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Differential diagnosis

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Differential diagnosis

Postby anasthasia » Mon Jul 27, 2009 7:18 pm

There is a place for everyone to add the differences between Asperger's syndrome and other disorders which can be misdiagnosed with it.
It might help distinguish between them.

Feel free to add some new.

What is the difference between Schizoid Personality Disorder and Asperger's Syndrome?

There are some core differences between AS and SPD, the biggest one being that AS is a form of autism while SPD isn't. We could say that AS is a person with a differently wired brain, but that a person with SPD has a "neurotypical" brain that just happened to develop a peculiar personality of extreme introversion and emotional detachment.
People with SPD don't have many of the "autistic" characteristics of AS, like the strong preference for logical patterns in things and people, a natural interest for numbers and other logic related things, the inability to read facial expressions and the lack of innate knowledge that other people aren't rule based and have motivations that might be different than the person with AS.
SPD is more about never-ending introspection, rationalisation and hyperreflection about pretty much everything. People with SPD have an extremely rich internal world that only rarely surface, and from the outside, people with SPD seem to be completely aloof and detached; but they are in no way autistic. It's just that they rationnalise and internalise everything, but their understanding of the world around them is completely unaffected. They can participate in discussions normally, can get along with people like anybody, but are very unlikely to participate in them by themselves if they don't have to and will almost always prefer to be alone. They do have a strong tendency to be perpetually daydreaming if left idle and are likely to think about fantasy and fictious worlds much more than "normal" people would.

People with SPD may be socially inept due to lack of practice and lack of motivation. They are withdrawn because it makes life easier, because they do not gain a great deal of happiness from getting close to people.
People with AS have an inability to understand social cues. I would say they are withdrawn when they are engrossed in their particular fascination.
People with Schizoid personality disorder are not diagnosed and treated because, they are unlikely to seek medical help and if they do so that doctor or psychiatrist will find it difficult to see how the patient can be helped.
Mostly though people who suffer from Asperger are mentally unable to read the emotional states of other people, while people who suffer from Schizoid Personality Disorder can have an excellent understanding of other people's emotions but don't care about them or don't seem them as being relevant.

People with Asperger's have developmental problems, and it poses a lot of social issues, such as inability to pick up on social cues. It's basically a mild form of autism, from what I know. They usually have limited interests, and like having constant routines that they follow.

What is the difference between being Bipolar and having Asperger's syndrome?


There is a huge difference between bipolar disorder and asperger’s they are totally different diagnosis. Bipolar disorder is a mood disorder.
A person could have both conditions.

Bipolar is a MOOD disorder caused by a chemical imbalance in the brain. It makes people have episodes of depression and mania. There are several forms of Bipolar, but they can be controlled with medication. For example, the gold standard for Bipolar 1 is Lithium. Many people with Bipolar 2 are on Lamicatal.
Asperger’s Syndrome is a PERVASIVE DEVELOPMENTAL disorder. People with aspergers have problems relating and with social interaction and tend to have restricted patterns of behavior, interests and activities. Unlike other autism spectrum disorders, people with aspergers have no delay in language or cognitive development.
The two are NOT related at all.

Someone with Asperger’s syndrome is “socially blind”. They struggle with social interactions, they are socially awkward, cannot read or use body language or facial expressions well, have difficulty making eye contact, may not understand sarcasm, jokes or politeness and tend to take things literally, may display socially inappropriate behavior without realizing it, may lack empathy, have obsessive interests and may have problems such as sensory issues and poor motor skills.
Someone with bipolar disorder has extreme emotional ups and downs. One day they may feel so depressed that they can’t get out of bed or do simple daily things. The next day they may feel great and be full of energy and feel like they can do anything.

What is the difference between Antisocial personality disorder and Asperger's syndrome?

Aspergers people are capable of love, and it's not uncommon at all for them to feel it - quite the reverse. Merely, they have problems understanding other people's needs, or guessing how other people feel - this means they are often bad at showing it. Bedwetting, again, is associated with a lot of disorders. Aspergers because a great many kids wet the bed when suffering anxiety in day-life (and Aspergers people of all abilities suffer high levels of anxiety... it's a scary world for them, and makes less sense than it does for us.)

A Sociopath, however, doesn't feel anything, and is usually driven by anger. They're cold and calculating, and have a bit of charm to them. (You'll find there are abrasive psychopaths who don't have this.) A sociopath learns normally, but just can't bond with anybody.

Aspergers people do not enjoy social interaction, and neither do the sociopathic, but for different neurological and biological reasons.

Aspergers people have impairments in imagination, and social skills.
Whereas Anti-social personality disorder people (inc sociopaths) have no regard for other people's rights, they know what they are. Aspergers don't understand them, but respect them once taught (well.. as far as any kid does). Whereas anti-social personality disorder people are often very deceitful, Aspergers people very rarely are... at least naturally (they can learn, believe me). Aspergers people tend to prefer a fixed routine, antisocial people are often impulsive and unpredictable. Aspergers people do show/feel remporse, antisocial people do not.

Of course, these are all generalizations, but these are very different disorders with different symptoms, causes and methods of treatment.


What is the difference between AS and ODD?

Asperger syndrome children/adults can be difficult to manage and exhibit noncompliant behaviors.
However, the reasons for the apparent noncompliance are different.
An important difference between an AS child/adult and a oppositional defiant child/adult is volition.
While the oppositional defiant child/adult will planfully disobey the »rules«, the AS child/adult will generally make an effort to follow the rules as he understands them.
However, his understanding of the rule may be impaired either because of a miscommunication (comprehension or language pragmatics), sensory overload, misreading of contextual (nonverbal) cues, inattention, or because he acted impulsively.
Additionally, when an AS child/adult learns a rule in one environment, the behavior will not generalize to a new setting. In the new setting the contextual cues are different, and the AS child/adult will perceive the similar setting/situation as entirely different.

What is the difference between Asperger's Syndrome and Obsessive Compulsive Disorder?

People with OCD do not lack the social skills as those with AS do.
However, in some instances a person with OCD may develop poor relationship with his/her peers.
This may occur when their obsessions and compulsions occupy a lot of their time, which can lead to social withdrawal.
Furthermore, if the compulsions are severe the person may be unable to hide them from his friends, which can lead to teasing.
Person may also develop poor self-esteem because he views himself as being different from other people, but overall people with OCD have normal peer relationships.
People with OCD can follow social rules, but they may adhere to an adult moral code, even as a child, and become upset when their childhood/teen peers do not follow certain rules.
Without training, guidance and instruction AS person will demonstrate difficulty adhering to social rules, such as not talking while others are talking or knowing when to appropriately end a conversation. Many AS people will also demonstrate poor motor coordination and clumsiness.

What is the difference between AS and Dyspraxia?

AS people have social deficits that affect the three areas known as the triad of impairments, and don't necessarily have any issues with movement and co-ordination. AS is probably the closest ASD to Dyspraxia as the movement and co-ordination difficulties are part of the diagnostic criteria.

although they present in very similar ways, Dyspraxia is when the gross motor movements, fine manipulative movements and spacial awareness are more affected and the social impairments are less distinct.

What is the difference between AS and semantic-pragmatic disorder?

Semantic-Pragmatic Disorder (SPD) or pragmatic language impairment (PLI) is a proposed concept of a developmental disorder related to autism and Asperger syndrome.
The name refers to the fact that people with SPD have special challenges with the semantic aspect of language (the meaning of what is being said) and the pragmatics of language (using language appropriately in social situations).
Individuals with SPD have particular trouble understanding the meaning of what others are saying, and they are challenged in using language appropriately to get their needs met and interact with others.

People with the disorder often exhibit:

• delayed language development
• aphasic speech (word search pauses, jargoning, echolalia, word order errors, word category errors, verb tense errors or dysfluency)
• difficulty with pronouns or pronoun reversal
• difficulty understanding questions
• difficulty understanding choices and making decisions.
• difficulty following conversations or stories. Conversations are "off topic" or "one sided".
• difficulty extracting the key points from a conversation or story; they tend to get lost in the details
• difficulty with verb tenses
• difficulty explaining or describing an event
• tendency to be concrete or prefer facts to stories
• have difficulty understanding satire or jokes
• have difficulty understanding contextual cues
• difficulty in reading comprehension
• difficulty with reading body language
• difficuly in making and maintaining friendships and relationships because of delayed language development.
• difficulty in distinguishing offensive remarks
• difficulty with organizational skills

People with SPD often share additional characteristics consistent with Asperger's. For example, they may dislike or avoid eye contact. Many have rigid habits, a shallower range of interests than most people (often with a deep knowledge of their areas of interest), sensory and eating sensitivities, coordination and muscle-tone issues. They may also display striking abilities in an area like mathematics, computer science, geography, astronomy, reading, history, politics or music.
SPD was originally defined in the literature on Language Disorder in 1983, by Rapin and Allen, although at that time it was classified as a syndrome.
They referred to a group of people who presented with mild autistic features and specific semantic pragmatic language problems. More recently, the term "pragmatic language impairment" (PLI) has been proposed.
According to Bishop & Norbury (2002), people with semantic-pragmatic disorder have fluent, complex and clearly articulated expressive language but exhibit problems with the way their language is used. These people typically are verbose. However, they usually have problems understanding and producing connected discourse, giving conversational responses that are socially inappropriate, tangential and/or stereotyped. They often develop obsessional interests.

The current view, therefore, is that the disorder has more to do with communication and information processing than language. For example, children with semantic pragmatic disorder will often fail to grasp the central meaning or saliency of events. This then leads to an excessive preference for routine and 'sameness' (seen in autism) as SPD children struggle to generalize and grasp the meaning of situations that are new; it also means that more difficulties occur in a stimulating environment than in a one-to-one setting.
A further problem caused by SPD is the assumption of literal communication. This would mean that obvious, concrete instructions are clearly understood and carried out, whereas simple but non-literal expressions such as jokes, sarcasm and general social chatting are difficult and can lead to misinterpretation.
Lies are also a confusing concept to children with SPD as it involves knowing what the speaker is thinking, intending and truly meaning beyond a literal interpretation.
There is debate over the relationship between semantic-pragmatic disorder and ASD as the clinical profile of semantic-pragmatic disorder is often seen in children with Asperger's Syndrome.

What is the difference between aspergers syndrome and social anxiety disorder?

Asperger's Syndrome is an autistic spectrum disorder (or pervasive development disorder) while Social Anxiety Disorder is a psychiatric condition. While some of the symptoms of the two disorders can mimic each other, most obviously discomfort in social situations and the ensuing physical signs such as a lack of eye contact or inability to communicate effectively, the major characteristics are quite different.

Asperger's is usually marked by a lack of empathy that is not associated with SAD (social anxiety disorder). The interpersonal problems that affect patients with both Asperger's and SAD have different root causes. SAD patients fail to make eye contact or have difficulty continuing conversations because they lack self-confidence and are anxious. Asperger's patients who exhibit the same behavior do not necessarily have a lack of self-confidence or anxiety; they simply are not able to pick up on the social clues that make these behaviors occur normally.
This is treated with medication and is a psychological disorder.

Many Asperger patients have an interest in social interaction but don't know how to act appropriately. They need to be taught the basic skills others take for granted when it comes to social interaction.
Whether Social Anxiety Disorder is anxiety caused by social situations and it usually due to a person's thoughts (cognition) running away from them.

Asperger's patients often have obsessive thoughts and repetitive behaviors, which is only noted in SAD patients as regards social interaction. For Asperger's patients this is pervasive and encompassing and has an early onset. Imagine for instance, a kindergartener who can list the box scores from every yankee's game ever played, but who displays no interest in watching baseball games or playing the sport itself. This is stereotypically autistic spectrum disorder and would not ordinarily occur in a person with SAD.

Early onset is another indicator of Asperger's Syndrome. Parents can generally trace symptomatic behavior back to a child's toddler years - perhaps as early as 30 months. It is clearly recognizable by age five. SAD may present in children, but is more commonly found in adolescents and adults.

What is the difference between AS and sensory integration disorder?

People with both disorders demonstrate challenges with high-level tasks that involve the integration of different areas of the brain. This can include emotional regulation as well as complex sensory functions. However, the key to diagnosing Asperger's as opposed to sensory integration disorder usually lies in the fact that AS people experience greater problems in the areas of language, empathy, and social skills. Sensory integration disorder people do not experience the same connective breakdowns for controlling emotional empathy and social interaction.
In both disorders, people experience difficulties in tasks that require their brains to make long-distance connections, for example, between the frontal lobes (which coordinate the activities of the brain) and with the cerebellum (which regulates the perceptions and responses within the brain).

What is the difference between narcissistic personality disorder and Asperger's syndrome?

The difference is that people with NPD are aware of the external while they are being self absorbed, where I think people with AS are so naturally focused on the internal and affected by the internal that they can't help but see everything from that point of view. So, basically, people with NPDs are aware of the world around them and use that to their advantage, where people with AS are in their own little world/see the world differently.

NPD is harder to notice, because being able to exploit means that they are capable of hiding their negative traits. But most people with AS have the traits that come across as negative noticed quite often.

The most obvious non-Aspie behavior in Borderline and NPD is pathological attention seeking behavior. They also demonstrate a marked interest in people over objects - the opposite of an Aspie. Moreover, that interest in people tends to manifest in manipulation and exploitation, not in the sincere desire to form a relationship, interact and experience intimacy. Most "fair" research on Aspie indicate that they place a high price on sincerity and genuinely do long for authentic relationships with others, even if they don't know how to achieve that.

Borderlines and NPDs are also "collectors" of people. While Borderlines tend to collect indiviudals or small groups to control, NPD in particular is known for collecting a wide assortment of associates and contacts to be used at that person's disposal, and often for a mutlilayered agenda. They are social opportunists to the nth degree, and exploit every opportunity to bring another person under their realm of control. They're good at keeping "groups" separated, like keeping their family apart from their work associates, or carrying on ex-martial affairs while keeping the lover(s) in the dark of their "real" lives. NPDs do this as a form of control, so people can't learn the full spectrum of that person's behavior and start to put the pieces together.

Another "dimension" to NPD that is distinctly un-AS is how they act towards people not under their realm of control. They are very much like Borderlines in this way - both act with hostility, distrust, even paranoia towards people they don't or cannot control.

The greater difference is that Aspergers Syndrome people can not deliberately manipulate others.
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Re: Differential diagnosis

Postby Chucky » Mon Jul 27, 2009 8:53 pm

Hi,

I have only read the first section regarding SPD and Asperger's, and I like t he way that the article distinguishes the two. To be honest, differentiating between these two disorders has now popped up 4 times in a week here on this website, and there had never previously been a mention of it. I intend to print off your post and read it tomorrow during the course of my working day, with the view to making it a 'sticky' thread. i think that this is a good resource for people. What do you think

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Re: Differential diagnosis

Postby UK-SW » Mon Jul 27, 2009 9:33 pm

Very interesting read, but I think we should be careful not to create too many stickies. Maybe this could be added to the "Broad Symptoms" thread instead?
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Re: Differential diagnosis

Postby flora » Mon Jul 27, 2009 9:56 pm

hey chucky, i have been diagnosed with SPD and chronical depression, and i was reading about it on wiki, AS was mentioned as something related at the bottom of the page. this is why i ended up here. there was hardly anything in its description that would acurately describe me. AS however much more. i could recognise 50% of the SPD traits and 75% of the AS traits sofar. acording to both wiki pages that is. thank you anasthasia, for the great article btw.
i think this is why more and more people end up here.

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Re: Differential diagnosis

Postby Chucky » Mon Jul 27, 2009 10:36 pm

SPD and chronic depression? - Before I even read the remainder of your post, I ewaas going to say why weren't you just diagnosed with Asperger's! Anyway, I'm not sure what to do with this useful thread now, because UK-SW is right in that we shouldn't have too many stickies - I hate stickies and the less there are the better. Maybe I will just laeve it here as a regular thread and see how long it remains active.

Thoughts welcome.

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Re: Differential diagnosis

Postby flora » Tue Jul 28, 2009 1:30 am

there is a same discussion going on at the SPD forum about AS v.s SPD. you might want to check it out. i didnt know that was also here, lol. gawd i'm so dense sometimes.
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Re: Differential diagnosis

Postby Postperson » Tue Jul 28, 2009 1:57 am

yeah you can end up with too many stickies in this situation. I think it's a very useful document. is there a FAQ, or useful reading section or something?

I was going to pop into the shcizoid forum at some stage. I used to lurk at a schizoid site because it was just so calm and unemotional compared to many AS sites, and I have known some IRL. I would love to have that ability to be unaffected by praise or blame.

I guess the great thing about this site is that it's so much easier for people to investigate these conditions here at the one site.
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Re: Differential diagnosis

Postby flora » Tue Jul 28, 2009 2:05 am

hey postperson, have you been diagnosed SPD too? you can also just PM me if you dont like to tell, was just interested. i read a bit on the SPD forum , but it just seems so unlike me. and chucky, why can't those 2 go together?
ack...so much to learn, not enough hours in a day. well, at least i'm actively seaching for a truthful answer. if anyone wants to share some thoughts, feel free to PM me any time.
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Re: Differential diagnosis

Postby Postperson » Tue Jul 28, 2009 4:27 am

No flora, I only have the one dx - Asperger's (schizotypal would be the nearest other dx for me, but I've ruled that out and am clear that Asperger's is correct for me) but I can relate to schizoids and have known them IRL. I find their ideas interesting, but the trouble with schizoids is that they don't 'need' others, also they have no impulse to 'help' others so that makes them difficult to have as 'friends'. eh what can you do. Aspies actually do want a social life and friends (at least at some stage of their life), they just don't have what it takes and often end up withdrawing for their own safety wheras schizoids are like that (socially withdrawn) from a very early age and it's not caused by social/language deficits. I have far too much emotion to be a schizoid.

anyways, they're the experts...
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Re: Differential diagnosis

Postby flora » Tue Jul 28, 2009 12:05 pm

thank you postperson, an awesome short version. that makes a lot of sense to me. i think i can safely rule out SPD :lol:
i can't imagine my world without emotion. i can seem to be distant and detached but thats more like a protective wall than anything else, because i tend to be too quick to trust people. i have no problem letting that down for loved ones.
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