How is Asperger's syndrome diagnosed?

Observation: The first step to diagnosis is having a specialist observe the child, talk with family members about their observations and interactions, and understand the child's social interaction, communication skills, and friendships. It may be helpful for the patient's family members to record observations of behaviors that seem abnormal. A psychological evaluation and assessment of communication skills may be conducted to determine which of a child's strengths and skills may be deficient. A psychosocial evaluation includes a careful history of when symptoms were first recognized, the child's development of motor skills and language patterns, and other aspects of personality and behavior (including favorite activities, unusual habits, and preoccupations). Emphasis is placed on social development, including past and present problems in social interaction and development of friendships.

Physical examination: During a physical examination, a healthcare provider will observe specific behaviors. The healthcare provider typically looks to see how the child responds to commands or questions. An assessment of communication strengths and weaknesses may include evaluating non-verbal forms of communication (gaze and gestures); the use of non-literal language (metaphor, irony, and humor); patterns of inflection; stress and volume modulation; turn-taking and sensitivity to verbal cues; and the content, clarity, and coherence of conversation.

Diagnostic criteria: To be diagnosed with Asperger syndrome, a person must have normal language development and normal intelligence. The individual must have impaired social interaction and repetitive and stereotyped behaviors and interests without significant delay in language or cognitive development. Other criteria include abnormal eye contact, aloofness, the failure to turn when called by name, the failure to use gestures to point or show, a lack of interactive play, and a lack of interest in peers. However, there is no standard set of diagnostic criteria that is used universally, which can result in different diagnoses from different doctors.

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• Poor social interaction.
• Unusual behavior, interests and activities.
• No delay in language development.
• No delay in self-help skills and curiosity about the environment.

Your doctor will take a medical history by asking questions about your child's development, including information about motor development, language, areas of special interest and social interactions. He or she will also ask about the mother's pregnancy and the family's history of medical conditions.

Testing can help your doctor find out whether your child's problem is related to Asperger's syndrome. Your primary care provider may refer your child to a specialist for testing, including:

• Psychological assessment. Intellectual function and learning style are evaluated. IQ (intelligence quotient) and motor skills tests are common. Personality assessment tests may also be done.
• Communication assessment. Speech and formal language are evaluated. Children are tested to find out how well they understand and use language to communicate ideas. Your doctor will also test for understanding of nonverbal forms of communication and nonliteral language skills, such as understanding of humor or metaphor. He or she will listen to your child's voice for volume, stress and pitch.
• Psychiatric examination. Your doctor may examine your child's family and peer relationships, reactions to new situations and the ability to understand the feelings of others and types of indirect communication such as teasing and sarcasm. Your doctor may want to observe your child at home and at school. He or she may also look for conditions such as anxiety and depression, which are often found in people with Asperger's syndrome.

When making a diagnosis, your doctor will see if your child meets the criteria published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), a publication of the American Psychiatric Association.