Formal diagnosis criteria for aspergers

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Below is the diagnostic criteria for aspergers. It doesn't state anything about having to have these symptoms showing before age 3. Does anyone know anything about this? A psychiatrist at the Marcus Autism Center in ATL GA told me that the child has to be showing symptoms before age 3 to be formally diagnosed. Is this true? If so, where is this in writing??


Diagnostic Criteria for 299.80 Asperger's Disorder

[The following is from Diagnostic and Statistical Manual of Mental Disorders: DSM IV]
(I) Qualitative impairment in social interaction, as manifested by at least two of the following:
(A) marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
(B) failure to develop peer relationships appropriate to developmental level
(C) a lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g.. by a lack of showing, bringing, or pointing out objects of interest to other people)
(D) lack of social or emotional reciprocity

(II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:

(A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(B) apparently inflexible adherence to specific, nonfunctional routines or rituals
(C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
(D) persistent preoccupation with parts of objects


(III) The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.

(IV) There is no clinically significant general delay in language (E.G. single words used by age 2 years, communicative phrases used by age 3 years)

(V) There is no clinically significant delay in cognitive development or in the development of age-appropriate self help skills, adaptive behavior (other than in social interaction) and curiosity about the environment in childhood.

(VI) Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia."

Im not an expert but as far as I know the signs are harder to see under the age of 3 because kids that age are still learning how to socialise anyway. For example you cant expect a conversation with a 3yo to be completely two way, verbally they are still learning too.

Yeah it didn't get really obvious till she got older, some of it you can pass of as them still being really young, kwim? ven her stims I had chalked up to bad habits and meltdowns I thought were lingering temper tantrums...

People look at a topic and latch onto certain points. And that's true for professionals, too.

It depends on whether this psychiatrist is talking about Asperger's or Autism (which are of course part of the same spectrum).

So, best that I understand with current DSM-4 (and I'm self-educated on this, not a professional):

other symptoms + language delay --> Autism

other symptoms without language delay --> Asperger's

(DSM-5, which is still in the works, more directly states that it's all one spectrum.)

Thanks, but has anyone heard that a child can not be dx with aspergers if no symptoms before age 3?

AS is supposed to be a milder form and they are supposed to develop normally and hit their normal milestones. Because the things they do at a young age is so normal at their age, it doesn't start to show until elementary school because kids have more developed social skills and the aspie is left behind with it. There are also the sensory issues and the clumsiness and the narrow interests and the routines. I am sure all that shows in the early years. Also they are not supposed to have a speech delay and their language develops normal. But most aspies are actually autistic, not AS. from what one of my online friends has told me, very few people diagnosed with AS truly have it. From what a member has said on here, most aspies meet the autistic criteria. So basically people who truly have AS may not be autistic under the new DSM since they are getting rid of AS. You do have to meet all three social deficits. Under the AS criteria, you only need to meet two.

This applies to classic autism, not Aspergers. From the DSM-IV criteria for Autistic Disorder:


You can also tell that psychiatrist that this criteria will no longer apply when the DSM-V takes effect in 2013, and Aspergers and Autistic Disorder are merged into Autism Spectrum Disorder.

Just heard that aspergers is going to be dropped from DSM and be merged with autism. Psych at Marcus Austism Center in ATL GA told me that aspergers is going to be dropped, but didn't say is going to be merged with autism.
If anything, they should all be seperated as much as possible. Most people, when they think of aspergers, they think of meltdowns, bad behaivor, defiance, disrespect, etc. My daughter has the other symptoms such as anxiety, depression, wants friends but can't get them, not agressive, etc. So we're having a harder time in our case getting help.
We were at Marcus Austism Center in ATL GA yesterday FINALLY! But was let down in some ways, I didn't think they would be so, don't want to use the word 'devious' but not sure what to use. The psych said she is the one who sees a new patient and 'asseses' them to see if they will even do an evaluation for them to see if they have autism, aspergers, etc.
This is not what she told me on the phone. On the phone she said that in my dd's situation, meds is the first step. I was getting kind of defensive at office when she said that she has to 'see how they act' for about 15 min in front of her, and that she doesn't seem to have aspergers. I got mad. I said 'well isn't an eval done to diagnose aspergers and not just a 15 minute look at? She got defensive and said 'well I have to see if she has any of the symptoms'. I said well seh does, but she isn't going to show them all at once in a strange place knowing someone is watching her. I thought Marcus was THE BEST, that's what I always heard. Without coming out and saying it, she was just going to turn her down. Well Kayla cried a lot telling her about the situation, I give psych a 3 page list of all symptoms. I said the symptoms didn't show until later, and they keep progressing over time.
What I think was happening is that the place has way too many patients and they are weeding them out for the worst ones. And that is NOT RIGHT! She said she coldn't believe that dd's school wouldnl't do an eval for IEP. I said well it has to do something to do with 'gatekeeping'. She kind of turned red and told her med student in the room 'yes we know about that!'
She kind of plopped the papers down on the table and said 'look, I tell you what'. They are doing a research eval here that is studying eye tracking. It is the exact same eval that is normally used to diagnose autism spectrum disorders.. This way, you can have it done next month instead of 8 months from now.
OH, at one point she said aspergers is going to be 'merged' with autism, but then said they won't be seeing kids with aspergers, only autism. Think I need to do some research on this place. Really dissapointed me.
And, she ordered some blood work and EKG for dd cause it seems she is taking too many meds. ANd we'll go back in 2 or 3 weeks to see about a med change. I had hoped to God that she would change meds right then! My dd is getting WORSE with those meds!
Anyway, I'm trying to see the positive instead of negative in this. --
We weren't even going to be able to have an appt to start with cause this same psych wrote to me before appt was set and said they don't do evals and referred me to different places. I looked on site, they DO evals. I called and asked her do they do evals, she said yes. Then I said thta she said no in the eamil. (gatekeeping) Then she started asking about her problems, and made the appt for meds in 3 months. So THAT was a miracle.
Then, telling us about the research evals in a month instead of 8. Another miracle!! She also said we could come to see her JUST for meds. Even though she originally said they see kids ONLY with autism spectrum disorders. And she was 'seeing' that my dd does not.
So, this is great even though it 'looked' bad.
Has anyone here used Marcus Autism Center in ATL GA? What are your experiences?

Ridiculous. The gold standard for diagnosing autism is called the ADOS (Autism Diagnostic Observation Schedule), and takes about 2 hours to administer. Often they do an IQ test as well, which is another 2 hours. Eye tracking may be an interesting research area, but I highly doubt it is a standard diagnostic tool at this point. Find a developmental pediatrician, developmental psychologist, or pediatric neurologist who is qualified and willing to administer the ADOS. It's not unusual to have a long wait -- we had a 3 month wait for an appt at a clinic in San Diego.

Isn't medication for either depression or anxiety by its very nature trial and error? (just that everyone's biochem is a little different) That's what I've read from several sources. I sometimes struggle with depression, haven't yet tried antidepressants, but they're kind of my ace in the hole.

And also it's sometimes important to step down from the medication in phases even if it doesn't seem to be working.

And/or to complicate things, even if the social rejection is not getting worse, it could be grinding on your daughter more.

PS Please note, I am not a parent. I am just a person who lives my life on the spectrum (happily and comfortably self-diagnosed).

Aah; thanks for enlightening me about the criteria. That does make things clearer for me; and yes, I do meet all the criteria ya stated.

Looking back, one thing that helped me a great deal as a young person was that not all my social eggs were in the one basket of school.

Just by luck, I lived on the edge of the school district and my boy scout troop was in the other school district. I did have one friend at my school and in the troop and his dad was the scoutmaster. My judo club was also outside my school district.

No. But it is common, with retrospect, for parents to realize the symptoms were there before the age of 3. It is also most common for them not to be recognized at that age because there isn't enough social interaction to actually be able to identify AS until later, when they are at an age to attempt engaging in more sophisticated social interactions. That is because the disparity between kids without AS and kids with AS is much easier to see later. At earlier ages, it's not usually as noticeable, because those without AS haven't developed enough yet either. So it's much harder to see the differences unless you really know what to look for.

But no, it is not a requirement. Just read the criteria. But there are a lot of differing opinons in the field. That's to be expected. Diagnosing any disorder in the DSM is only partly science. It is also, in large part, an art.

IMHO, if your doctor is dead set on insisting the symptoms MUST be clear by age three, get another opinion.

EDIT: Also, if you do have your child fully evaluated, and it is found that current behaviors "fit," it is very likely that after that you yourself will start having "Aha!" moments as you realize certain things that did happen before the age of three fit as well. The point is, looking first toward pre-age 3 behaviors, then dismissing the possibility, without first taking a harder look at current behaviors, THEN looking back, is a big mistake and why a lot of true Aspies are never diagnosed properly.

Don't forget, most of us develop coping skills that can confuse the issue. Because of our ability to sometimes learn to cope, a lot of our early signs are too easy to dismiss as unimportant.

I was told by my GP that autism cant be diagnosed before the age of 7, but I suspect he was fobbing me off to be honest! So I took my DD5 to see a health visitor instead and got on track that way avoiding seeing my GP again. This particular surgery is not known for excellence to say the least

I am sure it varies based on what you live, but this is what it seems like where I am:

If your child has severe enough traits, you can get an autism diagnosis or I think a PDD-NOS diagnosis before 3. If the traits are not severe enough they will wait to give an Aspergers diagnosis at 8 or so, because the social deficits are more readily apparent then.

When the new DSM comes out, they will theoretically give an Autism diagnosis in lieu of Aspergers, if the new criteria is met. Some doctors may continue to use the old terminology, but they probably are not supposed to. The new Autism criteria is supposed to be more streamlined, and may not diagnosis as many people as the current standards that have separate criteria for AU and AS but that will not be known for sure until doctors start using the new criteria.

http://www.dsm5.org/proposedrevisions/p ... spx?rid=94



Autism Spectrum Disorder

Must meet criteria A, B, C, and D:



A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:

1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction,

2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.

3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people

B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:

1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).

2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).

3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).

4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).

C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)

D. Symptoms together limit and impair everyday functioning.



Revised January 26, 2011

Severity Level for ASD


Social Communication


Restricted interests & repetitive behaviors

Level 3

‘Requiring very substantial support’


Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning; very limited initiation of social interactions and minimal response to social overtures from others.


Preoccupations, fixated rituals and/or repetitive behaviors markedly interfere with functioning in all spheres. Marked distress when rituals or routines are interrupted; very difficult to redirect from fixated interest or returns to it quickly.

Level 2

‘Requiring substantial support’


Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions and reduced or abnormal response to social overtures from others.


RRBs and/or preoccupations or fixated interests appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress or frustration is apparent when RRB’s are interrupted; difficult to redirect from fixated interest.

Level 1

‘Requiring support’


Without supports in place, deficits in social communication cause noticeable impairments. Has difficulty initiating social interactions and demonstrates clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions.


Rituals and repetitive behaviors (RRB’s) cause significant interference with functioning in one or more contexts. Resists attempts by others to interrupt RRB’s or to be redirected from fixated interest.





New name for category, autism spectrum disorder, which includes autistic disorder (autism), Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified.

Differentiation of autism spectrum disorder from typical development and other "nonspectrum" disorders is done reliably and with validity; while distinctions among disorders have been found to be inconsistent over time, variable across sites and often associated with severity, language level or intelligence rather than features of the disorder.
Because autism is defined by a common set of behaviors, it is best represented as a single diagnostic category that is adapted to the individual’s clinical presentation by inclusion of clinical specifiers (e.g., severity, verbal abilities and others) and associated features (e.g., known genetic disorders, epilepsy, intellectual disability and others.) A single spectrum disorder is a better reflection of the state of knowledge about pathology and clinical presentation; previously, the criteria were equivalent to trying to “cleave meatloaf at the joints”.

Three domains become two:

1) Social/communication deficits

2) Fixated interests and repetitive behaviors

Deficits in communication and social behaviors are inseparable and more accurately considered as a single set of symptoms with contextual and environmental specificities
Delays in language are not unique nor universal in ASD and are more accurately considered as a factor that influences the clinical symptoms of ASD, rather than defining the ASD diagnosis
Requiring both criteria to be completely fulfilled improves specificity of diagnosis without impairing sensitivity
Providing examples for subdomains for a range of chronological ages and language levels increases sensitivity across severity levels from mild to more severe, while maintaining specificity with just two domains
Decision based on literature review, expert consultations, and workgroup discussions; confirmed by the results of secondary analyses of data from CPEA and STAART, University of Michigan, Simons Simplex Collection databases

Several social/communication criteria were merged and streamlined to clarify diagnostic requirements.

In DSM-IV, multiple criteria assess same symptom and therefore carry excessive weight in making diagnosis
Merging social and communication domains requires new approach to criteria
Secondary data analyses were conducted on social/communication symptoms to determine most sensitive and specific clusters of symptoms and criteria descriptions for a range of ages and language levels

Requiring two symptom manifestations for repetitive behavior and fixated interests improves specificity of the criterion without significant decrements in sensitivity. The necessity for multiple sources of information including skilled clinical observation and reports from parents/caregivers/teachers is highlighted by the need to meet a higher proportion of criteria.

The presence, via clinical observation and caregiver report, of a history of fixated interests, routines or rituals and repetitive behaviors considerably increases the stability of autism spectrum diagnoses over time and the differentiation between ASD and other disorders.

Reorganization of subdomains increases clarity and continues to provide adequate sensitivity while improving specificity through provision of examples from different age ranges and language levels.

Unusual sensory behaviors are explicitly included within a sudomain of stereotyped motor and verbal behaviors, expanding the specfication of different behaviors that can be coded within this domain, with examples particularly relevant for younger children

Autism spectrum disorder is a neurodevelopmental disorder and must be present from infancy or early childhood, but may not be detected until later because of minimal social demands and support from parents or caregivers in early years.

In contrast to the DSM IV model:

Autistic Disorder

A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):

(1) qualitative impairment in social interaction, as manifested by at least two of the following:

(a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

(b) failure to develop peer relationships appropriate to developmental level

(c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)

(d) lack of social or emotional reciprocity

(2) qualitative impairments in communication as manifested by at least one of the following:

(a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)

(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

(c) stereotyped and repetitive use of language or idiosyncratic language

(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(3) restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

(b) apparently inflexible adherence to specific, nonfunctional routines or rituals

(c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole body movements)

(d) persistent preoccupation with parts of objects

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

C. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.