Monday, 29 June 2015

What is Asperger's Syndrome? What is an ASD?

The terminology surrounding this area is confusing, partly for historical reasons.

Where does the word autism come from?
The term 'autism' was first introduced by Swiss psychiatrist Eugen Bleuler in 1911. He drew the original Greek derivation -  to describe the self-absorption he felt characterised schizopherenia, the "autistic withdrawal of the patient to his fantasies, against which any influence from outside becomes an intolerable disturbance" 

But why Asperger's Syndrome?
In 1938 the Austrian Dr Hans Asperger (1906-1980) took the term 'autism' in  a different direction when he described an 'autistic psychopath' in a lecture on child psychology. The term 'psychopath' did not imply moral judgement here -   Asperger was describing a child whose self-absorption created problems in social interaction.

Five years later another specialist in this area, Leo Kanner, wrote a breakthrough paper on 'early infantile autism'.  Crucially he described cognitive impairment as a defining characteristic of the condition.

But in 1943 Asperger identified a  group of high achieving children who appeared to contradict Kanner's thesis. Though intellectually advanced, these young people appeared to have key autistic traits: a lack of empathy, little ability to form friendships, one-sided conversation, intense absorption in a special interest, and clumsy movements.

Asperger later noted that these 'odd' characteristics were sometimes combined with exceptional gifts, particularly in the ability to process and analyse information.  

So is Asperger's a form of autism?
The consensus has been that there is a continuum of Autistic Spectrum Disorders (ASDs). At one end is what might be termed 'fully blown' autism. This is associated with moderate to severe learning difficulties. 

Asperger's Syndrome is at the other end of the spectrum and is sometimes called 'high functioning' autism. 

Is everyone happy with this distinction?
Not exactly. The Diagnostic and Statistical Manual of Mental Disorders (DSM) only recognised Asperger's Syndrome  in 1981 and in 2013 the revised fifth edition (DSM-5) reversed this classification, with the decision 
to remove Asperger's syndrome as a separate diagnosis and replace it within the term ‘autism spectrum disorder’.

In the terminology of the DSM-5 – Asperger's syndrome would be seen as being at the ‘upper end’ of the autistic spectrum disorder (ASD). That means people with this type of ASD would normally have unaffected intelligence and language development, but would have milder symptoms affecting social interaction, behaviour and language comprehension.

Since this change there has been considerable confusion, with both terms - ASD and Asperger's Syndrome still in use.

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  1. Update: the new DSM introduces a major change in the terminology used in this areas - see below

    Asperger's syndrome is to be dropped from the psychiatrists' Diagnostic and Statistical Manual (DSM) of Mental Disorders, the American publication that is one of the most influential references for the profession around the world.

    The term "Asperger's disorder" will not appear in the DSM-5, the latest revision of the manual, and instead its symptoms will come under the newly added "autism spectrum disorder", which is already used widely. That umbrella diagnosis will include children with severe autism, who often do not talk or interact, as well as those with milder forms.

    The DSM is used in a number of countries to varying degrees. Psychiatrists in some countries including Britain use the International Classification of Diseases (ICD) published by the World Health Organisation or a combination of both handbooks.


  2. This is true, but the use of the term Aspergers is still professionally acceptable and appropriate is referring to these clients as it accurately identifies the symptoms. R.W. LPC, NCC


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