1.
Diagnosing Adults with
High Functioning Autism
or Asperger Syndrome
Tanya Breen
NZPsS Conference August 2011

2.
Areas covered today
1. Background information
2. Issues for adults suspected of having HFA/AS
3. Diagnostic processes
4. Clinical experience
5. Literature, information, support & resources for
professionals
6. Post diagnosis support

3.
Autistic disorder or autism
Pervasive developmental disorder characterised by
impairment in:
Social skills
Communication skills
Or by the presence of stereotyped behaviour and
interests
Delay/abnormality before age of 3 in at least one of:
social interaction, language, symbolic/imaginative play
High functioning autism (HFA) simply means “autism
with an IQ 70 or above”

4.
Asperger’s disorder
(or Asperger syndrome)
Essentially the same as autism but:
no clinically significant impairment in langauage
no clinically significant delay in cognitive development
or age-appropriate adaptive behaviour

5.
Autism Spectrum Disorder
Research indicates that after the age of 3, when IQ is
accounted for, there is no difference between people
with autistic disorder (autism) & Asperger syndrome
2008 - NZ Autism Spectrum Disorder Guideline
2013 - DSM-V will use ASD only

6.
Basic facts
NZ Autism Spectrum Disorder Guideline suggests that
over 40,000 people in NZ have ASD, & most are
undiagnosed adults
More males than females (but this seems to be
changing)
Probably genetic
Not related to MMR vaccine
Cannot be “cured”

7.
Issues for adults
ASD is a lifelong condition, not only a disorder of
childhood
Pervasive - effects all aspects of life
Often undiagnosed
Diagnostic overshadowing (ADHD, depression)
Misdiagnosed (atpical schizophrenia, personality
disorder)

8.
Impact varies time/situation
Relationships (friends, partners, children, colleagues)
Education (academic, organisational & physical
demands)
Work (unemployment, under-employment, income)
Emotional well-being (self-esteem, depression, anxiety,
abuse)
Health (attention to needs, sensory sensitivity, epilepsy)
Rights & responsibilities (citizenship, participation, legal
issues)

9.
Being undiagnosed means
Feeling different (“wrong planet”) or crazy
Being misunderstood, & often blamed unfairly
Almost constant anxiety
Isolation

10.
Being diagnosed means
Understanding of self & by others
Finding a peer group
Learning how to manage impact of symptoms
Getting the right help
Relief to some, shock to others
“Congratulations It’s Asperger Syndrome” Jen Birch
2003 www.aspergers.co.nz
"Beyond diagnosis: Welcome to the autism spectrum"
ASK Trust 2011 www.asknz.net

11.
But ...
Few formal or funded pathways for diagnosis exist for
adults without an intellectual disability or not “in trouble”
Mental health services lack relevant experience &
training
Private practitioners lack skills &/or confidence
The experience of adults seeking diagnosis is too often
one of being fobbed off, referred on, or poorly served

12.
Reason for today’s
presentation
Help you increase your skills
Increase your confidence
Increase the number of psychologists willing/able to
conduct these assessments
Improve life experiences of adults with HFA/AS
Please put your name and contact details on the list!

13.
Diagnostic assessment
See NZ ASD Guideline & www.asdguideline.com
Multidisciplinary gold standard, but sole practitioner
possible (supervision & peer support essential)
Methodical
Match complexity of assessment to reason for referral:
Curiosity vs. Trouble
Legal vs. Clinical
Referrer / payee

14.
Assessment components
Detailed health, developmental & behavioural history
Pattern of skills, disabilities & behaviours
Comprehensive file review (transitions, peer relations)
Medical evaluation (health sometimes neglected)
Direct evaluation (interview &/or observation)
IQ & other cognitive sills (not all geniuses)
Adaptive functioning (Vineland ABS-2 has ASD norms)
Mental health (multiple diagnoses, disagreement)

15.
Assessment components (ctd)
Neurological assessment (epilepsy)
Communication & audiology (hearing, body language)
Sensory, motor & perceptual (sensitivity)
Vision
Occupational & physical therapy
Social competence
Family resources & needs
Consideration of co-morbid & co-existing conditions

16.
What do I do?
Minimum: interview the person, observe how they
respond in meet/greet & interview, administer screens
or self-report tests
Medium: as above, plus interview significant others &
review historical documents
Comprehensive: as above, try to cover or have covered
all apects on previous slides, & use “gold standard”
tests like the Autism Diagnostic Interview - Revised

17.
Self report measures
Asperger Questionnaire (Baron-Cohen)
Empathizing & Systemizing Quotients (Baron-Cohen)
Physical Prediction Questionnaire (Baron-Cohen)
Friendship Questionnaire (Baron-Cohen)
Social Situations Questionnaire (Baron-Cohen)
Theory of Mind tests (various)

18.
Gold standard tests
Autism Diagnostic Interview - Revised - trainers in
Australia, one NZ workshop
Autism Diagnostic Observation Schedule - as above
DISCO - often used in other countries - no training has
occurred in NZ
NZ ASD Guideline updates: www.asdguideline.com

19.
Differential diagnosis
More obvious symptoms:
Obsessive interests (find out in advance, time them)
Communication skills (reciprocal conversations)
Social skills (meet & greet observation, small talk)
Unique and deep topics of conversation
But similar/same symptoms occur in many other
disorders (OCD, social phobia, psychoses, ADHD)

20.
Differential diagnosis (ctd)
Look for what was/is missing (a.k.a. behavioural
deficits):
Joint attention, sharing interests & pleasure
Responding to social cues
Giving (and needing) comfort
Recognising emotions in self and others
Subtle emotions (rather than extremes)
If these present in early childhood, ASD more likely

21.
Clinical cases
Brian, 30s - engineer, married, some relationship
issues, son recently diagnosed with ASD, recognition
of symptoms in Brian’s behaviour - ASD confirmed
Sally, 40s: long mental health history, multiple
diagnoses, professional disagreements, interventions
had little of no effect, repeated offending despite more
serious consequences - ASD confirmed (e.g. the line)

22.
Clinical cases (ctd)
Albert, 70s: retired farmer, adult children, wife saw
article on ASD on “Sunday”, suspect ASD is reason for
marital problems - ASD excluded
George, late 20s: charged with very serious offence
against a person, referral “role of ASD in offence?”,
long history of antisocial and criminal behaviour,
historically autism diagnosed after 1 hour consultation,
- ASD not confirmed

23.
Key autism journals
Autism
Autism Research
Focus on Autism and Other Developmental Disabilities
Research in Autism Spectrum Disorders
Journal of Autism and Developmental Disorders

24.
Other helpful journals
Mental Retardation and Developmental Disabilities
Research Reviews
Journal of Intellectual and Developmental Disability
Journal of Intellectual Disability Research
Journal of Applied Research in Intellectual Disabilities

25.
Information, support &
resources for professionals
Altogether Autism www.altogetherautism.org.nz
National contract for ASD information provision
Expert searching of Internet (17/8/11: 81,400,000
Google hits for autism &14,100,000 for Asperger)
Tailor made information packages (including reading
lists, recommended texts)
Access to clinical consultant & team of ASD experts
ASD Provider Database (please put names on list)
Circulates information on training

26.
Information, support &
resources for professionals
Ministry of Health sponsored website on ASD
recognition & referral www.asdguideline.com
Research Autism - website aimed at anyone people
with ASD, parents & carers, service providers and
policy makers. Big, up-to-date, & scientifically reliable
www.researchautism.net
Autism New Zealand bookshop and library
www.autismnz.org.nz
Werry Centre training, ADI-R & ADOS workshops

27.
Post diagnosis support
Learn about ASD & how it affects the individual & family
Hard copy information
Information on ASD (books and first person accounts,
reputable websites, You Tube, science & facts)
Networking with other people with ASD (national and
international websites, ASD organisations)
Contact Altogether Autism for an information pack

28.
Thank you & questions
Tanya Breen
Consultant Clinical Psychologist
tanya@tanyabreen.co.nz
Clinical Consultant, Altogether Autism
tanyabreen@altogetherautism.org.nz
Please put your name on the list!