The diagnosis of Asperger’s Syndrome was made in six children admitted to the psychiatric in-patient Clinic at the Maudsley and Bethlem Royal Hospitals, Denmark Hill, London SE5 8AZ, England. Previous evaluations by mental health professionals focusing on family dynamics had lead to accusations of parental, emotional or sexual abuse and suggestions of fabrication of the child’s behavioral disorder. Detailed in-patient psychiatric appraisal clarified the nature of the behavioral abnormalities and the diagnostic key features of Asperger’s Syndrome: 1) A formal concrete way of thinking, and 2) an inability to identify and understand human emotions and relationships. Four of the six children were boys. Communication difficulties ranged from a stilted speech to almost robotic manner. Abnormal preoccupations included toy cars, insects, fungi, poisons, violence to babies, ritualistic drawings and orderliness. Developmental delays and learning disorders involved language, spelling, reading and visual memory. Neurologic examination showed motor incoordination and nonspecific EEG abnormalities in one child and dilated ventricles in one. IQ scores varied from 60 to 138 with a mean of 90. Parents made to feel guilty, hostile and defensive were relieved and cooperative when the diagnosis was established and there anxieties were acknowledged. [1]

COMMENT. The syndrome described as an “autistic psychopathy” by an Austrian psychiatrist, Hans Asperger in 1944, includes abnormalities in language, poor social skills, peculiar interests and motor clumsiness. The clinical characteristics were reviewed in 34 patients, age 5-35 years [2]. Several children walked at a normal age but were slow to talk and became increasingly odd and withdrawn in personality. A genetic factor is suspected and no specific organic pathology has been identified. The syndrome listed in the ICD-10 but not in DSM-III-R is sometimes classified as a subgroup of the autistic spectrum with motor clumsiness, higher IQ and higher verbal skills [3]. Studies involving MRI and possible genetic or environmental factors require further investigation. In the absence of a specific etiology and biological marker, diagnosis is dependent on clinical criteria, a careful history, and full psychiatric and pediatric neurology evaluation.