Five boys with both Asperger’s disorder and Tourette syndrome, exceptional verbal intelligence, and clumsiness presented with peer-related social difficulties and a flapping stereotypy in a report from New York University Medical Center. Highly specialized interests - computers, chess, music - were characteristic. Speech was sing-song or mechanical, with poor pitch modulation, conversation overfocused or tangential, and eye contact poor. Neurologic exam revealed soft signs involving incoordination of tandem gait, finger tapping, and eye-hand clumsiness. WISC IQ showed very superior verbal scores (mean, 140) and lower performance scores (mean, 115). Despite the high IQ, academic performance was poor. Visuoperceptual, motor, and attentional impairments were noted. Tics exacerbated social difficulties. [1]

COMMENT. Asperger’s disorder should be considered in children of high verbal intelligence who do poorly in school, both academically and socially, and who exhibit stereotyped movements, speech and language disorders, tics, and motor clumsiness. Asperger’s disorder may overlap or occur concurrently with Tourette syndrome, pervasive developmental disorder, and attentional deficit disorders.