Unravelling Asperger Syndrome: A Brief Journey Through its Complex Diagnosis

First described by Hans Asperger in 1944, Asperger Syndrome (AS) entered the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1994, only to be removed in 2013. Despite its brief inclusion, AS generated significant interest, and controversy. Like autism, AS individuals exhibit social interaction difficulties and restricted interests but also display unique clinical features. Challenges in defining and distinguishing AS from autism led to its reclassification under Autistic Spectrum Disorders. We explore the short history of this intriguing condition.

Introduction: From Kanner’s ‘Refrigerator Mothers’ to Asperger’s ‘Fine-Boned Aristocrats’

Autism and Asperger Syndrome (AS) were first described by Kanner (1943) and Asperger (1944), respectively. Both Austrian-born physicians used “autistic” to describe children with impaired social interaction and repetitive behaviours, a term originally coined byEugen Bleuler. While Kanner’s work gained early recognition, Asperger’s findings remained obscure until Lorna Wing’s 1981 paper proposed the term AS for children with specific social and linguistic characteristics. Unlike Kanner, Asperger highlighted positive traits such as intellectual interests and a distinctive physical appearance. This contrasted with Kanner’s later controversial theories blaming “refrigerator mothers” (The refrigerator mother theory, also known as Bettelheim’s theory, is a largely discredited theory that autism is caused by a lack of maternal emotional warmth) for autism.

Asperger Syndrome: Navigating Diagnostic Variability

The inclusion of AS in DSM-IV expanded the autism spectrum to include AS and Pervasive Developmental Disorder Not Otherwise Specified. AS was characterised by social interaction deficits and restricted interests, with normal cognitive and linguistic development. However, multiple diagnostic criteria, including those by Gillberg (1988) and Szatmari et al. (1989), led to inconsistencies. The most problematic aspect was excluding AS if autism criteria were met, causing diagnostic confusion.

Navigating the Identity of Asperger’s Syndrome

The distinctiveness of AS as a diagnosis faced challenges from the start. The overlap with autism led to debates on whether AS truly existed or was simply high-functioning autism (HFA). Researchers struggled with consistent criteria, leading to varied interpretations. While some argued AS had unique features, others saw it as indistinguishable from HFA. Ultimately, the DSM-5 merged AS into Autism Spectrum Disorders, citing insufficient evidence for a meaningful distinction.

Is AS Different from HFA?

Studies comparing AS and HFA showed subtle differences in language development, social skills, and cognitive profiles. AS children displayed more sophisticated language but did not have superior social outcomes. Biological studies, including MRI and genetic research, produced mixed results, often finding quantitative rather than qualitative differences. The variability in diagnostic criteria further complicated distinguishing AS from HFA.

The Debate Continues

Despite merging AS into Autism Spectrum Disorders in DSM-5, the decision sparked criticism. Many felt it ignored AS’s unique features and restricted access to specialised treatments. The new Social Communication Disorder diagnosis was seen as a fallback for high-functioning individuals, potentially stigmatising. Some advocate for AS’s inclusion as a descriptive label within ASD to preserve its identity. The debate continues on whether AS should be recognised as a distinct entity, reflecting ongoing fascination with autism.

Brief Existence and Future

The history of Asperger Syndrome is marked by its brief existence as a separate diagnosis and the controversies surrounding its classification. The merging of AS into Autism Spectrum Disorders reflects the complexities in defining and understanding the autism spectrum. Whether AS will re-emerge as a distinct diagnosis remains uncertain, but its impact on the perception of autism endures.