Beyond Asperger’s: The Evolution of Autism Diagnosis and Care
Overview: This article discusses the history of Asperger’s Syndrome and how it is relevant to current understandings of autism and autism treatment.
Asperger’s Overview
Asperger’s Syndrome was a diagnosis first described by physician Hans Asperger in 1944. It was first included in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM)* in 1994 and was subsequently removed from the Fifth Edition in 2013.
Asperger’s syndrome was typified by many contemporary autism symptoms, including:
Social Symptoms such as poor reciprocity (give and take), poor use of non-verbal communication such as body language or tone, and relationship difficulties (hard time starting or maintaining relationships)
Behavioral Symptoms such as restricted interests and cognitive rigidity (hard time seeing someone else’s point of view or accepting alternative ideas)
These symptoms are almost indistinguishable from autism except that they are generally more intense. Asperger’s was diagnosed at a time when autism symptoms were considered “mild” with little significant impact on a person’s life experience. One of the chief differentiating factors between Asperger’s and autism was that people with Asperger’s did not include language delays. However, as was explained in the “Understanding Autism Symptoms” article, language impairment is not currently a requirement for an autism diagnosis. Psychologists, psychiatrists, therapists, and even clients struggled to differentiate Asperger’s from “high-functioning autism” or HFA.
During 1990’s and 2000’s doctors completed innumerable studies attempting to differentiate Asperger’s from HFA. These studies analyzed physical traits, neurodevelopment, socialization skills, and countless other symptoms and presentations. After decades of research, it was determined that there was “insufficient evidence to support a meaningful distinction between” Asperger’s and autism (Barahona-Corrêa and Filipe, 2016).
In the DSM-V, first published in 2013, the American Psychological Association removed Asperger’s Syndrome with the reasoning that there is no meaningful distinction between Asperger’s and autism. As a result of this change, a person previously diagnosed as having “Asperger’s Syndrome” would instead be diagnosed as having “Autism Spectrum Disorder, without accompanying language impairment.”
Current Relevance of the Diagnosis
Asperger’s Syndrome was a recognized diagnosis throughout the publication of the DSM-IV, from 1994 until 2013. This 19-year span covered a period of significant advancement in assessing and diagnosing autism symptoms. The CDC began tracking autism prevalence in 2000. In that first year of tracking, autism was diagnosed in 1 in 150 Americans, by 2014 that prevalence increased to 1 in 59 Americans, and most recently in 2020 the number was up to 1 in 36 Americans.
Given the increased attention and diagnosis of autism symptoms during the time when Asperger’s syndrome was a recognized diagnosis, there is a tremendous amount of research, books, publications, and content about Asperger’s syndrome. These resources are still relevant resources, guidance, and support for individuals with an “autism without language impairment” diagnoses. Older resources with content referring to “Asperger’s” need not be discounted or avoided simply due to the use of prior vernacular.
Hans Asperger: Acknowledging a Difficult Truth
Hans Asperger
Hans Asperger was an Austrian physician who practiced medicine in the middle part of the 20th century. He was the first doctor to identify and label autistic symptoms in children. By most accounts he cared for his clients and significantly improved medicine’s understanding of this unique disorder.
However, it is increasingly understood that Hans Asperger also collaborated with the 3rd Reich during the Nazi occupation of Austria (Baron-Cohen, 2018). Records show that he went to great lengths to protect his clients who showed high levels of intelligence while sending those with intellectual disabilities to Nazi clinics known for executing children. This research has further cemented the fact that the term “Asperger’s” does not belong in the mental health field.
For more on Dr. Asperger, the following article is recommended:
Czech, H. (2018). Hans Asperger, national socialism, and “race hygiene” in Nazi-era Vienna. Molecular autism, 9(1), 1-43.
References
Barahona-Corrêa, JB, Filipe CN. (2016). A Concise History of Asperger Syndrome: The Short Reign of a Troublesome Diagnosis. Front Psychology. doi: 10.3389/fpsyg.2015.02024. PMID: 26834663; PMCID: PMC4725185.
Baron-Cohen, S. (2018). The truth about Hans Asperger’s Nazi collusion. Nature 557, 305-306.
doi: https://doi.org/10.1038/d41586-018-05112-1
Center for Disease Control. (2024). Data & Statistics on Autism Spectrum Disorder. Retrieved from: https://www.cdc.gov/ncbddd/autism/data.html on 2/29/24
