on differences in implications for treatment, mechanisms of disorder, etc.

That is, examining the neurocognitive profile of these two conditions may help us better understand the developmental pathways of these disorders and design more effective treatment interventions. AS and HFA may be just variations of the same conditions, but the still unsettled question is whether such variations are significant enough, or reliable enough, to have a real impact in our understanding of the development, course, or treatment of these conditions.

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3 Responses to High functioning autism vs. Asperger’s. Autism diagnostic issues (Part II)

  1. passionlessDrone says:

    Hi Nestor –

    Have you given any thought towards analyzing studies that have identified the genetic and/or physiological differences between autism and aspergers and pdd-nos?

    For example, “Gene expression changes in children with autism” [Gregg 2008]

    Studies that aren’t relying empirical measurements, as opposed to fuzzy diagnostic shades are going to be telling us a lot about the different types of autism. Well, that’s my opinion anyways.

    I appreciate your blog.

    - pD

  2. Hi PD, You are correct that current research has a limitation in the accuracy of our diagnostic criteria. This creates a circular logic, in that for example we may use a criteria (e.g., differences in neuropsychological functioning) to both “explain” the subtypes as well as to “define” the subtypes.

    Unfortunately this is not an issue unique to Autism or even medicine in general, in that we often use a “syndrome” to categorize likely a number of different conditions that have different developmental trajectories, genetic associations, causative factors, and outcomes. Thanks for visiting. Nestor.

  3. mario coronado says:

    i think that every young named assperger, most of them just had non verbal lerning disorders…a lot receive just academic therapy; but commmunication and social practice its not part of the curricula of psychologist…or are so difficult that just only artist knowing about corporal language can help them (us)…
    wich is your comment

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