ARTICLES
An Epidemiological and Diagnostic Study of Asperger Syndrome According to Four Sets of Diagnostic Criteria

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ABSTRACT

Objective:

This study evaluated the diagnostic process and prevalence rates of Asperger syndrome (AS) according to the DSM-IV, ICD-10, and criteria developed by Gillberg and Gillberg and by Szatmari and colleagues and clarified confusion about AS.

Method:

An epidemiological study of 5,484 eight-year-old children in Finland, 4,422 (80.6%) of whom rated on the high-functioning Autism Spectrum Screening Questionnaire by parents and/or teacher, 125 of them screened and 110 examined by using structured interview, semistructured observation, IQ measurement, school day observation, and patient records. Diagnoses were performed by following the DSM-IV, ICD-10, and criteria developed by Gillberg and Gillberg and by Szatmari and colleagues in detail.

Results:

The prevalence rates per 1,000 were 2.5 according to the DSM-IV, 2.9 to ICD-10, 2.7 to Gillberg and Gillberg's criteria, and 1.6 to the criteria of Szatmari et al.

Conclusions:

The results emphasize the need to reconsider the diagnostic criteria of AS. The importance of multi-informant sources came up, and the need of several informants was highlighted, especially when diagnosing the broader pervasive developmental disorders.

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Asperger syndrome (AS) is a fairly new diagnosis. This disorder, termed “autistic psychopathy” at the very beginning, was originally identified by Hans Asperger (1944). In 1981 Lorna Wing prompted a huge interest in AS by publishing a review and series of 34 case reports

Participants

In Finland compulsory education offers equal educational possibilities for every child ages 7 to 16 years, and prolonged compulsory education for every child with mental retardation ages 6 to 17 years. To optimize the target population we chose school-age children. At primary school there is one main teacher for each class group who teaches the same pupils for several hours each day from 1 to several years. It is common for the same teacher to teach the same group of children for the first 2

RESULTS

AS prevalence according to the DSM-IV was 2.5/1,000 (95% CI 1.4-4.4); to the ICD-10, 2.9/1,000 (95% CI 1.7-5.0); to Gillberg and Gillberg, 1989, Gillberg, 1991, 2.7/1,000 (95% CI 1.6-4.7); and to Szatmari et al. (1989), 1.6/1,000 (95% CI 0.8-3.3). A total of 19 of 4,422 children were diagnosed as having AS (“clinical picture of AS”) according to any of the four diagnostic criteria used in this study, which yields a prevalence rate of 4.3/1,000, with a 95% CI of 2.8-6.7 (Table 3).

Items C, D, E,

DISCUSSION

This study provides the prevalence rates of AS according to four sets of diagnostic criteria and clarifies confusion about AS. Having school-age children as a target population and using both parents and teachers as informants yielded a prevalence rate of 2.5 according to the DSM-IV and 2.9 according to the ICD-10. Two of the children who met the ICD-10 criteria in our study had succeeded well enough and had not needed any outside help or guidance by the time of the study or no longer needed

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    This study received financial support from Finland's Slot Machine Association awarded to the Finnish Association for Autism and Asperger's Syndrome and from the Eija and Veikko Lesonen Foundation, Oulu, Finland, awarded to the Child Psychiatric Research Foundation, Finland. Dr. Mattila received research grants from the Rinnekoti Research Foundation, Espoo, Finland, the Alma and K.A. Snellman Foundation, Oulu, Finland, the Child Psychiatric Research Foundation, Finland and the Child Psychiatric Research Foundation, Oulu Area, Finland. The Graduate School of Circumpolar Wellbeing, Health and Adaptation is acknowledged for their support.

    Article Plus (online only) materials for this article appear on the Journal's Web site: www.jaacap.com.

    Disclosure: Dr. Moilanen is a member of the Lilly Strattera advisory board in Finland. The other authors have no financial relationships to disclose.

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