Asperger’s Disorder (also known as Asperger’s Syndrome, or AS), like other pervasive developmental disorders (PDDs), involves delays and deviant patterns of behavior in multiple areas of functioning, that often require the input of professionals with different areas of expertise, particularly overall developmental functioning, neuropsychological features, and behavioral status. Hence the clinical assessment of individuals with this disorder is most effectively conducted by an experienced interdisciplinary team.
A few principles should be made explicit prior to a discussion of the various areas of assessment. First, given the complexity of the condition, importance of developmental history, and common difficulties in securing adequate services for children and individuals with AS, it is very important that parents are encouraged to observe and participate in the evaluation. This guideline helps to demystify assessment procedures, avails the parents of shared observations that can then be clarified by the clinician, and fosters parental understanding of the child’s condition. All of these can then help the parents evaluate the programs of intervention offered in their community.
Second, evaluation findings should be translated into a single coherent view of the child: easily understood, detailed, concrete, and realistic recommendations should be provided. When writing their reports, professionals should strive to express the implications of their findings to the patient’s day-to-day adaptation, learning, and vocational training.
Third, the lack of awareness of many professionals and officials of the disorder, its features, and associated disabilities often necessitates direct and continuous contact on the part of the evaluators with the various professionals securing and implementing the recommended interventions. This is particularly important in the case of AS, as most of these individuals have average levels of Full Scale IQ, and are often not thought of as in need for special programming. Conversely, as AS becomes a more well-known diagnostic label, there is reason to believe that it is becoming a fashionable concept used in an often unwarranted fashion by practitioners who intend to convey only that their client is currently experiencing difficulties in social interaction and in peer relationships. The disorder is meant as a serious and debilitating developmental syndrome impairing the person’s capacity for socialization and not a transient or mild condition. Therefore, parents should be briefed about the present unsatisfactory state of knowledge about AS and the common confusions of use and abuse of the disorder currently prevailing in the mental health community. Ample opportunity should be given to clarify misconceptions and establish a consensus about the patient’s abilities and disabilities, which should not be simply assumed under the use of the diagnostic label.
In the majority of cases, a comprehensive assessment will involve the following components: history, psychological assessment, communication and psychiatric assessments, further consultation if needed, parental conferences, and recommendations.
Taking a History of the Asperger’s Patient
A careful history should be obtained, including information related to pregnancy and neonatal period, early development and characteristics of development, and medical and family history. A review of previous records including previous evaluations should be performed and the information incorporated and results compared in order to obtain a sense of course of development. Additionally, several other specific areas should be directly examined because of their importance in the diagnosis of Asperger’s Disorder. These include a careful history of onset/recognition of the problems, development of motor skills, language patterns, and areas of special interest (e.g., favorite occupations, unusual skills, collections). Particular emphasis should be placed on social development, including past and present problems in social interaction, patterns of attachment of family members, development of friendships, self-concept, emotional development, and mood presentation.
Psychological Assessment for Asperger’s
This component aims at establishing the overall level of intellectual functioning, profiles of strengths and weaknesses, and style of learning. The specific areas to be examined and measured include neuropsychological functioning (e.g., motor and psychomotor skills, memory, executive functions, problem-solving, concept formation, visual-perceptual skills), adaptive functioning (degree of self-sufficiency in real-life situations), academic achievement (performance in school-like subjects), and personality assessment (e.g., common preoccupations, compensatory strategies of adaptation, mood presentation).
The neuropsychological assessment of individuals with AS involves certain procedures of specific interest to this population. Whether or not a Verbal-Performance IQ discrepancy is obtained in intelligence testing, it is advisable to conduct a fairly comprehensive neuropsychological assessment including measures of motor skills (coordination of the large muscles as well as manipulative skills and visual-motor coordination, visual-perceptual skills) gestalt perception, spatial orientation, parts-whole relationships, visual memory, facial recognition, concept formation (both verbal and nonverbal), and executive functions. A recommended protocol would include the measures used in the assessment of children with Nonverbal Learning Disabilities (Rourke, 1989). Particular attention should be given to demonstrated or potential compensatory strategies: for example, individuals with significant visual-spatial deficits may translate the task or mediate their responses by means of verbal strategies or verbal guidance. Such strategies may be important for educational programming.
Communication Assessment for Asperger’s
The communication assessment aims to obtain both quantitative and qualitative information regarding the various aspects of the child’s communication skills. It should go beyond the testing of speech and formal language (e.g., articulation, vocabulary, sentence construction and comprehension), which are often areas of strength. The assessment should examine nonverbal forms of communication (e.g., gaze, gestures), nonliteral language (e.g., metaphor, irony, absurdities, and humor), prosody of speech (melody, volume, stress and pitch), pragmatics (e.g., turn-taking, sensitivity to cues provided by the interlocutor, adherence to typical rules of conversation), and content, coherence, and contingency of conversation; these areas are typically one of the major difficulties for individuals with AS. Particular attention should be given to perseveration on circumscribed topics and social reciprocity.
Psychiatric Examination for Asperger’s
The psychiatric examination should include observations of the child during more and less structured periods: for example, while interacting with parents and while engaged in assessment by other members of the evaluation team. Specific areas for observation and inquiry include the patient’s patterns of special interest and leisure time, social and affective presentation, quality of attachment to family members, development of peer relationships and friendships, capacities for self-awareness, perspective-taking and level of insight into social and behavioral problems, typical reactions in novel situations, and ability to intuit other person’s feelings and infer other person’s intentions and beliefs. Problem behaviors that are likely to interfere with remedial programming should be noted (e.g., marked aggression). The patient’s ability to understand ambiguous nonliteral communications (particularly teasing and sarcasm) should be examined (as, often, misunderstandings of such communications may elicit aggressive behaviors). Other areas of observation involve the presence of obsessions or compulsions, depression, anxiety and panic attacks, and coherence of thought.