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!