The disorder affects people in various ways, but individuals with Asperger's commonly share characteristics such as an ability to focus intensely on areas of interest, hyposensitivity or hypersensitivity to certain stimuli and sensory integration problems, self-stimulating ('stimming') behaviors such as rocking back and forth or verbal utterances, and difficulty interpreting facial expressions and other social cues. Some positive characteristics include things such as enhanced mental focus, excellent memory abilities, superior spatial skills, and an intuitive understanding of logical systems. These characteristics can often lead to fulfilling careers in mathematics, engineering, the sciences, music, art, or language.
There is significant controversy over the difference between AS and the broader category of high-functioning autism (HFA). While neither AS nor HFA have universally accepted definitions, most diagnostic manuals distinguish the two according to speech development. Delayed speech indicates HFA; normal onset of speech indicates Asperger's. However, at least one diagnostic guide takes the opposite position; that delayed onset of speech favors a diagnosis of AS.
Some clinicians deny that AS is differentiated from other autistic spectrum disorders and indicate that a "DSM-IV diagnosis of Asperger's disorder is unlikely or impossible". Instead they refer to Asperger's as HFA, or treat the diagnoses interchangeably, arguing that language delay is a difference in degree and not kind. Tests have shown no significant difference between patients diagnosed with AS and those diagnosed with HFA. Even among those who feel that the differences between AS and HFA are significant, it is common for diagnoses to be influenced by non-technical issues, such as availability of government benefits for one condition but not the other. Due to the mixed nature of its effects, and continued debate over its definition, Asperger's remains controversial among researchers, clinicians, and people with the diagnosis.
History
Hans Asperger, after whom the syndrome is named.
Hans Asperger described his young patients as "little professors."Asperger syndrome was named in honour of Hans Asperger by the English psychiatrist Lorna Wing, who first used the term in a 1981 paper. In 1994, AS was recognized in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as Asperger's Disorder.
In 1944, Hans Asperger (1906–1980), an Austrian psychiatrist and pediatrician, observed four children in his practice who had difficulty integrating socially. Although their intelligence appeared normal, the children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Their way of speaking was either disjointed or overly formal, and their all-absorbing interest in a single topic dominated their conversations. Asperger called the condition “autistic psychopathy” and described it as a condition primarily marked by social isolation. He also stated that "exceptional human beings must be given exceptional educational treatment, treatment which takes into account their special difficulties. Further, we can show that despite abnormality, human beings can fulfill their social role within the community, especially if they find understanding, love and guidance."
The Austrian-American child psychiatrist Leo Kanner identified a very similar syndrome in 1943, although the population characterized by Kanner was perhaps less "socially functional" than Asperger's. Kannerian autism is therefore characterized by significant cognitive and communicative deficiencies, including delays in language development or complete lack of language. (In contrast, AS is characterized by normal language acquisition.)
Asperger’s observations, published in German, were not widely known until 1981, when Lorna Wing published a series of case studies showing similar symptoms, which she called "Asperger’s Syndrome." Wing’s writings were widely published and popularized. In 1992, the tenth published edition of the World Health Organization’s diagnostic manual and the International Classification of Diseases (ICD-10) included AS, making it a distinct diagnosis. Later, in 1994, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the American Psychiatric Association’s diagnostic reference book also added AS.
Uta Frith (an early researcher of Kannerian autism) wrote that people with AS seem to have more than a touch of autism to them. Others, such as Lorna Wing and Tony Attwood, share Frith's assessment. Dr. Sally Ozonoff, of the University of California at Davis's MIND Institute, argues that there should be no dividing line between "high-functioning" autism and AS, and that the fact that some people do not start to produce speech until a later age is no reason to divide the two groups because they are identical in the way they need to be treated.
In January 2006, Professor Simon Baron-Cohen of the University of Cambridge, regarded as one of the leading current researchers in this field, proposed the theory that people with AS tend to hyper-systematize; that they tend to seek to approach all spheres of life, including the social sphere, by developing systems or sets of rules to operate to.
Classification
AS is an autism spectrum disorder (ASD), one of five neurological conditions characterized by difference in language and communication skills, as well as repetitive or restrictive patterns of thought and behavior. The four related disorders or conditions are autism, Rett syndrome, childhood disintegrative disorder, and PDD-NOS (pervasive developmental disorder not otherwise specified).
Some doctors believe that AS is not a separate and distinct disorder, referring to it as high-functioning autism (HFA). The diagnoses of AS or HFA are used interchangeably, complicating prevalence estimates: the same child can receive different diagnoses, depending on the screening tool the doctor uses, and some children will be diagnosed with HFA instead of AS, and vice versa. Many experienced clinicians apply the early onset of high-functioning autism or the regressive pattern of development as the distinguishing factor in differentiating between AS and HFA. Others feel that the speech delay associated with HFA is significant. The current classification of the pervasive developmental disorders (PDDs) is unsatisfying to many parents, clinicians, and researchers, and may not reflect the true nature of the conditions. Peter Szatmari, a Canadian researcher of PDD, feels that greater precision is needed to better differentiate between the various PDD diagnoses. The DSM-IV and ICD-10 focus on the idea that discrete biological entities exist within PDD, which leads to a preoccupation with searching for cross-sectional differences between PDD subtypes rather than recognition of the conditions as distinct points on a spectrum, a strategy which has not been very useful in classification or in clinical practice.
Diagnosis
Asperger's Disorder (Asperger Syndrome) is defined in section 299.80 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) by six main criteria:
Qualitative impairment in social interaction;
The presence of restricted, repetitive and stereotyped behaviors and interests;
Significant impairment in important areas of functioning;
No significant delay in language;
During the first three years of life, there can be no clinically significant delay in cognitive development such as curiosity about the existing environment or the acquisition of age appropriate learning skills, self-help skills, or adaptive behaviors (other than social interaction); and,
The symptoms must not be better accounted for by another specific pervasive developmental disorder or schizophrenia.
The diagnosis of AS is complicated by the use of several different screening instruments. The diagnostic criteria of the Diagnostic and Statistical Manual are criticized for being vague and subjective. Other sets of diagnostic criteria for AS are the ICD 10 World Health Organization Diagnostic Criteria, Szatmari Diagnostic Criteria,[30] Gillberg Diagnostic Criteria, and Attwood & Gray Discovery Criteria. The ICD-10 definition has similar criteria to the DSM-IV version. Asperger's syndrome had at different times been called Autistic psychopathy and Schizoid disorder of childhood, although those terms are now understood as archaic and inaccurate, and are therefore no longer accepted in common use.
aspbergers syndrome
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