How do doctors make an Asperger diagnosis?

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I keep reading on these forums that the online tests are not accurate, that it is necessary to consult a professional to get a proper diagnosis. I understand this, but how exactly does a professional diagnose someone? Doesn't he or she also just use tests?

Good point and there are many instances here where the professional has dismissed the possibility of AS for reasons that indicate a limited knowledge of how ASD's can manifest and also how to diagnose an ASD in an adult who has had years to learn coping mechanisms.

I'm in the process of getting a diagnosis, and so far I haven't done a single test. I've had a conversation with 2 psychiatrists, and Friday I'm going for another discussion with one of the psychiatrists and my partner. I don't know afterwards what will happen, but standardised tests haven't been mentioned so far.

I get the idea that doctors use the method of discussing with the patient and paying attention to all cues (including the non-verbal ones) to make a diagnosis, rather than using standardised tests.

At least, that's how they seem to do it here in the Netherlands. I can't tell how it is in other countries.

That is a problem indeed. Here in the Netherlands the Dutch Association of Psychiatrists has started this year to offer a special course "Autism among Adults" for its members, so that all psychiatrists can start to learn to handle the issue. I seem to be lucky enough that in my town there are a few psychiatrists who are already experts in the domain of Autism.

when i was dx in 1993 there were no tests,just doctor analysis,that was then this is now.i have no clue what dx means today

I'm not exactly sure, but i went to my GP for a formal diagnosis about a year ago, and he's either forgotten about me, or there's one big queue/pile of stuff to think about ...

They do include tests, but that's not the only only part of an evaluation - a lot of it is just watching the person while you put them in different situations via the tests. Also, they are a lot more descriptive of what each question means, and how you should answer than the online tests are, and they include tests I've never seen available online because they aren't simple "give me a number for this" tests.

A diagnosis includes tests, but it also includes them watching for traits, interviews with you, interviews with people who know you well, and various things like that.

So, no, a professional does not just use tests.


(Yes, I'd agree, evaluations in adults want people who have specifically studied how AS appears in adults. The person I went to was the most highly recommended person for diagnosing ASDs in Central Massachusetts and he explicitly had studied ASDs in both children and adults)

I'm not sure if this is the same everywhere, but where I live there are no doctors with experience of diagnosing asperger's in adults.
There seems to be plenty who feel qualified to dismiss asperger's as a diagnosis though.

I found Tony attwoods book " the complete guide to asperger's" very good for explaining the diagnostic criteria. It includes the DSM-IV criteria,
AAA )Adult Asperger Assessment,
Gillberg and Gillberg.
There seems to be a lot of variation from one place to another as to how a diagnosis is reached.
All very confusing.

One way is to go to a psychologist who has been trained on administering the ADOS (Autistic Diagnostic Observation Schedule), which is a test that involves a series of activities and conversations. It's more than just the answers you give -- the psychologist makes close observation of things like eye contact, use of gestures, reciprocity in conversation, etc. You can find out more on it from google or wikipedia. There are 4 different versions -- one for pre-verbal children, one for verbal young children, the third I think is either for older children or teens, and the fourth is for adults.

The psychologist also uses a lot of the history you report -- such as failure to develop peer relationships, troubles in the work environment, etc.

I don't know as much about the adult version of the test, but it was very interesting to watch when my 6 yo DS was evaluated. (Althougth I didn't realize what it was at the time, he was also given the non-verbal test at 30 months, and at that time the psychologist said he wasn't autistic, just strong willed!)

Some of the interesting parts of the test:
* DS was given a book that had an elaborate story about a frog (all in pictures, no words), and he was asked to tell the story as he paged through the book. (He described literally what he saw on each page, not developing the story at all.)
* at one point we walked to the office next door, and the psychologist watched while he had a conversation with the person there
* He was asked, "Why do people get married?" His answer was, "Because they want to wear a ring."
* They played with action figures, and the psychologist observed whether he could engage in pretend play, and whether he would go along when she tried to change the story
* He was asked what it meant to be happy/sad/mad/lonely and what things made him happy/sad/mad/lonely

It took about 1.5 hours, and I was impressed by the creativity of the people who created the test.

Link to this quote is at the bottom of the page.

I would guess that part of the problem getting diagnosis is finding the right doctor to do it.

Aspergers syndrome correlates with Asperger’s Disorder defined in section 299.80 of the DSM-IV by six main criteria:



A. Qualitative impairment in social interaction, as manifested by at least two of the following:

(1) 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
(2) failure to develop peer relationships appropriate to developmental level
(3) 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 to other people)
(4) lack of social or emotional reciprocity



B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

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



C.The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.



D. 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).



E. 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.



F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

Aspergers syndrome is also known as Asperger syndrome, or AS for short. It is a Pervasive Developmental Disorder, one of five neurological conditions characterized by difference in language and communication skills, as well as repetitive or restrictive patterns of thought and behavior. The other four related disorders or conditions are autism, Rett Syndrome, Childhood Disintegrative Disorder, and PDD-NOS (Pervasive Developmental Disorder Not Otherwise Specified).

Autism & Asperger Fact sheets

I was diagnosed at 8 years old but I don't remember how they did it. I remember going to the clinic after school once every 2 or 3 weeks with my mum, but I don't remember what they actually did.