Adult Asperger's Disorder Diagnosis / Testing / Assessment

Sitting in a coffee shop last week I heard an adult discuss how they were sure they had Asperger Disorder, or High Functioning Autism. "I read the symptoms and I have all of them!" he said. I've actually overheard several adults claim they have autism spectrum disorder, Asperger's or other forms of social cognitive deficit while trying to read, and they always have a story about how their doctor dismissed them, and they really know Asperger's is the cause of every problem in their life! All they need for happiness is a proper assessment and diagnosis of adult Asperger's. I honestly wish it were that easy.

The problem is that several factors complicate the diagnosis of Asperger syndrome (AS), an autism spectrum disorder (ASD). Like other ASD forms, Asperger syndrome is characterized by impairment in social interaction accompanied by restricted and repetitive interests and behavior; it differs from the other ASDs by having no general delay in language or cognitive development. But having social problems, not understanding, catching on or reacting properly to social cues does not in and of itself mean you have adult Asperger's. Those symptoms can mean many different things, ranging from simple "quirkiness" on your part, an "odd personality" to a serious personality disorder, mood disorder, anxiety disorder....or simple shyness. Matching the symptoms to your behaviour and experience is no way for an adult to be diagnosesed with Asperger's Disorder (Notice I sometimes refer to this this disorder as Asperger's Disorder, the most common name, and sometimes Asperger Syndrome, another common name. Both mean essentially the same thing.)

Further problems in the diagnosis of Asperger's, especially in an adult, include disagreement among diagnostic criteria, controversy over the distinction between AS and other ASD forms or even whether AS exists as a separate syndrome. Right now the plan seems to be to stop giving this diagnosis the next time the DSM (Diagnostic and Statistical Manual -  the "Bible" of psychiatric diagnosis, is published).  As with other ASD forms, early diagnosis is important, and differential diagnosis must consider several other conditions. If Asperger's Syndrome or Disorder is not diagnosed early much of the important information we need to make a final diagnosis becomes hard to obtain. We usually use parent reports, teacher reports and observations of play to make the diagnosis. This is hard to do for an adult!

Whena family medical doctor who you have been seeing dismisses your self diagnosis of adult Asperger's disorder or Syndrome it is often because the diagnosis requires that the impairments are "significant, and must affect important areas of function." Often a medical doctor who has seen you for a number of years and observed you makes a quick determination that your "impairments" simply are not "significant." Even though you might think they are. With a few simple questions he or she can, pretty much, rule out Asperger's as a major concern. So, no diagnosis of adult Asperger's for you.

Developmental screening during a routine check-up by a general practitioner or paediatrician should have identified these signs and symptoms, which we would expect would have had a greater impact on you when you were young. Because many individuals come to a physician or psychologist for a diagnosis of "adult Asperger's" when they are having trouble at work, school or other social situations they are very cautious about giving out the diagnosis. The issue often, for the family doctor, is one of severity of symptoms. Why do you need the diagnosis, and what good will it do you? Are you seeking treatment for adult Aspergers? Is there a problem at work? Home? What are the reasons for you coming in?

Many times the symptoms of adult Asperger's are the same as Anxiety Disorders and the treatment is often very similar. The likelihood they could make a diagnosis they might have to defend is small. And, as I've mentioned, many people seeking the diagnosis are have some sort of work or social problem.

There are some other reasons you are unlikely to get a diagnosis from your family doctor: "A comprehensive evaluation includes neurological and genetic assessment, with in-depth cognitive and language testing to establish IQ and evaluate psychomotor function, verbal and nonverbal strengths and weaknesses, style of learning, and skills for independent living. An assessment of communication strengths and weaknesses includes the evaluation of nonverbal forms of communication (gaze and gestures); the use of non-literal language (metaphor, irony, absurdities and humor); patterns of speech inflection, stress and volume; pragmatics (turn-taking and sensitivity to verbal cues); and the content, clarity and coherence of conversation."

Further, "Asperger syndrome can be misdiagnosed as a number of other conditions. Conditions that must be considered in a differential diagnosis include other pervasive developmental disorders (autism, PDD-NOS, childhood disintegrative disorder, Rett disorder), schizophrenia spectrum disorders (schizophrenia, schizotypal disorder, schizoid personality disorder), attention-deficit hyperactivity disorder, obsessive compulsive disorder, depression, semantic pragmatic disorder, selective mutism, stereotypic movement disorder and bipolar disorder[10] as well as traumatic brain injury or birth trauma, conduct disorder, Cornelia De Lange syndrome, fetal alcohol syndrome, fragile X syndrome, dyslexia, Fahr syndrome, hyperlexia, leukodystrophy, multiple sclerosis and Triple X syndrome."

That's a lot to expect your medical doctor to do in a 15 minute examination. And if your symptoms aren't severe, it's unlikely you swill get a diagnosis in the first place.

So what can you do if you really do need a professional and comprehensive diagnosis as an adult with possible Asperger's Disorder (Asperger Syndrome)? Ask for a referral to a neurologist, or a psychologist. Counsellors cannot diagnosis Asperger's. Social Workers can not. Most psychologists do not have the training, experience or the tools to do the testing required. You need to find psychologist who has experience with Asperger's in children as well as adults. Here in BC ACT (Autism Community Training) could recommend someone with the experience and training (they have a list of approved MDs and psychologists). The psychologist looking into your possible "adult Asperger's Disorder" needs to be familiar with the most commonly used tools, the ADOS and ADI-R. The Ministry requires these tools, along with a psychoeducational assessment and functional behavioural assessment before approving an assessment of any child. If your going to a psychologist for an adult assessment of Asperger's, you really should see a practitioner who uses these instruments with children.

A comprehensive assessment of an adult for Asperger's takes two or three days of testing, totalling anywhere from 6-10hours, and can cost from $1,800-$2,600. This kind of assessment is not covered by MSP. Only occasionally will extended health care cover these costs. So it's really best to set up an initial appointment with a psychologist or neurologist and discuss the pro's and con's of undergoing an assessment for adult Asperger's.

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As a Registered Psychologist I provide diagnostic assessments for children, adolescents and adults for Asperger's Disorder, Autism Spectrum Disorder and related social-cognitive deficits. Please feel free to visit my web page: www.relatedminds.com or www.socialcognitivetherapy.com for more information.

This page is not meant to supply medical or psychological advice, or make any suggestions about diagnosis. If you have questions about disorders such as adult Asperger Syndrome or adult Asperger's Disorder, call and speak directly with a Registered Psychologist. The internet is not a good place for any medical or psychological advice!

Aspergers and Relationships: An Adult Love Story

Young adults with Asperger's or high functioning autism have very few resources here in BC. Autism funding is cut at age 19, and there are very few psychologists or other practitioners with experience with adults. In my own practice I see many of these young people as they try to navigate the new and complex set of relationships in college or work that are not as structured or supported as their high school experience may have been. Many young adults with high functioning autism or Asperger's disorder get into social trouble at work, refusing to sign a get well card, or making repeated social mistakes when others are trying to include them. Often the highly intelligent and skilled engineers or other professionals just can't navigate the twists and turns of "small talk." And relationships, which people with autism seek (in spite of what many think) are way beyond their reach without help. I use several books designed especially for young adults, as well as materials based upon the work of Michelle Garcia Winner, a leader in the filed of therapy with children and adolescents with Asperger's or high functioning autism. I also try to find good audio-visual resources, and the New York Times has just printed an excellent article on high functioning autism / Aspergers which contains a wonderful story about a couple and has some excellent and insightful video in it. I recommend it to teens, young adults with autism or Aspegers, and the parents, families, husbands and wires of those with high functioning autism or Aspergers.  Here is the information and link:

Navigating Love and Autism
By AMY HARMON
Published: December 26, 2011
For Jack Robison and Kirsten Lindsmith, both of whom fall on the autism spectrum, being in a relationship together has created a unique set of comforts and challenges.

http://www.nytimes.com/2011/12/26/us/navigating-love-and-autism.html

Dr. Jim Roche
Offices in Vancouver and Burnaby
http://www.socialcognitivetherapy.com

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http://www.relatedminds.com
http://Therapists.PsychologyToday.com/rms/70682
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Autism Rates Increase...dramatically. Why?

According to the Centers for Disease Control (CDC), nearly one percent of U.S. children have some form of autism. This is 20 times higher than the rate of autism spectrum disorder found in the 1980s. In this NPR broadcast (link below) Alan Zarembo of The Los Angeles Times and clinical psychologist Catherine Lord discuss what’s behind the growing number of diagnoses. The explanations may not be as mysterious as some project.

Listen here: NPR

Aggression, Autism and Families

Dr. Jim Roche is a registered psychologist who provides diagnostic assessments for autism (ASD) and Asperger's Disorder as well as individual treatment and intervention for children, adolescents and adults with autism spectrum disorder in both his Vancouver and Burnaby BC offices. 


More information on Dr. Roche's autism related services can be found at: http://www.relatedminds.com  or at http://www.socialcognitivetherapy.com


A recent story in the LA Times about autism provides an excellent video about Jonah Funk, 13, who was diagnosed with autism nine years ago. His mother, Stacie, says she often describes herself as his eyes, his ears and his voice. "I want him to be treated fairly," she said. "I want him to receive the things he needs." The video is interesting in that it opens up this family's life from moment to moment, showing us both their successes as well as their ongoing problems. One of the issues that is evident in the video is Jonah's ongoing aggression. While appearing pretty mild, his parents are concerned about where this aggression will lead, as he disrupts the lives of his siblings and travel in the community becomes problematic.


What to do? Well, it's a good example of when professional help is necessary. A behavioural specialist is seen in the video, however this specialist isn't seen doing any real interventions. This is too bad, as it would be interesting to see what steps the intervention specialist, and Jonah's parents, are taking. From my perspective it's obviously well past time to conduct a functional behavioural analysis (FBA). This behavioural assessment will tell us what the function of the unwanted behaviour is, and we can then take two important steps towards dealing with it: 1) Teaching an appropriate alternative behaviour that meets the same function (know as a "FERB" or Functionally Equivalent Replacement Behaviour) and what environmental changes we need to make to reduce Jonah's need to engage in the behaviour.


Working with a highly trained behaviourist is important when trying to reduce these negative and sometimes aggressive behaviours. As a behavioural specialist in school districts for over the past 15 years I have relied upon one particular site for training materials: PENT California. The PENT site is a website provided for school based professionals working with all sorts of behavioural issues in the public schools. Their training materials are free, up to date and have withstood legal battles over the adequacy of an FBA. 


Working with a highly trained behaviourist is important when trying to reduce these negative and sometimes aggressive behaviours. As a behavioural specialist in school districts for over the past 15 years I have relied upon one particular site for training materials: PENT California. The PENT Positive Environment Network of Trainers) site is a website provided for school based professionals working with all sorts of behavioural issues in the public schools. Their training materials are free, up to date and have withstood legal battles over the adequacy of an FBA.  Completing a functional Analysis can be very difficult, and the individual completing it needs fairly advanced training and experience in behavioural theory. If you are having trouble with aggression, even minor aggression, I would talk with your school based team first. They may very well have someone who is an expert on these issues.  The next level would be the school psychologist who may have expertise on autism and aggression. After that, here in BC you might ask for a consultation from POPARD, the Provincial Outreach Program for Autism and Related Disorders. POPARD's professionals often have extensive training and experience in dealing with this type of low level behavioural issue. Finally, there are outside behavioural interventionists (usually approved by ACT: Autism Community Training, as a Behaviour Interventionist or behavioural specialist. At any rate, address these issues quickly. and start by having an FBA completed. These days we usually don't just use the term FBA, but instead use the terms FBA and PBSP, meaning "Positive Behavioural Support Plan," as the emphasis, as you can see from my description above, is not on punishment or control, but instead on skills development and environmental support. Usually that's all we need to change these low level aggressive behaviours before they become problematic.  

Click here to see the LA Times story: LATimes Video