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    How to Decipher Autism from Asperger's
    Sutter Neuroscience Institute

    How to Decipher Autism from Asperger’s Syndrome

    Michael G. Chez M.D.
    Director of Pediatric Neurology, Sutter Neuroscience Institute

    Autism and Asperger’s Syndrome are both part of the category called Pervasive Developmental Disorders based on standardized psychological description and include other conditions such as Rett’s Syndrome, Child Disintegrative Disorder, and Pervasive Developmental Disorder-Not Otherwise Specified. This brief article will focus only on Asperger’s Syndrome and how it differs from high functioning autism.

    First there are many more similarities than differences in these two groups. Autistic individuals and Asperger’s patients have a predominance of males over females of roughly 6:1 ratio. Both groups have significant social delays, and may have narrow interests that limit social interaction in a reciprocal way with others obsessing and repeating may occur in both groups. However the levels of interest may be more specific, sophisticated, or scientifically advanced in Asperger’s. For example a 6 year old, higher functioning autistic child may obsess on “Thomas the Train” toys or stories, while an Asperger’s child could be a tour guide at the California Railroad Museum. Both have interests in trains, but one is deceptively advanced for age while the other is delayed for age.

    Other issues that differentiate these conditions show that early on, both autism and Asperger patients may have some initial language delays, including pragmatic issues like pronouns or other fluency issues. Usually by age 3-5 years of age the Asperger patient becomes more fluent and corrects his language issues, while the autistic patient who is highly verbal may still make more dysflyuent and dyspraxic speech errors. Also receptive language issues show that auditory processing may be worse in autism, with worth discrimination against background noise, while this bothers Asperger patients to a lesser degree. Asperger’s patients may be able to read and decode with meaning while autism patients may mainly decode but lack understanding of content. Ironically autism patients may spell better than Asperger patients. In mathematics both groups often do well or better than verbal issues. Both groups may be somewhat monotone or robotic in speech. Both groups may have trouble with paying attention, but the Asperger group clinically may respond to a higher degree to stimulant or non-stimulant medication for attention deficit disorder (ADD) than the autism group which often may get more agitated on these medications. Rates of abnormal EEG tracings and seizure frequency is higher in the autism groups vs. the Asperger group. Patients with autism often have problems easily identified by age 3 years, while Aspergers with fluent language may often avoid diagnosis even up to adolescence. Both groups usually need supervision or guardianship after age 18 years, although some Asperger patients may be able to manage their life skills and finances well enough to live more independently. Both groups may ignore certain social norms about hygiene or other nuances. Autism may have more mood related behaviors while Asperger groups often have more depression and anxiety as they reach teenage years. Sleep dysfunction is also higher overall in the autism group.

    This brief article is somewhat oversimplified in the differentiation of these conditions. Sometimes these labels are hard to distinguish in a given individual. Main points to remember are the degree and type of early language and obsessive interests differ by age 3-5 years in early childhood. In school ages language and academic mainstreaming is higher functioning in Asperger’s children than autism, and by adolescence there may be sudden awareness among Asperger patients that they are having social isolation and may become more depressed and anxious.  Reference materials are often very good these days and readily available on Asperger’s patients. Working closely with your health professional team to better understand your child’s condition is encouraged.

    Dr. Chez is the Medical Director of the Sutter Autism and Neurodevelopment Center at Sutter Medical Center, Sacramento. He has more than 20 years experience treating children with conditions along the autism spectrum, has participated in numerous autism clinical research trials, and recently published a book titled “The Medical Management of Autism: A Guide for Parents and Professionals.” Learn more about Dr. Chez at www.sutterneuro.org.