History of Asperger syndrome
Encyclopedia
Asperger syndrome
, an autism spectrum disorder (ASD), is a relatively new diagnosis in the field of autism
. It was named in honor of Hans Asperger
(1906–80), an Austrian psychiatrist
and pediatrician. An English psychiatrist, Lorna Wing
, popularized the term "Asperger's syndrome" in a 1981 publication; the first book in English on Asperger syndrome was written by Uta Frith
in 1991 and the condition was subsequently recognized in formal diagnostic manuals later in the 1990s.
. Asperger called his young patients "little professors", and believed the individuals he described would be capable of exceptional achievement and original thought later in life. In a society governed by the Nazi eugenics
policy of sterilizing and killing social deviants and the mentally handicapped, Asperger's paper passionately defended the value of autistic individuals, writing "We are convinced, then, that autistic people have their place in the organism of the social community. They fulfil 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." Despite Asperger's phrase, it must be understood that autism bears no relationship to psychopathy
: the difficulties in relating to people felt by the autist are very different from those of the psychopath.
(1894–1981). Kanner emigrated to the United States in 1924; he described a similar syndrome in 1943, known as "classic autism" or "Kannerian autism
", characterized by significant cognitive and communicative deficiencies, including delayed or absent language development
. Kanner's descriptions were influenced by the developmental approach of Arnold Gesell
, while Asperger was influenced by accounts of schizophrenia
and personality disorders. Asperger's frame of reference was Eugen Bleuler
's typology, which Christopher Gillberg
has described as "out of keeping with current diagnostic manuals", adding that Asperger's descriptions are "penetrating but not sufficiently systematic". Asperger was unaware of Kanner's description published a year before his; the two researchers were separated by an ocean and a raging war, and Asperger's descriptions were ignored in the United States. During his lifetime, Asperger's work, in German, remained largely unknown outside the German-speaking world.
Lorna Wing
is credited with widely popularizing the term "Asperger's syndrome" in the English-speaking medical community in her 1981 publication of a series of case studies of children showing similar symptoms. Wing also placed AS on the autism spectrum, although Asperger was uncomfortable characterizing his patient on the continuum of autistic spectrum disorders. She chose "Asperger's syndrome" as a neutral term to avoid the misunderstanding equated by the term autistic psychopathy with sociopathic behavior. Wing's publication effectively introduced the diagnostic concept into American psychiatry and renamed the condition as Asperger's; however, her accounts blurred some of the distinctions between Asperger's and Kanner's descriptions because she included some mildly retarded children and some children who presented with language delay
s early in life.
, an early researcher of Kannerian autism, translated his original paper in 1991. AS became a distinct diagnosis in 1992, when it was included in the 10th published edition of the World Health Organization
’s diagnostic manual, International Classification of Diseases (ICD-10
); in 1994, it was added to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV) as Asperger's Disorder.
is a fundamental issue requiring further study. The diagnostic validity of Asperger syndrome is tentative
, there is little consensus among clinical researchers about the usage of the term "Asperger's syndrome", and there are questions about the empirical validation of the DSM-IV and ICD-10 criteria. It is likely that the definition of the condition will change as new studies emerge and it will eventually be understood as a multifactorial heterogeneous neurodevelopmental disorder involving a catalyst that results in prenatal or perinatal changes in brain structures.
There is uncertainty regarding the gender gap between males and females with Asperger's. A person with Asperger's is often remarked as possessing masculine traits like emotional distance from the inability to empathize, and far more boys than girls are diagnosed with Asperger's. Most studies on the syndrome were derived from research on males, neglecting specific attention to females with Aspergers Syndrome who often go misdiagnosed. For the most part, studies on girls with Asperger's are anecdotal.
that is set to be released in May 2013 is to eliminate Asperger syndrome as a separate diagnosis, and fold it under autism spectrum disorders. Under the proposed changes, ASD will be rated on a scale ranging from severe, through moderate, to mild, based on clinical presentation.
Asperger syndrome
Asperger's syndrome that is characterized by significant difficulties in social interaction, alongside restricted and repetitive patterns of behavior and interests. It differs from other autism spectrum disorders by its relative preservation of linguistic and cognitive development...
, an autism spectrum disorder (ASD), is a relatively new diagnosis in the field of autism
Autism
Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism affects information processing in the brain by altering how nerve cells and their...
. It was named in honor of Hans Asperger
Hans Asperger
Hans Asperger was an Austrian pediatrician, after whom Asperger syndrome was named. He wrote over 300 publications, mostly concerning autism in children.-Biography:...
(1906–80), an Austrian psychiatrist
Psychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
and pediatrician. An English psychiatrist, Lorna Wing
Lorna Wing
Lorna Wing, MD, FRCPsych, is an English psychiatrist and physician.As a result of having an autistic daughter, she became involved in researching developmental disorders, particularly autism spectrum disorders. She joined with other parents of autistic children to found the National Autistic...
, popularized the term "Asperger's syndrome" in a 1981 publication; the first book in English on Asperger syndrome was written by Uta Frith
Uta Frith
Uta Frith FRS FBA is a leading developmental psychologist working at the Institute of Cognitive Neuroscience at University College London. She has pioneered much of the current research in autism and dyslexia, and has written several books on these issues. Her book 'Autism: Explaining the Enigma'...
in 1991 and the condition was subsequently recognized in formal diagnostic manuals later in the 1990s.
Discovery of autistic psychopathy
Asperger was the director of the University Children's Clinic in Vienna, spending most of his professional life in Vienna and publishing largely in German. As a child, Asperger appeared to have exhibited some features of the very condition named after him, such as social remoteness and talent in language; photographs taken during his seminal work show that he had a frank and earnest face with an intense gaze. In 1944, Asperger described in the paper "'Autistic psychopathy' in childhood" four children in his practice who had difficulty in integrating themselves socially. Although their intelligence appeared normal, the children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Their 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 primarily marked by social isolationSocial isolation
Social isolation refers to a lack of contact with society for members of social species. There may be many causes and individuals in numerous generally social species are isolated at times, it need not be a pathological condition. In human society, in those cases where it is viewed as a pathology,...
. Asperger called his young patients "little professors", and believed the individuals he described would be capable of exceptional achievement and original thought later in life. In a society governed by the Nazi eugenics
Nazi eugenics
Nazi eugenics were Nazi Germany's racially-based social policies that placed the improvement of the Aryan race through eugenics at the center of their concerns...
policy of sterilizing and killing social deviants and the mentally handicapped, Asperger's paper passionately defended the value of autistic individuals, writing "We are convinced, then, that autistic people have their place in the organism of the social community. They fulfil 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." Despite Asperger's phrase, it must be understood that autism bears no relationship to psychopathy
Psychopathy
Psychopathy is a mental disorder characterized primarily by a lack of empathy and remorse, shallow emotions, egocentricity, and deceptiveness. Psychopaths are highly prone to antisocial behavior and abusive treatment of others, and are very disproportionately responsible for violent crime...
: the difficulties in relating to people felt by the autist are very different from those of the psychopath.
Relationship to Kanner's work
Two subtypes of autism were described between 1943 and 1944 by two Austrian researchers working independently—Asperger and Austrian-born child psychiatrist Leo KannerLeo Kanner
Leo Kanner was a Jewish American psychiatrist and physician known for his work related to autism. Kanner's work formed the foundation of child and adolescent psychiatry in the U.S. and worldwide....
(1894–1981). Kanner emigrated to the United States in 1924; he described a similar syndrome in 1943, known as "classic autism" or "Kannerian autism
Autism
Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism affects information processing in the brain by altering how nerve cells and their...
", characterized by significant cognitive and communicative deficiencies, including delayed or absent language development
Language development
Language development is a process starting early in human life, when a person begins to acquire language by learning it as it is spoken and by mimicry. Children's language development moves from simple to complex. Infants start without language. Yet by four months of age, babies can read lips and...
. Kanner's descriptions were influenced by the developmental approach of Arnold Gesell
Arnold Gesell
-External links:* Gesell's ; *...
, while Asperger was influenced by accounts of schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
and personality disorders. Asperger's frame of reference was Eugen Bleuler
Eugen Bleuler
Paul Eugen Bleuler was a Swiss psychiatrist most notable for his contributions to the understanding of mental illness and for coining the term "schizophrenia."-Biography:...
's typology, which Christopher Gillberg
Christopher Gillberg
Lars Christopher Gillberg , who has sometimes published as Gillberg and Gillberg with his wife Carina Gillberg, is a professor of child and adolescent psychiatry at Gothenburg University in Gothenburg, Sweden, and an honorary professor at the Institute of Child Health , University College London...
has described as "out of keeping with current diagnostic manuals", adding that Asperger's descriptions are "penetrating but not sufficiently systematic". Asperger was unaware of Kanner's description published a year before his; the two researchers were separated by an ocean and a raging war, and Asperger's descriptions were ignored in the United States. During his lifetime, Asperger's work, in German, remained largely unknown outside the German-speaking world.
Coinage
According to Ishikawa and Ichihashi in the Japanese Journal of Clinical Medicine, the first author to use the term Asperger's syndrome in the English-language literature was the German physician, Gerhard Bosch. Between 1951 and 1962, Bosch worked as a psychiatrist at Frankfurt University. In 1962, he published a monograph detailing five case histories of individuals with PDD that was translated to English eight years later, becoming one of the first to establish German research on autism, and attracting attention outside the German-speaking world.Lorna Wing
Lorna Wing
Lorna Wing, MD, FRCPsych, is an English psychiatrist and physician.As a result of having an autistic daughter, she became involved in researching developmental disorders, particularly autism spectrum disorders. She joined with other parents of autistic children to found the National Autistic...
is credited with widely popularizing the term "Asperger's syndrome" in the English-speaking medical community in her 1981 publication of a series of case studies of children showing similar symptoms. Wing also placed AS on the autism spectrum, although Asperger was uncomfortable characterizing his patient on the continuum of autistic spectrum disorders. She chose "Asperger's syndrome" as a neutral term to avoid the misunderstanding equated by the term autistic psychopathy with sociopathic behavior. Wing's publication effectively introduced the diagnostic concept into American psychiatry and renamed the condition as Asperger's; however, her accounts blurred some of the distinctions between Asperger's and Kanner's descriptions because she included some mildly retarded children and some children who presented with language delay
Language delay
Language delay is a failure to develop language abilities on the usual developmental timetable. Language delay is distinct from speech delay, in which the speech mechanism itself is the focus of delay...
s early in life.
Early studies
The first systematic studies appeared in the late 1980s in publications by Tantam (1988) in the UK, Gillberg and Gilbert in Sweden (1989), and Szatmari, Bartolucci and Bremmer (1989) in North America. The diagnostic criteria for AS were outlined by Gillberg and Gillberg in 1989; Szatmari also proposed criteria in 1989. Asperger's work became more widely available in English when Uta FrithUta Frith
Uta Frith FRS FBA is a leading developmental psychologist working at the Institute of Cognitive Neuroscience at University College London. She has pioneered much of the current research in autism and dyslexia, and has written several books on these issues. Her book 'Autism: Explaining the Enigma'...
, an early researcher of Kannerian autism, translated his original paper in 1991. AS became a distinct diagnosis in 1992, when it was included in the 10th published edition of the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
’s diagnostic manual, International Classification of Diseases (ICD-10
ICD-10
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...
); in 1994, it was added to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
(DSM-IV) as Asperger's Disorder.
Contemporary
Less than two decades after the widespread introduction of AS to English-speaking audiences, there are hundreds of books, articles and websites describing it; prevalence estimates have increased dramatically for ASD, with AS recognized as an important subgroup. However, questions remain concerning many aspects of AS; whether it should be a separate condition from high-functioning autismHigh-functioning autism
High-functioning autism is an informal term applied to autistic people who are deemed to be "higher functioning" than other autistic people, by one or more metrics. There is no consensus as to the definition. HFA is not yet a recognised diagnosis in the DSM-IV-TR or the ICD-10.The amount of...
is a fundamental issue requiring further study. The diagnostic validity of Asperger syndrome is tentative
Diagnosis of Asperger syndrome
Several factors complicate the diagnosis of Asperger syndrome , an autism spectrum disorder . Like other ASD forms, Asperger syndrome is characterized by impairment in social interaction accompanied by restricted and repetitive interests and behavior; it differs from the other ASDs by having no...
, there is little consensus among clinical researchers about the usage of the term "Asperger's syndrome", and there are questions about the empirical validation of the DSM-IV and ICD-10 criteria. It is likely that the definition of the condition will change as new studies emerge and it will eventually be understood as a multifactorial heterogeneous neurodevelopmental disorder involving a catalyst that results in prenatal or perinatal changes in brain structures.
There is uncertainty regarding the gender gap between males and females with Asperger's. A person with Asperger's is often remarked as possessing masculine traits like emotional distance from the inability to empathize, and far more boys than girls are diagnosed with Asperger's. Most studies on the syndrome were derived from research on males, neglecting specific attention to females with Aspergers Syndrome who often go misdiagnosed. For the most part, studies on girls with Asperger's are anecdotal.
Proposed changes in DSM-5
One of the proposed changes in DSM-5DSM-5
The next edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders , commonly called DSM-5 , is currently in consultation, planning and preparation...
that is set to be released in May 2013 is to eliminate Asperger syndrome as a separate diagnosis, and fold it under autism spectrum disorders. Under the proposed changes, ASD will be rated on a scale ranging from severe, through moderate, to mild, based on clinical presentation.