Asperger syndrome is an autism spectrum disorder, and people with it therefore show significant difficulties in social interaction, along with restricted and repetitive patterns of behavior and interests. It differs from other autism spectrum disorders by its relative preservation of
linguisticSince language development is the crucial part of the human cognitive nature, understanding language development is an important aspect to understand the base and to recall its various components of linguistics...
and
cognitive developmentCognitive development is a field of study in neuroscience and psychology focusing on a child's development in terms of information processing, conceptual resources, perceptual skill, and other topics in cognitive psychology. A large portion of research has gone into understanding how a child...
. Although not required for diagnosis, physical clumsiness and atypical use of language are frequently reported.
Asperger syndrome is also called
Asperger's syndrome,
Asperger (or
Asperger's)
disorder, or just
Asperger's; it is named after the Austrian pediatrician
Hans AspergerHans Asperger was the Austrian pediatrician after whom Asperger syndrome is named.-Life:Asperger studied medicine in Vienna and became employed as a member of the University Children's Hospital in Vienna. He married in 1935 and had five children...
who, in 1944, described children in his practice who lacked
nonverbal communicationNonverbal communications is usually understood as the process of communication through sending and receiving wordless messages.NVC can be communicated through gesture and touch , by body language or posture, by facial expression and eye contact...
skills, demonstrated limited
empathyEmpathy, which literally translates as 'in feeling', is the capability to share and understand another's emotions and feelings. It is often characterized as the ability to "put oneself into another's shoes".-Etymology:...
with their peers, and were physically clumsy. Fifty years later, it was standardized as a
diagnosisIn medicine, diagnosis is a label given for a medical condition or disease identified by its signs, symptoms, and from the results of various diagnostic procedures...
, but questions about many aspects remain. For example, there is lingering doubt about whether it is distinct from
high-functioning autismHigh-functioning autism is an informal term applied to autistic people who are deemed to have "higher functioning" than other autistic people, by one or more metrics. There is no consensus as to the definition. HFA is not a recognized diagnosis in the DSM-IV-TR or the ICD-10.The amount of overlap...
(HFA); partly because of this, its
prevalenceIn epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. It is used as an estimate of how...
is not firmly established. The exact
causeEtiology is the study of causation, or origination. The word is derived from the Greek , aitiologia, "giving a reason for" ....
is unknown, although research supports the likelihood of a
geneticGenetics, , a discipline of biology, is the science of heredity and variation in living organisms. The fact that living things inherit traits from their parents has been used since prehistoric times to improve crop plants and animals through selective breeding...
basis;
brain imagingNeuroimaging includes the use of various techniques to either directly or indirectly image the structure, function/pharmacology of the brain...
techniques have not identified a clear common pathology.
There is no single treatment, and the effectiveness of particular interventions is supported by only limited data. Intervention is aimed at improving symptoms and function. The mainstay of management is behavioral therapy, focusing on specific deficits to address poor communication skills, obsessive or repetitive routines, and physical clumsiness. Most individuals improve over time, but difficulties with communication, social adjustment and
independent livingIndependent living, as seen by its advocates, is a philosophy, a way of looking at disability and society, and a worldwide movement of people with disabilities who proclaim to work for self-determination, self-respect and equal opportunities...
continue into adulthood. Some researchers and people with Asperger's have advocated a shift in attitudes toward the view that it is a difference, rather than a disability that must be treated or cured.
Classification
Asperger syndrome (AS) is one of the autism spectrum disorders (ASD) or
pervasive developmental disorderThe diagnostic category pervasive developmental disorders , as opposed to specific developmental disorders , refers to a group of five disorders characterized by delays in the development of multiple basic functions including socialization and communication...
s (PDD), which are a
spectrum of psychological conditionsSpectrum disorder in psychiatry is a term used to describe a mental disorder when there is thought to be "not a unitary disorder but rather a syndrome composed of subgroups" that can range from relatively "severe" to relatively "mild and nonclinical deficits"....
that are characterized by abnormalities of social interaction and communication that pervade the individual's functioning, and by restricted and repetitive interests and behavior. Like other psychological development disorders, ASD begins in infancy or childhood, has a steady course without remission or relapse, and has impairments that result from maturation-related changes in various systems of the brain. ASD, in turn, is a subset of the broader autism
phenotypeA phenotype is any observable characteristic or trait of an organism: such as its morphology, development, biochemical or physiological properties, or behavior. Phenotypes result from the expression of an organism's genes as well as the influence of environmental factors and possible interactions...
(BAP), which describes individuals who may not have ASD but do have autistic-like
traitsA trait is a distinct variant of a phenotypic character of an organism that may be inherited, environmentally determined or somewhere in between. For example, eye color is a character or abstraction of an attribute, while blue, brown and hazel are traits.- Definition :A trait may be any single...
, such as social deficits. Of the other four ASD forms,
autismAutism is a disorder of neural development that is characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism involves many parts of the brain; how this occurs is not well understood...
is the most similar to AS in signs and likely causes but its diagnosis requires impaired communication and allows delay in
cognitive developmentCognitive development is a field of study in neuroscience and psychology focusing on a child's development in terms of information processing, conceptual resources, perceptual skill, and other topics in cognitive psychology. A large portion of research has gone into understanding how a child...
;
Rett syndromeRett syndrome is a neurodevelopmental disorder that is classified as an autism spectrum disorder by the DSM-IV. It was first described by Austrian pediatrician Andreas Rett in 1966. The clinical features include a deceleration of the rate of head growth and small hands and feet...
and
childhood disintegrative disorderChildhood disintegrative disorder , also known as Heller's syndrome and disintegrative psychosis, is a rare condition characterized by late onset of developmental delays in language, social function, and motor skills...
share several signs with autism but may have unrelated causes; and
pervasive developmental disorder not otherwise specified (PDD-NOS)Pervasive Developmental Disorder - Not Otherwise Specified is one of the pervasive developmental disorders and autism spectrum disorders....
is diagnosed when the criteria for a more specific disorder are unmet.
The extent of the overlap between AS and high-functioning autism (
HFAHigh-functioning autism is an informal term applied to autistic people who are deemed to have "higher functioning" than other autistic people, by one or more metrics. There is no consensus as to the definition. HFA is not a recognized diagnosis in the DSM-IV-TR or the ICD-10.The amount of overlap...
—autism unaccompanied by
mental retardationMental retardation is a generalized disorder, characterized by significantly impaired cognitive functioning and deficits in two or more adaptive behaviors with onset before the age of 18...
) is unclear. The current ASD classification is to some extent an artifact of how autism was discovered, and may not reflect the true nature of the spectrum. A panel session at a 2008 diagnosis-related autism research planning conference noted problems with the classification of AS as a distinct subgroup of ASD, and two of three breakout groups recommended eliminating AS as a separate diagnosis in future versions of the
Diagnostic and Statistical Manual of Mental DisordersThe Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides diagnostic criteria for mental disorders...
and of the International Statistical Classification of Diseases and Related Health Problems.
Asperger syndrome is also called
Asperger's syndrome (AS),
Asperger (or
Asperger's)
disorder (AD), or just
Asperger's. There is little consensus among clinical researchers about whether the condition's name should end in "syndrome" or "disorder".
Characteristics
A
pervasive developmental disorderThe diagnostic category pervasive developmental disorders , as opposed to specific developmental disorders , refers to a group of five disorders characterized by delays in the development of multiple basic functions including socialization and communication...
, Asperger syndrome is distinguished by a pattern of symptoms rather than a single symptom. It is characterized by qualitative impairment in social interaction, by stereotyped and restricted patterns of behavior, activities and interests, and by no clinically significant delay in cognitive development or general delay in language. Intense preoccupation with a narrow subject, one-sided verbosity, restricted
prosodyIn linguistics, prosody is the rhythm, stress, and intonation of connected speech...
, and physical clumsiness are typical of the condition, but are not required for diagnosis.
Social interaction
The lack of demonstrated
empathyEmpathy, which literally translates as 'in feeling', is the capability to share and understand another's emotions and feelings. It is often characterized as the ability to "put oneself into another's shoes".-Etymology:...
is possibly the most dysfunctional aspect of Asperger syndrome. Individuals with AS experience difficulties in basic elements of social interaction, which may include a failure to develop friendships or to seek shared enjoyments or achievements with others (for example, showing others objects of interest), a lack of social or emotional reciprocity, and impaired
nonverbal behaviorsNonverbal communications is usually understood as the process of communication through sending and receiving wordless messages.NVC can be communicated through gesture and touch , by body language or posture, by facial expression and eye contact...
in areas such as
eye contactEye contact is a meeting of the eyes between two individuals.In human beings, eye contact is a form of nonverbal communication and is thought to have a large influence on social behavior. Coined in the early to mid-1960s, the term has come in the West to often define the act as a meaningful and...
,
facial expressionA facial expression results from one or more motions or positions of the muscles of the face. These movements convey the emotional state of the individual to observers. Facial expressions are a form of nonverbal communication...
, posture, and gesture.
Unlike those with autism, people with AS are not usually withdrawn around others; they approach others, even if awkwardly. For example a person with AS may engage in a one-sided, long-winded speech about a favorite topic, while misunderstanding or not recognizing the listener's feelings or reactions, such as a need for privacy or haste to leave. This social awkwardness has been called "active but odd". This failure to react appropriately to social interaction may appear as disregard for other people's feelings, and may come across as insensitive.
The cognitive ability of children with AS often allows them to articulate social norms in a laboratory context, where they may be able to show a theoretical understanding of other people's emotions; however, they typically have difficulty acting on this knowledge in fluid, real-life situations. People with AS may analyze and distill their observation of social interaction into rigid behavioral guidelines, and apply these rules in awkward ways, such as forced eye contact, resulting in a demeanor that appears rigid or socially naive. Childhood desire for companionship can become numbed through a history of failed social encounters.
The
hypothesisA hypothesis is a proposed explanation for an observable phenomenon. The term derives from the Greek, ὑποτιθέναι - hypotithenai meaning "to put under" or "to suppose." For a hypothesis to be put forward as a scientific hypothesis, the scientific method requires that one can test it...
that individuals with AS are predisposed to violent or criminal behavior has been investigated but is not supported by data. More evidence suggests children with AS are victims rather than victimizers. A 2008 review found that an overwhelming number of reported violent criminals with AS had coexisting psychiatric disorders such as
schizoaffective disorderSchizoaffective disorder is a psychiatric diagnosis that describes a mental disorder characterized by recurring episodes of mood disorder and psychosis. Distortions in perception alternate with and occur simultaneously with elevated or depressed mood...
.
Restricted and repetitive interests and behavior
People with Asperger syndrome often display behavior, interests, and activities that are restricted and repetitive and are sometimes abnormally intense or focused. They may stick to inflexible routines, move in
stereotypedA stereotypy is a repetitive or ritualistic movement, posture, or utterance, found in patients with mental retardation, autism spectrum disorders, tardive dyskinesia and stereotypic movement disorder. Stereotypies may be simple movements such as body rocking, or complex, such as self-caressing,...
and repetitive ways, or preoccupy themselves with parts of objects.
Pursuit of specific and narrow areas of interest is one of the most striking features of AS. Individuals with AS may collect volumes of detailed information on a relatively narrow topic such as dinosaurs or members of Congress, without necessarily having genuine understanding of the broader topic. For example, a child might memorize camera model numbers while caring little about photography. This behavior is usually apparent by grade school, typically age 5 or 6 in the United States. Although these special interests may change from time to time, they typically become more unusual and narrowly focused, and often dominate social interaction so much that the entire family may become immersed. Because narrow topics often capture the interest of children, this symptom may go unrecognized.
Stereotyped and repetitive motor behaviors are a core part of the diagnosis of AS and other ASDs. They include hand movements such as flapping or twisting, and complex whole-body movements. These are typically repeated in longer bursts and look more voluntary or ritualistic than
ticA tic is a sudden, repetitive, nonrhythmic, stereotyped motor movement or vocalization involving discrete muscle groups. Tics can be invisible to the observer, such as abdominal tensing or toe crunching. Common motor and vocal tics are, respectively, eye blinking and throat clearing...
s, which are usually faster, less rhythmical and less often symmetrical.
Speech and language
Although individuals with Asperger syndrome acquire language skills without significant general delay and their speech typically lacks significant abnormalities,
language acquisitionLanguage acquisition is the study of the processes through which humans acquire language. By itself, language acquisition refers to first language acquisition, which studies infants' acquisition of their native language, whereas second language acquisition deals with acquisition of additional...
and use is often atypical. Abnormalities include verbosity, abrupt transitions, literal interpretations and miscomprehension of
nuanceNuance is a small or subtle distinction. It can also refer to the following:*Nuance Communications, the name of a company that sells voice and productivity software solutions.*Nuance, the name of a 1980s dance music group....
, use of
metaphorA metaphor is a figure of speech concisely comparing two things, saying that one is the other. The English metaphor derives from the 16th c...
meaningful only to the speaker,
auditory perception deficitsAuditory Processing Disorder is a disorder in the way auditory information is processed in the brain. It is not a sensory hearing impairment; individuals with APD usually have normal peripheral hearing ability...
, unusually
pedantA pedant is a person who is overly concerned with formalism and precision, or who makes a show of his learning.-Etymology:The English language word "pedant" comes from the French pédant or its older mid-15th century Italian source pedante, "teacher, schoolmaster"...
ic,
formalIn linguistics, a register is a variety of a language used for a particular purpose or in a particular social setting. For example, an English speaker may adhere more closely to prescribed grammar, pronounce words ending in -ing with a velar nasal instead of an alveolar nasal In linguistics, a...
or idiosyncratic speech, and oddities in
loudnessLoudness is the quality of a sound that is the primary psychological correlate of physical strength .Loudness, a subjective measure, is often confused with objective measures of sound pressure such as decibels or sound intensity. Filters such as A-weighting attempt to adjust sound measurements to...
,
pitchTone is the use of pitch in language to distinguish lexical or grammatical meaning—that is, to distinguish or inflect words. All languages use pitch to express emotional and other paralinguistic information, and to convey emphasis, contrast, and other such features in what is called intonation, but...
,
intonationIn linguistics, intonation is variation of pitch while speaking which is not used to distinguish words. Intonation and stress are two main elements of linguistic prosody....
,
prosodyIn linguistics, prosody is the rhythm, stress, and intonation of connected speech...
, and
rhythmRhythm is the variation of the length and accentuation of a series of sounds or other events.-Rhythm in linguistics:...
.
Three aspects of communication patterns are of clinical interest: poor prosody, tangential and circumstantial speech, and marked verbosity. Although
inflectionIn grammar, inflection or inflexion is the way language modifies word forms to handle grammatical relations and relational categories such as tense, mood, voice, aspect , person, number , gender, case . Beside conjugation and declension there is comparison with its maximum category number of two In...
and intonation may be less rigid or monotonic than in autism, people with AS often have a limited range of intonation: speech may be unusually fast, jerky or loud. Speech may convey a sense of
incoherenceCoherence in linguistics is what makes a text semantically meaningful.It is especially dealt with in text linguistics. Coherence is achieved through syntactical features such as the use of deictic, anaphoric and cataphoric elements or a logical tense structure, as well as presuppositions and...
; the conversational style often includes monologues about topics that bore the listener, fails to provide
contextContext is a notion used in the language sciences in two different ways, namely as*verbal context*social context...
for comments, or fails to suppress internal thoughts. Individuals with AS may fail to monitor whether the listener is interested or engaged in the conversation. The speaker's conclusion or point may never be made, and attempts by the listener to elaborate on the speech's content or logic, or to shift to related topics, are often unsuccessful.
Children with AS may have an unusually sophisticated vocabulary at a young age and have been colloquially called "little professors", but have difficulty understanding figurative language and tend to use language literally. Children with AS appear to have particular weaknesses in areas of nonliteral language that include humor, irony, and teasing. Although individuals with AS usually understand the cognitive basis of humor they seem to lack understanding of the intent of humor to share enjoyment with others. Despite strong evidence of impaired humor appreciation, anecdotal reports of humor in individuals with AS seem to challenge some psychological theories of AS and autism.
Other
Individuals with Asperger syndrome may have signs or symptoms that are independent of the diagnosis, but can affect the individual or the family. These include differences in perception and problems with motor skills, sleep, and emotions.
Individuals with AS often have excellent auditory and
visual perceptionVisual perception is the ability to interpret information and surroundings from visible light reaching the eye. The resulting perception is also known as eyesight, sight or vision...
. Children with ASD often demonstrate enhanced perception of small changes in patterns such as arrangements of objects or well-known images; typically this is domain-specific and involves processing of fine-grained features. Conversely, compared to individuals with high-functioning autism, individuals with AS have deficits in some tasks involving visual-spatial perception, auditory perception, or
visual memoryVisual memory is a part of memory preserving some characteristics of our senses pertaining to visual experience. We are able to place in memory information that resembles objects, places, animals or people in sort of a mental image...
. Many accounts of individuals with AS and ASD report other unusual sensory and perceptual skills and experiences. They may be unusually sensitive or insensitive to sound, light, touch, texture, taste, smell, pain, temperature, and other stimuli, and they may exhibit
synesthesiaSynesthesia —from the Ancient Greek , "together," and , "sensation"—is a neurologically based phenomenon in which stimulation of one sensory or cognitive pathway leads to automatic, involuntary experiences in a second sensory or cognitive pathway...
; these sensory responses are found in other developmental disorders and are not specific to AS or to ASD. There is little support for increased
fight-or-flight responseThe "fight-or-flight response", also called the "fight-or-flight-or-freeze response", the "fright, fight or flight response", "hyperarousal" or the "acute stress response", was first described by Walter Cannon in 1929....
or failure of
habituationHabituation is the psychological process in humans and animals in which there is a decrease in psychological response and behavioral response to a stimulus after repeated exposure to that stimulus over a duration of time.- Background :...
in autism; there is more evidence of decreased responsiveness to sensory stimuli, although several studies show no differences.
Hans Asperger's initial accounts and other diagnostic schemes include descriptions of physical clumsiness. Children with AS may be delayed in acquiring skills requiring motor dexterity, such as riding a bicycle or opening a jar, and may seem to move awkwardly or feel "uncomfortable in their own skin". They may be poorly coordinated, or have an odd or bouncy gait or posture, poor handwriting, or problems with visual-motor integration. They may show problems with
proprioceptionProprioception is the sense of the relative position of neighbouring parts of the body...
(sensation of body position) on measures of
apraxiaApraxia is a neurological disorder characterized by loss of the ability to execute or carry out learned purposeful movements, despite having the desire and the physical ability to perform the movements...
(motor planning disorder), balance,
tandem gaitTandem gait is a gait where the toes of the back foot touch the heel of the front foot at each step. Neurologists sometimes ask patients to walk in a straight line using tandem gait as a test to help diagnose ataxia, especially truncal ataxia, because sufferers of these disorders will have an...
, and finger-thumb apposition. There is no evidence that these motor skills problems differentiate AS from other high-functioning ASDs.
Children with AS are more likely to have sleep problems, including difficulty in falling asleep, frequent
nocturnal awakeningsMiddle-of-the-night insomnia is insomnia characterized by difficulty returning to sleep after awakening in the middle of the night. Also referred to as nocturnal awakenings, middle of the night awakenings and middle insomnia, this category of insomnia is different from initial or sleep-onset...
, and early morning awakenings. AS is also associated with high levels of
alexithymiaAlexithymia from the Ancient Greek words λέξις and θύμος modified by an alpha-privative—literally "without words for emotions"—is a term coined by psychotherapist Peter Sifneos in 1973 to describe a state of deficiency in understanding, processing, or describing emotions.- Classification...
, which is difficulty in identifying and describing one's emotions. Although AS, lower sleep quality, and alexithymia are associated, their causative relationship is unclear.
As with other forms of ASD, parents of children with AS have higher levels of stress.
Causes
Hans Asperger described common symptoms among his patients' family members, especially fathers, and research supports this observation and suggests a genetic contribution to Asperger syndrome. Although no specific gene has yet been identified, multiple factors are believed to play a role in the
expressionThe term "Expressivity" is used in geneticsthat refering to variations of a phenotypein individuals carrying a particular genotype.The term can be used to qualitatively orquantitatively characterize the extent of the...
of autism, given the
phenotypicA phenotype is any observable characteristic or trait of an organism: such as its morphology, development, biochemical or physiological properties, or behavior. Phenotypes result from the expression of an organism's genes as well as the influence of environmental factors and possible interactions...
variability seen in this group of children. Evidence for a genetic link is the tendency for AS to run in families and an observed higher
incidenceIncidence is a measure of the risk of developing some new condition within a specified period of time. Although sometimes loosely expressed simply as the number of new cases during some time period, it is better expressed as a proportion or a rate with a denominator.Incidence proportion is the...
of family members who have behavioral symptoms similar to AS but in a more limited form (for example, slight difficulties with social interaction, language, or reading). Most research suggests that all
autism spectrum disorders have shared genetic mechanismsAutism has a strong genetic basis, although the genetics of autism is complex and it is unclear whether ASD is explained more by multigene interactions or by rare mutations with major effects. Early studies of twins estimated the heritability of autism to be more than 90%; in other words, that 90%...
, but AS may have a stronger genetic component than autism. There is probably a common group of genes where particular
alleleAn allele is one of a series of different forms of a gene. The word is a short form of allelomorph , which was used in the early days of genetics to describe variant forms of a gene detected as different phenotypes...
s render an individual vulnerable to developing AS; if this is the case, the particular combination of alleles would determine the severity and symptoms for each individual with AS.
A few ASD cases have been linked to exposure to teratogens (agents that cause birth defects) during the first eight weeks from
conceptionHuman fertilization is the union of a human egg and sperm, usually occurring in the ampulla of the uterine tube. It is also the initiation of prenatal development. Scientists discovered the dynamics of human fertilization in the nineteenth century....
. Although this does not exclude the possibility that ASD can be initiated or affected later, it is strong evidence that it arises very early in development. Many environmental factors have been hypothesized to act after birth, but none has been confirmed by scientific investigation.
Mechanism
Asperger syndrome appears to result from developmental factors that affect many or all functional brain systems, as opposed to localized effects. Although the specific underpinnings of AS or factors that distinguish it from other ASDs are unknown, and no clear pathology common to individuals with AS has emerged, it is still possible that AS's mechanism is separate from other ASD.
NeuroanatomicalNeuroanatomy is the study of the anatomy of nervous tissue and neural structures of the nervous system. In vertebrate animals, the routes that the myriad nerves take from the brain to the rest of the body , and the internal structure of the brain in particular, are both extremely elaborate...
studies and the associations with
teratogensTeratology is the study of abnormalities of physiological development. It is often thought of as the study of birth defects, but it is much broader than that, taking in other developmental stages, such as puberty; and other life forms, such as plants...
strongly suggest that the mechanism includes alteration of brain development soon after conception. Abnormal migration of embryonic cells during
fetal developmentPrenatal or antenatal development is the process in which an embryo or fetus gestates during pregnancy, from fertilization until birth. Often, the terms fetal development, foetal development, or embryology are used in a similar sense.After fertilization the embryogenesis starts...
may affect the final structure and connectivity of the brain, resulting in alterations in the neural circuits that control thought and behavior. Several theories of mechanism are available; none is likely to provide a complete explanation.
The underconnectivity theory hypothesizes underfunctioning high-level neural connections and synchronization, along with an excess of low-level processes. It maps well to general-processing theories such as
weak central coherence theoryThe weak central coherence theory , also called the Central coherence theory , suggests that a specific perceptual-cognitive style, loosely described as a limited ability to understand context or to "see the big picture", underlies the central disturbance in autism and related autism spectrum...
, which hypothesizes that a limited ability to see the big picture underlies the central disturbance in ASD. A related theory—enhanced perceptual functioning—focuses more on the superiority of locally oriented and perceptual operations in autistic individuals.
The
mirror neuron systemA mirror neuron is a neuron that fires both when an animal acts and when the animal observes the same action performed by another. Thus, the neuron "mirrors" the behavior of the other, as though the observer were itself acting. Such neurons have been directly observed in primates, and are...
(MNS) theory hypothesizes that alterations to the development of the MNS interfere with imitation and lead to Asperger's core feature of social impairment. For example, one study found that activation is delayed in the core circuit for imitation in individuals with AS. This theory maps well to
social cognitionSocial cognition is the study of how people process social information, especially its encoding, storage, retrieval, and application to social situations. Social cognition’s focus on information processing has many affinities with its sister discipline, cognitive psychology...
theories like the
theory of mindTheory of mind is the ability to attribute mental states—beliefs, intents, desires, pretending, knowledge, etc.—to oneself and others and to understand that others have beliefs, desires and intentions that are different from one's own...
, which hypothesizes that autistic behavior arises from impairments in ascribing mental states to oneself and others, or
hyper-systemizingThe empathizing–systemizing theory seeks to classify people on the basis of their skills in two factors of empathizing and systemizing. It measures skills using as Empathy Quotient and Systemizing Quotient , and attempts to explain the social and communication symptoms in autism spectrum...
, which hypothesizes that autistic individuals can systematize internal operation to handle internal events but are less effective at
empathizingEmpathy, which literally translates as 'in feeling', is the capability to share and understand another's emotions and feelings. It is often characterized as the ability to "put oneself into another's shoes".-Etymology:...
by handling events generated by other agents.
Other possible mechanisms include
serotoninSerotonin is a monoamine neurotransmitter. It is found extensively in the gastrointestinal tract of animals, and about 80 to 90 percent of the human body's total serotonin is located in the enterochromaffin cells in the gut, where it is used to regulate intestinal movements...
dysfunction and cerebellar dysfunction.
Screening
Parents of children with Asperger syndrome can typically trace differences in their children's development to as early as 30 months of age. Developmental screening during a routine check-up by a
general practitionerA general practitioner or GP is a medical practitioner who provides primary care and specializes in family medicine. A general practitioner treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes...
or pediatrician may identify signs that warrant further investigation. The diagnosis of AS is complicated by the use of several different screening instruments, including the Asperger Syndrome Diagnostic Scale (ASDS), Autism Spectrum Screening Questionnaire (ASSQ), Childhood Asperger Syndrome Test (CAST),
Gilliam Asperger's Disorder ScaleThe Gilliam Asperger's Disorder Scale is a tool for assisting the medical diagnosis of Asperger syndrome. More specifically, it is a rating scale for behaviour, which can be used by either individuals or professionals, and is commonly used by school psychologists.It comprises 32 diagnostic...
(GADS), Krug Asperger's Disorder Index (KADI), and the
Autism Spectrum QuotientThe Autism Spectrum Quotient, or AQ, is a questionnaire published in 2001 by Simon Baron-Cohen and his colleagues at the Autism Research Centre in Cambridge, UK. Consisting of fifty questions, it aims to investigate whether adults of normal intelligence have symptoms of autism or one of the other...
(AQ; with versions for children, adolescents and adults). None have been shown to reliably differentiate between AS and other ASDs.
Diagnosis
Standard diagnostic criteria require impairment in social interaction, and repetitive and stereotyped patterns of behavior, activities and interests, without significant delay in language or cognitive development. Unlike the international standard, U.S. criteria also require significant impairment in day-to-day functioning. Other sets of diagnostic criteria have been proposed by Szatmari
et al. and by Gillberg and Gillberg.
Diagnosis is most commonly made between the ages of four and eleven. A comprehensive assessment involves a multidisciplinary team that observes across multiple settings, and includes neurological and genetic assessment as well as tests for cognition, psychomotor function, verbal and nonverbal strengths and weaknesses, style of learning, and skills for independent living. The current "gold standard" in diagnosing ASDs combines clinical judgment with the
Autism Diagnostic Interview-RevisedThe Autism Diagnostic Interview-Revised is structured interview conducted with the parents of individuals who have been referred for the evaluation of possible autism or autism spectrum disorders...
(ADI-R)—a semistructured parent interview—and the Autism Diagnostic Observation Schedule (ADOS)—a conversation and play-based interview with the child. Delayed or mistaken diagnosis can be traumatic for individuals and families; for example, misdiagnosis can lead to medications that worsen behavior. Many children with AS are initially misdiagnosed with
attention-deficit hyperactivity disorderAttention-deficit hyperactivity disorder is a neurobehavioral developmental disorder. ADHD is primarily characterized by "the co-existence of attentional problems and hyperactivity, with each behavior occurring infrequently alone." While symptoms may appear to be innocent and merely annoying...
(ADHD). Diagnosing adults is more challenging, as standard diagnostic criteria are designed for children and the expression of AS changes with age; adult diagnosis requires painstaking clinical examination and thorough
medical historyThe medical history or anamnesis of a patient is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information , with the aim of obtaining information useful in formulating a diagnosis and providing...
gained from both the individual and other people who know the person, focusing on childhood behavior. Conditions that must be considered in a
differential diagnosisA differential diagnosis is a systematic method used to identify unknowns. This method, essentially a process of elimination, is used by taxonomists to identify living organisms, and by physicians or other clinicians to diagnose the specific disease in a patient.Not all medical diagnoses are...
include other ASDs, the
schizophreniaSchizophrenia , from the Greek roots skhizein and phrēn, phren- is a psychiatric diagnosis that describes a mental disorder characterized by abnormalities in the perception or expression of reality...
spectrum, ADHD, obsessive compulsive disorder, major depressive disorder,
semantic pragmatic disorderPragmatic language impairment is an impairment in understanding pragmatic areas of language. This type of impairment was previously called semantic-pragmatic disorder . Pragmatic language impairments are related to autism and Asperger syndrome...
,
nonverbal learning disorderNonverbal learning disorder or nonverbal learning disability is a proposed condition characterized by a significant discrepancy between high verbal and lower performance scores on an IQ test, with deficits in motor, visual-spatial, and social skills...
,
Tourette syndromeTourette syndrome is an inherited neuropsychiatric disorder with onset in childhood, characterized by the presence of multiple physical tics and at least one vocal tic; these tics characteristically...
,
stereotypic movement disorderStereotypic movement disorder is a disorder of childhood involving repetitive, nonfunctional motor behavior , that markedly interferes with normal activities or results in bodily injury, and persists for four weeks or longer. The behavior must not be due to the direct effects of a substance or...
and
bipolar disorderBipolar disorder, also known as manic depressive disorder, manic depression or bipolar affective disorder, is a serious mental disorder that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated mood clinically referred to as mania or, if...
.
Underdiagnosis and overdiagnosis are problems in marginal cases. The cost of screening and diagnosis and the challenge of obtaining payment can inhibit or delay diagnosis. Conversely, the increasing popularity of drug treatment options and the expansion of benefits has motivated providers to overdiagnose ASD. There are indications AS has been diagnosed more frequently in recent years, partly as a residual diagnosis for children of normal intelligence who do not have autism but have social difficulties. In 2006, it was reported to be the fastest-growing psychiatric diagnosis in
Silicon ValleySilicon Valley is the southern part of the San Francisco Bay Area in Northern California, United States. The term originally referred to the region's large number of silicon chip innovators and manufacturers, but eventually came to refer to all the high-tech businesses in the area; it is now...
children; also, there is a predilection for adults to self-diagnose it. There are questions about the
external validityExternal validity is the validity of generalized inferences in scientific studies, usually based on experiments as experimental validity....
of the AS diagnosis. That is, it is unclear whether there is a practical benefit in distinguishing AS from HFA and from PDD-NOS; the same child can receive different diagnoses depending on the screening tool. The debate about distinguishing AS from HFA is partly due to a
tautological dilemmaIn rhetoric, a tautology is an unnecessary or unessential repetition of meaning, using different and dissimilar words that effectively say the same thing twice...
where disorders are defined based on severity of impairment, so that studies that appear to confirm differences based on severity are to be expected.
Management
Asperger syndrome treatment attempts to manage distressing symptoms and to teach age-appropriate social, communication and vocational skills that are not naturally acquired during development, with intervention tailored to the needs of the individual child, based on multidisciplinary assessment. Although progress has been made, data supporting the efficacy of particular interventions are limited.
Therapies
The ideal treatment for AS coordinates therapies that address core symptoms of the disorder, including poor communication skills and obsessive or repetitive routines. While most professionals agree that the earlier the intervention, the better, there is no single best treatment package. AS treatment resembles that of other high-functioning ASDs, except that it takes into account the linguistic capabilities, verbal strengths, and nonverbal vulnerabilities of individuals with AS. A typical program generally includes:
- the training of social skills for more effective interpersonal interactions,
- cognitive behavioral therapy to improve stress management
Stress management is the amelioration of stress, especially chronic stress.-Historical foundations:Walter Cannon and Hans Selye used animal studies to establish the earliest scientific basis for the study of stress...
relating to anxiety or explosive emotions, and to cut back on obsessive interests and repetitive routines,
- medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
, for coexisting conditions such as major depressive disorder and anxiety disorderAnxiety disorder is a blanket term covering several different forms of abnormal and pathological fears and anxieties which only came under the aegis of psychiatry at the very end of the 19th century. Current psychiatric diagnostic criteria recognize a wide variety of anxiety disorders...
,
- occupational
Occupational therapy, often abbreviated as "OT", incorporates meaningful and purposeful occupation to enable people with limitations or impairments to participate in everyday life. Occupational therapists work with individuals, families, groups and populations to facilitate health and well-being...
or physical therapyPhysical therapy is a health care profession which provides services to individuals in order to develop, maintain and restore maximum movement and functional ability throughout life...
to assist with poor sensory integrationSensory integration is defined as the neurological process that organizes sensation from one’s own body and the environment, thus making it possible to use the body effectively within the environment. Specifically, it deals with how the brain processes multiple sensory modality inputs into usable...
and motor coordinationMotor coordination is a term used to refer to the coordination of movements, usually between different subsequent parts of the same movement or movements of several limbs or even several actors.Motor coordination arise from a complex coordination between:...
,
- social communication intervention, which is specialized speech therapy to help with the pragmatics
Pragmatics is a subfield of linguistics which studies the ways in which context contributes to meaning. Pragmatics encompasses speech act theory, conversational implicature, talk in interaction and other approaches to language behavior in philosophy, sociology, and linguistics. It studies how the...
of the give and take of normal conversation,
- the training and support of parents, particularly in behavioral techniques to use in the home.
Of the many studies on behavior-based early intervention programs, most are case studies of up to five participants, and typically examine a few problem behaviors such as self-injury,
aggressionIn psychology, as well as other social and behavioral sciences, aggression refers to behavior between members of the same species that is intended to cause pain or harm. Predatory or defensive behavior between members of different species is not normally considered "aggression." Aggression takes a...
, noncompliance,
stereotypiesA stereotypy is a repetitive or ritualistic movement, posture, or utterance, found in patients with mental retardation, autism spectrum disorders, tardive dyskinesia and stereotypic movement disorder. Stereotypies may be simple movements such as body rocking, or complex, such as self-caressing,...
, or spontaneous language; unintended
side effectsIn medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect, and may result from an unsuitable or incorrect dosage or...
are largely ignored. Despite the popularity of social skills training, its effectiveness is not firmly established. A randomized controlled study of a model for training parents in problem behaviors in their children with AS showed that parents attending a one-day workshop or six individual lessons reported fewer behavioral problems, while parents receiving the individual lessons reported less intense behavioral problems in their AS children. Vocational training is important to teach job interview etiquette and workplace behavior to older children and adults with AS, and organization software and personal data assistants to improve the work and life management of people with AS are useful.
Medications
No medications directly treat the core symptoms of AS. Although research into the efficacy of pharmaceutical intervention for AS is limited, it is essential to diagnose and treat
comorbidIn medicine, comorbidity is either:* The presence of one or more disorders in addition to a primary disease or disorder; or* The effect of such additional disorders or diseases....
conditions. Deficits in self-identifying emotions or in observing effects of one's behavior on others can make it difficult for individuals with AS to see why medication may be appropriate. Medication can be effective in combination with behavioral interventions and environmental accommodations in treating comorbid symptoms such as anxiety disorder, major depressive disorder, inattention and aggression. The
atypical neurolepticThe atypical antipsychotics are a group of antipsychotic drugs used to treat psychiatric conditions. Some atypical antipsychotics are FDA approved for use in the treatment of schizophrenia...
medications
risperidoneRisperidone is an atypical antipsychotic used to treat schizophrenia , the mixed and manic states associated with bipolar disorder, and irritability in children with autism...
and
olanzapineOlanzapine is an atypical antipsychotic, approved by the FDA for the treatment of schizophrenia and bipolar disorder...
have been shown to reduce the associated symptoms of AS; risperidone can reduce repetitive and self-injurious behaviors, aggressive outbursts and impulsivity, and improve stereotypical patterns of behavior and social relatedness. The
selective serotonin reuptake inhibitor Selective serotonin reuptake inhibitors or serotonin-specific reuptake inhibitor are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, and some personality disorders...
s (SSRIs)
fluoxetineFluoxetine is an antidepressant of the selective serotonin reuptake inhibitor class. Fluoxetine is approved for the treatment of major depression , obsessive-compulsive disorder , bulimia nervosa, anorexia nervosa, panic disorder and premenstrual dysphoric disorder...
,
fluvoxamineFluvoxamine is an antidepressant which functions as a selective serotonin reuptake inhibitor and is predominantly used to treat obsessive–compulsive disorder.-History:...
and
sertralineSertraline hydrochloride is an antidepressant of the selective serotonin reuptake inhibitor class. It was introduced to the market by Pfizer in 1991. Sertraline is primarily used to treat major depression in adult outpatients as well as obsessive–compulsive, panic, and social anxiety disorders in...
have been effective in treating restricted and repetitive interests and behaviors.
Care must be taken with medications; abnormalities in
metabolismMetabolism is the set of chemical reactions that occur in living organisms to maintain life. These processes allow organisms to grow and reproduce, maintain their structures, and respond to their environments. Metabolism is usually divided into two categories. Catabolism breaks down organic matter,...
,
cardiac conductionThe normal electrical conduction in the heart allows the impulse that is generated by the sinoatrial node of the heart to be propagated to the myocardium . The myocardium contracts after stimulation...
times, and an increased risk of
type 2 diabetesDiabetes mellitus type 2 or type 2 diabetes is a disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency...
have been raised as concerns with these medications, along with serious long-term neurological side effects. SSRIs can lead to manifestations of behavioral activation such as increased impulsivity, aggression and sleep disturbance.
Weight gainWeight gain is an increase in body weight. This can be either an increase in muscle mass, fat deposits, or excess fluids such as water.-Description:In some cases, weight gain can also occur as a result of developing tumors or other abnormal growths...
and fatigue are commonly reported side effects of risperidone, which may also lead to increased risk for extrapyramidal symptoms such as restlessness and
dystoniaDystonia is a neurological movement disorder in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. The disorder may be inherited or caused by other factors such as birth-related or other physical trauma, infection, poisoning Dystonia is a neurological...
and increased serum
prolactinProlactin or Luteotropic hormone is a peptide hormone discovered by Dr. Henry Friesen, primarily associated with lactation. In breastfeeding, the act of an infant suckling the nipple stimulates the production of prolactin, which fills the breast with milk via a process called lactogenesis, in...
levels. Sedation and weight gain are more common with olanzapine, which has also been linked with diabetes. Sedative side-effects in school-age children have ramifications for classroom learning. Individuals with AS may be unable to identify and communicate their internal moods and emotions or to tolerate side effects that for most people would not be problematic.
Prognosis
There is some evidence that as many as 20% of children with AS "grow out" of it, and fail to meet the diagnostic criteria as adults.
As of 2006, no studies addressing the long-term outcome of individuals with Asperger syndrome are available and there are no systematic long-term follow-up studies of children with AS. Individuals with AS appear to have normal
life expectancyLife expectancy is the expected number of years of life remaining at a given age. It is denoted by e
x, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...
but have an increased
prevalenceIn epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. It is used as an estimate of how...
of comorbid
psychiatricPsychiatry is a medical specialty officially devoted to the treatment and study of mental disorders. The term was first coined by the German physician Johann Christian Reil in 1808....
conditions such as major depressive disorder and anxiety disorder that may significantly affect
prognosisPrognosis is a medical term to describe the likely outcome of an illness. When applied to large populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because previous...
. Although social impairment is lifelong, outcome is generally more positive than with individuals with lower functioning autism spectrum disorders; for example, ASD symptoms are more likely to diminish with time in children with AS or HFA. Although most students with AS/HFA have average mathematical ability and test slightly worse in mathematics than in general intelligence, some are gifted in mathematics and AS has not prevented some adults from major accomplishments such as winning the
Nobel PrizeThe Nobel Prize is a Sweden-based international monetary prize. The award was established by the 1895 will and estate of Swedish chemist and inventor Alfred Nobel. It was first awarded in Physics, Chemistry, Physiology or Medicine, Literature, and Peace in 1901...
.
Children with AS may require
special educationSpecial education is the education of students with special needs in a way that addresses the students' individual differences and needs. Ideally, this process involves the individually planned and systematically monitored arrangement of teaching procedures, adapted equipment and materials,...
services because of their social and behavioral difficulties although many attend regular education classes. Adolescents with AS may exhibit ongoing difficulty with self care, organization and disturbances in social and romantic relationships; despite high cognitive potential, most young adults with AS remain at home, although some do marry and work independently. The "different-ness" adolescents experience can be traumatic. Anxiety may stem from preoccupation over possible violations of routines and rituals, from being placed in a situation without a clear schedule or expectations, or from
concern with failing in social encountersSocial anxiety is a term used to describe an experience of anxiety regarding social situations, interactions with others and being evaluated or scrutinized by other people. It occurs early in childhood as a normal part of the development of social functioning, but may go unnoticed until adolescence...
; the resulting stress may manifest as inattention, withdrawal, reliance on obsessions, hyperactivity, or aggressive or oppositional behavior. Depression is often the result of chronic frustration from repeated failure to engage others socially, and
mood disorderA mood disorder is the term given for a group of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders classification system where a disturbance in the person's mood is hypothesized to be the main underlying feature...
s requiring treatment may develop. Clinical experience suggests the rate of suicide may be higher among those with AS, but this has not been confirmed by systematic empirical studies.
Education of families is critical in developing strategies for understanding strengths and weaknesses; helping the family to cope improves outcomes in children. Prognosis may be improved by diagnosis at a younger age that allows for early interventions, while interventions in adulthood are valuable but less beneficial. There are legal implications for individuals with AS as they run the risk of exploitation by others and may be unable to comprehend the societal implications of their actions.
Epidemiology
PrevalenceIn epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. It is used as an estimate of how...
estimates vary enormously. A 2003 review of
epidemiologicalAn Epidemiological study is a statistical study on human populations, which attempts to link human health effects to a specified cause....
studies of children found
prevalenceIn epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. It is used as an estimate of how...
rates ranging from 0.03 to 4.84 per 1,000, with the ratio of autism to Asperger syndrome ranging from 1.5:1 to 16:1; combining the average ratio of 5:1 with a conservative prevalence estimate for autism of 1.3 per 1,000 suggests indirectly that the prevalence of AS might be around 0.26 per 1,000. Part of the variance in estimates arises from differences in diagnostic criteria. For example, a relatively small 2007 study of 5,484 eight-year-old children in Finland found 2.9 children per 1,000 met the ICD-10 criteria for an AS diagnosis, 2.7 per 1,000 for Gillberg and Gillberg criteria, 2.5 for DSM-IV, 1.6 for Szatmari
et al., and 4.3 per 1,000 for the union of the four criteria. Boys seem to be more likely to have AS than girls; estimates of the sex ratio range from 1.6:1 to 4:1, using the Gillberg and Gillberg criteria.
Anxiety disorder and major depressive disorder are the most common conditions seen at the same time;
comorbidityIn medicine, comorbidity is either:* The presence of one or more disorders in addition to a primary disease or disorder; or* The effect of such additional disorders or diseases....
of these in persons with AS is estimated at 65%. Depression is common in adolescents and adults; children are likely to present with
ADHDAttention-deficit hyperactivity disorder is a neurobehavioral developmental disorder. ADHD is primarily characterized by "the co-existence of attentional problems and hyperactivity, with each behavior occurring infrequently alone." While symptoms may appear to be innocent and merely annoying...
. Reports have associated AS with
medical conditionsMedical states or medical conditions are used to describe a patient's condition in a hospital. These terms are most commonly used by the news media and are rarely used by doctors, who in their daily business prefer to deal with medical problems in greater detail.-USA practice:A wide range of terms...
such as
aminoaciduriaAminoaciduria is the presence of amino acids in the urine. Small amounts of amino acids are also present in normal urine. Increased total urine amino acids may result from metabolic disorders, chronic liver disease or renal disorders. Aminoacidurias can be broadly classified in to primary and...
and
ligamentous laxityLigamentous laxity is a term given to describe "loose ligaments."In a 'normal' body, ligaments are naturally tight in such a way that the joints are restricted to 'normal' ranges of motion. This creates normal joint stability...
, but these have been case reports or small studies and no factors have been associated with AS across studies. One study of males with AS found an increased rate of
epilepsyEpilepsy is a common chronic neurological disorder characterized by recurrent unprovoked seizures...
and a high rate (51%) of
nonverbal learning disorderNonverbal learning disorder or nonverbal learning disability is a proposed condition characterized by a significant discrepancy between high verbal and lower performance scores on an IQ test, with deficits in motor, visual-spatial, and social skills...
. AS is associated with
ticA tic is a sudden, repetitive, nonrhythmic, stereotyped motor movement or vocalization involving discrete muscle groups. Tics can be invisible to the observer, such as abdominal tensing or toe crunching. Common motor and vocal tics are, respectively, eye blinking and throat clearing...
s,
Tourette syndromeTourette syndrome is an inherited neuropsychiatric disorder with onset in childhood, characterized by the presence of multiple physical tics and at least one vocal tic; these tics characteristically...
, and
bipolar disorderBipolar disorder, also known as manic depressive disorder, manic depression or bipolar affective disorder, is a serious mental disorder that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated mood clinically referred to as mania or, if...
, and the repetitive behaviors of AS have many similarities with the symptoms of
obsessive-compulsive disorderObsessive–compulsive disorder is a mental disorder characterized by intrusive thoughts that produce anxiety, by repetitive behaviors aimed at reducing anxiety, or by combinations of such thoughts and behaviors...
and
obsessive-compulsive personality disorderObsessive–compulsive personality disorder is a personality disorder which involves an obsession with perfection, rules, and organization. People with OCPD may feel anxious when they perceive that things are not right...
. Although many of these studies are based on psychiatric clinic samples without using standardized measures, it seems reasonable to conclude that comorbid conditions are relatively common.
History
Named after the Austrian pediatrician
Hans AspergerHans Asperger was the Austrian pediatrician after whom Asperger syndrome is named.-Life:Asperger studied medicine in Vienna and became employed as a member of the University Children's Hospital in Vienna. He married in 1935 and had five children...
(1906–1980), Asperger syndrome is a relatively new diagnosis in the field of autism.
As a child, Asperger appears to have exhibited some features of the very condition named after him, such as remoteness and talent in language; photographs taken during his seminal work show that he had an earnest face with an intense gaze. In 1944, Asperger described four children in his practice who had difficulty in integrating themselves socially. The children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Asperger called the condition "autistic psychopathy" and described it as primarily marked by
social isolationSocial isolation is the pervasive withdrawal or avoidance of social contact or communication. It can contribute toward many emotional, behavioural and physical disorders including anxiety, panic attacks, eating disorders, addictions, substance abuse, violent behaviour and overall disease.-Illness...
. Unlike today's AS, autistic psychopathy could be found in people of all levels of intelligence, including those with mental retardation. In the context of the
Nazi eugenicsNazi eugenics were Nazi Germany's racially-based social policies that placed the improvement of the race through eugenics at the center of their concerns and targeted those humans they identified as "life unworthy of life" , including but not limited to the criminal, degenerate, dissident,...
policy of sterilizing and killing social deviants and the mentally handicapped, Asperger passionately defended the value of autistic individuals, writing "We are convinced, then, that autistic people have their place in the organism of the social community. They fulfil their role well, perhaps better than anyone else could, and we are talking of people who as children had the greatest difficulties and caused untold worries to their care-givers." Asperger also called his young patients "little professors", and believed some would be capable of exceptional achievement and original thought later in life. His paper was published during wartime and in German, so it was not widely read elsewhere.
Lorna WingLorna Wing, MD, FRCPsych, is an English psychiatrist and physician.As a result of having an autistic daughter, she became involved in researching developmental disorders, particularly autism spectrum disorders. She joined with other parents of autistic children to found the National Autistic...
popularized the term
Asperger syndrome in the English-speaking medical community in her 1981 publication of a series of case studies of children showing similar symptoms, and
Uta FrithUta Frith FRS FBA is a leading developmental psychologist working at the Institute of Cognitive Neuroscience at University College London. She has pioneered much of the current research in autism and dyslexia, and has written several books on these issues...
translated Asperger's paper to English in 1991. Sets of diagnostic criteria were outlined by Gillberg and Gillberg in 1989 and by Szatmari
et al. in the same year. AS became a standard diagnosis in 1992, when it was included in the tenth edition of the
World Health OrganizationThe World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health...
's diagnostic manual,
International Classification of Diseases (
ICD-10The International Statistical Classification of Diseases and Related Health Problems10th Revision is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization...
); in 1994, it was added to the fourth edition of the
American Psychiatric AssociationThe American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...
's diagnostic reference,
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
Hundreds of books, articles and websites now describe AS, and prevalence estimates have increased dramatically for ASD, with AS recognized as an important subgroup. Whether it should be seen as distinct from high-functioning autism is a fundamental issue requiring further study, and there are questions about the
empirical validationAn empirical validation of a hypothesis is required for it togain acceptance in the scientific community. Normally this validation is achieved by the scientific method of hypothesis commitment, experimental design, peer review, adversarial review, reproduction of results, conference presentation...
of the DSM-IV and ICD-10 criteria.
Cultural aspects
People with Asperger syndrome may refer to themselves in casual conversation as
aspies, coined by
Liane Holliday WilleyLiane Holliday Willey, EdD is a popular keynote speaker and best-selling American author. She is a wife, mother and avid horsewoman. She was diagnosed with Asperger syndrome in 1996...
in 1999. The word
neurotypicalNeurotypical is a term that was coined in the autistic community as a label for people who are not on the autism spectrum: specifically, neurotypical people have neurological development and states that are consistent with what most people would perceive as normal, particularly in regards to their...
(abbreviated
NT) describes a person whose neurological development and state are typical, and is often used to refer to non-autistic people.
The
InternetThe Internet is a global system of interconnected computer networks that use the standardized Internet Protocol Suite to serve billions of users worldwide...
has allowed individuals with AS to communicate and
celebrateAutistic Pride Day is a celebration of the neurodiversity of people on the autism spectrum on June 18 each year. Autistic pride is pride in autism, about shifting views of autism from "disease" to "difference"...
with each other in a way that was not previously possible because of their rarity and geographic dispersal. A
subculture of aspiesSociological and cultural aspects of autism come into play with recognition of autism, approaches to its support services and therapies, and how autism affects how we define personhood. The autism rights movement is based on a belief that autism is a different way of being and not a disorder to be...
has formed. Internet sites like
Wrong PlanetWrong Planet is an online community for individuals with Autism and Asperger syndrome. The site was started in 2004 by Dan Grover and Alex Plank and includes a chatroom, a large forum, a dating section, and articles describing how to deal with daily issues...
have made it easier for individuals to connect.
Autistic people have advocated a shift in perception of autism spectrum disorders as complex
syndromeIn medicine and psychology, the term syndrome refers to the association of several clinically recognizable features, signs , symptoms , phenomena or characteristics that often occur together, so that the presence of one feature alerts the physician to the presence of the others...
s rather than diseases that must be cured. Proponents of this view reject the notion that there is an "ideal" brain configuration and that any deviation from the norm is
pathologicalAnatomical pathology or Anatomic pathology is a medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, chemical, immunologic and molecular examination of organs, tissues, and whole bodies .Anatomical pathology is itself divided in subspecialties, the...
; they promote tolerance for what they call
neurodiversityNeurodiversity is an idea which asserts that atypical neurological development is a normal human difference that is to be recognized and respected as any other human variation. The concept of neurodiversity is embraced by some autistic individuals and people with related conditions...
. These views are the basis for the
autistic rightsThe autism rights movement is a social movement that encourages autistic people, their caregivers and society to adopt a position of neurodiversity, accepting autism as a variation in functioning rather than a mental disorder to be cured...
and autistic pride movements. There is a contrast between the attitude of adults with self-identified AS, who typically do not want to be cured and are proud of their identity, and parents of children with AS, who typically seek assistance and a cure for their children.
Some researchers have argued that AS can be viewed as a different cognitive style, not a disorder or a disability, and that it should be removed from the standard
Diagnostic and Statistical Manual, much as
homosexualityHomosexuality is the romantic or sexual attraction or behavior among members of the same sex, situationally or as an enduring disposition. As a sexual orientation, homosexuality is considered to lie within the heterosexual-homosexual continuum of human sexuality, and refers to an individual’s...
was removed. In a 2002 paper,
Simon Baron-CohenSimon Baron-Cohen FBA is Professor of Developmental Psychopathology in the Departments of Psychiatry and Experimental Psychology, a Fellow of Trinity College, Cambridge, and Director of the Autism Research Centre at the University of Cambridge, in the United Kingdom....
wrote of those with AS, "In the social world there is no great benefit to a precise eye for detail, but in the worlds of math, computing, cataloguing, music, linguistics, engineering, and science, such an eye for detail can lead to success rather than failure." Baron-Cohen cited two reasons why it might still be useful to consider AS to be a disability: to ensure provision for legally required special support, and to recognize emotional difficulties from reduced empathy. It has been argued that the genes for Asperger's combination of abilities have operated throughout recent
human evolutionHuman evolution, or anthropogenesis, is the origin and evolution of Homo sapiens as a distinct species from other hominids, great apes and placental mammals...
and have made remarkable contributions to human history.
External links