The Asperger’s Syndrome Debate: Rethinking the Terminology and Its Implications.

Asperger’s Syndrome was incorporated into the Statistical and Diagnostic Manual of Mental Disorders 4 (DSM) in 1994 and described as a subtype of pervasive developmental disorders.

However, in 2013, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), one of the main references used by mental health professionals to diagnose disorders, made a significant change. The DSM-5 eliminated the category of Asperger’s Syndrome and used only the term “Autism Spectrum Disorder” to describe a wide range of symptoms and levels of severity.

So why has this term fallen out of favor? This change was made with the aim of eliminating arbitrary distinctions between different categories of autism and recognizing the diversity of experiences and characteristics within the spectrum.

The Controversy Surrounding the Term Asperger’s

Hans Asperger was born in Austria in 1906. He studied medicine and psychiatry at the University of Vienna and later worked at the University Children’s Clinic in Vienna. In the early 1940s, during his time at the clinic, Asperger began observing and studying a group of children who exhibited unique social and communication difficulties.

Furthermore, there has been criticism of the term “Asperger” in relation to its original name, Hans Asperger, who was later discovered to have collaborated with the Nazi regime during World War II. 

According to the book Asperger’s Children: The Origins of Autism in Nazi Vienna, the Austrian pediatrician, would have referred dozens of children to a clinic called ‘Am Spiegelgrund’ in Vienna, where doctors experimented on them, leading to their deaths. In addition, Dr. Asperger publicly legitimized racial hygiene policies, including forced sterilizations, and actively cooperated, on several occasions, with the Nazi program of child euthanasia. These revelations generated discussions about the continuity of the use of the term, and many professionals chose to abandon it.

In 1944, Hans Asperger published a paper titled “Die ‘Autistischen Psychopathen’ im Kindesalter” (translated as “Autistic Psychopathy in Childhood”) in German. In this paper, he describes a group of children who displayed social isolation, limited empathy, intense focus on particular interests, and a lack of nonverbal communication skills. Asperger referred to these children as “autistic psychopaths,” using psychopathy to indicate a personality disorder rather than a psychiatric illness. When his work became better known, it was referred to as Asperger’s Syndrome.

In 1981, British psychiatrist Lorna Wing translated Asperger’s original paper into English, bringing attention to his work in the English-speaking world. She also played a crucial role in popularizing the term “Asperger’s syndrome” to describe a milder form of autism that had become recognized as a distinct condition.

Asperger’s Syndrome Features

Some of the features commonly associated with Asperger’s syndrome, as identified by Lorna Wing, include:

• Social Difficulties: Individuals with Asperger’s syndrome often experience challenges in understanding and navigating social interactions. They may struggle with interpreting social cues, making eye contact, and understanding nonverbal communication, which can lead to difficulties in forming and maintaining friendships and relationships.
• Repetitive Behaviors and Special Interests: People with Asperger’s syndrome may engage in repetitive behaviors or routines. They may also develop intense interests in specific subjects and become highly knowledgeable in those areas.
• Communication Differences: Individuals with Asperger’s syndrome show impaired social interaction and have limited non-verbal communication with little facial expression or use of gestures.
• Motor Skill Challenges: Some individuals with Asperger’s syndrome may experience motor coordination difficulties, leading to challenges with activities that require fine and gross motor skills.
• Sensory Sensitivities: Many people with Asperger’s syndrome have heightened sensitivity to sensory stimuli. They may be over-responsive or under-responsive to sensory inputs such as sounds, lights, textures, or tastes.
• Difficulty with Changes: Individuals with Asperger’s syndrome may struggle with changes in routines or unexpected transitions, preferring a structured and predictable environment.

• A chromosomal abnormality (such as fragile X syndrome).
• A mother’s use of prescription medicines taken during pregnancy (such as valproic acid for seizures or mood disorders, or thalidomide for anxiety).
• Having been born to older parents, may put a child at higher risk of an autism spectrum disorder diagnosis.

However, the fact that more boys are diagnosed with autism than girls may be related to whether women and girls are misdiagnosed with mental health issues or whether their autistic traits are lost amid the symptoms of co-occurring conditions. Some tools used to diagnose autism are designed to identify autistic traits that may be more common in autistic men and boys, points out an article specializing in the area. 

Still, according to the article, some of the main characteristics of autism are “repetitive behaviors” and highly focused interests. However, in autistic women and girls, these behaviors and interests may be similar to those of non-autistic women and girls, such as twirling hair and reading books, and as such may go unnoticed despite the greater intensity or focus typical of autistic people.

Asperger’s syndrome (AS) and autism both come under the autism spectrum disorder (ASD). Both conditions make social interaction challenging, but people with Asperger’s do not have problems with language and thinking.

It’s important to note that the term “Asperger’s syndrome” is no longer used as a separate diagnosis, and all these features are now considered within the broader context of Autism Spectrum Disorder (ASD). However, numerous individuals who were diagnosed prior to the elimination of Asperger Syndrome from the DSM still refer to their diagnosis in this way and, colloquially, may still refer to themselves as “Aspies.” They argue that by keeping Asperger’s in their name, people searching for services that fit their specific needs and those from other countries where the term is still used as a diagnosis can find them.

It’s essential to recognize that autism is a spectrum, and individuals may present these features to varying degrees, with unique strengths and challenges. Each person's experience with ASD is different, and they should be treated with understanding, acceptance, and support. Because “When you meet one person with Autism, you’ve met one person with autism” (Dr. Stephen Shore, author and autistic professor of special education at Adelphi University). 

Sources:

1. https://agenciabrasil.ebc.com.br/saude/noticia/2020-02/mundo-lembra-psiquiatra-que-descreveu-sindrome-de-asperger
2. https://abamais.com/por-que-nao-deveriamos-usar-o-termo-asperger-para-referir-se-a-um-dos-niveis-do-autismo/
3. https://www.correiobraziliense.com.br/app/noticia/mundo/2018/04/19/interna_mundo,674780/medico-que-deu-nome-a-famosa-sindrome-cooperou-ativamente-com-os-nazis.shtml
4. https://www.sciencedirect.com/topics/psychology/autistic-psychopathy