Editing Asperger syndrome (section)

== Diagnosis ==
Standard diagnostic criteria require impairment in social interaction and repetitive and stereotyped patterns of behavior, activities, and interests, without significant delay in language or cognitive development. Unlike the international standard,<ref name="ICD-10-F84.0" /> the [[DSM-IV-TR]] criteria also required significant impairment in day-to-day functioning;<ref name="DSM-IV-TR 299.80" /> As noted above, in the 2010s, Asperger syndrome, as a separate diagnosis, was eliminated and folded into autism spectrum disorder in the [[DSM-5]] and the [[ICD-11]]. Other sets of diagnostic criteria have been proposed by [[Peter Szatmari#Diagnostic criteria for Asperger Syndrome|Szatmari ''et al.'']]<ref>{{cite journal | vauthors = Szatmari P, Bremner R, Nagy J | s2cid = 45611340 | title = Asperger's syndrome: a review of clinical features | journal = Canadian Journal of Psychiatry | volume = 34 | issue = 6 | pages = 554–60 | date = August 1989 | pmid = 2766209 | doi = 10.1177/070674378903400613}}</ref> and by [[Christopher Gillberg#Gillberg's criteria for Asperger syndrome|Gillberg and Gillberg]].<ref name=Gill>{{cite journal | vauthors = Gillberg IC, Gillberg C | title = Asperger syndrome – some epidemiological considerations: a research note | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 30 | issue = 4 | pages = 631–38 | date = July 1989 | pmid = 2670981 | doi = 10.1111/j.1469-7610.1989.tb00275.x}}</ref>

Diagnosis of ASD (and previously AS) is most commonly made between the ages of four and eleven.<ref name="McPart2006" /> A comprehensive assessment involves a multidisciplinary team<ref name=NINDS /><ref name="Baskin"/><ref name=Fitzgerald /> that observes across multiple settings,<ref name=McPart2006 /> and includes neurological and genetic assessment as well as tests for cognition, psychomotor function, verbal and nonverbal strengths and weaknesses, style of learning, and skills for independent living.<ref name=NINDS /> The "gold standard" in diagnosing ASDs combines clinical judgment with the [[Autism Diagnostic Interview-Revised]] (ADI-R), a semistructured parent interview; and the [[Autism Diagnostic Observation Schedule]] (ADOS), a conversation and play-based interview with the child.<ref name="Woodbury-Smith" /> Delayed or mistaken diagnosis can be traumatic for individuals and families; for example, misdiagnosis can lead to medications that worsen behavior.<ref name=Fitzgerald /><ref name="leskovec">{{cite journal | vauthors = Leskovec TJ, Rowles BM, Findling RL | title = Pharmacological treatment options for autism spectrum disorders in children and adolescents | journal = Harvard Review of Psychiatry | volume = 16 | issue = 2 | pages = 97–112 | year = 2008 | pmid = 18415882 | doi = 10.1080/10673220802075852 | s2cid = 26112061}}</ref>

Underdiagnosis and [[overdiagnosis]] may be problems. The cost and difficulty of [[Screening (medicine)|screening]] and assessment can delay diagnosis. Conversely, the increasing popularity of drug treatment options and the expansion of benefits has motivated providers to overdiagnose ASD.<ref>{{cite journal | vauthors = Shattuck PT, Grosse SD | title = Issues related to the diagnosis and treatment of autism spectrum disorders | journal = [[Developmental Disabilities Research Reviews]] | volume = 13 | issue = 2 | pages = 129–35 | year = 2007 | pmid = 17563895 | doi = 10.1002/mrdd.20143}}</ref> There are indications AS has been diagnosed more frequently in recent years, partly as a residual diagnosis for children of normal intelligence who are not autistic but have social difficulties.<ref name="Klin-Volkmar" />

There are questions about the [[external validity]] of the AS diagnosis. That is, it is unclear whether there is a practical benefit in distinguishing AS from autism or PDD-NOS;<ref name="Klin-Volkmar">{{cite journal | vauthors = Klin A, Volkmar FR | title = Asperger syndrome: diagnosis and external validity | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 12 | issue = 1 | pages = 1–13, v | date = January 2003 | pmid = 12512395 | doi = 10.1016/S1056-4993(02)00052-4}}</ref> different screening tools may render different diagnoses for the same person.<ref name="NINDS" />

=== Differential diagnosis ===
Many children with AS are initially misdiagnosed with [[attention deficit hyperactivity disorder]] (ADHD).<ref name="McPart2006" /> Diagnosing adults is more challenging, as standard diagnostic criteria are designed for children and the expression of AS changes with age.<ref name=LehnhardtDiffDiag2013rev /><ref>{{cite journal | vauthors = Tantam D | title = The challenge of adolescents and adults with Asperger syndrome | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 12 | issue = 1 | pages = 143–63, vii–viii | date = January 2003 | pmid = 12512403 | doi = 10.1016/S1056-4993(02)00053-6}}</ref> Adult diagnosis requires painstaking clinical examination and thorough [[medical history]] gained from both the individual and other people who know the person, focusing on childhood behavior.<ref name="ASAdulthood">{{cite journal | vauthors = Roy M, Dillo W, Emrich HM, Ohlmeier MD | title = Asperger's syndrome in adulthood | journal = Deutsches Ärzteblatt International | volume = 106 | issue = 5 | pages = 59–64 | date = January 2009 | pmid = 19562011 | pmc = 2695286 | doi = 10.3238/arztebl.2009.0059}}</ref>

Conditions that must be considered in a [[differential diagnosis]] along with ADHD include other ASDs, the [[schizophrenia spectrum]], [[personality disorder]]s, [[obsessive–compulsive disorder]], [[major depressive disorder]], [[semantic pragmatic disorder]], [[nonverbal learning disorder]], [[social anxiety disorder]],<ref name="Fitzgerald">{{cite journal|vauthors=Fitzgerald M, Corvin A|year=2001|url=http://apt.rcpsych.org/cgi/content/full/7/4/310|title=Diagnosis and differential diagnosis of Asperger syndrome|journal=Advances in Psychiatric Treatment |volume=7|issue=4|pages=310–18|url-status=live|archive-url=https://web.archive.org/web/20070910134556/http://apt.rcpsych.org/cgi/content/full/7/4/310|archive-date=10 September 2007|doi=10.1192/apt.7.4.310|doi-access=free}}</ref><ref name="LehnhardtDiffDiag2013rev">{{cite journal | vauthors = Lehnhardt FG, Gawronski A, Pfeiffer K, Kockler H, Schilbach L, Vogeley K | title = The investigation and differential diagnosis of Asperger syndrome in adults | journal = Deutsches Ärzteblatt International | volume = 110 | issue = 45 | pages = 755–63 | date = November 2013 | pmid = 24290364 | pmc = 3849991 | doi = 10.3238/arztebl.2013.0755}}</ref> [[Tourette syndrome]],<ref name="RapinTS" /> [[stereotypic movement disorder]], [[bipolar disorder]],<ref name="Foster">{{cite journal | vauthors = Foster B, King BH | title = Asperger syndrome: to be or not to be? | journal = Current Opinion in Pediatrics | volume = 15 | issue = 5 | pages = 491–94 | date = October 2003 | pmid = 14508298 | doi = 10.1097/00008480-200310000-00008 | s2cid = 21415556}}</ref> social-cognitive deficits due to brain damage from [[alcohol use disorder]],<ref name="pmid18412750">{{cite journal | vauthors = Uekermann J, Daum I | title = Social cognition in alcoholism: a link to prefrontal cortex dysfunction? | journal = Addiction | volume = 103 | issue = 5 | pages = 726–35 | date = May 2008 | pmid = 18412750 | doi = 10.1111/j.1360-0443.2008.02157.x}}</ref> and [[obsessive–compulsive personality disorder]] (OCPD).<ref name="Gillberg&Billstedt2000">{{cite journal | vauthors = Gillberg C, Billstedt E | title = Autism and Asperger syndrome: coexistence with other clinical disorders | journal = Acta Psychiatrica Scandinavica | volume = 102 | issue = 5 | pages = 321–30 | date = November 2000 | pmid = 11098802 | doi = 10.1034/j.1600-0447.2000.102005321.x | s2cid = 40070782}}</ref><ref name="Fitzgerald2001a">{{cite journal|vauthors=Fitzgerald M|s2cid=3814840|title=Diagnosis and differential diagnosis of Asperger syndrome|journal=Advances in Psychiatric Treatment|date=1 July 2001|volume=7|issue=4|pages=310–18|doi=10.1192/apt.7.4.310|doi-access=free}}</ref>