Asperger Syndrome Health Article

DSM-IV criteria for Asperger syndrome

DSM-IV specifies six diagnostic criteria for AS:

• The child's social interactions are impaired in at least two of the following ways: markedly limited use of nonverbal communication; lack of age-appropriate peer relationships; failure to share enjoyment, interests, or accomplishment with others; lack of reciprocity in social interactions.
• The child's behavior, interests, and activities are characterized by repetitive or rigid patterns, such as an abnormal preoccupation with one or two topics, or with parts of objects; repetitive physical movements; or rigid insistence on certain routines and rituals.
• The affected individual's social, occupational, or educational functioning is significantly impaired.
• The child has normal age-appropriate language skills.
• The child has normal age-appropriate cognitive skills, self-help abilities, and curiosity about the environment.
• The child does not meet criteria for another specific PDD or schizophrenia.

Other diagnostic scales and checklists

Other instruments that have been used to identify children with AS include Gillberg's criteria, a six-item list compiled by a Swedish researcher that specifies problems in social interaction, a preoccupying narrow interest, forcing routines and interests on the self or others, speech and language problems, nonverbal communication problems, and physical clumsiness; and the Australian Scale for Asperger Syndrome (ASAS), a detailed multi-item questionnaire developed in 1996.

Brain imaging findings

As of 2005, only a few structural abnormalities of the brain have been linked to AS. Findings include abnormally large folds in the brain tissue in the left frontal region, abnormally small folds in the operculum (a lid-like structure composed of portions of three adjoining brain lobes), and damage to the left temporal lobe. The first brain imaging study (using single-photon emission tomography [SPECT]) of patients with AS found a lower-than-normal blood supply in the left parietal area of the brain. Brain imaging studies on a larger sample of patients is the next stage of research.

Treatment and management

As of 2005, there is no cure for AS and no prescribed regimen for affected patients. Specific treatments are based on the individual's symptom pattern.

Medications

The drugs that are recommended most often for children with AS include psychostimulants (methylphenidate, pemoline), clonidine, or one of the tricyclic antidepressants (TCAs) for hyperactivity or inattention; beta blockers, neuroleptics, or lithium for anger or aggression; selective serotonin reuptake inhibitors (SSRIs) or TCAs for rituals and preoccupations; and SSRIs or TCAs for anxiety symptoms. One alternative herbal remedy that has been tried with AS patients is St. John's Wort.