Asperger syndrome differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

Overview

There are several differential diagnosis to consider in the diagnosis of Asperger Syndrome (AS) including attention deficit–hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), schizophrenia, schizoid personality disorder, schizotypal personality disorder and mood disorders.

Differential Diagnosis of Asperger Syndrome

• Conditions that must be considered in a differential diagnosis include:
  • Autism spectrum disorder (ASD)
  • Attention deficit–hyperactivity disorder (ADHD)
  • Obsessive compulsive disorder (OCD)
  • Schizophrenia
  • Schizophrenia simplex
  • Residual schizophrenia
  • Schizoid personality disorder
  • Schizotypal personality disorder
  • Semantic pragmatic disorder
  • Nonverbal learning disorder
  • Mood disorders (depression and anxiety)
  • Stereotypic movement disorder
  • Alexithymia
  • Avoidant personality disorder
  • Antisocial personality disorder
  • Borderline personality disorder
  • Narcissistic personality disorder
  • Nonverbal learning disorder
  • Post traumatic stress disorder (PTSD)
  • Social phobia
  • Compulsive (anankastic) personality disorder

• The following table shows the overlap of some differential diagnoses of AS that have abnormal social interaction:

Some Differential Diagnosis of Asperger Syndrome (Modified Table from The Investigation and Differential Diagnosis of Asperger Syndrome in Adults)
	Asperger Syndrome	Schizoid Personality Disorder	Schizotypal Personality Disorder	Avoidant Personality Disorder	Social Phobia	Obsessive Personality Disorder	Obsessive-compulsive disorder (OCD)	Attention deficit–hyperactivity disorder (ADHD)
Abnormal social interaction	+	+	+	+	+	+	+	+
Abnormal verbal communication	+	+	+	-	-	-	-	-
Abnormal facial expression/gestures/prosody	+	+	+	+	+/-	-	-	+/-
Abnormal eye contact	+	+	+/-	+	+/-	-	-	+/-
Abnormal theory of mind	+	+/-	+/-	+/-	+/-	+/-	-	+/-
Abnormal empathy	+	+/-	+/-	-	-	+/-	-	+/-
Abnormal interests/rituals/compulsions	+	+/-	+/-	-	-	+	+	-
Abnormal attention	+/-	-	-	-	-	-	-	+
Abnormal psychomotor function	+	-	+/-	-	-	-	-	+/-
Abnormal self-injurious behavior	+/-	+/-	+/-	-	-	-	-	+/-
Abnormal psychotic manifestations	+/-	-	+/-	-	-	-	-	-
Abnormal social interaction in childhood	+	+/-	+/-	+/-	-	-	-	+
Abnormal biographical stress factors	-	+	+/-	+	+/-	+	+/-	+/-

Some Differential Diagnosis of Asperger Syndrome (Modified Table from The Investigation and Differential Diagnosis of Asperger Syndrome in Adults)
	Abnormal social interaction	Abnormal verbal communication	Abnormal facial expression/ gestures /prosody	Abnormal eye contact	Abnormal theory of mind	Abnormal empathy	Abnormal interests/ rituals/ compulsions	Abnormal attention	Abnormal psychomotor function	Abnormal self-injurious behavior	Abnormal psychotic manifestations	Abnormal social interaction in childhood	Abnormal biographical stress factors
Asperger Syndrome	+	+	+	+	+	+	+	+/-	+	+/-	+/-	+	-
Schizoid Personality Disorder	+	+	+	+	+/-	+/-	+/-	-	-	+/-	-	+/-	+
Schizotypal Personality Disorder	+	+	+	+/-	+/-	+/-	+/-	-	+/-	+/-	+/-	+/-	+/-
Avoidant Personality Disorder	+	-	+	+	+/-	-	-	-	-	-	-	+/-	+
Social Phobia	+	-	+/-	+/-	+/-	-	-	-	-	-	-	-	+/-
Obsessive Personality Disorder	+	-	-	-	+/-	+/-	+	-	-	-	-	-	+
Obsessive-compulsive disorder (OCD)	+	-	-	-	-	-	+	-	-	-	-	-	+/-
Attention deficit–hyperactivity disorder (ADHD)	+	-	+/-	+/-	+/-	+/-	-	+	+/-	+/-	-	+	+/-

References

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