Rorschach Protocols From Children and Adolescents With Asperger s Disorder

JOURNAL OF PERSONALITY ASSESSMENT, 76(3), 482 495 Copyright 2001, Lawrence Erlbaum Associates, Inc. Rorschach Protocols From Children and Adolescents With Asperger s Disorder Margot Holaday, Jay Moak, and Molly A. Shipley Department of Psychology University of Southern Mississippi Rorschach protocols from 24 boys with Asperger s Disorder matched by age to 24 boys with other emotional or behavioral disorders (the contrast group) were compared to each other and to Exner s (1995) normative data. Eight variables based on Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM IV]; American Psychiatric Association, 1994) criteria and a review of the literature for Asperger s Disorder were predicted to discriminate between groups with the Asperger s group having more extreme scores. Five variables (COP, CDI, H, M, and EA) were significantly different from the contrast group and T and WSumC were significantly different from the normative data in both the Asperger s group and the contrast group. Asperger s Disorder, described by the man whose name it carries in 1944, was included as a diagnostic category for the first time in 1993 in the World Health Organization International Classification of Diseases, Tenth Revision (ICD 10; as cited in Volkmar, Klin, & Pauls, 1998), and in the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM IV], American Psychiatric Association, 1994). However, researchers continue to debate whether Asperger s Disorder is a separate category or if the disorder is on a continuum with Asperger s representing the highest functioning level of autism (Bishop, 1989; Schopler, Mesibov, & Kunce, 1998; Volkmar & Lord, 1998). One of the primary differences between the disorders is that children with Asperger s develop language at about the same time as children without problems and children with autism have delayed speech, if they learn to communicate using language at all. In addition, children with Asperger s appear to develop normally until about the age of 3 when unusual behaviors are first observed. The fact that they can and do use language and usually have normal to high intelligence allows clinicians to include the Rorschach in test batteries. The purpose of this study is to examine Rorschach protocols from children and adoles-

ASPERGER S AND RORSCHACH 483 cents diagnosed with Asperger s Disorder to determine if diagnostic criteria in the DSM IV and specific characteristics described in the literature can be observed on hypothesized Rorschach variables. ASPERGER S DISORDER Although information is limited, prevalence rates for Asperger s Disorder appear to be about 1 to 10 cases in 10,000 with significantly more boys than girls affected (Gillberg & Gillberg, 1989; Klin, Volkmar, Sparrow, Cicchetti, & Rourke, 1995). Until children with Asperger s are placed in day care or school where they are confronted with the necessity of interacting with people other than family members, they appear to meet normal developmental milestones on time. However, by age 3 to 5, they display marked difficulties in social interaction including a lack of empathy, poverty of expression and gesture, inability to use or appreciate humor, poor understanding of the reciprocal nature of conversation, intellectualization of affect, and egocentrism (Attwood, 1998; Pomeroy, 1998; Volkmar, Klin, & Pauls, 1998). These children often have no idea how to cooperate in team sports, are bullied by other children, have no best friend although they may be interested in other people, show odd behaviors in group settings, make naive or embarrassing remarks, and are insensitive to the feelings of others (Attwood, 1998; Klin et al., 1995; Pomeroy, 1998). They tend to be either aloof or socially intrusive without the ability to modify their behavior to fit within socially and environmentally appropriate expectations. They are always out of context (Szatmari, 1991, p. 82). Furthermore, children with Asperger s Disorder also have unusual patterns of speech such as an odd prosody or idiosyncratic language; insertion of unexpected noises or bursts of speech into conversations; peculiar voice characteristics; a pedantic or stereotyped style with fussy, old-fashioned language; tendency to adhere to literal interpretations of words; and difficulty understanding ambiguous or metaphorical language (Bishop, 1989; Ehlers, Gillberg, & Wing, 1999; Klin et al., 1995; Pomeroy, 1998). Some researchers attribute this deficit in social interaction as a failure to develop a theory of mind, defined as the ability to think about one s own thoughts and beliefs, think about other people s thoughts and beliefs, and understand how others might view social interactions (Bauminger & Kasari, 1999; Happe & Frith, 1995). Cognitively, children and adolescents with Asperger s Disorder tend to show unusual thoughts, obsessions, or preoccupations; uneven rates of skills acquisition; good rote memory but nonverbal learning disabilities; normal intelligence; isolated special skills; and attachments to unusual objects (Ehlers et al., 1999; Klin et al., 1995; Szatmari, 1991; Volkmar et al., 1998). Academically, children with Asperger s Disorder can decode words, but have difficulty analyzing and synthesizing what they read (Prior & Ozonoff, 1998). Neuropsychological problems include deficits or delays in fine and gross motor skills, visual-motor integration, visual-spatial perception, and auditory perception

484 HOLADAY, MOAK, SHIPLEY (Klin et al., 1995). Problems include difficulty in learning to tie shoelaces and being poor at sports or handwriting. They often display clumsiness or odd gait; peculiar staring behaviors; poor body awareness; poor posture; conduct problems; and markedly unusual, limited, or inappropriate facial expressions (Attwood, 1998; Ehlers et al., 1999; Pomeroy, 1998; Volkmar et al., 1998). They tend to enjoy repetitive activities, are resistant to change, prefer factual books rather than fiction, and do not spend time in make-believe play (Kerbeshian, Burd, & Fisher, 1990; Volkmar et al., 1998). DSM IV CRITERIA AND RORSCHACH VARIABLES Psychologists in the field use the DSM IV as the basis of diagnoses. One of the most commonly given tests to assist in determining mental problems is the Rorschach (Archer, Maruish, Imhof, & Piotrowski, 1991). The purpose of this study is to determine whether specific variables on the Rorschach correspond to DSM IV criteria and whether there are significant differences between children and adolescents with Asperger s Disorder and those with other behavioral and emotional problems on those same variables. Hypotheses were formed by the first author after the data had been collected by other psychologists and examiners who were not aware that their files would be used for this research. The second author also did not know the hypotheses to avoid the possibility of scorer bias. The diagnostic criteria for Asperger s Disorder (American Psychiatric Association, 1994) that seem most likely to be symbolized through specific Rorschach variables are as follows: (a) impairment in social interaction, CDI > 3; (b) failure to develop peer relationships, T = 0; (c) lack of spontaneous seeking to share enjoyment, interests, or achievements with other people, H < 2; (d) lack of social or emotional reciprocity, COP = 0; and (e) restricted repetitive and stereotyped patterns of interests, PSV > 0 (American Psychiatric Association, 1994, p. 77). These criteria are described in the literature in the context of the failure to develop a theory of mind, with a lack of the abilities to be empathic, use humor or appreciate humor, express affect appropriately, or understand feelings in others, indicating that M and WSumC and EA would be depressed as well. All variables are coded according to Exner s (1993) Comprehensive System. To be useful, this cluster of variables should help practitioners discriminate between Asperger s Disorder and other psychiatric diagnoses. According to Exner (1993) the hypothesized variables should be interpreted in the following ways: If CDI > 3 people are likely to have impoverished or unrewarding social relationships limited interpersonal effectiveness or successes, frequent social ineptness, or even instances of social chaos (p. 363). If T = 0, people appear more guarded and/or distant in interpersonal contacts (p. 385). If H < 2, there is a lack of interest in other people based on actual experience (p. 511). If

ASPERGER S AND RORSCHACH 485 COP < 2, people may have difficulty understanding, exhibiting, or expecting mutual give-and-take, cooperative behaviors between people. If PSV > 0, people may exhibit cognitive inflexibility [or have] some cognitive operations that are limited or impaired (p. 458). If M < 2, people may show deficits in reasoning, imagination, and higher form[s] of conceptualization (p. 419). If WSumC < 3, people may have emotional and affective instability and lowered capacity for modulation of the experience and expression of affect. If EA < 5, people may have fewer organized resources with which to cope with problems. Other DSM IV diagnostic criteria for Asperger s Disorder that do not seem to be associated with Rorschach variables are impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures; inflexible adherence to specific, non-functional routines or rituals; stereotyped and repetitive motor mannerisms; persistent preoccupation with parts of objects; and no clinically significant general delay in language cognitive development age appropriate self-help skills, adaptive behavior and curiosity about the environment (p. 77). Protocols METHOD Rorschach protocols from all children and adolescents (27) with Asperger s Disorder tested during the years 1990 to 1999 were collected from archival files in a Texas school district. The unusually large number of children with the disorder living withinthedistrictisapparentlyduetothefactthatparentspurposelymovetothiscity to take advantage of the special programs available for their children (H. Williams, personal communication, August 29, 1999). Diagnoses for Asperger s Disorder are always made by teams of two to four professionals, at least one of whom is a licensed psychologist. Nineteen professionals participated in the assessment and diagnoses of these children and adolescents using interviews with teachers, parents, nurses, and speech therapists; classroom observations; behavioral checklists; the Childhood Autism Rating Scale (Schopler, Reicher, & Renner, 1986); human figure drawings; intelligence tests; achievement tests; speech, vision, and hearing screenings; sentence completion; Thematic Apperception Test (Murray, 1943); Bender Visual Motor Gestalt Test (Bender, 1938); Reitan Indiana Aphasia Screening Test; and the Rorschach. None of the children and adolescents in the Asperger s group or the contrast group had IQs below 70. Full-scale IQ scores were not available and vocabulary scores were not recorded separately in records. The collection included 25 Rorschachs from boys and 2 from girls. One boy s protocol was not used because there were only 13 responses. (The Exner [1993] Comprehensive System requires 14 or more responses for interpretative validity.) Because the literature indicated that girls with Asperger s Disorder were generally more seriously impaired than

486 HOLADAY, MOAK, SHIPLEY boys and might show different patterns of behavior, the decision was made to use only the protocols from the 24 boys (Fombonne, 1998). Because differences between the responses from children with Asperger s Disorder and normative data (Exner, 1995) might be due to cultural or local influences and because all children with behavioral and emotional problems are likely to have deviant responses, a contrast group from the same district was needed. Protocols for an appropriate contrast group were found by searching the files for records of boys of the same ages who had been referred for testing because of their inappropriate behaviors or emotional displays in the classroom, but who did not meet eligibility for special education services according to federal guidelines and Texas state laws. They also had been administered a full battery of tests except for the Reitan Indiana Aphasia Screening Test and the Childhood Autism Rating Scale. Therefore, these boys had severe problems that should be evident on their Rorschach protocols, but children with Asperger s Disorder should still display more extreme scores on the hypothesized variables. By using protocols from boys who had behavioral and emotional problems, we stacked the deck against our own hypotheses. The average age of the boys in the Asperger s group was 12.2 years with ages rangingfrom7to18years.theaverageageoftheboysinthecontrastgroupwas12.9 years with ages ranging from 7 to 18 years. In the Asperger s group, 17 boys were reported as White, 5 were African American, 1 was Asian American, and 1 was Hispanic. In the contrast group, 9 were White, 10 were African American, and 5 were Hispanic. Although there is a difference in the racial balance between the two groups, no literature was located that indicated that children and adolescents of different races living in the same environment respond differently to the Rorschach. Instead, researchers presented data for all children and adolescents in their samples on the same tables regardless of race (Exner, 1995; Gacono & Meloy, 1994). Both the Asperger s group and the contrast group were compared to the normative data provided by Exner (1995). The means for each of the variables from the corresponding age tables were entered for each boy in both groups. This data set (n = 48) was considered as a third group so that differences between the contrast group and the normative tables could be shown. If the contrast group with known problems in behavior and emotional functioning produces different values for the hypothesized variables from the normative group and the Asperger s group, then psychologists in the field would have more confidence in the usefulness of the Rorschach in diagnosing children and adolescents with Asperger s Disorder. The problem facing examiners is that most of the children referred for evaluation reveal differences between their protocols and the normative tables. Therefore it would be most helpful to identify specific variables that are different between children already known to have problems by diagnostic categories. All Rorschachs were rescored by one or both authors independent of each other using the Exner (1993) Comprehensive System. The second author was blind to

ASPERGER S AND RORSCHACH 487 the hypotheses. Interrater agreements for one third of the protocols from the Asperger s group yielded 92.5% overall agreement with 92.4% for Developmental Quality, 87.9% for Determinants, 89.3% for Form Quality, 97.1% for Pairs, 91.9% for Contents, 97.0% for Populars, 93.6% for Z scores, and 90.5% for Special scores. All Rorschachs scored by the second author were checked by the senior author and disagreements were resolved by consensus. Rorschachs for the contrast group were scored independently but all responses with difficult scoring were discussed and resolved together. RESULTS Significant differences between the 24 protocols from boys with Asperger s Disorder and 24 boys with behavioral or emotional problems were found on 5 of the 8 hypothesized variables (Table 1). There were significant differences among the three groups at the.005 level or greater when the normative data were considered the third group on all 8 variables. A Tukey honestly significant difference procedure (α =.05) showed that boys with Asperger s Disorder had fewer COP responses (M =.21, SD =.51) than the contrast group (M = 1.21, SD = 1.50) or the normative data (M = 1.78, SD =.18); higher scores on the CDI (M = 3.92, SD =.72) than the con- TABLE 1 Comparisons of Variables From the Asperger s Group, the Contrast Group, and Exner s Normative Data Asperger s Group a Contrast Group a Normative Data ANOVA Variables M SD M SD M SD F Value p Tukey HSD COP 0.21 0.51 a 1.21 1.50 b 1.78.18 c 30.76 <.001 a < b < c CDI 3.92 0.72 a 2.58 1.21 b 0.13.06 c 259.32 <.001 a > b > c T 0.17 0.48 a 0.42 0.78 a 0.98.06 b 28.95 <.001 a < b M 1.25 1.45 a 3.58 2.45 b 4.00.40 b 30.25 <.001 a < b H 1.21 1.22 a 3.04 2.03 b 2.97.52 b 18.89 <.001 a < b WSumC 2.33 2.88 a 1.88 1.94 a 4.43.37 b 21.66 <.001 a < b EA 3.58 3.33 a 5.46 2.86 b 8.40.44 c 41.63 <.001 a < b PSV 0.67 1.24 a 0.42 0.58 a 0.11.15 b 5.55 =.005 a > b Note. Tukey honestly significant differences (HSD) comparisons are given for α =.05. Subscript a indicates the group or groups that are significantly different from group(s) subscript b and c. For example, for T both the Asperger s group and the contrast group have scores that are significantly less than the normative data: subscript a (groups) < than subscript b (group). For EA, the Asperger s group score is significantly lower than the contrast group and the contrast group is significantly lower than the normative data: a < b < c. a n = 24.

488 HOLADAY, MOAK, SHIPLEY trast group (M = 2.58, SD = 1.21) or the normative data (M =.13, SD =.06); fewer M responses (M = 1.25, SD = 1.45) than the contrast group (M = 3.58, SD = 2.45) or the normative data (M = 4.00, SD =.40); fewer H responses (M = 1.21, SD = 1.22) than the contrast group (M = 3.04, SD = 2.03) or the normative data (M = 2.97, SD =.52); and their EA was lower (M = 3.58, SD = 3.33) than the contrast group (M = 5.46, SD = 2.86) or the normative data (M = 8.40, SD =.44). Both the Asperger s group and the contrast group were significantly different from the normative data on the three remaining variables, T, WSumC, and PSV (see Table 1). Finally, Table 2 (children) and Table 3 (adolescents) were included at the request of a reviewer so that all variables found in the Asperger s group and the contrast group could be visually examined in comparison with Exner s (1993) normative tables. DISCUSSION The results of this study indicate that five hypotheses linking specific Rorschach variables to DSM IV criteria for Asperger s Disorder are supported when Rorschachs from boys with Asperger s Disorder and boys with other behavioral and emotional problems are compared. Criterion A (American Psychiatric Association, 1994), qualitative impairment in social interaction in boys with Asperger s, was evidenced by their underreporting human content (H) or human movement (M), and cooperative movement (COP) in humans or animals. Their tendency to have positive coping deficit indexes (CDI) indicates impoverished or unrewarding social relationships, social ineptness, and the inability to form and direct responses (Exner, 1993, p. 363). Lower numbers of human movement responses and fewer color responses indicated that these boys also did not have the needed psychological resources available to cope with the demands of participating equally in a socialized environment such as a public school (EA). Three other hypothesized variables did not discriminate between the Asperger s group and the contrast group but were also significantly different from normative data. WSumC, the display or experience of emotion, and T, evidence of the ability to establish and maintain intimacy and closeness, were missing or minimally represented in the Asperger s records, and responses with PSV, perseverations with cognitive inflexibility or impairment, were more frequent, but not statistically significant. Further research is needed to determine how useful the means found in this study will be in identifying other boys with Asperger s Disorder. We suggest that researchers use the following guidelines: COP =0,CDI >3,H <2,M <2,EA <4, WSumC = half the value expected for the chronological age, and T = 0. The last two variables, WSumC and T, appear to indicate the presence of emotional or behavioral problems and not a specific diagnostic category. A comparison of both groups to Exner s (1993) normative data reveals that both boys with Asperger s and boys with other severe behavioral and emotional problems give about the same number of responses to the Rorschach, but what

TABLE 2 Comparison of Variables for Asperger s Group, the Contrast Group, and Exner s Normative Tables for Ages 7 to 11 Asperger s Group Contrast Group Exner s Group Variables M SD M SD M SD R 19.30 7.24 22.43 8.36 20.53 2.46 W 10.80 4.64 9.29 3.68 10.33 1.57 D 0.70 [0.82] 0.14 [1.35] 9.00 1.28 Dd 1.80 [2.66] 1.71 [2.56] 1.20 [.84] S 1.90 [2.77] 0.86 [0.90] 1.73 [.58] DQ+ 4.60 3.95 5.00 2.71 6.40 1.94 DQo 12.00 5.87 16.00 6.32 11.67 1.80 DQv 2.60 [4.12] 1.43 [2.30] 1.61 [.65] DQv+ 0.01 [0.32] 0.00 0.00 0.45 [.65] FQx+ 0.00 0.00 0.00 0.00 0.26 0.31 FQxo 6.60 2.12 9.29 2.87 14.22 1.83 FQxu 6.10 5.38 7.00 4.83 3.49 1.37 FQx 6.30 3.40 5.43 2.44 2.04 0.76 M 1.20 [1.62] 3.71 2.63 3.12 1.85 FM 3.00 2.87 2.29 2.14 4.22 1.47 m 2.20 [2.53] 0.86 [1.86] 0.67 0.58 FC 0.40 [0.70] 0.71 [0.95] 1.89 0.86 CF 0.50 [0.71] 0.14 [0.38] 2.79 0.78 C 0.90 [1.91] 0.57 [1.51] 0.43 [.48] Cn 0.00 0.00 0.14 [0.38] 0.00 [0] WGSumC 2.05 [3.05] 1.36 [2.53] 5.13 1.07 Sum C' 0.80 [1.32] 0.43 [0.53] 1.16 [.79] Sum T 0.00 0.00 0.43 [0.53] 0.97 [.63] Sum V 0.10 [0.32] 0.00 0.00 0.00 [0] Sum Y 0.10 [0.32] 0.29 [0.49] 0.83 [.85] Sum Shading 1.00 1.70 1.14 0.90 2.96 1.27 Fr + rf 0.20 [0.63] 0.00 0.00 0.42 [.43] FD 0.40 [0.70] 0.43 [0.53] 0.63 [.34] F 11.30 6.48 13.71 6.52 9.14 1.84 Pair 4.50 2.07 8.57 3.64 8.97 1.69 3r+(2)/R 0.30 0.22 0.41 0.22 0.57 0.12 Lambda 4.39 [6.60] 2.34 [2.56] 0.81 0.37 EA 3.25 2.87 5.07 3.40 8.25 1.95 es 6.20 4.61 4.29 3.35 8.60 2.59 D 0.70 [0.82] 0.14 [1.35] 0.18 0.54 AdjD 0.40 [0.70] 0.43 [0.98] 0.10 0.41 a 5.20 4.13 5.29 3.20 6.26 1.23 p 1.30 [1.49] 1.57 1.51 2.51 1.40 Ma 1.20 [1.62] 3.14 2.19 2.72 1.36 Mp 0.00 0.00 0.57 [0.79] 0.27 0.45 Intellect 0.70 [0.95] 0.43 [0.79] 1.03 0.98 Zf 10.80 3.26 11.57 3.95 11.16 1.54 (continued)

TABLE 2 (Continued) Asperger s Group Contrast Group Exner s Group Variables M SD M SD M SD Zd 0.05 [6.22] 2.14 [4.77] 0.40 2.03 Blends 1.80 [1.81] 1.29 [1.50] 4.38 1.23 Afr 0.41 0.11 0.62 0.17 0.79 0.13 Populars 2.70 1.34 5.00 1.73 5.78 0.63 X + % 36.60 13.79 43.57 14.15 0.74 0.09 F + % 30.50 17.01 48.86 24.75 0.70 0.08 X % 32.80 16.21 25.29 13.11 0.09 0.06 Xu% 29.50 16.99 28.71 9.38 0.17 0.07 S % 6.90 [15.22] 7.57 [10.28] 0.06 [.15] Isolate 0.27 0.20 0.05 [0.06] 0.16 0.05 H 0.90 0.74 4.14 2.12 2.87 1.03 (H) 0.90 0.74 1.57 1.27 1.32 0.61 Hd 0.60 [0.7] 1.57 [2.51] 0.57 0.40 Hx 0.00 0.00 0.00 0.00 0.00 [0] A 8.50 3.69 9.14 3.63 8.28 1.59 (A) 0.40 [0.52] 0.00 0.00 0.73 [.68] Ad 2.10 2.08 1.57 [1.72] 0.53 [.98] (Ad) 0.10 [0.32] 0.00 0.00 0.23 [.39] An 0.30 [0.67] 0.57 [1.51] 0.36 [.60] Art 0.80 [1.03] 0.43 [0.79] 0.32 0.71 Ay 0.10 [0.32] 0.00 0.00 0.13 [.28] Bl 0.10 [0.32] 0.29 [0.49] 0.33 [.48] Bt 1.00 [1.05] 0.14 [0.38] 1.45 0.65 Cg 0.70 [0.82] 1.57 [2.07] 1.84 1.08 Cl 0.70 [1.34] 0.00 0.00 0.16 [.39] Ex 0.40 [0.84] 0.00 0.00 0.26 [.54] Fi 0.60 [1.07] 0.57 [0.79] 0.69 [.68] Fd 0.30 [0.48] 0.00 0.00 0.18 [.46] Ge 0.10 [0.32] 0.00 0.00 0.00 [0] Hh 0.20 [0.63] 0.29 [0.49] 0.59 0.36 Ls 1.10 [1.85] 0.71 [1.11] 0.93 0.59 Na 1.20 1.03 0.29 [0.76] 0.70 [.48] Sc 1.50 [1.84] 1.29 [1.60] 1.55 [.72] Sx 0.00 0.00 0.00 0.00 0.00 [0] Xy 0.10 [0.32] 0.00 0.00 0.00 [0] DV1 0.40 [0.52] 0.14 [0.38] 1.01 [.61] INCOM 0.30 [0.48] 1.00 [1.29] 1.37 [.75] DR 0.40 [0.97] 0.00 0.00 0.67 [.72] FABCOM 0.50 [0.85] 0.43 [0.53] 1.05 [.89] DV2 0.00 0.00 0.00 0.00 0.07 [.21] INC2 0.30 [0.67] 0.00 0.00 0.11 [.59] DR2 0.90 [2.18] 0.00 0.00 0.00 [0] FAB2 0.20 [0.42] 0.14 [0.38] 0.05 [.39] (continued) 490

TABLE 2 (Continued) Asperger s Group Contrast Group Exner s Group Variables M SD M SD M SD ALOG 0.10 [0.32] 0.29 [0.76] 0.61 [.49] CONTAM 0.00 0.00 0.00 0.00 0.00 0.00 Sum6SpSc 3.10 2.42 2.00 1.73 5.95 2.16 Sum6SpSc2 1.40 [2.07] 0.14 [0.38] 0.27 [.51] WSum6 12.70 12.31 6.29 5.62 13.06 4.72 AB 0.00 0.00 0.00 0.00 0.00 [0] AG 0.50 [0.97] 0.86 [0.90] 1.37 0.78 CFB 0.00 0.00 0.00 0.00 0.00 0.00 COP 0.10 [0.32] 1.43 1.27 2.03 1.14 CP 0.20 [0.42] 0.00 0.00 0.00 [0] MOR 1.60 [1.71] 0.57 [0.79] 0.87 [.64] PER 0.20 [0.42] 0.14 [0.38] 1.16 0.78 PSV 0.90 [1.45] 0.00 0.00 0.26 [.61] HVI 1.30 0.82 2.14 1.86 > 0.01 na DEPI 3.50 1.35 2.43 0.79 0.00 0.00 OBS 0.00 0.00 0.00 0.00 0.00 0.00 SCZI 2.60 1.51 2.00 1.00 0.00 0.00 SCON 5.80 1.93 3.57 1.51 na na CDI 4.10 0.57 2.00 1.15 0.09 na Note. Brackets indicate that the standard deviation may not be reliable or is misleading. TABLE 3 Comparison of Variables for Asperger s Group, the Contrast Group, and Exner s Normative Tables for Ages 12 to 18 Asperger s Group Contrast Group Exner s Group Variables M SD M SD M SD R 19.71 5.64 18.18 4.99 21.94 4.21 W 10.43 7.30 10.59 3.08 8.87 2.20 D 0.93 [1.38] 0.35 [1.06] 11.42 3.66 Dd 2.57 [3.20] 2.00 1.94 1.65 [1.31] S 2.21 [2.89] 1.94 1.60 1.44 [1.31] DQ+ 5.07 4.14 5.65 2.98 7.88 2.02 DQo 13.00 5.01 11.00 5.93 12.67 3.62 DQv 1.43 [1.40] 1.18 [1.63] 0.75 [1.29] DQv+ 0.21 [0.58] 0.35 [0.61] 0.14 [0.42] FQx+ 0.00 0.00 0.00 0.00 0.36 0.70 FQxo 7.43 3.67 9.53 3.41 16.35 3.34 FQxu 5.36 2.31 5.00 2.37 3.08 1.57 FQx 6.64 4.05 3.18 2.19 1.60 0.91 M 1.29 [1.38] 3.53 2.45 4.35 2.17 FM 3.00 3.01 2.06 1.64 4.82 1.73 (continued)

TABLE 3 (Continued) Asperger s Group Contrast Group Exner s Group Variables M SD M SD M SD m 2.00 [3.92] 1.29 1.76 1.17 0.78 FC 1.00 1.30 0.59 [0.94] 3.14 1.14 CF 1.50 [1.99] 1.00 [1.06] 2.85 1.53 C 0.36 [0.63] 0.53 [0.72] 0.03 [0.16] Cn 0.00 0.00 0.06 [0.24] 0.02 [0.13] WGSumC 2.54 [2.85] 2.09 1.69 4.47 1.68 Sum C' 1.29 [1.68] 0.41 [0.62] 1.63 [1.35] Sum T 0.29 [0.61] 0.41 [0.87] 1.06 [0.51] Sum V 0.00 0.00 0.18 [0.39] 0.18 [0.49] Sum Y 0.21 [0.58] 0.18 [0.53] 1.30 [1.27] Sum Shading 1.79 [2.12] 1.18 [1.33] 4.17 2.55 Fr + rf 0.29 [1.07] 0.29 [0.69] 0.50 [0.45] FD 0.36 [0.93] 0.76 0.66 1.33 [0.97] F 11.29 4.50 9.12 3.87 6.48 2.71 Pair 4.93 2.89 6.24 3.19 9.10 2.00 3r (2)/R 0.30 [0.19] 0.40 0.18 0.44 0.10 Lambda 3.19 [3.96] 1.17 0.67 0.65 0.22 EA 3.82 3.70 5.62 2.71 8.82 2.34 es 6.79 6.25 4.53 2.65 9.16 3.40 D 0.93 [1.38] 0.35 [1.06] 0.45 1.39 AdjD 0.50 [0.76] 0.53 [1.18] 0.25 1.07 a 4.29 4.07 4.94 2.75 6.99 1.73 p 2.07 1.98 2.00 1.12 3.36 1.93 Ma 0.86 0.86 2.41 1.91 2.58 1.44 Mp 0.43 [0.76] 1.18 1.01 1.77 1.46 Intellect 0.93 [1.98] 0.71 [1.16] 1.04 0.83 Zf 11.93 6.72 12.18 2.81 12.68 2.59 Zd 1.14 [5.70] 1.85 [6.66] 1.03 2.96 Blends 2.64 [3.65] 2.12 1.50 6.34 2.16 Afr 0.49 0.21 0.44 0.14 0.65 0.18 Populars 3.79 2.12 5.59 2.00 6.33 1.23 X + % 38.57 15.05 52.00 12.33 0.78 0.07 F + % 36.43 20.51 48.06 16.85 0.62 0.18 X % 33.29 17.21 17.53 11.24 0.07 0.05 Xu% 26.86 8.91 27.47 12.01 0.14 0.06 S % 12.36 [18.34] 16.06 [19.25] 0.18 [0.27] Isolate 0.24 0.18 0.21 0.13 0.15 0.07 H 1.43 [1.45] 2.59 1.87 3.42 1.96 (H) 1.07 [1.21] 1.47 1.23 1.04 0.90 Hd 0.57 [0.76] 0.71 [1.05] 0.57 0.82 Hx 0.07 0.27 0.12 [0.33] 0.00 [0.00] A 9.57 3.41 7.59 4.51 7.98 1.96 (A) 0.21 [0.43] 0.35 [0.79] 0.36 [0.55] Ad 1.50 [1.74] 1.35 [1.46] 2.08 [1.20] (Ad) 0.07 0.27 0.06 [0.24] 0.05 [0.30] (continued)

TABLE 3 (Continued) Asperger s Group Contrast Group Exner s Group Variables M SD M SD M SD An 0.21 [0.43] 0.12 [0.49] 0.43 [0.79] Art 0.43 [0.94] 0.53 [0.87] 0.85 0.63 Ay 0.29 [0.73] 0.06 [0.24] 0.14 [0.34] Bl 0.36 [0.63] 0.12 [0.33] 0.22 [0.41] Bt 1.29 [1.64] 1.00 1.00 1.68 0.82 Cg 1.00 [1.30] 0.59 [0.87] 1.47 1.11 Cl 0.07 0.27 0.12 [0.33] 0.09 [0.35] Ex 0.07 0.27 0.18 [0.53] 0.12 [0.32] Fi 0.14 [0.36] 0.35 [0.70] 0.69 [0.52] Fd 0.00 0.00 0.06 [0.24] 0.30 [0.51] Ge 0.00 0.00 0.12 [0.33] 0.01 [0.09] Hh 0.36 [0.5] 0.71 [0.99] 0.89 0.60 Ls 1.21 [1.42] 0.76 [0.97] 1.12 0.71 Na 0.71 [1.07] 0.53 [0.8] 0.12 [0.35] Sc 1.14 [1.23] 1.29 [1.36] 1.70 [1.34] Sx 0.00 0.00 0.00 0.00 0.11 [0.44] Xy 0.00 0.00 0.00 0.00 0.04 [0.19] DV1 0.36 [0.84] 0.82 [1.07] 0.98 [0.70] INCOM 0.57 [0.94] 0.76 0.75 0.88 [0.74] DR 0.21 [0.58] 0.06 [0.24] 0.13 [0.33] FABCOM 0.14 [0.53] 0.24 [0.56] 0.23 [0.46] DV2 0.07 [0.27] 0.00 0.00 0.03 [0.16] INC2 0.79 [1.37] 0.41 [0.62] 0.01 [0.09] DR2 0.14 [0.53] 0.00 0.00 0.01 [0.09] FAB2 0.50 [1.09] 0.24 [0.44] 0.04 [0.19] ALOG 0.00 0.00 0.00 0.00 0.05 [0.26] CONTAM 0.14 [0.36] 0.00 0.00 0.00 0.00 Sum6SpSc 2.93 [3.69] 2.53 1.59 2.27 1.36 Sum6SpSc2 1.50 [2.47] 0.65 [0.70] 0.08 [0.27] WSum6 11.36 [15.99] 6.76 5.19 4.71 3.33 AB 0.07 [0.27] 0.06 [0.24] 0.03 [0.16] AG 0.71 [1.44] 0.53 [0.94] 1.14 0.91 CFB 0.00 0.00 0.00 0.00 0.00 0.00 COP 0.29 [0.61] 1.12 [1.62] 1.54 0.97 CP 0.14 [0.36] 0.00 0.00 0.00 [0.00] MOR 2.14 [2.82] 0.76 [1.20] 0.54 [0.83] PER 0.29 [0.47] 0.35 [0.70] 0.92 0.65 PSV 0.50 [1.09] 0.59 [0.62] 0.04 [0.19] HVI 1.57 [1.70] 1.71 1.36 0.01 na DEPI 3.43 1.40 3.18 1.19 0.01 na OBS 0.00 0.00 0.00 0.00 0.00 0.00 SCZI 2.64 1.39 1.24 [1.30] 0.00 0.00 SCON 5.36 2.17 4.29 1.61 na na CDI 3.79 0.80 2.94 1.30 0.06 na Note. Brackets indicate that the standard deviation may not be reliable or may be misleading.

494 HOLADAY, MOAK, SHIPLEY they say about the blots is significantly different for key variables. Although the Rorschach is not intended to provide DSM IV diagnoses, the challenge for psychologists is to discriminate between boys with Asperger s Disorder and boys with other problems. This study provides evidence that following DSM IV criteria and translating them into Rorschach variables is possible and useful. REFERENCES American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. Archer, R. P., Maruish, M., Imhof, E. A., & Piotrowski, C. (1991). Psychological test usage with adolescent clients: 1990 survey findings. Professional Psychology: Research and Practice, 22, 247 252. Attwood, T. (1998). Asperger s syndrome: A guide for parents and professionals. London: Athenaeum. Bauminger, N., & Kasari, C. (1999). Brief report: Theory of mind in high functioning children with autism. Journal of Autism and Developmental Disorders, 29, 81 86. Bender, L. (1938). A Visual Motor Gestalt Test and its clinical use. American Orthopsychiatric Association Research Monographs, No. 3. New York: American Orthopsychiatric Association Bishop, D. V. M. (1989). Autism, Asperger s syndrome and semantic-pragmatic disorder: Where are the boundaries? British Journal of Disorders of Communication, 24, 107 121. Ehlers, S., Gillberg, C., & Wing, L. (1999). A screening questionnaire for Asperger syndrome and other high functioning autism spectrum disorders in school age children. Journal of Autism and Developmental Disorders, 29, 129 141. Exner, J. E., Jr. (1993). The Rorschach: A comprehensive system: Vol. 1. Basic foundations (3rd ed.). New York: Wiley. Exner, J. E., Jr. (1995). A Rorschach workbook for the comprehensive system (4th ed.). Asheville, NC: Rorschach Workshops. Fombonne, E. (1998). Epidemiological surveys of autism. In F. R. Volkmar (Ed.), Autism and pervasive developmental disorders (pp. 32 63). Cambridge, England: Cambridge University Press. Gacono, C. B., & Meloy, J. R. (1994). The Rorschach assessment of aggressive and psychopathic personalities. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc. Gillberg, I. C., & Gillberg, C. (1989). Asperger s syndrome Some epidemiological considerations: A research note. Journal of Child Psychology and Psychiatry, 30, 631 638. Happe, F., & Frith, U. (1995). Theory of mind in autism. In E. Schopler, G. B. Mesibov, & L. J. Kunce (Eds.), Learning and cognition in autism (pp. 177 198). New York: Plenum. Kerbeshian, J., Burd, L., & Fisher, W. (1990). Asperger s syndrome: To be or not to be? British Journal of Psychiatry, 156, 721 725. Klin, A., Volkmar, F. R., Sparrow, S. S., Cicchetti, D. V., & Rourke, B. P. (1995). Validity and neuropsychological characterization of Asperger syndrome: Convergence with nonverbal learning disabilities syndrome. Journal of Child Psychology and Psychiatry, 36, 1127 1140. Pomeroy, J. C. (1998). Subtyping pervasive developmental disorder. In E. Schopler, G. B. Mesibov, & L. J. Kunce (Eds.), Asperger syndrome or high functioning autism? (pp. 29 60). New York: Plenum. Prior, M., & Ozonoff, S. (1998). Psychological factors in autism. In F. R. Volkmar (Ed.), Autism and developmental disorders (pp. 64 108). Cambridge, England: Cambridge University Press. Murray, H. A. (1943). Thematic Apperception Test. Cambridge, MA: Harvard University Press. Schopler, E., Mesibov, G. B., & Kunce, L. J. (Eds.). (1998). Asperger syndrome or high functioning autism? New York: Plenum.

ASPERGER S AND RORSCHACH 495 Schopler, E., Reicher, R. J., & Renner, B. R. (1986). The Childhood Autism Rating Scale (CARS) for diagnostic screening and classification of autism. New York: Irvington. Szatmari, P. (1991). Asperger s syndrome: Diagnosis, treatment, and outcome. Psychiatric Clinics of North America, 14, 81 93. Volkmar, F. R., Klin, A., & Pauls, D. (1998). Nosological and genetic aspects of Asperger syndrome. Journal of Autism and Developmental Disorders, 28, 457 463. Volkmar, F. R., & Lord, C. (1998). Diagnosis and definition of autism and other pervasive developmental disorders. In F. R. Volkmar (Ed.), Autism and pervasive developmental disorders (pp. 1 31). Cambridge, England: Cambridge University Press. Margot Holaday 705 Martens Court 71 54 Laredo, TX 78041 6010 Received July 18, 2000 Revised October 17, 2000