Asperger syndrome vs Autism

David Crisp, a National Autistic Society-trained autism speaker from Wired4autism, discusses the diagnostic differences between Asperger’s syndrome (AS) and autism spectrum disorder (ASD).

AS and ASD are neurodevelopmental conditions. Historically seen as different, the two were merged in 2013 with the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM5).

They remain as separate diagnoses in the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD10) but are expected to merge again on January 1 2022 with the publication of ICD11.

So where does this leave Asperger Syndrome? For now, Asperger Syndrome remains a valid diagnosis.

But it all depends on which diagnostic classification a clinician prefers to use. To further confuse the issue, DSM5, is generally preferred in the United States, and ICD10 is the preferred classification in the UK.

Clinical diagnoses can only be given by a clinician, using a recognised classification system. Currently, the two most widely used are DSM5 ICD10.

Under DSM5, there is one category for autism , being Autism Spectrum Disorder, while AS falls under the broader diagnosis of autism. To confuse matters further, some clinicians remained with ICD10 after DSM5 was published, while others migrated.

Autism Spectrum Disorders

‘Autism spectrum disorder is a lifelong condition that affects how a person communicates, relates to other people, and how they experience the world around them.’ (Current NHS definition).

Autism is a broad spectrum of characteristics and one person’s experience of autistic spectrum disorders (ASD) may be very different from another’s.
Some characteristics of ASD can include:

• difficulty with everyday conversations
• difficulty responding to or understanding social cues
• difficulty reading other people’s facial expressions
• difficulty understanding other people’s emotions
• delayed speech or language skills
• difficulty developing or understanding relationships
• engaging in repetitive actions, such as hand-flapping or rocking
• intense interests in certain topics
• atypical speech, such as in a singsong voice
• significant need for structure
• becoming overwhelmed or angry in new situations
• heightened sensitivity to certain stimulants, such as being overwhelmed by loud noises or bright lights
• possible intellectual delays

ASD is generally diagnosed in childhood, although late diagnosis in adults is becoming more frequent. There are approximately 700,000 diagnosed autistics in the UK. However, it is currently estimated that about one in 68 children may have ASD.

Asperger Syndrome

AS was first introduced into the DSM in 1994. At the time, it was a separate diagnosis from ASD. Many people with AS had no difficulties with language or cognitive skills, but they typically had trouble with social and communication skills.

Asperger Syndrome was named after Hans Asperger (1906-1980), an Austrian psychiatrist and paediatrician, and the term was first used by the English psychiatrist Dr Lorna Wing in a 1981 publication.

Bringing AS under the umbrella of ASD, in 2013, was met with some criticism. This partly concerned the fact that some people with AS tend to have less explicit characteristics of ASD.

A person’s AS diagnosis can be an important part of their identity. Many adopt the term “Aspie” to identify themselves as different from autistics that may have a learning disability.

However, following reports linking Asperger to ‘race hygiene’ in Nazi-era Vienna, which began to circulate in 2005, others chose to distance themselves from the term ‘Asperger Syndrome’.

Diagnostic criteria for Asperger Syndrome

A person with characteristics of AS may now receive a diagnosis of ASD because the condition falls under the broader classification of ASD in DSM5, from 2013.

The diagnostic criteria for AS was first included in DSM4 in 1993 and included:

• severe impairment in social interaction
• repetitive patterns of behaviour
• intense or passionate interest in certain topics

The criteria also noted that a person with AS has ‘neurotypical’ intelligence and language development, which means that they may be similar to those of someone without a developmental condition.

Differences between AS and ASD

AS and ASD are no longer considered different conditions. ASD is the name for a group of conditions, and AS is one of these. A person who might have received an AS diagnosis in the past may now receive a broader diagnosis of ASD.

Many people who were diagnosed with AS consider this to be a part of their identity, particularly as there can be an unfair assumption that ASD is always a significant disability, and a person who identifies as having AS may wish to avoid the ASD label due to this associated stigma.

The diagnostic criteria previously recognised that people with Asperger Syndrome do not experience the language delay so often associated with autism and have an average, or above-average, IQ.

A person with AS may require less support than an autistic person, depending on the characteristics of their condition.

However, they have a high incidence of comorbid conditions, especially anxiety and depression, as they have an awareness that they struggle with the social aspects of communication and interacting with others. This leaves them socially isolated and many are at a significant socioeconomic disadvantage compared to the general, neurotypical population.

Because doctors now consider AS to be a part of ASD, people with an AS diagnosis may now be able to access services for autistic people, which may have been denied to them in the past, due to their absence of an intellectual disability.

Neurodivergent

Since 2013, doctors have considered Asperger Syndrome to fall within the broader classification of Autistic Spectrum Disorders. However, a person with a diagnosis of AS may not wish to identify as having ASD.

Many now prefer to describe themselves as neurodivergent, where the emphasis is on their different way of being, rather than being identified by a strict diagnostic label.

In essence, autistics are wired differently and have a different operating system than neurotypicals. Through understanding and acceptance, these differences can be appreciated and valued.

Not everyone who is autistic will require support, but all require acceptance and understanding. But if anyone wants help managing elements of their ASD, various options are available.

Photo Credit – Ryan Quintal