Three diagnostic approaches to Asperger syndrome: implications for research.
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.


METHODS
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.
Klin
Ami
A
Yale Child Study Center, 230 South Frontage Road, New Haven, CT 06520, USA. ami.klin@Yale.Edu
Pauls
David
D
Schultz
Robert
R
Volkmar
Fred
F
D000293:Adolescent; D000328:Adult; D020817:Asperger Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D001321:Autistic Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D002648:Child; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000453:epidemiology; D007406:Interview, Psychological; D008297:Male; D013064:Speech Disorders / Q000175:diagnosis / Q000453:epidemiology