Overview

Aspergers disorder is characterized by impairment and oddity of social interaction and restricted interest and behavior reminiscent of those seen in autistic disorder. Unlike Autistic disorder, in Aspergers disorder no significant delays occur in language,cognitive development, or age appropriate self help skills

In 1944, Hans Asperger, an Austrian physician,described a syndrome that he name autistic psychopathy

His original description of the syndrome applied to persons with normal intelligence who exhibit a qualitative impairment in reciprocal social interaction and behavioral oddities without delays in language development.

Differential diagnosis of Asperger disorder includes other diagnoses within the autism spectrum and other disorders.
Diagnostic overlap and comorbidity occurs in most mental health conditions

Within autism spectrum

Although absence of language impairment before

age three, normal language skills, and normal intelligence often are used to distinguish between Asperger disorder and autistic disorder,the ability of these criteria to truly distinguish Asperger disorder, autistic disorder, and PDD-NOS is uncertain

Condition

Features that may help to distinguish the condition from Asperger disorder
Significant abnormalities in language,play,and cognitive skills;onset before age three years Significant abnormalities in language,play,and cognitive skills;onset of symptoms before age three years, but diagnosis may be made later than for autistic disorder.The difference between HFA and Asperger disorder is an area of controversy

Autistic Disorder

High-function autism

PDD-NOS Rett disorder Childhood disintegrative disorder

Some, but not all of the criteria for autistic disorder are present Female predominance; head growth deceleration; loss of skills Marked intellectual disability and language impairment

Condition ADHD Schizophrenia Selective mutism

Features that may help to distinguish the condition from Asperger disorder Lack of impairment in social interaction;lack of restricted patterns of behavior;normal pragmatic language skills Hallucination;Delusion;Disorganized speech Lack of impairment in social interaction;normal ability for communication in some settings;lack of restricted patterns of behavior and stereotypies Normal social skills; lack of restricted patterns of behavior;lack of stereotypies;onset before age three years Less impairment in social skills and pragmatic language than for individuals on the autism spectrum; verbal skills typically stronger than nonverbal skill; do not show the same repetitive behaviors and restricted interests Normal social skills; normal pragmatic language;restricted/repetitive behavior are a source of anxiety rather than pleasure Lack of pervasive impairments in social development; lack of circumscribed interestes;subjective distress about social interactions and about specific situations

Language disorder Nonverbal learning disorder

OCD Social phobia

Varying degrees of impairment in social and behavioral function Individulized according to childs age and needs Multidisciplinary approach

Emotional regulation Executive dysfunction Language skills Social skills Adaptive function Academic support Educational plan Motor skills

May be a useful adjunct to behavioral/environmental interventions Do not treat Asperger disorder itself Should be initiated only after educational and behavioral interventions are in place

More sensitive to medication effects More likely to have adverse effects Start at lower doses Doses should be increased more slowly Monitored for side effects

Few studies on psychopharmachologic interventions in children and adolescents with Asperger disorder. Most of studies are small,retrospective and open label

However, there are well-design prospective RCT demonstrating the beneficial effects of risperidone in the treatment of disruptive behavior,and methylphenidate in the treatment of disruptive behaviors and hyperactivity/inattention in children with autism

Psychopharmacologic approaches are target to specific symptoms and comorbid conditions. No pharmacologic treatments target core social perception or the pragmatic language deficits of Asperger disorder

Anxiety
May presents as fearfulness of certain situations

or in response to certain triggers, obsessive compulsive behaviors, and/or disruptive behaviors and difficulty managing anger Treated with the same therapies that are used to treat anxiety in other children.

The role of SSRI in the treatment of anxiety in patients with ASD is uncertain. There are no RCT that specifically assess the efficacy of SSRI in individuals with Asperger disorder However, in metaanalysis of RCT in children without ASD , SSRI were more effective than placebo in reducing core symptoms of anxiety in children and adolescents

May be related to comorbid ADHD Or to other factors that affect function in children with Asperger disorder.