very annoying diagnostic criteria for

Very annoying: the diagnostic criteria for Asperger's are not all that

useful

More confirmation that Asperger's is a very vague clinical concept.

Three diagnostic approaches to Asperger syndrome: implications for

research

J Autism Dev Disord. 2005 Apr;35(2):221-34.

Klin A, Pauls D, Schultz R, Volkmar F.

Yale Child Study Center, 230 South Frontage Road, New Haven, CT

06520, USA. ami.klin@Yale.Edu

OBJECTIVE: To examine the implications for research of the use of

three alternative definitions for Asperger syndrome (AS).

Differences across the three nosologic systems were examined in

terms of diagnostic assignment, IQ profiles, comorbid symptoms, and

familial aggregation of social and other psychiatric symptoms.

METHOD: Standard data on diagnosis, intellectual functioning,

comorbidity patterns, and family history were obtained on 65

individuals screened for a very high probability of having autism

without mental retardation (or higher functioning autism, HFA) or

AS. Diagnoses of AS were established based on three different

approaches: DSM-IV, presence/absence of communicative phrase speech

by 3 years, and a system designed to highlight prototypical

features of AS. RESULTS: Agreement between the three diagnostic

systems was poor. AS could be differentiated from HFA (but not from

PDD-NOS) on the basis of IQ profiles in two of the three systems.

Differences in patterns of comorbid symptomatology were obtained in

two of the three systems, although differences were primarily

driven by the PDD-NOS category. Only one of the approaches yielded

differences relative to aggregation of the "broader phenotype" in

family members. CONCLUSIONS: Diagnostic assignments of AS based on

three commonly used approaches have low agreement and lead to

different results in comparisons of IQ profiles, patterns of

comorbidity, and familial aggregation of psychiatric symptoms

across the approach-specific resultant groups of HFA, AS, and

PDD-NOS.

Researchers need to find more reliable ways to partition their study

groups. Asperger's and Autism in general is a "garbage bag" type of

diagnosis and is likely to be eventually retired.