Asperger syndrome
Asperger syndrome (AS), also known as Asperger's syndrome or Asperger's, is a term formerly used to describe a neurodevelopmental disorder characterized by significant difficulties in social interaction and nonverbal communication, along with restricted, repetitive patterns of behavior and interests.[5] Asperger syndrome has been merged with other disorders into autism spectrum disorder (ASD) and is no longer considered a stand-alone diagnosis.[10][11][12] It was considered[13] milder than other diagnoses which were merged into ASD due to relatively unimpaired spoken language and intelligence.[14]
"Asperger's" redirects here. For other uses, see Asperger (disambiguation).
The syndrome was named after the Austrian pediatrician Hans Asperger, who, in 1944, described children in his care who struggled to form friendships, did not understand others' gestures or feelings, engaged in one-sided conversations about their favorite interests, and were clumsy.[15] In 1994, the diagnosis of Asperger syndrome was included in the fourth edition (DSM-IV) of the American Diagnostic and Statistical Manual of Mental Disorders; 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 (PDD-NOS).[5][16] It was similarly merged into autism spectrum disorder in the International Classification of Diseases (ICD-11) as of 2021.[17][18]
The exact cause of Asperger syndrome is poorly understood.[5] While it has high heritability, the underlying genetics have not been determined conclusively.[19][20] Environmental factors are also believed to play a role.[5] Brain imaging has not identified a common underlying condition.[19] There is no single treatment, and the UK's National Health Service (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".[21] According to the Royal College of Psychiatrists,[22] 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.[19] Interventions may include social skills training, cognitive behavioral therapy, physical therapy, speech therapy, parent training, and medications for associated problems, such as mood or anxiety.[8] Autistic characteristics tend to become less obvious in adulthood,[22] but social and communication difficulties usually persist.[23]
In 2015, Asperger syndrome was estimated to affect 37.2 million people globally, or about 0.5% of the population.[9] The exact percentage of people affected has still not been firmly established.[19] Autism spectrum disorder is diagnosed in males more often than females,[24] and females are typically diagnosed at a later age.[25][26] The modern conception of Asperger syndrome came into existence in 1981 and went through a period of popularization.[27][28][29] It became a standardized diagnosis in the 1990s[30] and was merged into ASD in 2013.[12] Many questions and controversies about the condition remain.[23]
Classification
The extent of the overlap between Asperger syndrome and high-functioning autism (HFA – autism unaccompanied by intellectual disability) is unclear.[31][32][33] The ASD classification is to some extent an artifact of how autism was discovered,[34] and it may not reflect the true nature of the spectrum;[35] methodological problems have beset Asperger syndrome as a valid diagnosis from the outset.[36][37] In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in May 2013,[38] Asperger syndrome, as a separate diagnosis, was eliminated and folded into autism spectrum disorder.[39] Like the diagnosis of Asperger syndrome,[40] the change was controversial.[40][41] Subsequently, it was also not included in the ICD-11, which came into effect in 2022.[42]
The World Health Organization (WHO) previously defined Asperger syndrome (AS) as one of the pervasive developmental disorders (PDD), which are a spectrum of psychological disorders that are characterized by abnormalities of social interaction and communication that pervade the individual's functioning, and by restricted and repetitive interests and behavior. Like other neurodevelopmental disorders, ASD begins in infancy or childhood, has a steady course without remission or relapse, and has impairments that result from maturation-related changes in various systems of the brain.[43]
Screening
Parents of children with Asperger syndrome can typically trace differences in their children's development to as early as 30 months of age.[78] Developmental screening during a routine check-up by a general practitioner or pediatrician may identify signs that warrant further investigation.[8][19] The United States Preventive Services Task Force in 2016 found it was unclear if screening was beneficial or harmful among children in whom there are no concerns.[103]
Different screening instruments are used to diagnose AS,[8][74] including the Asperger Syndrome Diagnostic Scale (ASDS); Autism Spectrum Screening Questionnaire (ASSQ); Childhood Autism Spectrum Test (CAST), previously called the Childhood Asperger Syndrome Test;[104] Gilliam Asperger's disorder scale (GADS); Krug Asperger's Disorder Index (KADI);[105] and the autism-spectrum quotient (AQ), with versions for children,[106] adolescents,[107] and adults.[108] None have been shown to reliably differentiate between AS and other ASDs.[19]
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.[23] As of 2006, no studies addressing the long-term outcome of individuals with Asperger syndrome are available and there are no systematic long-term follow-up studies of children with AS.[31] Individuals with AS appear to have normal life expectancy, but have an increased prevalence of comorbid psychiatric conditions, such as major depressive disorder and anxiety disorders that may significantly affect prognosis.[19][23] Although social impairment may be lifelong, the outcome is generally more positive than with individuals with lower-functioning autism spectrum disorders;[19] for example, ASD symptoms are more likely to diminish with time in children with AS or HFA.[140] Most students with AS and HFA have average mathematical ability and test slightly worse in mathematics than in general intelligence.[141] 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.[142]
Although many attend regular education classes, some children with AS may attend special education classes such as separate classroom and resource room because of their social and behavioral difficulties.[31] Adolescents with AS may exhibit ongoing difficulty with self-care 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.[19] The "different-ness" adolescents experience can be traumatic.[143] 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;[19] the resulting stress may manifest as inattention, withdrawal, reliance on obsessions, hyperactivity, or aggressive or oppositional behavior.[126] Depression is often the result of chronic frustration from repeated failure to engage others socially, and mood disorders requiring treatment may develop.[19] Clinical experience suggests the rate of suicide may be higher among those with AS, but this has not been confirmed by systematic empirical studies.[144]
Education of families is critical in developing strategies for understanding strengths and weaknesses;[47] helping the family to cope improves outcomes in children.[51] Prognosis may be improved by diagnosis at a younger age that allows for early interventions, while interventions in adulthood are valuable but less beneficial.[47] 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.[47]