Asperger's and language developmental delays

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Hey, guys. I'd appreciate some insight on something that's been nagging me.

I've been formally diagnosed with Asperger's, even though I had a language developmental delay when I was a kid (I couldn't talk until I was four years old). I was under the impression that this feature usually precludes a diagnosis of Asperger's, in favour of something like higher-functioning autism.

I brought it up with my psychologist, who specialises in ASD. She said that not all psychologists/psychiatrists believe that this feature should distinguish between AS and HFA (which begs the question of what should distinguish the two). A consulting psychiatrist I was seeing during my last hospital stay also confirmed the diagnosis, but didn't explain her reasoning to me.

I'm in two minds on this one. Was I right in assuming that people who have had a language developmental delay aren't usually diagnosed with AS? If not, how often are such people diagnosed with AS?

Cheers.

Thats what I thought too.

There are low, and middle functioning autistics ( that part Im assuming-never actually heard the term MFA) .

And then there are HFA's who function fairly well in the world and outwardly look like aspies, and both pass for normal much of the time. But because I learned to talk at the normal time -that makes me an aspie. You would be a HFA because of you speach delay.

So I dunno.

Back when Aspergers was first put into the DSM, a lack of speech delay was the key criteria used to separate Aspergers from Autism. Things have changed since then and research suggests that there is no meaningful distinction between those without a speech delay (who would have been labelled Aspergers) and those with a speech delay who eventually learned to speak at a normal level (who would have been labelled Autistic). This is a big part of the reason for the changes coming in the DSM 5.

That makes sense. Except it DOESNT make sense.


As I understand it- its aspergers thats being ditched as a category- not the varying degrees of autism. So if there is no real difference between aspergers and HFA then someone like myself who learned to talk at the normal time would be reclassified from 'aspergers' to HFA.

And there would be no aspies anymore ( ie no one labeled as such).

But the original poster would seem to be a textbook HFA ( in the old system)but is being labeled as an 'aspie' for some reason- and they are going to continue to label him as an aspie in the new era even though that label is going to be discontinued! So it all makes even LESS sense!

Usually not. However, there's a lot of disagreement about how to distinguish AS vs HFA. I've seen people claim that AS is active-but-odd (enjoys interacting but awkward and strange at it) while HFA is aloof (avoids interaction whenever possible). I've seen people claim that AS are clumsy and HFA are well-coordinated. I've also seen people claim that AS have VIQ>PIQ while HFA have VIQ equal or less than PIQ. Each of those criteria will carve out the group along different lines, and many people will be considered AS by some and HFA by others. For example, a person who had a speech delay, then went through a developmental spurt and ended up with VIQ > PIQ, is clumsy, and is socially aloof would cause some disagreement.

This is the big reason why they're getting rid of AS and lumping it all under one label in the DSM-5. There's no agreement about what the distinction should be, and the one thing most commonly suggested (early language delay) isn't as predictive as they thought. (Ongoing language delay, of course, makes a significant difference, but autistic kids who outgrow their language delays aren't significantly different from those who never had any language delay.)

In the new DSM, there is no Asperger's, just Autism Spectrum Disorder. So the language delay requirement has been removed from the DSM, meaning your doctor is right. A significant number of the medical community thought it was not a significant enough difference to even merit a separate diagnosis from Autism.

Both my sons have Aspergers. One started speaking at the usual age the other didn't speak till he was nearly four. Are they going to get rid of the term Aspergers?

I had a mild speech delay and my parents said I was a "Lazy talker" so no I don't think there is any connection...hence it means nothing.

As I understand it (though I'm not an expert, of course)...

A language delay rules out Asperger's (under DSM-IV), but autistic disorder also requires more of the other criteria to be met -- so it's possible to fit an Asperger's diagnosis except for the absense of language delay, but still not quite fit an autistic disorder diagnosis... and in that case, what should they do? Asperger's would still be a good fit, even though not strictly correct.. or they could call it PDD-NOS, which may seem unnecessarily vague.

On a side note, although a language delay is disallowed for Asperger's, it's not required for autistic disorder if another communication impairment is present instead.

Does Australia use the DSM or the IDC? If the IDC then you should have been DXd with HFA as the diagnostic criteria for AS mean that there is no language delay.

According the APA the DSM may be phased out as a diagnostic manual in favour of the IDC at some point, because the IDC is international.

What was the reason for your language development delay? Mine was for hearing loss.

Yeah, I was wondering why my psychologist didn't just give the label of HFA. It's as much a label as AS, but it would be a more conforming one. Maybe she staunchly believes that it's an arbitrary distinction, and thus worth discarding.


The DSM, I think. It was the only one that my psychologist talked about. And she went over it in some detail, including Asperger's not being in the new DSM-V as a distinct diagnosis (in favour of a more comprehensive autism spectrum). I'm not sure what diagnostic criteria she used, but apparently her assessment was based on interviews with my family and me, an IQ test (WAIS-IV, which was conducted by another psychologist), plus taking notes on behaviour and body language (among other things). I was kinda expecting a formal diagnosis to be more "formal".


Not sure. My parents had me looked at by a number of specialists when I was 3 (a hearing test was the first examination that was done). The doctors eventually determined that I had a learning and speech impediment. I was taught to speak at a special school the following year, and I started normal primary school with everyone else when I was 5.

You cannot have a diagnosis of autism (officially) if there is no speech delay - you will always get either AS or ASD.

However, some children diagnosed later are given ASD/AS because speech has "caught up" so even where there was delay there is no longer. The prognosis for kids whose speech catches up within a certain timescale is the same as for those with AS where there is no discernible delay in speech development - there is no difference in the way those children develop therefore they can be diagnosed with the same condition.

Also, if there is another source for the delay in speech - eg. hearing loss due to some cause outside autism such as glue ear - the speech delay will not be considered part of the ASC presentation

Some people are reassessed as AS after an initial diagnosis of autism because it is considered a "better" or perhaps "more desirable" diagnosis. Or, probably, it's a cheaper diagnosis - AS does not automatically imply the need for support services.

This is the only difference in criteria between AS and autism - and there are huge rifts within the professional community over whether or not speech delay is in fact present even in AS people.

The consensus at the moment is that even superficially normal or precocious development in speech still comes with delays in other areas - both receptive and expressive, mostly relating to pragmatic use of language and the understanding of the subtleties like jokes, sarcasm, hyper- literalism..... You can have the most advanced vocabulary of any 2 year old known to have ever existed but if you can't understand sarcasm before you're 5 you have a delay somewhere in your language development!

Consequently, the single distinguishing feature between AS and autism is no longer relevant to diagnosis which is causing a lot of confusion and is in turn leading to a reassessment of the criteria and the understanding that the core root of both conditions is the same.

Neither of these is accurate, for reasons explained in this study.

Autism diagnosis actually doesn't require speech delay. Speech delay counts towards diagnosis, but a kid with normal speech milestones plus echolalia and/or difficulty with back-and-forth conversation would meet the language criteria of autism.

Which also means you can't have AS and not autism, because they haven't managed to find any kids who have social impairment and repetitive behavior meeting criteria for AS, who don't also show either echolalia or conversational impairment.

In order to diagnose AS at all, clinicians have had to ignore part of the criteria (the 'does not meet criteria for autism' bit at the very end). So essentially there are no properly-diagnosed cases of DSM-IV Asperger Syndrome.

What about when fewer than six of the DSM's criteria are met to a significant degree? That would mean they wouldn't meet the criteria for autistic disorder... but Asperger's only seems to require three.

I wish I had gone to your doctor. Now I have to explain what PDD-NOS is everytime I got to a group for people with Asperger's.