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Asperger syndrome (AS), also known as Asperger's syndrome or Asperger's, is a diagnostic label that has historically been used to describe a
neurodevelopmental disorder Neurodevelopmental disorders are a group of mental conditions negatively affecting the development of the nervous system, which includes the brain and spinal cord. According to the American Psychiatric Association Diagnostic and Statistical Manu ...
characterized by significant difficulties in
social interaction A social relation is the fundamental unit of analysis within the social sciences, and describes any voluntary or involuntary interpersonal relationship between two or more conspecifics within and/or between groups. The group can be a language or ...
and
nonverbal communication Nonverbal communication is the transmission of messages or signals through a nonverbal platform such as eye contact (oculesics), body language (kinesics), social distance (proxemics), touch (Haptic communication, haptics), voice (prosody (lingui ...
, along with restricted, repetitive patterns of behavior and interests. Asperger syndrome has been merged with other conditions into
autism spectrum disorder Autism, also known as autism spectrum disorder (ASD), is a neurodevelopmental disorder characterized by differences or difficulties in social communication and interaction, a preference for predictability and routine, sensory processing di ...
(ASD) and is no longer a diagnosis in the
WHO The World Health Organization (WHO) is a specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Geneva, Switzerland, and has 6 regional offices and 15 ...
's
ICD-11 The ICD-11 is the eleventh revision of the International Classification of Diseases (ICD). It replaces the ICD-10 as the global standard for recording health information and causes of death. The ICD is developed and annually updated by the World H ...
or the APA's
DSM-5-TR The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the ''Diagnostic and Statistical Manual of Mental Disorders'', the taxonomy (general), taxonomic and diagnostic tool published by the ...
. It was considered milder than other diagnoses which were merged into ASD due to relatively unimpaired
spoken language A spoken language is a form of communication produced through articulate sounds or, in some cases, through manual gestures, as opposed to written language. Oral or vocal languages are those produced using the vocal tract, whereas sign languages ar ...
and
intelligence Intelligence has been defined in many ways: the capacity for abstraction, logic, understanding, self-awareness, learning, emotional knowledge, reasoning, planning, creativity, critical thinking, and problem-solving. It can be described as t ...
. The syndrome was named in 1976 by English psychiatrist Lorna Wing after the Austrian
pediatrician Pediatrics (American English) also spelled paediatrics (British English), is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, pediatrics covers many of their youth ...
Hans Asperger Johann Friedrich Karl Asperger (, ; 18 February 1906 – 21 October 1980) was an Austrian physician. Noted for his early studies on atypical neurology, specifically in children, he is the namesake of the former autism spectrum disorder Asperger ...
, who, in 1944, described children in his care who struggled to form friendships, did not understand others'
gestures A gesture is a form of nonverbal communication or non-vocal communication in which visible bodily actions communicate particular messages, either in place of, or in conjunction with, speech. Gestures include movement of the hands, face, or othe ...
or
feelings According to the '' APA Dictionary of Psychology'', a feeling is "a self-contained phenomenal experience"; feelings are "subjective, evaluative, and independent of the sensations, thoughts, or images evoking them". The term ''feeling'' is closel ...
, engaged in one-sided conversations about their favorite interests, and were clumsy. In 1990 (coming into effect in 1993), the diagnosis of Asperger syndrome was included in the tenth edition (
ICD-10 ICD-10 is the 10th revision of the International Classification of Diseases (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social cir ...
) of the
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
's
International Classification of Diseases The International Classification of Diseases (ICD) is a globally used medical classification that is used in epidemiology, health management and clinical diagnosis. The ICD is maintained by the World Health Organization (WHO), which is the dir ...
, and in 1994, it was also included in the fourth edition (DSM-4) of the
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 39,200 members who are in ...
's ''
Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (''DSM''; latest edition: ''DSM-5-TR'', published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a com ...
''. However, with the publication of DSM-5 in 2013 the syndrome was removed, and the symptoms are now included within autism spectrum disorder along with classic autism and
pervasive developmental disorder not otherwise specified Pervasive developmental disorder not otherwise specified (PDD-NOS) is a historic psychiatric diagnosis first defined in 1980 that has since been incorporated into autism spectrum disorder in the DSM-5 (2013). According to the earlier DSM-IV, PDD ...
(PDD-NOS). It was similarly merged into autism spectrum disorder in the
International Classification of Diseases The International Classification of Diseases (ICD) is a globally used medical classification that is used in epidemiology, health management and clinical diagnosis. The ICD is maintained by the World Health Organization (WHO), which is the dir ...
(
ICD-11 The ICD-11 is the eleventh revision of the International Classification of Diseases (ICD). It replaces the ICD-10 as the global standard for recording health information and causes of death. The ICD is developed and annually updated by the World H ...
) in 2018 (published, coming into effect in 2022). The exact cause of autism, including what was formerly known as Asperger syndrome, is not well understood. While it has high heritability, the underlying
genetics Genetics is the study of genes, genetic variation, and heredity in organisms.Hartl D, Jones E (2005) It is an important branch in biology because heredity is vital to organisms' evolution. Gregor Mendel, a Moravian Augustinians, Augustinian ...
have not been determined conclusively. Environmental factors are also believed to play a role.
Brain imaging Neuroimaging is the use of quantitative (computational) techniques to study the structure and function of the central nervous system, developed as an objective way of scientifically studying the healthy human brain in a non-invasive manner. Incre ...
has not identified a common underlying condition. There is no single treatment, and the UK's
National Health Service The National Health Service (NHS) is the term for the publicly funded health care, publicly funded healthcare systems of the United Kingdom: the National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care (Northern ...
(NHS) guidelines suggest that "treatment" of any form of autism should not be a goal, since autism is not "a disease that can be removed or cured". According to the
Royal College of Psychiatrists The Royal College of Psychiatrists is the main professional organisation of psychiatrists in the United Kingdom, and is responsible for representing psychiatrists, for psychiatric research and for providing public information about mental healt ...
, while co-occurring conditions might require treatment, "management of autism itself is chiefly about the provision of the education, training, and social support/care required to improve the person's ability to function in the everyday world". The effectiveness of particular interventions for autism is supported by only limited data. Interventions may include social skills training,
cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD, and anxiety disorders. Cognitive behavioral therapy focuses on challenging and chang ...
,
physical therapy Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease preventio ...
,
speech therapy Speech is the use of the human voice as a medium for language. Spoken language combines vowel and consonant sounds to form units of meaning like words, which belong to a language's lexicon. There are many different intentional speech acts, suc ...
, parent training, and medications for associated problems, such as mood or anxiety. NIH Publication No. 05-5624. Autistic characteristics tend to become less obvious in adulthood, but social and communication difficulties usually persist. In 2015, Asperger syndrome was estimated to affect 37.2 million people globally, or about 0.5% of the population. The exact percentage of people affected has still not been firmly established. Autism spectrum disorder is diagnosed in males more often than females, and females are typically diagnosed at a later age. The modern conception of Asperger syndrome came into existence in 1981 and went through a period of popularization. It became a standardized
diagnosis Diagnosis (: diagnoses) is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in a lot of different academic discipline, disciplines, with variations in the use of logic, analytics, and experience, to determine " ...
in the 1990s and was merged into ASD in 2013. Many questions and controversies about the condition remain.


Classification

The extent of the overlap between Asperger syndrome and other forms of autism, particularly what was sometimes called
high-functioning autism High-functioning autism (HFA) was historically an autism classification to describe a person who exhibited no intellectual disability but otherwise showed autistic traits, such as difficulty in social interaction and communication. The term was ...
is unclear. The ASD classification is to some extent an artifact of how autism was discovered, and it may not reflect the true nature of the spectrum; methodological problems have beset Asperger syndrome as a valid diagnosis from the outset. As noted above, in the 2010s, Asperger syndrome, as a separate diagnosis, was eliminated and folded into autism spectrum disorder in the
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiat ...
and the
ICD-11 The ICD-11 is the eleventh revision of the International Classification of Diseases (ICD). It replaces the ICD-10 as the global standard for recording health information and causes of death. The ICD is developed and annually updated by the World H ...
. Like the diagnosis of Asperger syndrome, the change was controversial. The
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
(WHO) previously defined Asperger syndrome (AS) as one of the
pervasive developmental disorder The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD), was a group of disorders characterized by delays in the development of multiple basic functions including socialization and ...
s (PDD), which are a spectrum of psychological disorders that are characterized by abnormalities of
social interaction A social relation is the fundamental unit of analysis within the social sciences, and describes any voluntary or involuntary interpersonal relationship between two or more conspecifics within and/or between groups. The group can be a language or ...
and communication that pervade the individual's functioning, and by restricted and repetitive interests and behavior. Like other neurodevelopmental conditions, 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.


Characteristics

As a
pervasive developmental disorder The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD), was a group of disorders characterized by delays in the development of multiple basic functions including socialization and ...
, 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 Verbosity, or verboseness, is speech or writing that uses more words than necessary. The opposite of verbosity is succinctness. Some teachers, including the author of ''The Elements of Style'', warn against verbosity. Similarly Mark Twain and ...
, restricted prosody, and physical clumsiness are typical of the condition, but are not required for diagnosis. Suicidal thoughts and behaviors are a serious concern within the autistic population. One study found that adults with Asperger syndrome exhibited suicidal thoughts at 9 times the rate of the general population. Of autistic study participants, 66% had experienced
suicidal ideation Suicidal ideation, or suicidal thoughts, is the thought process of having ideas or ruminations about the possibility of dying by suicide.World Health Organization, ''ICD-11 for Mortality and Morbidity Statistics'', ver. 09/2020MB26.A Suicidal i ...
, while 35% had planned or attempted suicide.


Social interaction

A lack of demonstrated
empathy Empathy is generally described as the ability to take on another person's perspective, to understand, feel, and possibly share and respond to their experience. There are more (sometimes conflicting) definitions of empathy that include but are ...
affects aspects of social relatability for persons with Asperger syndrome. Individuals with Asperger syndrome 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 (e.g., showing others objects of interest); a lack of social or emotional reciprocity; and impaired nonverbal behaviors in areas such as
eye contact Eye contact occurs when two people or non-human animals look at each other's eyes at the same time. In people, eye contact is a form of nonverbal communication and can have a large influence on social behavior. Coined in the early to mid-1960s, ...
,
facial expression Facial expression is the motion and positioning of the muscles beneath the skin of the face. These movements convey the emotional state of an individual to observers and are a form of nonverbal communication. They are a primary means of conveying ...
, posture, and gesture. People with Asperger syndrome may not be as withdrawn around others, compared with those with other forms of autism; they approach others, even if awkwardly. For example, a person with Asperger syndrome 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 wish to change the topic of talk or end the interaction. This social awkwardness has been called "active but odd". Such failures to react appropriately to social interaction may appear as disregard for other people's feelings and may come across as rude or insensitive. However, not all individuals with Asperger syndrome will approach others. Some may even display
selective mutism Selective mutism (SM) is an anxiety disorder in which a person who is otherwise capable of speech becomes unable to speak when exposed to specific situations, specific places, or to specific people, one or multiple of which serve as triggers. Se ...
, not speaking at all to most people and excessively to specific others. The cognitive ability of children with Asperger syndrome often allows them to articulate
social norms A social norm is a shared standard of acceptance, acceptable behavior by a group. Social norms can both be informal understandings that govern the behavior of members of a society, as well as be codified into wikt:rule, rules and laws. Social norma ...
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 Asperger syndrome may analyze and distill their observations 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 naïve. A history of failed attempts to establish reciprocal social relationships can cause autistic individuals to isolate themselves and cease attempts to engage; however, autistic people overwhelmingly report a desire for social contact and friendship.


Violent or criminal behavior

The
hypothesis A hypothesis (: hypotheses) is a proposed explanation for a phenomenon. A scientific hypothesis must be based on observations and make a testable and reproducible prediction about reality, in a process beginning with an educated guess o ...
that individuals with Asperger syndrome are predisposed to violent or criminal behavior has been investigated but is unsupported by data. More evidence suggests that children diagnosed with Asperger syndrome are more likely to be victims, rather than offenders. A 2008 review found that about 80% of reported violent criminals with Asperger syndrome also had other coexisting psychotic
psychiatric disorders A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
such as
schizoaffective disorder Schizoaffective disorder is a mental disorder characterized by symptoms of both schizophrenia (psychosis) and a mood disorder, either bipolar disorder or depression. The main diagnostic criterion is the presence of psychotic symptoms for at leas ...
. The sample size of this review was small (''n'' = 37).


Empathy

People with an Asperger profile might not be recognized for their empathetic qualities, due to variation in the ways
empathy Empathy is generally described as the ability to take on another person's perspective, to understand, feel, and possibly share and respond to their experience. There are more (sometimes conflicting) definitions of empathy that include but are ...
is felt and expressed. Some people feel deep empathy, but do not outwardly communicate these sentiments through facial expressions or language. Some people come to empathy through intellectual processes, using logic and reasoning to arrive at the feelings. People with Asperger profiles may be bullied or excluded by peers, and might as a result be guarded around people, which could appear as lack of empathy. People with Asperger profiles can still be caring individuals; indeed, it is particularly common for those with the profile to feel and exhibit deep concern for individual rights, human welfare, animal rights, environmental protection, and other global and humanitarian causes. Evidence suggests that in the "
double empathy problem The theory of the double empathy problem is a psychological and sociological theory first coined in 2012 by Damian Milton, an autistic autism researcher. This theory proposes that many of the difficulties autistic individuals face when socializ ...
model, autistic people have a unique interaction style which is significantly more readable by other autistic people, compared to non-autistic people."


Restricted and repetitive interests and behavior

People with Asperger syndrome can 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
stereotyped In social psychology, a stereotype is a generalized belief about a particular category of people. It is an expectation that people might have about every person of a particular group. The type of expectation can vary; it can be, for example ...
and repetitive ways, preoccupy themselves with parts of objects, or engage in compulsive behaviors like lining objects up to form patterns. The pursuit of specific and narrow areas of interest is one of the most striking among possible features of AS. Individuals with AS may collect volumes of detailed information on a relatively narrow topic such as weather data or star names without necessarily having a 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 age five or six. Although these
special interests Advocacy groups, also known as lobby groups, interest groups, special interest groups, pressure groups, or public associations, use various forms of advocacy or lobbying to influence public opinion and ultimately public policy. They play an impor ...
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, called
stimming Self-stimulatory behavior (also called stimming, stims, self-stimulation, stereotypy, and stereotypic movement disorder) is the repetition of physical movements, sounds, words, moving objects, or other behaviors. Stimming is a type of restricted ...
, are a core part of the diagnosis of AS and other ASDs. Stims are believed to be used for self-soothing and regulate
sensory input Sensory may refer to: Biology * Sensory ecology, how organisms obtain information about their environment * Sensory neuron, nerve cell responsible for transmitting information about external stimuli * Sensory perception, the process of acquiri ...
. 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
tic A tic is a sudden and repetitive motor movement or vocalization that is not rhythmic and involves discrete muscle groups. Tics are typically brief and may resemble a normal behavioral characteristic or gesture. Tics can be invisible to the obs ...
s, which are usually faster, less rhythmical, and less often symmetrical. Stimming may have a connection with tics, and studies have reported a consistent comorbidity between AS and
Tourette syndrome Tourette syndrome (TS), or simply Tourette's, is a common neurodevelopmental disorder that begins in childhood or adolescence. It is characterized by multiple movement (motor) tics and at least one vocal (phonic) tic. Common tics are blinkin ...
in the range of 8–20%, with one figure as high as 80% for tics of some kind or another, for which several explanations have been put forward, including common genetic factors and
dopamine Dopamine (DA, a contraction of 3,4-dihydroxyphenethylamine) is a neuromodulatory molecule that plays several important roles in cells. It is an organic chemical of the catecholamine and phenethylamine families. It is an amine synthesized ...
,
glutamate Glutamic acid (symbol Glu or E; known as glutamate in its anionic form) is an α-amino acid that is used by almost all living beings in the biosynthesis of proteins. It is a Essential amino acid, non-essential nutrient for humans, meaning that ...
, or
serotonin Serotonin (), also known as 5-hydroxytryptamine (5-HT), is a monoamine neurotransmitter with a wide range of functions in both the central nervous system (CNS) and also peripheral tissues. It is involved in mood, cognition, reward, learning, ...
abnormalities. According to the Adult Asperger Assessment (AAA) diagnostic test, a lack of interest in fiction and a positive preference towards non-fiction is common among adults with AS.


Speech and language

Although individuals with Asperger syndrome acquire language skills without significant general delay and their speech typically lacks significant abnormalities,
language acquisition Language acquisition is the process by which humans acquire the capacity to perceive and comprehend language. In other words, it is how human beings gain the ability to be aware of language, to understand it, and to produce and use words and s ...
and use is often atypical. Abnormalities include verbosity; abrupt transitions; literal interpretations and miscomprehension of nuance; use of metaphor meaningful only to the speaker; auditory perception deficits; unusually
pedantic Pedantry ( ) is an excessive concern with Formalism (philosophy), formalism, minor details, and rules that are not important. Etymology Pedantry is the adjective form of the 1580s English word pedant, which meant a male schoolteacher at the tim ...
,
formal Formal, formality, informal or informality imply the complying with, or not complying with, some set of requirements ( forms, in Ancient Greek). They may refer to: Dress code and events * Formal wear, attire for formal events * Semi-formal atti ...
, or
idiosyncratic An idiosyncrasy is a unique feature of something. The term is often used to express peculiarity. Etymology The term "idiosyncrasy" originates from Greek ', "a peculiar temperament, habit of body" (from ', "one's own", ', "with" and ', "blend ...
speech; and oddities in loudness, pitch, intonation, prosody, and rhythm.
Echolalia Echolalia is the unsolicited repetition of vocalizations made by another person; when repeated by the same person, it is called palilalia. In its profound form it is automatic and effortless. It is one of the echophenomena, closely related to ...
has also been observed in individuals with AS. Three aspects of communication patterns are of clinical interest: poor prosody,
tangential In geometry, the tangent line (or simply tangent) to a plane curve at a given point is, intuitively, the straight line that "just touches" the curve at that point. Leibniz defined it as the line through a pair of infinitely close points on ...
and
circumstantial speech Circumstantial speech, also referred to as circumstantiality, is the result of a so-called "non-linear thought pattern" and occurs when the focus of a conversation drifts, but often comes back to the point.''Problem-Based Psychiatry'' by Ben Green ...
, and marked verbosity. Although
inflection In linguistic Morphology (linguistics), morphology, inflection (less commonly, inflexion) is a process of word formation in which a word is modified to express different grammatical category, grammatical categories such as grammatical tense, ...
and intonation may be less rigid or monotonic than in classic 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 incoherence; the conversational style often includes monologues about topics that bore the listener, fails to provide
context In semiotics, linguistics, sociology and anthropology, context refers to those objects or entities which surround a ''focal event'', in these disciplines typically a communicative event, of some kind. Context is "a frame that surrounds the event ...
for comments, or fails to suppress internal thoughts. Individuals with AS may fail to detect 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 a sophisticated vocabulary at a young age and such children have often been colloquially called "little professors" but have difficulty understanding
figurative language The distinction between literal and figurative language exists in all natural languages; the phenomenon is studied within certain areas of language analysis, in particular stylistics, rhetoric, and semantics. *Literal language is the usage of wor ...
and tend to use language literally. Children with AS appear to have particular weaknesses in areas of nonliteral language that include
humor Humour ( Commonwealth English) or humor (American English) is the tendency of experiences to provoke laughter and provide amusement. The term derives from the humoral medicine of the ancient Greeks, which taught that the balance of fluids i ...
,
irony Irony, in its broadest sense, is the juxtaposition of what, on the surface, appears to be the case with what is actually or expected to be the case. Originally a rhetorical device and literary technique, in modernity, modern times irony has a ...
,
teasing Teasing has multiple meanings and uses. In human interactions, teasing exists in three major forms: ''playful'', ''hurtful'', and ''educative''. Teasing can have a variety of effects, depending on how it is used and its intended effect. When t ...
, and
sarcasm Sarcasm is the caustic use of words, often in a humorous way, to mock someone or something. Sarcasm may employ ambivalence, although it is not necessarily ironic. Most noticeable in spoken word, sarcasm is mainly distinguished by the inflectio ...
. Although individuals with AS usually understand the cognitive basis of humor, they seem to lack understanding of the intent of humor to share the 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.


Motor and sensory perception

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 perception Visual perception is the ability to detect light and use it to form an image of the surrounding Biophysical environment, environment. Photodetection without image formation is classified as ''light sensing''. In most vertebrates, visual percept ...
. 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 with individuals with high-functioning autism, individuals with AS have deficits in some tasks involving visual-spatial perception, auditory perception, or
visual memory Visual memory describes the relationship between perceptual processing and the Encoding (memory), encoding, Storage (memory), storage and Recall (memory), retrieval of the resulting neural representations. Visual memory occurs over a broad time ...
. 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, and other stimuli; 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 response The fight-or-flight or the fight-flight-freeze-or-fawn (also called hyperarousal or the acute stress response) is a physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival. It was first describ ...
or failure of
habituation Habituation is a form of non-associative learning in which an organism’s non-reinforced response to an inconsequential stimulus decreases after repeated or prolonged presentations of that stimulus. For example, organisms may habituate to re ...
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
dexterity Fine motor skill (or dexterity) is the coordination of small muscles in movement with the eyes, hands and fingers. The complex levels of manual dexterity that humans exhibit can be related to the nervous system. Fine motor skills aid in the growt ...
, 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
motor coordination In physiology, motor coordination is the orchestrated movement of multiple body parts as required to accomplish intended actions, like walking. This coordination is achieved by adjusting kinematic and kinetic parameters associated with each bo ...
. They may show problems with
proprioception Proprioception ( ) is the sense of self-movement, force, and body position. Proprioception is mediated by proprioceptors, a type of sensory receptor, located within muscles, tendons, and joints. Most animals possess multiple subtypes of propri ...
(sensation of body position) on measures of
developmental coordination disorder Developmental coordination disorder (DCD), also known as developmental motor coordination disorder, developmental dyspraxia, or simply dyspraxia (from Ancient Greek ''praxis'' 'activity'), is a neurodevelopmental disorder characterized by impai ...
(
motor planning In psychology and neuroscience, motor planning is a set of processes related to the preparation of a movement that occurs during the reaction time (the time between the presentation of a stimulus to a person and that person's initiation of a motor ...
disorder), balance,
tandem gait Tandem, or in tandem, is an arrangement in which two or more animals, machines, or people are lined up one behind another, all facing in the same direction. ''Tandem'' can also be used more generally to refer to any group of persons or objects w ...
, 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 awakenings Middle-of-the-night insomnia, or "sleep maintenance insomnia", also called terminal insomnia in contrast with "initial insomnia", is characterized by having difficulty returning to sleep after waking up during the night or very early in the mornin ...
, and early morning awakenings. AS is also associated with high levels of
alexithymia Alexithymia, also called emotional blindness, is a neuropsychological phenomenon characterized by significant challenges in recognizing, expressing, feeling, sourcing, and describing one's emotions. It is associated with difficulties in attachme ...
, which is difficulty in identifying and describing one's emotions. Although AS, lower sleep quality, and alexithymia are associated with each other, their causal relationship is unclear.


Causes

Hans Asperger described common traits among his patients' family members, especially fathers, and research supports this observation and suggests a genetic contribution to Asperger syndrome. Although no specific genetic factor has yet been identified, multiple factors are believed to play a role in the expression of autism, given the variability in symptoms seen in children. Hundreds of genes have been linked to AS, and these genes play crucial role in a multitude of
biological process Biological processes are those processes that are necessary for an organism to live and that shape its capacities for interacting with its environment. Biological processes are made of many chemical reactions or other events that are involved in ...
es, exerting influence over the maturation and functioning of the brain. Evidence for a genetic link is that AS tends to run in families where more family members have limited behavioral symptoms similar to AS (for example, some problems with social interaction, or with language and reading skills). Most behavioral genetic research suggests that all autism spectrum disorders have shared genetic mechanisms. There may be shared genes in which particular
allele An allele is a variant of the sequence of nucleotides at a particular location, or Locus (genetics), locus, on a DNA molecule. Alleles can differ at a single position through Single-nucleotide polymorphism, single nucleotide polymorphisms (SNP), ...
s make an individual vulnerable, and varying combinations result in differing severity and symptoms in each person with AS. A few ASD cases have been linked to exposure to
teratogens Teratology is the study of abnormalities of physiological development in organisms during their life span. It is a sub-discipline in medical genetics which focuses on the classification of congenital abnormalities in Dysmorphic feature, dysmor ...
(agents that cause
birth defect A birth defect is an abnormal condition that is present at birth, regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can range from mild to severe. Birth de ...
s) during the first eight weeks from conception. Although this does not exclude the possibility that ASD can be initiated or affected later, it is strong evidence that ASD arises very early in development. Many
environmental factor An environmental factor, ecological factor or eco factor is any factor, abiotic or biotic, that influences living organisms. Abiotic factors include ambient temperature, amount of sunlight, air, soil, water and pH of the water soil in which an ...
s have been hypothesized to act after birth, but none has been confirmed by scientific investigation. These environmental elements can act as independent and significant risk factors, or they can potentially influence pre-existing genetic factors in people who have a
genetic predisposition Genetic predisposition refers to a genetic characteristic which influences the possible phenotypic development of an individual organism within a species or population under the influence of environmental conditions. The term genetic susceptibil ...
.


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 ASDs.
Neuroanatomical Neuroanatomy is the study of the structure and organization of the nervous system. In contrast to animals with radial symmetry, whose nervous system consists of a distributed network of cells, animals with bilateral symmetry have segregated, defin ...
studies and the associations with
teratogens Teratology is the study of abnormalities of physiological development in organisms during their life span. It is a sub-discipline in medical genetics which focuses on the classification of congenital abnormalities in Dysmorphic feature, dysmor ...
strongly suggest that the mechanism includes alteration of brain development soon after conception. Abnormal
fetal development Prenatal development () involves the development of the embryo and of the fetus during a viviparous animal's gestation. Prenatal development starts with fertilization, in the germinal stage of embryonic development, and continues in fetal deve ...
may affect the final structure and connectivity of the brain, resulting in altered neural circuits controlling thought and behavior. Several theories of mechanism are available; none are likely to provide a complete explanation.


General-processing theories

One general-processing theory is
weak central coherence theory The weak central coherence theory (WCC), also called the central coherence theory (CC), suggests that a specific Perception, perceptual-Cognition, cognitive style, loosely described as a limited ability to understand context or to "see the big pict ...
, 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 Perception () is the organization, identification, and interpretation of sensory information in order to represent and understand the presented information or environment. All perception involves signals that go through the nervous syste ...
operations in autistic individuals.


Mirror neuron system (MNS) theory

The
mirror neuron system A 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. Mirror neurons a ...
(MNS) theory hypothesizes that alterations to the development of the MNS interfere with
imitation Imitation (from Latin ''imitatio'', "a copying, imitation") is a behavior whereby an individual observes and replicates another's behavior. Imitation is also a form of learning that leads to the "development of traditions, and ultimately our cu ...
and lead to Asperger syndrome's core feature of social impairment. One study found that activation is delayed in the core circuit for imitation in individuals with AS. This theory maps well to social cognition theories like the
theory of mind In psychology and philosophy, theory of mind (often abbreviated to ToM) refers to the capacity to understand other individuals by ascribing mental states to them. A theory of mind includes the understanding that others' beliefs, desires, intent ...
, which hypothesizes that autistic behavior arises from impairments in ascribing mental states to oneself and others; or hyper-systemizing, which hypothesizes that autistic individuals can systematize internal operation to handle internal events but are less effective at empathizing when handling events generated by other agents.


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, the
DSM-IV-TR The ''Diagnostic and Statistical Manual of Mental Disorders'' (''DSM''; latest edition: ''DSM-5-TR'', published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a c ...
criteria also required significant impairment in day-to-day functioning; As noted above, in the 2010s, Asperger syndrome, as a separate diagnosis, was eliminated and folded into autism spectrum disorder in the
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiat ...
and the
ICD-11 The ICD-11 is the eleventh revision of the International Classification of Diseases (ICD). It replaces the ICD-10 as the global standard for recording health information and causes of death. The ICD is developed and annually updated by the World H ...
. Other sets of diagnostic criteria have been proposed by Szatmari ''et al.'' and by Gillberg and Gillberg. Diagnosis of ASD (and previously AS) 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 "gold standard" in diagnosing ASDs combines clinical judgment with the
Autism Diagnostic Interview-Revised The Autism Diagnostic Interview-Revised (ADI-R) is a structured interview conducted with the parents of individuals who have been referred for the evaluation of possible autism or autism spectrum disorders. The interview, used by researchers and cl ...
(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. Underdiagnosis and
overdiagnosis Overdiagnosis is the diagnosis of disease that will never cause symptoms or death during a patient's ordinarily expected lifetime and thus presents no practical threat regardless of being pathologic. Overdiagnosis is a side effect of screening ...
may be problems. The cost and difficulty of screening and assessment can 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 are not autistic but have social difficulties. There are questions about the
external validity External validity is the validity of applying the conclusions of a scientific study outside the context of that study. In other words, it is the extent to which the results of a study can generalize or transport to other situations, people, stimul ...
of the AS diagnosis. That is, it is unclear whether there is a practical benefit in distinguishing AS from autism or PDD-NOS; different screening tools may render different diagnoses for the same person.


Differential diagnosis

Many children with AS are initially misdiagnosed with
attention deficit hyperactivity disorder Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by symptoms of inattention, hyperactivity, impulsivity, and emotional dysregulation that are excessive and pervasive, impairing in multiple con ...
(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 history The medical history, case history, or anamnesis (from Greek: ἀνά, ''aná'', "open", and μνήσις, ''mnesis'', "memory") of a patient is a set of information the physicians collect over medical interviews. It involves the patient, and ev ...
gained from both the individual and other people who know the person, focusing on childhood behavior. Conditions that must be considered in a
differential diagnosis In healthcare, a differential diagnosis (DDx) is a method of analysis that distinguishes a particular disease or condition from others that present with similar clinical features. Differential diagnostic procedures are used by clinicians to di ...
along with ADHD include other ASDs, the schizophrenia spectrum,
personality disorder Personality disorders (PD) are a class of mental health conditions characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the culture. ...
s,
obsessive–compulsive disorder Obsessive–compulsive disorder (OCD) is a mental disorder in which an individual has intrusive thoughts (an ''obsession'') and feels the need to perform certain routines (''Compulsive behavior, compulsions'') repeatedly to relieve the dis ...
,
major depressive disorder Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive depression (mood), low mood, low self-esteem, and anhedonia, loss of interest or pleasure in normally ...
,
semantic pragmatic disorder Social (pragmatic) communication disorder (SPCD), also known as pragmatic language impairment (PLI), is a neurodevelopmental disorder characterized by difficulties in the social use of verbal and nonverbal communication. Individuals who are define ...
,
nonverbal learning disorder Nonverbal learning disorder (NVLD or NLD) is a proposed neurodevelopmental disorder characterized by core deficits in nonverbal skills, especially visual-spatial processing. People with this condition have normal or advanced verbal intelligence ...
,
social anxiety disorder Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impairing ability to function in at least some asp ...
,
Tourette syndrome Tourette syndrome (TS), or simply Tourette's, is a common neurodevelopmental disorder that begins in childhood or adolescence. It is characterized by multiple movement (motor) tics and at least one vocal (phonic) tic. Common tics are blinkin ...
,
stereotypic movement disorder Stereotypic movement disorder (SMD) is a motor disorder with onset in childhood involving restrictive and/or repetitive, nonfunctional motor behavior (e.g., hand waving or head banging), that markedly interferes with normal activities or results ...
,
bipolar disorder Bipolar disorder (BD), previously known as manic depression, is a mental disorder characterized by periods of Depression (mood), depression and periods of abnormally elevated Mood (psychology), mood that each last from days to weeks, and in ...
, social-cognitive deficits due to brain damage from
alcohol use disorder Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal. Problematic use of alcohol has been mentioned in the earliest historical records. The World Hea ...
, and
obsessive–compulsive personality disorder Obsessive–compulsive personality disorder (OCPD) is a cluster C personality disorder marked by a spectrum of obsessions with rules, lists, schedules, and order, among other things. Symptoms are usually present by the time a person reaches a ...
(OCPD).


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 In a physical examination, medical examination, clinical examination, or medical checkup, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questio ...
by a
general practitioner A general practitioner (GP) is a doctor who is a Consultant (medicine), consultant in general practice. GPs have distinct expertise and experience in providing whole person medical care, whilst managing the complexity, uncertainty and risk ass ...
or pediatrician may identify signs that warrant further investigation. The
United States Preventive Services Task Force The United States Preventive Services Task Force (USPSTF) is "an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services". ...
in 2016 found it was unclear if screening was beneficial or harmful among children in whom there are no concerns. Different screening instruments are used to diagnose AS, including the Asperger Syndrome Diagnostic Scale (ASDS); Autism Spectrum Screening Questionnaire (ASSQ); Childhood Autism Spectrum Test (CAST), previously called the Childhood Asperger Syndrome Test; Gilliam Asperger's disorder scale (GADS); Krug Asperger's Disorder Index (KADI); and the
autism-spectrum quotient The autism-spectrum quotient (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 average intel ...
(AQ), with versions for children, adolescents, and adults. None have been shown to reliably differentiate between AS and other ASDs.


Management

Treatment attempts to manage distressing symptoms and to teach age-appropriate social, communication, and vocational skills that are not naturally acquired during development. Intervention is tailored to the needs of the individual based on multidisciplinary assessment. Although progress has been made, data supporting the
efficacy Efficacy is the ability to perform a task to a satisfactory or expected degree. The word comes from the same roots as '' effectiveness'', and it has often been used synonymously, although in pharmacology a distinction is now often made betwee ...
of particular interventions are limited.


Therapies

Managing ASD may involve multiple therapies that address core symptoms of the disorder. While many professionals agree that the earlier the professional support the better, there is no combination that is recommended above others. Professional support for ASD varies depending on the individual; it takes into account the linguistic capabilities, verbal strengths, and nonverbal vulnerabilities of individuals. Many of those diagnosed with ASD or similar disorders advocate against behavioral therapies, like Applied behavior analysis (ABA) and Cognitive behavioral therapy (CBT), often as part of the
autism rights movement The autistic rights movement, also known as the autism acceptance movement, is a social movement allied with the disability rights movement. It emphasizes the neurodiversity paradigm, viewing autism as a set of naturally occurring variations in ...
, on the grounds that these approaches frequently reinforce the demand on autistic people to mask their neurodivergent characteristics or behaviors to favor a more ' neurotypical' and narrow conception of normality. ABA has faced a great deal of
criticism Criticism is the construction of a judgement about the negative or positive qualities of someone or something. Criticism can range from impromptu comments to a written detailed response. , ''the act of giving your opinion or judgment about the ...
over the years. Recently, studies have shown that ABA may be abusive and can increase PTSD symptoms in patients. The
Autistic Self Advocacy Network The Autistic Self Advocacy Network (ASAN) is an American 501(c)(3) nonprofit organization, nonprofit advocacy organization run by and for autistic individuals. ASAN advocates for the inclusion of autistic people in decisions that affect them, inc ...
campaigns against the use of ABA in autism. In the case of CBT and talking therapies, the effectiveness varies, with many reporting that they appeared 'too self-aware' to gain significant benefit, as the therapy was designed with neurotypical people in mind. In autistic children, specifically, they also report that it is only mildly beneficial in aiding with their anxieties. A typical program of professional support generally includes: *
Applied behavior analysis Applied behavior analysis (ABA), also referred to as behavioral engineering, is a behavior modification system based on the principles of respondent and operant conditioning. ABA is the applied form of behavior analysis; the other two are: ...
(ABA) procedures, including
positive behavior support Positive behavior support (PBS) uses tools from applied behaviour analysis and values of normalisation and social role valorisation theory to improve quality of life, usually in schools. PBS uses functional analysis to understand what maintains ...
(PBS)—or training and support of parents and school faculty in behavior management strategies to use in the home and school, and
social skills A social skill is any competence facilitating interaction and communication with others where social rules and relations are created, communicated, and changed in verbal and nonverbal ways. The process of learning these skills is called socia ...
training for more effective interpersonal interactions. The
Autistic Self Advocacy Network The Autistic Self Advocacy Network (ASAN) is an American 501(c)(3) nonprofit organization, nonprofit advocacy organization run by and for autistic individuals. ASAN advocates for the inclusion of autistic people in decisions that affect them, inc ...
campaigns against the use of ABA in autism; *
Cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD, and anxiety disorders. Cognitive behavioral therapy focuses on challenging and chang ...
to improve
stress management Stress management consists of a wide spectrum of techniques and psychotherapy, psychotherapies aimed at controlling a person's level of psychological stress, especially chronic stress, generally for the purpose of improving the function of everyda ...
relating to anxiety or explosive emotions and to help reduce obsessive interests (although this may produce negative impact by demonising special interests) and repetitive routines; *
Medication Medication (also called medicament, medicine, pharmaceutical drug, medicinal product, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, treat, or preventive medicine, prevent disease. Drug therapy (pharmaco ...
for coexisting conditions such as
major depressive disorder Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive depression (mood), low mood, low self-esteem, and anhedonia, loss of interest or pleasure in normally ...
and
anxiety disorder Anxiety disorders are a group of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause phys ...
s; * Occupational or
physical therapy Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease preventio ...
to assist with poor
sensory processing Sensory processing is the process that organizes and distinguishes sensation (sensory information) 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 ...
and
motor coordination In physiology, motor coordination is the orchestrated movement of multiple body parts as required to accomplish intended actions, like walking. This coordination is achieved by adjusting kinematic and kinetic parameters associated with each bo ...
; and, *
Social communication Communication is commonly defined as the transmission of information. Its precise definition is disputed and there are disagreements about whether unintentional or failed transmissions are included and whether communication not only transmit ...
intervention, which is specialized
speech therapy Speech is the use of the human voice as a medium for language. Spoken language combines vowel and consonant sounds to form units of meaning like words, which belong to a language's lexicon. There are many different intentional speech acts, suc ...
to help with the
pragmatics In linguistics and the philosophy of language, pragmatics is the study of how Context (linguistics), context contributes to meaning. The field of study evaluates how human language is utilized in social interactions, as well as the relationship ...
and give-and-take of normal conversation. Of the many studies on behavior-based early intervention programs, most are
case report In medicine, a case report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. Case reports may contain a demographic profile of the patient, but usually describe an unusual or novel occurrenc ...
s of up to five participants and typically examine a few problem behaviors such as
self-injury Self-harm refers to intentional behaviors that cause harm to oneself. This is most commonly regarded as direct injury of one's own skin tissues, usually without suicidal intention. Other terms such as cutting, self-abuse, self-injury, and s ...
,
aggression Aggression is behavior aimed at opposing or attacking something or someone. Though often done with the intent to cause harm, some might channel it into creative and practical outlets. It may occur either reactively or without provocation. In h ...
, noncompliance, stereotypies, or spontaneous language; unintended
side effect In medicine, a side effect is an effect of the use of a medicinal drug or other treatment, usually adverse but sometimes beneficial, that is unintended. Herbal and traditional medicines also have side effects. A drug or procedure usually use ...
s 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 may be important to teach job interview etiquette and workplace behavior to older children and adults with AS, and organization software and personal data assistants can improve the work and life management of people with AS. Fecal Microbiota Transplantation (FMT) is an innovative therapy for AS that aims to restore microbial balance in the patient's
gastrointestinal tract The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the Digestion, digestive system that leads from the mouth to the anus. The tract is the largest of the body's systems, after the cardiovascula ...
by introducing healthy fecal microbiota acquired from people with a diverse microbial composition. This approach attempts to reconstruct the patient's gut microbiota by taking into account the intricate interactions between the human gut and the
central nervous system The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain, spinal cord and retina. The CNS is so named because the brain integrates the received information and coordinates and influences the activity o ...
via the gut-brain axis (GBA). Any disruption in gut health has been linked to an increased susceptibility to diverse
neurodevelopmental disorder Neurodevelopmental disorders are a group of mental conditions negatively affecting the development of the nervous system, which includes the brain and spinal cord. According to the American Psychiatric Association Diagnostic and Statistical Manu ...
s. It is vital to remember that research of AS specifically operates upon the out-dated classification of this syndrome as external to ASD (Autism Spectrum Disorder). Similarly, we should also note that ASD is a spectrum and support varies dramatically depending on the individual.


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
comorbid In medicine, comorbidity refers to the simultaneous presence of two or more medical conditions in a patient; often co-occurring (that is, concomitant or concurrent) with a primary condition. It originates from the Latin term (meaning "sicknes ...
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 disorders, major depressive disorder, inattention, and aggression. The
atypical antipsychotic The atypical antipsychotics (AAP), also known as second generation antipsychotics (SGAs) and serotonin–dopamine antagonists (SDAs), are a group of antipsychotic drugs (antipsychotic drugs in general are also known as tranquilizers and neurol ...
medications
risperidone Risperidone, sold under the brand name Risperdal among others, is an atypical antipsychotic used to treat schizophrenia and bipolar disorder, as well as aggressive and self-injurious behaviors associated with autism spectrum disorder. It is t ...
,
olanzapine Olanzapine, sold under the brand name Zyprexa among others, is an atypical antipsychotic primarily used to treat schizophrenia and bipolar disorder. It is also sometimes used off-label for treatment of chemotherapy-induced nausea and vomitin ...
and
aripiprazole Aripiprazole, sold under the brand name Abilify, among others, is an atypical antipsychotic primarily used in the treatment of schizophrenia, bipolar disorder, and irritability associated with autism spectrum disorder; other uses include as ...
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 (SSRIs) are a class of drugs that are typically used as antidepressants in the treatment of major depressive disorder, anxiety disorders, and other psychological conditions. SSRIs primarily work by blo ...
s (SSRIs)
fluoxetine Fluoxetine, sold under the brand name Prozac, among others, is an Antidepressant, antidepressant medication of the selective serotonin reuptake inhibitor (SSRI) class used for the treatment of major depressive disorder, Anxiety disorder, anx ...
,
fluvoxamine Fluvoxamine, sold under the brand name Luvox among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It is primarily used to treat major depressive disorder and, perhaps more-especially, obsessive–compu ...
, and
sertraline Sertraline, sold under the brand name Zoloft among others, is an Antidepressant, antidepressant medication of the selective serotonin reuptake inhibitor (SSRI) class used to treat major depressive disorder, generalized anxiety disorder, socia ...
have been effective in treating restricted and repetitive interests and behaviors, while stimulant medication, such as
methylphenidate Methylphenidate, sold under the brand names Ritalin ( ) and Concerta ( ) among others, is a central nervous system (CNS) stimulant used in the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy. It may be taken Oral adm ...
, can reduce inattention. In addition, scientists have made a noteworthy finding that
oxytocin Oxytocin is a peptide hormone and neuropeptide normally produced in the hypothalamus and released by the posterior pituitary. Present in animals since early stages of evolution, in humans it plays roles in behavior that include Human bonding, ...
, a hormone, plays a significant role in shaping human social behavior and the formation of interpersonal connections. Care must be taken with medications, as side effects may be more common and harder to evaluate in individuals with AS, and tests of drugs' effectiveness against comorbid conditions routinely exclude individuals from the autism spectrum. Abnormalities in
metabolism Metabolism (, from ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cellular processes; the co ...
, cardiac conduction times, and an increased risk of
type 2 diabetes Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent ...
have been raised as concerns with antipsychotic 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 A sleep disorder, or somnipathy, is a medical disorder affecting an individual's sleep patterns, sometimes impacting physical, mental, social, and emotional functioning. Polysomnography and actigraphy are tests commonly ordered for diagnosing s ...
.
Weight gain Weight gain is an increase in body weight. This can involve an increase in muscle mass, fat deposits, excess fluids such as water or other factors. Weight gain can be a symptom of a serious medical condition. Description Weight gain occurs ...
and fatigue are commonly reported side effects of risperidone, which may also lead to increased risk for
extrapyramidal symptoms Extrapyramidal symptoms (EPS) are signs and symptoms, symptoms that are wikt:archetypical, archetypically associated with the extrapyramidal system of the brain's cerebral cortex. When such symptoms are caused by medications or other drugs, they ...
such as restlessness and
dystonia Dystonia is a neurology, neurological Hyperkinesia, hyperkinetic Movement disorders, movement disorder in which sustained or repetitive muscle contractions occur involuntarily, resulting in twisting and repetitive movements or abnormal fixed po ...
and increased serum
prolactin Prolactin (PRL), also known as lactotropin and mammotropin, is a protein best known for its role in enabling mammals to produce milk. It is influential in over 300 separate processes in various vertebrates, including humans. Prolactin is secr ...
levels. Sedation and weight gain are more common with
olanzapine Olanzapine, sold under the brand name Zyprexa among others, is an atypical antipsychotic primarily used to treat schizophrenia and bipolar disorder. It is also sometimes used off-label for treatment of chemotherapy-induced nausea and vomitin ...
, 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 children with AS may see a lessening of symptoms; up to 20% of children may no longer meet the diagnostic criteria as adults, although social and communication difficulties may persist. , 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 expectancy Human life expectancy is a statistical measure of the estimate of the average remaining years of life at a given age. The most commonly used measure is ''life expectancy at birth'' (LEB, or in demographic notation ''e''0, where '' ...
, but have an increased
prevalence In epidemiology, prevalence is the proportion of a particular population found to be affected by a medical condition (typically a disease or a risk factor such as smoking or seatbelt use) at a specific time. It is derived by comparing the number o ...
of
comorbid In medicine, comorbidity refers to the simultaneous presence of two or more medical conditions in a patient; often co-occurring (that is, concomitant or concurrent) with a primary condition. It originates from the Latin term (meaning "sicknes ...
psychiatric conditions, such as major depressive disorder and anxiety disorders that may significantly affect
prognosis Prognosis ( Greek: πρόγνωσις "fore-knowing, foreseeing"; : prognoses) is a medical term for predicting the likelihood or expected development of a disease, including whether the signs and symptoms will improve or worsen (and how quickly) ...
. Although social impairment may be lifelong, the 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 forms of autism sometimes described as " high functioning". Most students with AS and forms of autism sometimes seen as "high functioning" have average mathematical ability and test slightly worse in mathematics than in general intelligence. However, mathematicians are at least three times more likely to have autism-spectrum traits than the general population, and are more likely to have family members with autism. Although many attend regular education classes, some children with AS may attend
special education Special education (also known as special-needs education, aided education, alternative provision, exceptional student education, special ed., SDC, and SPED) is the practice of educating students in a way that accommodates their individual di ...
classes such as separate classroom and
resource room A resource room is a type of support for students with disabilities in need of special education that allows them to be leave their general education classroom placement and go to another location for targeted instructional support. It is one of ma ...
because of their social and behavioral difficulties. Adolescents with AS may exhibit ongoing difficulty with
self-care Self-care has been defined as the process of establishing behaviors to ensure holistic well-being of oneself, to promote health, and actively manage illness when it occurs. Individuals engage in some form of self-care daily with food choices, ...
or organization, and disturbances in social and romantic relationships. Despite high cognitive potential, most young adults with AS remain at home, yet 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 encounters; 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 In psychology, frustration is a common emotional response to opposition, related to anger, annoyance and disappointment. Frustration arises from the perceived resistance to the fulfillment of an individual's Will (philosophy), will or goal and ...
from repeated failure to engage others socially, and
mood disorder A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where the main underlying characteristic is a disturbance in the person's mood. The classification is in the ''Diagnostic ...
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

Frequency estimates vary enormously. In 2015, it was estimated that 37.2 million people globally are affected. A 2003 review of
epidemiological studies Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population, and application of this knowledge to prevent diseases. It is a cornerstone ...
of children found autism 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 geometric mean 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. Females with autism spectrum disorders may be underdiagnosed.


Comorbidities

Anxiety disorders and major depressive disorder are the most common conditions seen at the same time;
comorbidity In medicine, comorbidity refers to the simultaneous presence of two or more medical conditions in a patient; often co-occurring (that is, concomitant or concurrent) with a primary condition. It originates from the Latin term (meaning "sicknes ...
of these in persons with AS is estimated at 65%. Reports have associated AS with
medical conditions A disease is a particular abnormal condition that adversely affects the structure or function of all or part of an organism and is not immediately due to any external injury. Diseases are often known to be medical conditions that are asso ...
such as
aminoaciduria Aminoaciduria occurs when the urine contains abnormally high amounts of amino acids. In the healthy kidney, the glomeruli filter all amino acids out of the blood, and the renal tubules then reabsorb over 95% of the filtered amino acids back into ...
and
ligamentous laxity Ligamentous laxity or ligament laxity can appear in a variety of ways and levels of severity. In most people, ligaments (which are the tissues that connect bones to each other) are naturally tight in such a way that the joints are restricted to ...
, 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
epilepsy Epilepsy is a group of Non-communicable disease, non-communicable Neurological disorder, neurological disorders characterized by a tendency for recurrent, unprovoked Seizure, seizures. A seizure is a sudden burst of abnormal electrical activit ...
and a high rate (51%) of
nonverbal learning disorder Nonverbal learning disorder (NVLD or NLD) is a proposed neurodevelopmental disorder characterized by core deficits in nonverbal skills, especially visual-spatial processing. People with this condition have normal or advanced verbal intelligence ...
. AS is associated with
tic A tic is a sudden and repetitive motor movement or vocalization that is not rhythmic and involves discrete muscle groups. Tics are typically brief and may resemble a normal behavioral characteristic or gesture. Tics can be invisible to the obs ...
s,
Tourette syndrome Tourette syndrome (TS), or simply Tourette's, is a common neurodevelopmental disorder that begins in childhood or adolescence. It is characterized by multiple movement (motor) tics and at least one vocal (phonic) tic. Common tics are blinkin ...
and
bipolar disorder Bipolar disorder (BD), previously known as manic depression, is a mental disorder characterized by periods of Depression (mood), depression and periods of abnormally elevated Mood (psychology), mood that each last from days to weeks, and in ...
. The repetitive behaviors of AS have many similarities with the symptoms of obsessive–compulsive disorder and
obsessive–compulsive personality disorder Obsessive–compulsive personality disorder (OCPD) is a cluster C personality disorder marked by a spectrum of obsessions with rules, lists, schedules, and order, among other things. Symptoms are usually present by the time a person reaches a ...
, and 26% of a sample of young adults with AS were found to meet the criteria for
schizoid personality disorder Schizoid personality disorder (, often abbreviated as SzPD or ScPD) is a personality disorder characterized by a lack of interest in social relationships, a tendency toward a solitary or sheltered lifestyle, secretiveness, emotional coldness, ...
(which is characterised by severe social seclusion and emotional detachment), more than any other personality disorder in the sample. However many of these studies are based on clinical samples or lack standardized measures; nonetheless, comorbid conditions are relatively common.


Correlated characteristics

Research indicates that individuals with Aspergers have significantly higher rates of LGBT identities and feelings than the general population. They are also significantly more likely to be
non-theistic Nontheism or non-theism is a range of both religious and non-religious attitudes characterized by the absence of espoused belief in the existence of God or gods. Nontheism has generally been used to describe apathy or silence towards the subject ...
.


History

Asperger syndrome was named after the Austrian pediatrician
Hans Asperger Johann Friedrich Karl Asperger (, ; 18 February 1906 – 21 October 1980) was an Austrian physician. Noted for his early studies on atypical neurology, specifically in children, he is the namesake of the former autism spectrum disorder Asperger ...
(1906–1980), but not coined by him. Asperger syndrome was a relatively new diagnosis in the field of autism, though a syndrome like it was described as early as 1925 by Soviet child psychiatrist
Grunya Sukhareva Grunya Efimovna Sukhareva (, , alternative transliteration Suchareva) (11 November 1891 – 26 April 1981) was a Soviet child psychiatrist and the first psychiatrist to identify and pathologize autism. Biography Grunya Efimovna Sukhareva was born ...
(1891–1981), As a child, Asperger appears to have exhibited some features of the very condition named after him, such as remoteness and talent in language. In 1944, Asperger gave detailed descriptions of four representative children in his practice who had difficulty in integrating themselves socially and showing empathy towards peers. They also lacked nonverbal communication skills and were physically clumsy. Asperger described this "autistic psychopathy" as
social isolation Social isolation is a state of complete or near-complete lack of contact between an individual and society. It differs from loneliness, which reflects temporary and involuntary lack of contact with other humans in the world. Social isolation c ...
. Fifty years later, several standardizations of AS as a
medical diagnosis Medical diagnosis (abbreviated Dx, Dx, or Ds) is the process of determining which disease or condition explains a person's symptoms and signs. It is most often referred to as a diagnosis with the medical context being implicit. The information ...
were tentatively proposed, many of which diverge significantly from Asperger's original work. Unlike what became known as AS, Asperger believed autistic psychopathy could be found in people of all levels of intelligence, including those with intellectual disability: as such, Asperger's understanding of autistic pathology was more akin to what is known as the
autism spectrum Autism, also known as autism spectrum disorder (ASD), is a neurodevelopmental disorder characterized by differences or difficulties in social communication and interaction, a preference for predictability and routine, sensory processing d ...
today. Asperger defended the value of so-called "high-functioning" autistic individuals, writing: "We are convinced, then, that autistic people have their place in the organism of the social community. They fulfill 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 believed some would be capable of exceptional achievement and original thought later in life. Asperger's paper was published during
World War II World War II or the Second World War (1 September 1939 – 2 September 1945) was a World war, global conflict between two coalitions: the Allies of World War II, Allies and the Axis powers. World War II by country, Nearly all of the wo ...
and in German, so it was not widely read elsewhere. Lorna Wing used the term ''Asperger syndrome'' in 1976, and popularized it to the English-speaking medical community in her February 1981 publication of case studies of children showing the symptoms described by Asperger, and
Uta Frith Dame Uta Frith ( Aurnhammer; born 25 May 1941) is a German-British developmental psychologist and emeritus professor in cognitive development at the UCL Institute of Cognitive Neuroscience, Institute of Cognitive Neuroscience at University Coll ...
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 when it was included in the tenth edition of the
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
's diagnostic manual, ''International Classification of Diseases'' (
ICD-10 ICD-10 is the 10th revision of the International Classification of Diseases (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social cir ...
), published in 1990 and coming into effect in 1993; and in the fourth edition of the
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 39,200 members who are in ...
's diagnostic reference, ''Diagnostic and Statistical Manual of Mental Disorders'' (
DSM-IV The ''Diagnostic and Statistical Manual of Mental Disorders'' (''DSM''; latest edition: ''DSM-5-TR'', published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a com ...
), published in 1994. Hundreds of books, articles, and websites later described AS and prevalence estimates increased dramatically for ASD, with AS recognized as an important subgroup. Whether AS should be seen as distinct from autism, particularly forms of autism sometimes described as " high functioning", became an issue receiving significant attention and disagreement, along with questions about the empirical validation of the DSM-IV and ICD-10 criteria. With the publication of the next major editions of the DSM and ICD, the
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiat ...
(published in 2013) and the
ICD-11 The ICD-11 is the eleventh revision of the International Classification of Diseases (ICD). It replaces the ICD-10 as the global standard for recording health information and causes of death. The ICD is developed and annually updated by the World H ...
(published in 2018, coming into effect in 2022), AS was eliminated as a separate diagnosis and folded into the autism spectrum. A scale of "severity" levels was included in the DSM-5, whereby most people previously diagnosed with AS would have been classified as "level 1"; but these levels are widely opposed by the
autistic community Societal and cultural aspects of autism or sociology of autism come into play with recognition of autism, approaches to its support services and therapies, and how autism affects the definition of personhood. The autistic community is divided pr ...
and are not included in the ICD-11. The ICD-11 characterizes ASD with qualifiers describing the presence of disorders of intellectual development and the degree of functional
language impairment Language disorders or language impairments are disorders that involve the processing of linguistic information. Problems that may be experienced can involve grammar (syntax and/or morphology), semantics (meaning), or other aspects of language. ...
; the former diagnosis of Asperger syndrome is characterized as ''autism spectrum disorder without disorder of intellectual development and with mild or no impairment of functional language''.


Society and culture

People identifying with Asperger syndrome may refer to themselves in casual conversation as ''aspies'' (a term first used in print in the ''
Boston Globe ''The Boston Globe,'' also known locally as ''the Globe'', is an American daily newspaper founded and based in Boston, Massachusetts. The newspaper has won a total of 27 Pulitzer Prizes. ''The Boston Globe'' is the oldest and largest daily new ...
'' in 1998). Some autistic people have advocated a shift in perception of autism spectrum disorders as complex
syndrome A syndrome is a set of medical signs and symptoms which are correlated with each other and often associated with a particular disease or disorder. The word derives from the Greek language, Greek σύνδρομον, meaning "concurrence". When a sy ...
s, neurodivergences, and/or neurominority cognitive styles rather than diseases that must be cured. Proponents of this neurodiversity paradigm reject the notion that there is an "ideal" brain configuration and that any deviation from the norm is
pathological Pathology is the study of disease. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in the context of modern medical treatme ...
; they promote tolerance of
neurodiversity The neurodiversity paradigm is a framework for understanding human brain function that considers the diversity within sensory processing, Motor skill, motor abilities, Social anxiety, social comfort, cognition, and Attention, focus as neurobiol ...
. These views are the basis for the autistic rights and autistic pride movements, within the broader neurodiversity movement. There is a contrast between the attitude of people with AS, who typically do not want to be cured and are proud of their identity; and parents of children with AS, who more often seek a "cure" of their children's autism. Some researchers have argued that AS and other autism can be viewed as a different cognitive style, not a disorder, and that it should be removed from psychiatric and medical manuals classifying diseases (''
ICD The International Classification of Diseases (ICD) is a globally used medical classification that is used in epidemiology, health management and clinical diagnostics, diagnosis. The ICD is maintained by the World Health Organization (WHO), which ...
'') or mental disorders ('' DSM''), much as
homosexuality Homosexuality is romantic attraction, sexual attraction, or Human sexual activity, sexual behavior between people of the same sex or gender. As a sexual orientation, homosexuality is "an enduring pattern of emotional, romantic, and/or sexu ...
was removed. Even some people typically associated with a pathology paradigm for autism are willing to consider AS a neutral difference. For example, in 2002,
Simon Baron-Cohen Sir Simon Philip Baron-Cohen (born 15 August 1958) is a British clinical psychologist and professor of developmental psychopathology at the University of Cambridge. He is the director of the university's Autism Research Centre and a Fellow of ...
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 maths, computing, cataloging, 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, which was commonly associated with autism during that time but has since lost support. A preliminary, freely readable draft, with slightly different wording in the quoted text, is in: Baron-Cohen argues that the genes for ASD's combination of abilities have operated throughout recent
human evolution ''Homo sapiens'' is a distinct species of the hominid family of primates, which also includes all the great apes. Over their evolutionary history, humans gradually developed traits such as Human skeletal changes due to bipedalism, bipedalism, de ...
and have made remarkable contributions to human history. By contrast, Pier Jaarsma and Welin wrote in 2011 that the "broad version of the neurodiversity claim, covering low-functioning as well as high-functioning autism, is problematic. Only a narrow conception of neurodiversity, referring exclusively to high-functioning autists, is reasonable." They say that "higher functioning" individuals with autism may "not ebenefited with such a psychiatric defect-based diagnosis ... some of them are being harmed by it, because of the disrespect the diagnosis displays for their natural way of being", but "think that it is still reasonable to include other categories of autism in the psychiatric diagnostics. The narrow conception of the neurodiversity claim should be accepted but the broader claim should not."


References


Further reading

* Autistic Empire
Are you Autistic? Take the test
– an online version of the Adult Asperger's Assessment developed by Cohen, S. et al. (2005) (see Woodbury-Smith MR, "Screening adults for Asperger Syndrome using the AQ: a preliminary study of its diagnostic validity in clinical practice", in §References). * A public paper re-calibrating the Autism Diagnostic Observation Schedule for appropriate assessment of autistic adults, who typically score lower on measures of impairment than autistic children due to compensatory strategies. * Royal College of Psychiatrists (2017)
Interview Guide for the Diagnostic Assessment of Able Adults with Autistic Spectrum Disorder
– based on the Autism Diagnostic Interview-Revised (ADI-R) {{Authority control * 1976 neologisms Neurogenetic disorders Neurological disorders Obsolete terms for mental disorders Neurological disorders in children Wikipedia medicine articles ready to translate Wikipedia neurology articles ready to translate