Diagnostico Diferencial En Diagnostico Del Sindrome De Aspeger

Diagnosis and differential diagnosis of Asperger syndrome
Michael Fitzgerald and Aiden Corvin Adv. Psychiatr. Treat. 2001 7: 310-318 Access the most recent version at doi:10.1192/apt.7.4.310

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APT (2001), vol. 7, p.310

Advances in Psychiatric Treatment (2001), vol. 7, pp. 310–318 Fitzgerald & Corvin

Diagnosis and differential diagnosis of Asperger syndrome
Michael Fitzgerald & Aiden Corvin

Asperger syndrome is an uncommon condition, but probably more common than classic autism (the only published population study estimated prevalence at 36 per 10 000 children for Asperger syndrome and 5 per 10 000for autism (Ehlers & Gillberg, 1993)). Misdiagnosis or delayed diagnosis of this disorder is a serious problem, and the average age at diagnosis is several years later than for autism (Gillberg, 1989). Obviously, this can be traumatic for individuals and families; furthermore, the most effective intervention programmes begin early, and establishing management strategies at an early age canminimise later behavioural problems (Howlin, 1998). In 1944 Hans Asperger described a condition he termed autistic psychopathy, characterised by problems in social integration and non-verbal communication associated with idiosyncratic verbal communication and an egocentric preoccupation with unusual and circumscribed interests. Patients with this condition had difficulties with empathy and intuition andhad a tendency to intellectualisation. They were also clumsy (50–90% had motor coordination problems), found it hard to take part in team sports and exhibited behavioural difficulties including aggression and being victims of bullying. Asperger did not provide diagnostic criteria for this condition and it remained obscure until a review article by Lorna Wing in 1981. Wing renewed interest in thecondition, which she renamed Asperger syndrome, and described the following difficulties in the first 2 years of life of children with the condition: (a) a lack of normal interest and pleasure in people around them;

(b) a reduction in the quality and quantity of babbling; (c) a significant reduction in shared interests; (d) a significant reduction in the wish to communicate verbally ornon-verbally; (e) a delay in speech acquisition and impoverishment of content; (f) no imaginative play or imaginative play confined to one or two rigid patterns. A number of authors have subsequently suggested diagnostic criteria, but the six proposed by Gillberg (1991) are, arguably, closest to Asperger’s original description of the syndrome (Box 1). Inclusion of the syndrome in both internationaldiagnostic systems (ICD–10 (World Health Organization, 1992) and DSM–IV (American Psychiatric Association, 1994)) has resulted in broad clinical recognition of the diagnosis, but also in confusion. Asperger syndrome has been renamed Asperger disorder in DSM–IV, and the criteria of both differ from Gillberg’s criteria and Asperger ’s original description of the syndrome.

Box 1 Gillberg’s (1991)diagnostic criteria for Asperger syndrome Social impairments Narrow interests Repetitive routines Speech and language peculiarities Non-verbal communication problems Motor clumsiness

Michael Fitzgerald is Henry Marsh Professor of Child Psychiatry at Trinity College Dublin (Child and Family Centre, Ballyfermot Road, Ballyfermot, Dublin 10, Ireland. Tel: +353 1 626 7512; fax: +353 1 454 4418; e-mail:...