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Asperger syndrome
Asperger syndrome
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Asperger syndrome or Asperger's syndrome or Asperger disorder (/[invalid input: 'icon']ˈ[invalid input: 'ɑ']spərɡərz/^[1] or /ˈæspərɡərz/^[2]) is an autism spectrum disorder that is characterized by significant difficulties in social interaction, along with restricted and repetitive patterns of behavior and interests. It differs from other autism spectrum disorders by its relative preservation of linguistic and cognitive development. Although not required for diagnosis, physical clumsiness and atypical use of language are frequently reported.^[3]^[4]

Asperger syndrome is named after the Austrian pediatrician Hans Asperger who, in 1944, studied and described children in his practice who lacked nonverbal communication skills, demonstrated limited empathy with their peers, and were physically clumsy.^[5] Fifty years later, it was standardized as a diagnosis, but many questions remain about aspects of the disorder.^[6] For example, there is doubt about whether it is distinct from high-functioning autism (HFA);^[7] partly because of this, its prevalence is not firmly established.^[3] It has been proposed that the diagnosis of Asperger's be eliminated, to be replaced by a diagnosis of autism spectrum disorder on a severity scale.^[8]

The exact cause is unknown, although research supports the likelihood of a genetic basis; brain imaging techniques have not identified a clear common pathology.^[3] There is no single treatment, and the effectiveness of particular interventions is supported by only limited data.^[3] Intervention is aimed at improving symptoms and function. The mainstay of management is behavioral therapy, focusing on specific deficits to address poor communication skills, obsessive or repetitive routines, and physical clumsiness.^[9] Most children improve as they mature to adulthood, but social and communication difficulties may persist.^[6] Some researchers and people with Asperger's have advocated a shift in attitudes toward the view that it is a difference, rather than a disability that must be treated or cured.^[10]^[11]

Classification

Asperger syndrome (AS) is one of the autism spectrum disorders (ASD) or pervasive developmental disorders (PDD), which are a spectrum of psychological conditions 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 psychological development 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.^[12] ASD, in turn, is a subset of the broader autism phenotype (BAP), which describes individuals who may not have ASD but do have autistic-like traits, such as social deficits.^[13] Of the other four ASD forms, autism is the most similar to AS in signs and likely causes but its diagnosis requires impaired communication and allows delay in cognitive development; Rett syndrome and childhood disintegrative disorder share several signs with autism but may have unrelated causes; and pervasive developmental disorder not otherwise specified (PDD-NOS) is diagnosed when the criteria for a more specific disorder are unmet.^[14]

The extent of the overlap between AS and high-functioning autism (HFA—autism unaccompanied by mental retardation) is unclear.^[7]^[15]^[16] The current ASD classification is to some extent an artifact of how autism was discovered,^[17] and may not reflect the true nature of the spectrum.^[18] One of the proposed changes in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, set to be published in May 2013,^[19] would eliminate Asperger syndrome as a separate diagnosis, and fold it under autistic disorder (autism spectrum disorder), which would be rated on a severity scale.^[8] The proposed change is controversial,^[20]^[21]^[22] and it has been argued that the syndrome's diagnostic criteria should be changed instead.^[23]

Asperger syndrome is also called Asperger's syndrome (AS),^[3] Asperger (or Asperger's) disorder (AD),^[15]^[24] or just Asperger's.^[25] There is little consensus among clinical researchers about whether the condition's name should end in "syndrome" or "disorder".^[7]

Characteristics

A pervasive developmental disorder, Asperger syndrome is distinguished by a pattern of symptoms rather than a single symptom. It is characterized by qualitative impairment in social interaction, by stereotyped and restricted patterns of behavior, activities and interests, and by no clinically significant delay in cognitive development or general delay in language.^[24] Intense preoccupation with a narrow subject, one-sided verbosity, restricted prosody, and physical clumsiness are typical of the condition, but are not required for diagnosis.^[7]

Social interaction

The lack of demonstrated empathy is possibly the most dysfunctional aspect of Asperger syndrome.^[4] Individuals with AS experience difficulties in basic elements of social interaction, which may include a failure to develop friendships or to seek shared enjoyments or achievements with others (for example, showing others objects of interest), a lack of social or emotional reciprocity, and impaired nonverbal behaviors in areas such as eye contact, facial expression, posture, and gesture.^[3]

Unlike those with autism, people with AS are not usually withdrawn around others; they approach others, even if awkwardly. For example, a person with AS may engage in a one-sided, long-winded speech about a favorite topic, while misunderstanding or not recognizing the listener's feelings or reactions, such as a need for privacy or haste to leave.^[7] This social awkwardness has been called "active but odd".^[3] This failure to react appropriately to social interaction may appear as disregard for other people's feelings, and may come across as insensitive.^[7] However, not all individuals with AS will approach others. Some of them may even display selective mutism, speaking not at all to most people and excessively to specific people. Some may choose to talk only to people they like.^[26]

The cognitive ability of children with AS often allows them to articulate social norms in a laboratory context,^[3] where they may be able to show a theoretical understanding of other people's emotions; however, they typically have difficulty acting on this knowledge in fluid, real-life situations.^[7] People with AS may analyze and distill their observations of social interaction into rigid behavioral guidelines, and apply these rules in awkward ways, such as forced eye contact, resulting in a demeanor that appears rigid or socially naive. Childhood desire for companionship can become numbed through a history of failed social encounters.^[3]

The hypothesis that individuals with AS are predisposed to violent or criminal behavior has been investigated but is not supported by data.^[3]^[27] More evidence suggests children with AS are victims rather than victimizers.^[28] A 2008 review found that an overwhelming number of reported violent criminals with AS had coexisting psychiatric disorders such as schizoaffective disorder.^[29]

Restricted and repetitive interests and behavior

People with Asperger syndrome often display behavior, interests, and activities that are restricted and repetitive and are sometimes abnormally intense or focused. They may stick to inflexible routines, move in stereotyped and repetitive ways, or preoccupy themselves with parts of objects.^[24]

Pursuit of specific and narrow areas of interest is one of the most striking features of AS.^[3] Individuals with AS may collect volumes of detailed information on a relatively narrow topic such as weather data or star names, without necessarily having genuine understanding of the broader topic.^[3]^[7] For example, a child might memorize camera model numbers while caring little about photography.^[3] This behavior is usually apparent by grade school, typically age 5 or 6 in the United States.^[3] Although these special interests may change from time to time, they typically become more unusual and narrowly focused, and often dominate social interaction so much that the entire family may become immersed. Because narrow topics often capture the interest of children, this symptom may go unrecognized.^[7]

Stereotyped and repetitive motor behaviors are a core part of the diagnosis of AS and other ASDs.^[30] They include hand movements such as flapping or twisting, and complex whole-body movements.^[24] These are typically repeated in longer bursts and look more voluntary or ritualistic than tics, which are usually faster, less rhythmical and less often symmetrical.^[31]

Speech and language

Although individuals with Asperger syndrome acquire language skills without significant general delay and their speech typically lacks significant abnormalities, language acquisition and use is often atypical.^[7] Abnormalities include verbosity, abrupt transitions, literal interpretations and miscomprehension of nuance, use of metaphor meaningful only to the speaker, auditory perception deficits, unusually pedantic, formal or idiosyncratic speech, and oddities in loudness, pitch, intonation, prosody, and rhythm.^[3]

Three aspects of communication patterns are of clinical interest: poor prosody, tangential and circumstantial speech, and marked verbosity. Although inflection and intonation may be less rigid or monotonic than in autism, people with AS often have a limited range of intonation: speech may be unusually fast, jerky or loud. Speech may convey a sense of incoherence; the conversational style often includes monologues about topics that bore the listener, fails to provide context for comments, or fails to suppress internal thoughts. Individuals with AS may fail to monitor whether the listener is interested or engaged in the conversation. The speaker's conclusion or point may never be made, and attempts by the listener to elaborate on the speech's content or logic, or to shift to related topics, are often unsuccessful.^[7]

Children with AS may have an unusually sophisticated vocabulary at a young age and have been colloquially called "little professors", but have difficulty understanding figurative language and tend to use language literally.^[3] Children with AS appear to have particular weaknesses in areas of nonliteral language that include humor, irony, and teasing. Although individuals with AS usually understand the cognitive basis of humor, they seem to lack understanding of the intent of humor to share enjoyment with others.^[15] Despite strong evidence of impaired humor appreciation, anecdotal reports of humor in individuals with AS seem to challenge some psychological theories of AS and autism.^[32] According to the Adult Asperger Assessment (AAA) diagnostic test, a lack of interest in fiction and the positive preference towards non-fiction is common among adults with the disorder, which might explain the lack of understanding of verbal symbolisms and nonliteral language for people with Asperger's.^[33]

Other

Individuals with Asperger syndrome may have signs or symptoms that are independent of the diagnosis, but can affect the individual or the family.^[34] These include differences in perception and problems with motor skills, sleep, and emotions.

Individuals with AS often have excellent auditory and visual perception.^[35] Children with ASD often demonstrate enhanced perception of small changes in patterns such as arrangements of objects or well-known images; typically this is domain-specific and involves processing of fine-grained features.^[36] Conversely, compared to individuals with high-functioning autism, individuals with AS have deficits in some tasks involving visual-spatial perception, auditory perception, or visual memory.^[3] Many accounts of individuals with AS and ASD report other unusual sensory and perceptual skills and experiences. They may be unusually sensitive or insensitive to sound, light, and other stimuli;^[37] these sensory responses are found in other developmental disorders and are not specific to AS or to ASD. There is little support for increased fight-or-flight response or failure of habituation in autism; there is more evidence of decreased responsiveness to sensory stimuli, although several studies show no differences.^[38]

Hans Asperger's initial accounts^[3] and other diagnostic schemes^[39] include descriptions of physical clumsiness. Children with AS may be delayed in acquiring skills requiring motor dexterity, such as riding a bicycle or opening a jar, and may seem to move awkwardly or feel "uncomfortable in their own skin". They may be poorly coordinated, or have an odd or bouncy gait or posture, poor handwriting, or problems with visual-motor integration.^[3]^[7] They may show problems with proprioception (sensation of body position) on measures of apraxia (motor planning disorder), balance, tandem gait, and finger-thumb apposition. There is no evidence that these motor skills problems differentiate AS from other high-functioning ASDs.^[3]

Children with AS are more likely to have sleep problems, including difficulty in falling asleep, frequent nocturnal awakenings, and early morning awakenings.^[40]^[41] AS is also associated with high levels of alexithymia, which is difficulty in identifying and describing one's emotions.^[42] Although AS, lower sleep quality, and alexithymia are associated, their causal relationship is unclear.^[41]

As with other forms of ASD, parents of children with AS have higher levels of stress.^[43]

Causes

Hans Asperger described common symptoms among his patients' family members, especially fathers, and research supports this observation and suggests a genetic contribution to Asperger syndrome. Although no specific gene has yet been identified, multiple factors are believed to play a role in the expression of autism, given the phenotypic variability seen in children with AS.^[3]^[44] Evidence for a genetic link is the tendency for AS to run in families and an observed higher incidence of family members who have behavioral symptoms similar to AS but in a more limited form (for example, slight difficulties with social interaction, language, or reading).^[9] Most research suggests that all autism spectrum disorders have shared genetic mechanisms, but AS may have a stronger genetic component than autism.^[3] There is probably a common group of genes where particular alleles render an individual vulnerable to developing AS; if this is the case, the particular combination of alleles would determine the severity and symptoms for each individual with AS.^[9]

A few ASD cases have been linked to exposure to teratogens (agents that cause birth defects) during the first eight weeks from conception. Although this does not exclude the possibility that ASD can be initiated or affected later, it is strong evidence that it arises very early in development.^[45] Many environmental factors have been hypothesized to act after birth, but none has been confirmed by scientific investigation.^[46]

Mechanism

Asperger syndrome appears to result from developmental factors that affect many or all functional brain systems, as opposed to localized effects.^[47] Although the specific underpinnings of AS or factors that distinguish it from other ASDs are unknown, and no clear pathology common to individuals with AS has emerged,^[3] it is still possible that AS's mechanism is separate from other ASD.^[48] Neuroanatomical studies and the associations with teratogens strongly suggest that the mechanism includes alteration of brain development soon after conception.^[45] Abnormal migration of embryonic cells during fetal development may affect the final structure and connectivity of the brain, resulting in alterations in the neural circuits that control thought and behavior.^[49] Several theories of mechanism are available; none are likely to provide a complete explanation.^[50]

The underconnectivity theory hypothesizes underfunctioning high-level neural connections and synchronization, along with an excess of low-level processes.^[51] It maps well to general-processing theories such as weak central coherence theory, which hypothesizes that a limited ability to see the big picture underlies the central disturbance in ASD.^[53] A related theory—enhanced perceptual functioning—focuses more on the superiority of locally oriented and perceptual operations in autistic individuals.^[54]

The mirror neuron system (MNS) theory hypothesizes that alterations to the development of the MNS interfere with imitation and lead to Asperger's core feature of social impairment.^[52]^[55] For example, one study found that activation is delayed in the core circuit for imitation in individuals with AS.^[56] This theory maps well to social cognition theories like the theory of mind, which hypothesizes that autistic behavior arises from impairments in ascribing mental states to oneself and others,^[57] or hyper-systemizing, which hypothesizes that autistic individuals can systematize internal operation to handle internal events but are less effective at empathizing by handling events generated by other agents.^[58]

Other possible mechanisms include serotonin dysfunction^[59] and cerebellar dysfunction.^[60]

Screening

Parents of children with Asperger syndrome can typically trace differences in their children's development to as early as 30 months of age.^[44] Developmental screening during a routine check-up by a general practitioner or pediatrician may identify signs that warrant further investigation.^[3]^[9] The diagnosis of AS is complicated by the use of several different screening instruments,^[9]^[39] including the Asperger Syndrome Diagnostic Scale (ASDS), Autism Spectrum Screening Questionnaire (ASSQ), Childhood Asperger Syndrome Test (CAST), Gilliam Asperger's Disorder Scale (GADS), Krug Asperger's Disorder Index (KADI),^[61] and the Autism Spectrum Quotient (AQ; with versions for children,^[62] adolescents^[63] and adults^[64]). None have been shown to reliably differentiate between AS and other ASDs.^[3]

Diagnosis

Standard diagnostic criteria require impairment in social interaction and repetitive and stereotyped patterns of behavior, activities and interests, without significant delay in language or cognitive development. Unlike the international standard,^[12] U.S. criteria also require significant impairment in day-to-day functioning.^[24] Other sets of diagnostic criteria have been proposed by Szatmari et al.^[65] and by Gillberg and Gillberg.^[66]

Diagnosis is most commonly made between the ages of four and eleven.^[3] A comprehensive assessment involves a multidisciplinary team^[4]^[9]^[67] that observes across multiple settings,^[3] and includes neurological and genetic assessment as well as tests for cognition, psychomotor function, verbal and nonverbal strengths and weaknesses, style of learning, and skills for independent living.^[9] The "gold standard" in diagnosing ASDs combines clinical judgment with the Autism Diagnostic Interview-Revised (ADI-R)—a semistructured parent interview—and the Autism Diagnostic Observation Schedule (ADOS)—a conversation and play-based interview with the child.^[6] Delayed or mistaken diagnosis can be traumatic for individuals and families; for example, misdiagnosis can lead to medications that worsen behavior.^[67]^[68] Many children with AS are initially misdiagnosed with attention-deficit hyperactivity disorder (ADHD).^[3] Diagnosing adults is more challenging, as standard diagnostic criteria are designed for children and the expression of AS changes with age;^[69] adult diagnosis requires painstaking clinical examination and thorough medical history gained from both the individual and other people who know the person, focusing on childhood behavior.^[33] Conditions that must be considered in a differential diagnosis include other ASDs, the schizophrenia spectrum, ADHD, obsessive compulsive disorder, major depressive disorder, semantic pragmatic disorder, nonverbal learning disorder,^[67] Tourette syndrome,^[31] stereotypic movement disorder and bipolar disorder.^[44]

Underdiagnosis and overdiagnosis are problems in marginal cases. The cost and difficulty of screening and assessment can delay diagnosis. Conversely, the increasing popularity of drug treatment options and the expansion of benefits has motivated providers to overdiagnose ASD.^[70] There are indications AS has been diagnosed more frequently in recent years, partly as a residual diagnosis for children of normal intelligence who do not have autism but have social difficulties.^[71] In 2006, it was reported to be the fastest-growing psychiatric diagnosis in Silicon Valley children; also, there is a predilection for adults to self-diagnose it.^[72] There are questions about the external validity of the AS diagnosis. That is, it is unclear whether there is a practical benefit in distinguishing AS from HFA and from PDD-NOS;^[71] the same child can receive different diagnoses depending on the screening tool.^[9] The debate about distinguishing AS from HFA is partly due to a tautological dilemma where disorders are defined based on severity of impairment, so that studies that appear to confirm differences based on severity are to be expected.^[73]

Management

Asperger syndrome treatment attempts to manage distressing symptoms and to teach age-appropriate social, communication and vocational skills that are not naturally acquired during development,^[3] with intervention tailored to the needs of the individual based on multidisciplinary assessment.^[74] Although progress has been made, data supporting the efficacy of particular interventions are limited.^[3]^[75]

Therapies

The ideal treatment for AS coordinates therapies that address core symptoms of the disorder, including poor communication skills and obsessive or repetitive routines. While most professionals agree that the earlier the intervention, the better, there is no single best treatment package.^[9] AS treatment resembles that of other high-functioning ASDs, except that it takes into account the linguistic capabilities, verbal strengths, and nonverbal vulnerabilities of individuals with AS.^[3] A typical program generally includes:^[9]

The training of social skills for more effective interpersonal interactions,^[76]
Cognitive behavioral therapy to improve stress management relating to anxiety or explosive emotions,^[77] and to cut back on obsessive interests and repetitive routines,
Medication, for coexisting conditions such as major depressive disorder and anxiety disorder,^[78]
occupational or physical therapy to assist with poor sensory integration and motor coordination,
Social communication intervention, which is specialized speech therapy to help with the pragmatics of the give and take of normal conversation,^[79]
The training and support of parents, particularly in behavioral techniques to use in the home.

Of the many studies on behavior-based early intervention programs, most are case studies of up to five participants, and typically examine a few problem behaviors such as self-injury, aggression, noncompliance, stereotypies, or spontaneous language; unintended side effects are largely ignored.^[80] Despite the popularity of social skills training, its effectiveness is not firmly established.^[81] A randomized controlled study of a model for training parents in problem behaviors in their children with AS showed that parents attending a one-day workshop or six individual lessons reported fewer behavioral problems, while parents receiving the individual lessons reported less intense behavioral problems in their AS children.^[82] Vocational training is important to teach job interview etiquette and workplace behavior to older children and adults with AS, and organization software and personal data assistants can improve the work and life management of people with AS.^[3]

Medications

No medications directly treat the core symptoms of AS.^[78] Although research into the efficacy of pharmaceutical intervention for AS is limited,^[3] it is essential to diagnose and treat comorbid conditions.^[4] Deficits in self-identifying emotions or in observing effects of one's behavior on others can make it difficult for individuals with AS to see why medication may be appropriate.^[78] Medication can be effective in combination with behavioral interventions and environmental accommodations in treating comorbid symptoms such as anxiety disorder, major depressive disorder, inattention and aggression.^[3] The atypical antipsychotic medications risperidone and olanzapine have been shown to reduce the associated symptoms of AS;^[3] risperidone can reduce repetitive and self-injurious behaviors, aggressive outbursts and impulsivity, and improve stereotypical patterns of behavior and social relatedness. The selective serotonin reuptake inhibitors (SSRIs) fluoxetine, fluvoxamine and sertraline have been effective in treating restricted and repetitive interests and behaviors.^[3]^[4]^[44]

Care must be taken with medications, as side effects may be more common and harder to evaluate in individuals with AS, and tests of drugs' effectiveness against comorbid conditions routinely exclude individuals from the autism spectrum.^[78] Abnormalities in metabolism, cardiac conduction times, and an increased risk of type 2 diabetes have been raised as concerns with these medications,^[83]^[84] along with serious long-term neurological side effects.^[80] SSRIs can lead to manifestations of behavioral activation such as increased impulsivity, aggression and sleep disturbance.^[44] Weight gain and fatigue are commonly reported side effects of risperidone, which may also lead to increased risk for extrapyramidal symptoms such as restlessness and dystonia^[44] and increased serum prolactin levels.^[85] Sedation and weight gain are more common with olanzapine,^[84] which has also been linked with diabetes.^[83] Sedative side-effects in school-age children^[86] have ramifications for classroom learning. Individuals with AS may be unable to identify and communicate their internal moods and emotions or to tolerate side effects that for most people would not be problematic.^[87]

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.^[6] 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.^[7] 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 disorder that may significantly affect prognosis.^[3]^[6] Although social impairment is lifelong, the outcome is generally more positive than with individuals with lower functioning autism spectrum disorders;^[3] for example, ASD symptoms are more likely to diminish with time in children with AS or HFA.^[88] Although most students with AS/HFA have average mathematical ability and test slightly worse in mathematics than in general intelligence, some are gifted in mathematics^[89] and AS has not prevented some adults from major accomplishments such as winning the Nobel Prize.^[90]

Children with AS may require special education services because of their social and behavioral difficulties although many attend regular education classes.^[7] Adolescents with AS may exhibit ongoing difficulty with self care, organization and disturbances in social and romantic relationships; despite high cognitive potential, most young adults with AS remain at home, although some do marry and work independently.^[3] The "different-ness" adolescents experience can be traumatic.^[91] 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;^[3] the resulting stress may manifest as inattention, withdrawal, reliance on obsessions, hyperactivity, or aggressive or oppositional behavior.^[77] Depression is often the result of chronic frustration from repeated failure to engage others socially, and mood disorders requiring treatment may develop.^[3] Clinical experience suggests the rate of suicide may be higher among those with AS, but this has not been confirmed by systematic empirical studies.^[92]

Education of families is critical in developing strategies for understanding strengths and weaknesses;^[4] helping the family to cope improves outcomes in children.^[28] Prognosis may be improved by diagnosis at a younger age that allows for early interventions, while interventions in adulthood are valuable but less beneficial.^[4] 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.^[4]

Epidemiology

Prevalence estimates vary enormously. A 2003 review of epidemiological studies of children found autism prevalence rates ranging from 0.03 to 4.84 per 1,000, with the ratio of autism to Asperger syndrome ranging from 1.5:1 to 16:1;^[93] combining the geometric mean ratio of 5:1 with a conservative prevalence estimate for autism of 1.3 per 1,000 suggests indirectly that the prevalence of AS might be around 0.26 per 1,000.^[94] Part of the variance in estimates arises from differences in diagnostic criteria. For example, a relatively small 2007 study of 5,484 eight-year-old children in Finland found 2.9 children per 1,000 met the ICD-10 criteria for an AS diagnosis, 2.7 per 1,000 for Gillberg and Gillberg criteria, 2.5 for DSM-IV, 1.6 for Szatmari et al., and 4.3 per 1,000 for the union of the four criteria. Boys seem to be more likely to have AS than girls; estimates of the sex ratio range from 1.6:1 to 4:1, using the Gillberg and Gillberg criteria.^[95]

Anxiety disorder and major depressive disorder are the most common conditions seen at the same time; comorbidity of these in persons with AS is estimated at 65%.^[3] Depression is common in adolescents and adults; children are likely to present with ADHD.^[96] Reports have associated AS with medical conditions such as aminoaciduria and ligamentous laxity, but these have been case reports or small studies and no factors have been associated with AS across studies.^[3] One study of males with AS found an increased rate of epilepsy and a high rate (51%) of nonverbal learning disorder.^[97] AS is associated with tics, Tourette syndrome, and bipolar disorder, and the repetitive behaviors of AS have many similarities with the symptoms of obsessive-compulsive disorder and obsessive-compulsive personality disorder.^[98] However many of these studies are based on clinical samples or lack standardized measures; nonetheless, comorbid conditions are relatively common.^[6]

History

Named after the Austrian pediatrician Hans Asperger (1906–1980), Asperger syndrome is a relatively new diagnosis in the field of autism.^[99] As a child, Asperger appears to have exhibited some features of the very condition named after him, such as remoteness and talent in language.^[100]^[101] In 1944, Asperger described four children in his practice^[4] who had difficulty in integrating themselves socially. The children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Asperger called the condition "autistic psychopathy" and described it as primarily marked by social isolation.^[9] Unlike today's AS, autistic psychopathy could be found in people of all levels of intelligence, including those with mental retardation.^[102] In the context of the Nazi eugenics policy of sterilizing and killing social deviants and the mentally handicapped, Asperger 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."^[5] Asperger also called his young patients "little professors",^[5] and believed some would be capable of exceptional achievement and original thought later in life.^[4] His paper was published during wartime and in German, so it was not widely read elsewhere.

Lorna Wing popularized the term Asperger syndrome in the English-speaking medical community in her 1981 publication^[103] of a series of case studies of children showing similar symptoms,^[99] and Uta Frith translated Asperger's paper to English in 1991.^[5] Sets of diagnostic criteria were outlined by Gillberg and Gillberg in 1989 and by Szatmari et al. in the same year.^[95] AS became a standard diagnosis in 1992, when it was included in the tenth 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 American Psychiatric Association's diagnostic reference, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).^[9]

Hundreds of books, articles and websites now describe AS, and prevalence estimates have increased dramatically for ASD, with AS recognized as an important subgroup.^[99] Whether it should be seen as distinct from high-functioning autism is a fundamental issue requiring further study,^[4] and there are questions about the empirical validation of the DSM-IV and ICD-10 criteria.^[7]

Cultural aspects

People identifying with Asperger syndrome may refer to themselves in casual conversation as aspies, coined by Liane Holliday Willey in 1999.^[104] The word neurotypical (abbreviated NT) describes a person whose neurological development and state are typical, and is often used to refer to non-autistic people. The Internet has allowed individuals with AS to communicate and celebrate diversity with each other in a way that was not previously possible because of their rarity and geographic dispersal. A subculture of aspies has formed. Internet sites like Wrong Planet have made it easier for individuals to connect.^[10]

Autistic people have advocated a shift in perception of autism spectrum disorders as complex syndromes rather than diseases that must be cured. Proponents of this view reject the notion that there is an "ideal" brain configuration and that any deviation from the norm is pathological; they promote tolerance for what they call neurodiversity.^[105] These views are the basis for the autistic rights and autistic pride movements.^[106] There is a contrast between the attitude of adults with self-identified AS, who typically do not want to be cured and are proud of their identity, and parents of children with AS, who typically seek assistance and a cure for their children.^[107]

Some researchers have argued that AS can be viewed as a different cognitive style, not a disorder or a disability,^[10] and that it should be removed from the standard Diagnostic and Statistical Manual, much as homosexuality was removed.^[108] In a 2002 paper, Simon Baron-Cohen wrote of those with AS, "In the social world there is no great benefit to a precise eye for detail, but in the worlds of maths, computing, cataloguing, music, linguistics, engineering, and science, such an eye for detail can lead to success rather than failure." Baron-Cohen cited two reasons why it might still be useful to consider AS to be a disability: to ensure provision for legally required special support, and to recognize emotional difficulties from reduced empathy.^[11] It has been argued that the genes for Asperger's combination of abilities have operated throughout recent human evolution and have made remarkable contributions to human history.^[109]

References

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^ ^a ^b World Health Organization (2006). "F84. Pervasive developmental disorders". International Statistical Classification of Diseases and Related Health Problems (10th (ICD-10) ed.). ISBN 92-4-154419-8. {{cite book}}: |access-date= requires |url= (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)
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^ Rausch JL, Johnson ME (2008). "Diagnosis of Asperger's disorder". In Rausch JL, Johnson ME, Casanova MF (eds.) (ed.). Asperger's Disorder. Informa Healthcare. pp. 19–62. ISBN 0-8493-8360-9. {{cite book}}: |editor= has generic name (help)CS1 maint: multiple names: editors list (link)
^ Brasic JR (2010-07-07). "Asperger's Syndrome". Medscape eMedicine. Retrieved 2010-11-25.
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^ ^a ^b Tsatsanis KD (2003). "Outcome research in Asperger syndrome and autism". Child Adolesc Psychiatr Clin N Am. 12 (1): 47–63. doi:10.1016/S1056-4993(02)00056-1. PMID 12512398.
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^
Alexithymia and AS:
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^ ^a ^b Just MA, Cherkassky VL, Keller TA, Kana RK, Minshew NJ (2007). "Functional and anatomical cortical underconnectivity in autism: evidence from an FMRI study of an executive function task and corpus callosum morphometry". Cereb Cortex. 17 (4): 951–961. doi:10.1093/cercor/bhl006. PMID 16772313.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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^ Baron-Cohen S, Leslie AM, Frith U (1985). "Does the autistic child have a 'theory of mind'?" (PDF). Cognition. 21 (1): 37–46. doi:10.1016/0010-0277(85)90022-8. PMID 2934210. Retrieved 2007-06-28.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Baron-Cohen S (2006). "The hyper-systemizing, assortative mating theory of autism" (PDF). Prog Neuropsychopharmacol Biol Psychiatry. 30 (5): 865–872. doi:10.1016/j.pnpbp.2006.01.010. PMID 16519981. Retrieved 2009-06-08.
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^ Szatmari P, Bremner R, Nagy J (1989). "Asperger's syndrome: a review of clinical features". Can J Psychiatry. 34 (6): 554–60. PMID 2766209.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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^ Shattuck PT, Grosse SD (2007). "Issues related to the diagnosis and treatment of autism spectrum disorders". Ment Retard Dev Disabil Res Rev. 13 (2): 129–135. doi:10.1002/mrdd.20143. PMID 17563895.
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^ ^a ^b Matson JL (2007). "Determining treatment outcome in early intervention programs for autism spectrum disorders: a critical analysis of measurement issues in learning based interventions". Res Dev Disabil. 28 (2): 207–218. doi:10.1016/j.ridd.2005.07.006. PMID 16682171.
^ Rao PA, Beidel DC, Murray MJ (2008). "Social skills interventions for children with Asperger's syndrome or high-functioning autism: a review and recommendations". J Autism Dev Disord. 38 (2): 353–361. doi:10.1007/s10803-007-0402-4. PMID 17641962.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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^ ^a ^b Newcomer JW (2007). "Antipsychotic medications: metabolic and cardiovascular risk". J Clin Psychiatry. 68 (suppl 4): 8–13. PMID 17539694.
^ ^a ^b Chavez B, Chavez-Brown M, Sopko MA, Rey JA (2007). "Atypical antipsychotics in children with pervasive developmental disorders". Pediatr Drugs. 9 (4): 249–266. doi:10.2165/00148581-200709040-00006. PMID 17705564.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Staller J (2006). "The effect of long-term antipsychotic treatment on prolactin". J Child Adolesc Psychopharmacol. 16 (3): 317–326. doi:10.1089/cap.2006.16.317. PMID 16768639.
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^ Blacher J, Kraemer B, Schalow M (2003). "Asperger syndrome and high functioning autism: research concerns and emerging foci". Curr Opin Psychiatry. 16 (5): 535–542. doi:10.1097/00001504-200309000-00008.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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^ Chiang HM, Lin YH (2007). "Mathematical ability of students with Asperger syndrome and high-functioning autism" (PDF). Autism. 11 (6): 547–556. doi:10.1177/1362361307083259. PMID 17947290. Retrieved 2009-03-06.
^ Herera S (2005-02-25). "Mild autism has 'selective advantages'". CNBC. Retrieved 2007-11-14.
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External links

Asperger's Syndrome at Curlie

Template:Link FA Template:Link FA

[1] ttp://www.merriam-webster.com/dictionary/asperger's%20syndrome

[2] Dictionary.com, "Asperger's Syndrome," in Dictionary.com Unabridged. Source location: Random House, Inc. http://dictionary.reference.com/browse/asperger's+syndrome. Available: http://dictionary.reference.com. Accessed: April 19, 2011.

[McPartland-3] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t ^u ^v ^w ^x ^y ^z ^aa ^ab ^ac ^ad ^ae ^af ^ag ^ah ^ai ^aj ^ak ^al ^am ^an ^ao ^ap ^aq McPartland J, Klin A (2006). "Asperger's syndrome". Adolesc Med Clin. 17 (3): 771–88, abstract xiii. doi:10.1016/j.admecli.2006.06.010. PMID 17030291.

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 ==Classification==
-Asperger syndrome (AS) is one of the [[autism spectrum disorder]]s (ASD) or [[pervasive developmental disorder]]s (PDD), which are a [[spectrum disorder|spectrum of psychological conditions]] 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 psychological development 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.<ref name=ICD-10-F84.0>{{cite book |chapterurl=http://apps.who.int/classifications/apps/icd/icd10online/?gf80.htm+f840 |year=2006 |accessdate=2007-06-25 |title= International Statistical Classification of Diseases and Related Health Problems |edition= 10th ([[ICD-10]]) |author= World Health Organization |chapter= F84. Pervasive developmental disorders |isbn=92-4-154419-8}}</ref> ASD, in turn, is a subset of the broader autism [[phenotype]] (BAP), which describes individuals who may not have ASD but do have [[Autism|autistic]]-like [[Trait (biology)|traits]], such as social deficits.<ref>{{cite journal |author= Piven J, Palmer P, Jacobi D, Childress D, Arndt S |title= Broader autism phenotype: evidence from a family history study of multiple-incidence autism families |journal= Am J Psychiatry |year=1997 |volume=154 |issue=2 |pages=185–90 |pmid=9016266 |url=http://ajp.psychiatryonline.org/cgi/reprint/154/2/185.pdf |format=PDF}}</ref> Of the other four ASD forms, [[autism]] is the most similar to AS in signs and likely causes but its diagnosis requires impaired communication and allows delay in [[cognitive development]]; [[Rett syndrome]] and [[childhood disintegrative disorder]] share several signs with autism but may have unrelated causes; and [[PDD not otherwise specified|pervasive developmental disorder not otherwise specified (PDD-NOS)]] is diagnosed when the criteria for a more specific disorder are unmet.<ref>{{cite journal |author= Lord C, Cook EH, Leventhal BL, [[David Amaral|Amaral DG]] |title= Autism spectrum disorders |journal=Neuron |volume=28 |issue=2 |year=2000 |pages=355–63 |doi=10.1016/S0896-6273(00)00115-X |pmid=11144346}}</ref>
+Asperger syndrome (AS) is one of the [[autism spectrum disorder]]s (ASD) or [[pervasive developmental disorder]]s (PDD), which are a [[spectrum disorder|spectrum of psychological conditions]] 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 psychological development 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.<ref name=ICD-10-F84.0>{{cite book |chapterurl=http://apps.who.int/classifications/apps/icd/icd10online/?gf80.htm+f840 |year=2006 |accessdate=2007-06-25 |title= International Statistical Classification of Diseases and Related Health Problems |edition= 10th ([[ICD-10]]) |author= World Health Organization |chapter= F84. Pervasive developmental disorders |isbn=92-4-154419-8}}</ref> ASD, in turn, is a subset of the broader autism [[phenotype]] (BAP), which describes individuals who may not have ASD but do have [[Autism|autistic]]-like [[Trait (biology)|traits]], such as social deficits.<ref>{{cite journal |author= Piven J, Palmer P, Jacobi D, Childress D, Arndt S |title= Broader autism phenotype: evidence from a family history study of multiple-incidence autism families |journal= Am J Psychiatry |year=1997 |volume=154 |issue=2 |pages=185–90 |pmid=9016266 |url=http://ajp.psychiatryonline.org/cgi/reprint/154/2/185.pdf |format=PDF}}</ref> Of the other four ASD forms, [[autism]] is the most similar to AS in signs and likely causes but its diagnosis requires impaired communication and allows delay in [[cognitive development]]; [[Rett syndrome]] and [[childhood disintegrative disorder]] share several signs with autism but may have unrelated causes; and [[PDD not otherwise specified|pervasive developmental disorder not otherwise specified (PDD-NOS)]] is diagnosed when the criteria for a more specific disorder are unmet.<ref>{{cite journal |author= Lord C, Cook EH, Leventhal BL, [[David Amaral|Amaral DG]] |title= Autism spectrum disorders |journal=Neuron |volume=28 |issue=2 |year=2000 |pages=355–363 |doi=10.1016/S0896-6273(00)00115-X |pmid=11144346}}</ref>
 The extent of the [[Diagnosis of Asperger syndrome#Differences from high-functioning autism|overlap between AS and high-functioning autism]] ([[High-functioning autism|HFA]]—autism unaccompanied by [[mental retardation]]) is unclear.<ref name=Klin/><ref name=Kasari>{{cite journal |author= Kasari C, Rotheram-Fuller E |title= Current trends in psychological research on children with high-functioning autism and Asperger disorder |journal= Curr Opin Psychiatry |volume=18 |issue=5 |pages=497–501 |year=2005 |pmid=16639107 |doi=10.1097/01.yco.0000179486.47144.61}}</ref><ref>
-{{cite journal |journal= J Autism Dev Disord |year=2008 |volume=38 |issue=9 |pages=1611–24 |title= Examining the validity of autism spectrum disorder subtypes |author= Witwer AN, Lecavalier L |doi=10.1007/s10803-008-0541-2 |pmid=18327636}}
+{{cite journal |journal= J Autism Dev Disord |year=2008 |volume=38 |issue=9 |pages=1611–1624 |title= Examining the validity of autism spectrum disorder subtypes |author= Witwer AN, Lecavalier L |doi=10.1007/s10803-008-0541-2 |pmid=18327636}}
-</ref> The current ASD classification is to some extent an artifact of how autism was discovered,<ref>{{cite journal |author=Sanders JL |title=Qualitative or quantitative differences between Asperger's Disorder and autism? historical considerations |journal=J Autism Dev Disord |volume= 39|issue= 11|pages= 1560–7|year=2009 |pmid=19548078 |doi=10.1007/s10803-009-0798-0 }}</ref> and may not reflect the true nature of the spectrum.<ref>{{cite journal |author= Szatmari P |year=2000 |title= The classification of autism, Asperger's syndrome, and pervasive developmental disorder |journal= Can J Psychiatry |volume=45 |issue=8 |pages=731–38 |pmid=11086556 |url=http://ww1.cpa-apc.org:8080/Publications/Archives/CJP/2000/Oct/Classification.asp}}</ref> One of the proposed changes in the [[DSM-V|Diagnostic and Statistical Manual of Mental Disorders, 5th edition]], set to be published in May 2013,<ref>{{cite web |url=http://dsm5.org/Pages/Default.aspx |title=DSM-5 development |publisher=American Psychiatric Association |year=2010 |accessdate=2010-02-20 }}</ref> would eliminate Asperger syndrome as a separate diagnosis, and fold it under autistic disorder (autism spectrum disorder), which would be rated on a severity scale.<ref name=DSMV>{{cite web|title=299.80 Asperger's Disorder |work=DSM-5 Development |publisher=American Psychiatric Association |accessdate=2010-12-21 |url=http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=97# }}</ref> The proposed change is controversial,<ref>{{cite journal |author=Faras H, Al Ateeqi N, Tidmarsh L |title=Autism spectrum disorders |journal=Ann Saudi Med |volume=30 |issue=4 |pages=295–300 |year=2010 |pmid=20622347 |pmc=2931781 |doi=10.4103/0256-4947.65261}}</ref><ref>{{cite news |author=Landau E |url=http://www.cnn.com/2010/HEALTH/02/11/aspergers.autism.dsm.v/ |title=Move to merge Asperger's, autism in diagnostic manual stirs debate |work=CNN |date=2010-02-11 }}</ref><ref name=Wallis>{{cite news |title=A powerful identity, a vanishing diagnosis |author=Wallis C |work=The New York Times |date=2009-11-02 |url=http://www.nytimes.com/2009/11/03/health/03asperger.html }}</ref> and it has been argued that the syndrome's diagnostic criteria should be changed instead.<ref>{{cite journal |author=Ghaziuddin M |title=Should the DSM V drop Asperger syndrome? |journal=J Autism Dev Disord |volume=40 |issue= 9 |pages= 1146–8 |year=2010 |pmid=20151184 |doi=10.1007/s10803-010-0969-z }}</ref>
+</ref> The current ASD classification is to some extent an artifact of how autism was discovered,<ref>{{cite journal |author=Sanders JL |title=Qualitative or quantitative differences between Asperger's Disorder and autism? historical considerations |journal=J Autism Dev Disord |volume= 39|issue= 11|pages= 1560–1567|year=2009 |pmid=19548078 |doi=10.1007/s10803-009-0798-0 }}</ref> and may not reflect the true nature of the spectrum.<ref>{{cite journal |author= Szatmari P |year=2000 |title= The classification of autism, Asperger's syndrome, and pervasive developmental disorder |journal= Can J Psychiatry |volume=45 |issue=8 |pages=731–8 |pmid=11086556 |url=http://ww1.cpa-apc.org:8080/Publications/Archives/CJP/2000/Oct/Classification.asp}}</ref> One of the proposed changes in the [[DSM-V|Diagnostic and Statistical Manual of Mental Disorders, 5th edition]], set to be published in May 2013,<ref>{{cite web |url=http://dsm5.org/Pages/Default.aspx |title=DSM-5 development |publisher=American Psychiatric Association |year=2010 |accessdate=2010-02-20 }}</ref> would eliminate Asperger syndrome as a separate diagnosis, and fold it under autistic disorder (autism spectrum disorder), which would be rated on a severity scale.<ref name=DSMV>{{cite web|title=299.80 Asperger's Disorder |work=DSM-5 Development |publisher=American Psychiatric Association |accessdate=2010-12-21 |url=http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=97# }}</ref> The proposed change is controversial,<ref>{{cite journal |author=Faras H, Al Ateeqi N, Tidmarsh L |title=Autism spectrum disorders |journal=Ann Saudi Med |volume=30 |issue=4 |pages=295–300 |year=2010 |pmid=20622347 |pmc=2931781 |doi=10.4103/0256-4947.65261}}</ref><ref>{{cite news |author=Landau E |url=http://www.cnn.com/2010/HEALTH/02/11/aspergers.autism.dsm.v/ |title=Move to merge Asperger's, autism in diagnostic manual stirs debate |work=CNN |date=2010-02-11 }}</ref><ref name=Wallis>{{cite news |title=A powerful identity, a vanishing diagnosis |author=Wallis C |work=The New York Times |date=2009-11-02 |url=http://www.nytimes.com/2009/11/03/health/03asperger.html }}</ref> and it has been argued that the syndrome's diagnostic criteria should be changed instead.<ref>{{cite journal |author=Ghaziuddin M |title=Should the DSM V drop Asperger syndrome? |journal=J Autism Dev Disord |volume=40 |issue= 9 |pages= 1146–1148 |year=2010 |pmid=20151184 |doi=10.1007/s10803-010-0969-z }}</ref>
 Asperger syndrome is also called ''Asperger's syndrome'' (AS),<ref name=McPartland/> ''Asperger'' (or ''Asperger's'') ''disorder'' (AD),<ref name=Kasari/><ref name=BehaveNet/> or just ''Asperger's''.<ref name=Rausch>{{cite book |title= Asperger's Disorder |editor= Rausch JL, Johnson ME, Casanova MF (eds.) |publisher= Informa Healthcare |year=2008 |chapter= Diagnosis of Asperger's disorder |author= Rausch JL, Johnson ME |pages=19–62 |isbn=0-8493-8360-9}}</ref> There is little consensus among clinical researchers about whether the condition's name should end in "syndrome" or "disorder".<ref name=Klin/>
 ==Characteristics==
-A [[pervasive developmental disorder]], Asperger syndrome is distinguished by a pattern of symptoms rather than a single symptom. It is characterized by qualitative impairment in social interaction, by stereotyped and restricted patterns of behavior, activities and interests, and by no clinically significant delay in cognitive development or general delay in language.<ref name=BehaveNet>{{cite book |title= Diagnostic and Statistical Manual of Mental Disorders |edition= 4th, text revision ([[DSM-IV-TR]]) |author= American Psychiatric Association |year=2000 |isbn=0-89042-025-4 |chapter= Diagnostic criteria for 299.80 Asperger's Disorder (AD) |chapterurl=http://www.behavenet.com/capsules/disorders/asperger.htm |accessdate=2007-06-28 |publisher=<!-- pacify Citation bot --> |location=<!-- pacify Citation bot --> }}</ref> Intense preoccupation with a narrow subject, one-sided [[verbosity]], restricted [[Prosody (linguistics)|prosody]], and physical clumsiness are typical of the condition, but are not required for diagnosis.<ref name=Klin>{{cite journal |journal= Rev Bras Psiquiatr |year=2006 |volume=28 |issue= suppl 1 |pages=S3–S11 |title= Autism and Asperger syndrome: an overview |author= Klin A |doi=10.1590/S1516-44462006000500002 |pmid=16791390 |url=http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462006000500002&lng=en&nrm=iso&tlng=en}}</ref>
+A [[pervasive developmental disorder]], Asperger syndrome is distinguished by a pattern of symptoms rather than a single symptom. It is characterized by qualitative impairment in social interaction, by stereotyped and restricted patterns of behavior, activities and interests, and by no clinically significant delay in cognitive development or general delay in language.<ref name=BehaveNet>{{cite book |title= Diagnostic and Statistical Manual of Mental Disorders |edition= 4th, text revision ([[DSM-IV-TR]]) |author= American Psychiatric Association |year=2000 |isbn=0-89042-025-4 |chapter= Diagnostic criteria for 299.80 Asperger's Disorder (AD) |chapterurl=http://www.behavenet.com/capsules/disorders/asperger.htm |accessdate=2007-06-28 |publisher=<!-- pacify Citation bot --> |location=<!-- pacify Citation bot --> }}</ref> Intense preoccupation with a narrow subject, one-sided [[verbosity]], restricted [[Prosody (linguistics)|prosody]], and physical clumsiness are typical of the condition, but are not required for diagnosis.<ref name=Klin>{{cite journal |journal= Rev Bras Psiquiatr |year=2006 |volume=28 |issue= suppl 1 |pages=s3–s11 |title= Autism and Asperger syndrome: an overview |author= Klin A |doi=10.1590/S1516-44462006000500002 |pmid=16791390 |url=http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462006000500002&lng=en&nrm=iso&tlng=en}}</ref>
 ===Social interaction===
 {{further|[[Sociological and cultural aspects of autism#Asperger syndrome and interpersonal relationships|Asperger syndrome and interpersonal relationships]]}}
-The lack of demonstrated [[empathy]] is possibly the most dysfunctional aspect of Asperger syndrome.<ref name=Baskin/> Individuals with AS experience difficulties in basic elements of social interaction, which may include a failure to develop friendships or to seek shared enjoyments or achievements with others (for example, showing others objects of interest), a lack of social or emotional [[Reciprocity (social psychology)|reciprocity]], and impaired [[Nonverbal communication|nonverbal behaviors]] in areas such as [[eye contact]], [[facial expression]], posture, and gesture.<ref name=McPartland>{{cite journal |author= McPartland J, Klin A |title= Asperger's syndrome |journal= Adolesc Med Clin |volume=17 |issue=3 |pages=771–88 |year=2006 |pmid=17030291 |doi= 10.1016/j.admecli.2006.06.010}}</ref>
+The lack of demonstrated [[empathy]] is possibly the most dysfunctional aspect of Asperger syndrome.<ref name=Baskin/> Individuals with AS experience difficulties in basic elements of social interaction, which may include a failure to develop friendships or to seek shared enjoyments or achievements with others (for example, showing others objects of interest), a lack of social or emotional [[Reciprocity (social psychology)|reciprocity]], and impaired [[Nonverbal communication|nonverbal behaviors]] in areas such as [[eye contact]], [[facial expression]], posture, and gesture.<ref name=McPartland>{{cite journal |author= McPartland J, Klin A |title= Asperger's syndrome |journal= Adolesc Med Clin |volume=17 |issue=3 |pages=771–88; abstract xiii |year=2006 |pmid=17030291 |doi= 10.1016/j.admecli.2006.06.010}}</ref>
 Unlike those with autism, people with AS are not usually withdrawn around others; they approach others, even if awkwardly. For example, a person with AS may engage in a one-sided, long-winded speech about a favorite topic, while misunderstanding or not recognizing the listener's feelings or reactions, such as a need for privacy or haste to leave.<ref name=Klin/> This social awkwardness has been called "active but odd".<ref name=McPartland/> This failure to react appropriately to social interaction may appear as disregard for other people's feelings, and may come across as insensitive.<ref name=Klin/>  However, not all individuals with AS will approach others. Some of them may even display [[selective mutism]], speaking not at all to most people and excessively to specific people. Some may choose to talk only to people they like.<ref>{{cite web |url=http://emedicine.medscape.com/article/912296-overview |work=Medscape eMedicine |title=Asperger's Syndrome |author=Brasic JR |date=2010-07-07 |accessdate=2010-11-25}}</ref>
@@ Line 43: / Line 43: @@
 The cognitive ability of children with AS often allows them to articulate [[social norms]] in a laboratory context,<ref name=McPartland/> where they may be able to show a theoretical understanding of other people's emotions; however, they typically have difficulty acting on this knowledge in fluid, real-life situations.<ref name=Klin/> People with AS may analyze and distill their observations of social interaction into rigid behavioral guidelines, and apply these rules in awkward ways, such as forced eye contact, resulting in a demeanor that appears rigid or socially naive. Childhood desire for companionship can become numbed through a history of failed social encounters.<ref name=McPartland/>
-The [[hypothesis]] that individuals with AS are predisposed to violent or criminal behavior has been investigated but is not supported by data.<ref name="McPartland"/><ref>{{cite journal |journal=J Autism Dev Disord |year=2008 |title= Offending behaviour in adults with Asperger syndrome |author= Allen D, Evans C, Hider A, Hawkins S, Peckett H, Morgan H |pmid=17805955 |doi=10.1007/s10803-007-0442-9 |volume=38 |issue=4 |pages=748–58}}</ref> More evidence suggests children with AS are victims rather than victimizers.<ref name=Tsatsanis>{{cite journal |journal= Child Adolesc Psychiatr Clin N Am |year=2003 |volume=12 |issue=1 |pages=47–63 |title=Outcome research in Asperger syndrome and autism |author= Tsatsanis KD |pmid=12512398 |url=http://www.childpsych.theclinics.com/article/PIIS1056499302000561/fulltext |doi=10.1016/S1056-4993(02)00056-1}}</ref> A 2008 review found that an overwhelming number of reported violent criminals with AS had coexisting [[psychiatric disorders]] such as [[schizoaffective disorder]].<ref>{{cite journal |author= Newman SS, Ghaziuddin M |title=Violent crime in Asperger syndrome: the role of psychiatric comorbidity |journal=J Autism Dev Disord |volume=38 |issue=10 |pages=1848–52 |year=2008 |pmid=18449633 |doi=10.1007/s10803-008-0580-8}}</ref>
+The [[hypothesis]] that individuals with AS are predisposed to violent or criminal behavior has been investigated but is not supported by data.<ref name="McPartland"/><ref>{{cite journal |journal=J Autism Dev Disord |year=2008 |title= Offending behaviour in adults with Asperger syndrome |author= Allen D, Evans C, Hider A, Hawkins S, Peckett H, Morgan H |pmid=17805955 |doi=10.1007/s10803-007-0442-9 |volume=38 |issue=4 |pages=748–758}}</ref> More evidence suggests children with AS are victims rather than victimizers.<ref name=Tsatsanis>{{cite journal |journal= Child Adolesc Psychiatr Clin N Am |year=2003 |volume=12 |issue=1 |pages=47–63 |title=Outcome research in Asperger syndrome and autism |author= Tsatsanis KD |pmid=12512398 |url=http://www.childpsych.theclinics.com/article/PIIS1056499302000561/fulltext |doi=10.1016/S1056-4993(02)00056-1}}</ref> A 2008 review found that an overwhelming number of reported violent criminals with AS had coexisting [[psychiatric disorders]] such as [[schizoaffective disorder]].<ref>{{cite journal |author= Newman SS, Ghaziuddin M |title=Violent crime in Asperger syndrome: the role of psychiatric comorbidity |journal=J Autism Dev Disord |volume=38 |issue=10 |pages=1848–1852 |year=2008 |pmid=18449633 |doi=10.1007/s10803-008-0580-8}}</ref>
 ===Restricted and repetitive interests and behavior===
@@ Line 51: / Line 51: @@
 Pursuit of specific and narrow areas of interest is one of the most striking features of AS.<ref name=McPartland/> Individuals with AS may collect volumes of detailed information on a relatively narrow topic such as weather data or star names, without necessarily having genuine understanding of the broader topic.<ref name=McPartland/><ref name=Klin/> For example, a child might memorize camera model numbers while caring little about photography.<ref name=McPartland/> This behavior is usually apparent by grade school, typically age 5 or 6 in the United States.<ref name=McPartland/> Although these special interests may change from time to time, they typically become more unusual and narrowly focused, and often dominate social interaction so much that the entire family may become immersed. Because narrow topics often capture the interest of children, this symptom may go unrecognized.<ref name=Klin/>
-Stereotyped and repetitive motor behaviors are a core part of the diagnosis of AS and other ASDs.<ref>{{cite journal |journal= J Autism Dev Disord |year=2005 |volume=35 |issue=2 |pages=145–58 |title= Repetitive behavior profiles in Asperger syndrome and high-functioning autism |author= South M, Ozonoff S, McMahon WM |doi=10.1007/s10803-004-1992-8 |pmid=15909401}}</ref> They include hand movements such as flapping or twisting, and complex whole-body movements.<ref name=BehaveNet/> These are typically repeated in longer bursts and look more voluntary or ritualistic than [[tic]]s, which are usually faster, less rhythmical and less often symmetrical.<ref name=RapinTS>{{cite journal |author= Rapin I |title= Autism spectrum disorders: relevance to Tourette syndrome |journal= Adv Neurol |volume=85 |pages=89–101 |year=2001 |pmid=11530449}}</ref>
+Stereotyped and repetitive motor behaviors are a core part of the diagnosis of AS and other ASDs.<ref>{{cite journal |journal= J Autism Dev Disord |year=2005 |volume=35 |issue=2 |pages=145–158 |title= Repetitive behavior profiles in Asperger syndrome and high-functioning autism |author= South M, Ozonoff S, McMahon WM |doi=10.1007/s10803-004-1992-8 |pmid=15909401}}</ref> They include hand movements such as flapping or twisting, and complex whole-body movements.<ref name=BehaveNet/> These are typically repeated in longer bursts and look more voluntary or ritualistic than [[tic]]s, which are usually faster, less rhythmical and less often symmetrical.<ref name=RapinTS>{{cite journal |author= Rapin I |title= Autism spectrum disorders: relevance to Tourette syndrome |journal= Adv Neurol |volume=85 |pages=89–101 |year=2001 |pmid=11530449}}</ref>
 ===Speech and language===
@@ Line 58: / Line 58: @@
 Three aspects of communication patterns are of clinical interest: poor prosody, tangential and circumstantial speech, and marked verbosity. Although [[inflection]] and intonation may be less rigid or monotonic than in autism, people with AS often have a limited range of intonation: speech may be unusually fast, jerky or loud. Speech may convey a sense of [[Coherence (linguistics)|incoherence]]; the conversational style often includes monologues about topics that bore the listener, fails to provide [[Context (language use)|context]] for comments, or fails to suppress internal thoughts. Individuals with AS may fail to monitor whether the listener is interested or engaged in the conversation. The speaker's conclusion or point may never be made, and attempts by the listener to elaborate on the speech's content or logic, or to shift to related topics, are often unsuccessful.<ref name=Klin/>
-Children with AS may have an unusually sophisticated vocabulary at a young age and have been colloquially called "little professors", but have difficulty understanding [[figurative language]] and tend to use language literally.<ref name=McPartland/> Children with AS appear to have particular weaknesses in areas of nonliteral language that include humor, irony, and teasing. Although individuals with AS usually understand the cognitive basis of [[humor]], they seem to lack understanding of the intent of humor to share enjoyment with others.<ref name=Kasari/> Despite strong evidence of impaired humor appreciation, anecdotal reports of humor in individuals with AS seem to challenge some psychological theories of AS and autism.<ref>{{cite journal |author= Lyons V, Fitzgerald M |title= Humor in autism and Asperger syndrome |journal= J Autism Dev Disord |volume=34 |issue=5 |pages=521–31 |year=2004 |pmid=15628606 |doi=10.1007/s10803-004-2547-8}}</ref> According to the Adult Asperger Assessment (AAA) diagnostic test, a lack of interest in fiction and the positive preference towards non-fiction is common among adults with the disorder, which might explain the lack of understanding of verbal symbolisms and nonliteral language for people with Asperger's.<ref name=ASAdulthood/>
+Children with AS may have an unusually sophisticated vocabulary at a young age and have been colloquially called "little professors", but have difficulty understanding [[figurative language]] and tend to use language literally.<ref name=McPartland/> Children with AS appear to have particular weaknesses in areas of nonliteral language that include humor, irony, and teasing. Although individuals with AS usually understand the cognitive basis of [[humor]], they seem to lack understanding of the intent of humor to share enjoyment with others.<ref name=Kasari/> Despite strong evidence of impaired humor appreciation, anecdotal reports of humor in individuals with AS seem to challenge some psychological theories of AS and autism.<ref>{{cite journal |author= Lyons V, Fitzgerald M |title= Humor in autism and Asperger syndrome |journal= J Autism Dev Disord |volume=34 |issue=5 |pages=521–531 |year=2004 |pmid=15628606 |doi=10.1007/s10803-004-2547-8}}</ref> According to the Adult Asperger Assessment (AAA) diagnostic test, a lack of interest in fiction and the positive preference towards non-fiction is common among adults with the disorder, which might explain the lack of understanding of verbal symbolisms and nonliteral language for people with Asperger's.<ref name=ASAdulthood/>
 ===Other===
-Individuals with Asperger syndrome may have signs or symptoms that are independent of the diagnosis, but can affect the individual or the family.<ref>{{cite journal |author=Filipek PA, Accardo PJ, Baranek GT ''et al.'' |title=The screening and diagnosis of autistic spectrum disorders |journal=J Autism Dev Disord |year=1999 |volume=29 |issue=6 |pages=439–84 |doi=10.1023/A:1021943802493 |pmid=10638459 }}</ref> These include differences in perception and problems with motor skills, sleep, and emotions.
+Individuals with Asperger syndrome may have signs or symptoms that are independent of the diagnosis, but can affect the individual or the family.<ref>{{cite journal |author=Filipek PA |title=The screening and diagnosis of autistic spectrum disorders |journal=J Autism Dev Disord |year=1999 |volume=29 |issue=6 |pages=439–484 |doi=10.1023/A:1021943802493 |pmid=10638459 |author-separator=, |author2=Accardo PJ |author3=Baranek GT |display-authors=3 |last4=Cook |first4=Jr. |last5=Dawson |first5=Geraldine |last6=Gordon |first6=Barry |last7=Gravel |first7=Judith S. |last8=Johnson |first8=Chris P. |last9=Kallen |first9=Ronald J. }}</ref> These include differences in perception and problems with motor skills, sleep, and emotions.
-Individuals with AS often have excellent [[Auditory perception|auditory]] and [[visual perception]].<ref>{{cite journal |journal= J Child Psychol Psychiatry |year=2004 |volume=45 |issue=4 |pages=672–86 |title= Emanuel Miller lecture: confusions and controversies about Asperger syndrome |author= Frith U |doi=10.1111/j.1469-7610.2004.00262.x |pmid=15056300}}</ref> Children with ASD often demonstrate enhanced perception of small changes in patterns such as arrangements of objects or well-known images; typically this is domain-specific and involves processing of fine-grained features.<ref>{{cite book |chapter= Psychological factors in autism |author= Prior M, Ozonoff S |pages=69–128 |title= Autism and Pervasive Developmental Disorders |edition=2nd |editor= Volkmar FR |publisher= Cambridge University Press |year=2007 |isbn=0-521-54957-4}}</ref> Conversely, compared to individuals with high-functioning autism, individuals with AS have deficits in some tasks involving visual-spatial perception, auditory perception, or [[visual memory]].<ref name=McPartland/> Many accounts of individuals with AS and ASD report other unusual sensory and perceptual skills and experiences. They may be unusually sensitive or insensitive to sound, light, and other stimuli;<ref>{{cite book |author= Bogdashina O |title= Sensory Perceptional Issues in Autism and Asperger Syndrome: Different Sensory Experiences, Different Perceptual Worlds |publisher= Jessica Kingsley |year=2003 |isbn=1-84310-166-1}}</ref> these sensory responses are found in other developmental disorders and are not specific to AS or to ASD. There is little support for increased [[fight-or-flight response]] or failure of [[habituation]] in autism; there is more evidence of decreased responsiveness to sensory stimuli, although several studies show no differences.<ref>{{cite journal |author= Rogers SJ, Ozonoff S |title= Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence |journal= J Child Psychol Psychiatry |volume=46 |issue=12 |pages=1255–68 |year=2005 |pmid=16313426 |doi=10.1111/j.1469-7610.2005.01431.x}}</ref>
+Individuals with AS often have excellent [[Auditory perception|auditory]] and [[visual perception]].<ref>{{cite journal |journal= J Child Psychol Psychiatry |year=2004 |volume=45 |issue=4 |pages=672–686 |title= Emanuel Miller lecture: confusions and controversies about Asperger syndrome |author= Frith U |doi=10.1111/j.1469-7610.2004.00262.x |pmid=15056300}}</ref> Children with ASD often demonstrate enhanced perception of small changes in patterns such as arrangements of objects or well-known images; typically this is domain-specific and involves processing of fine-grained features.<ref>{{cite book |chapter= Psychological factors in autism |author= Prior M, Ozonoff S |pages=69–128 |title= Autism and Pervasive Developmental Disorders |edition=2nd |editor= Volkmar FR |publisher= Cambridge University Press |year=2007 |isbn=0-521-54957-4}}</ref> Conversely, compared to individuals with high-functioning autism, individuals with AS have deficits in some tasks involving visual-spatial perception, auditory perception, or [[visual memory]].<ref name=McPartland/> Many accounts of individuals with AS and ASD report other unusual sensory and perceptual skills and experiences. They may be unusually sensitive or insensitive to sound, light, and other stimuli;<ref>{{cite book |author= Bogdashina O |title= Sensory Perceptional Issues in Autism and Asperger Syndrome: Different Sensory Experiences, Different Perceptual Worlds |publisher= Jessica Kingsley |year=2003 |isbn=1-84310-166-1}}</ref> these sensory responses are found in other developmental disorders and are not specific to AS or to ASD. There is little support for increased [[fight-or-flight response]] or failure of [[habituation]] in autism; there is more evidence of decreased responsiveness to sensory stimuli, although several studies show no differences.<ref>{{cite journal |author= Rogers SJ, Ozonoff S |title= Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence |journal= J Child Psychol Psychiatry |volume=46 |issue=12 |pages=1255–1268 |year=2005 |pmid=16313426 |doi=10.1111/j.1469-7610.2005.01431.x}}</ref>
-Hans Asperger's initial accounts<ref name="McPartland"/> and other diagnostic schemes<ref name="EhlGill">{{cite journal |author= Ehlers S, Gillberg C |title= The epidemiology of Asperger's syndrome. A total population study |journal= J Child Psychol Psychiat |year=1993 |volume=34 |issue=8 |pages=1327–50 |doi=10.1111/j.1469-7610.1993.tb02094.x |pmid=8294522}}</ref> include descriptions of physical clumsiness. Children with AS may be delayed in acquiring skills requiring motor dexterity, such as riding a bicycle or opening a jar, and may seem to move awkwardly or feel "uncomfortable in their own skin". They may be poorly coordinated, or have an odd or bouncy gait or posture, poor handwriting, or problems with visual-motor integration.<ref name="McPartland"/><ref name="Klin"/> They may show problems with [[proprioception]] (sensation of body position) on measures of [[apraxia]] (motor planning disorder), balance, [[tandem gait]], and finger-thumb apposition. There is no evidence that these motor skills problems differentiate AS from other high-functioning ASDs.<ref name= "McPartland"/>
+Hans Asperger's initial accounts<ref name="McPartland"/> and other diagnostic schemes<ref name="EhlGill">{{cite journal |author= Ehlers S, Gillberg C |title= The epidemiology of Asperger's syndrome. A total population study |journal= J Child Psychol Psychiat |year=1993 |volume=34 |issue=8 |pages=1327–1350 |doi=10.1111/j.1469-7610.1993.tb02094.x |pmid=8294522}}</ref> include descriptions of physical clumsiness. Children with AS may be delayed in acquiring skills requiring motor dexterity, such as riding a bicycle or opening a jar, and may seem to move awkwardly or feel "uncomfortable in their own skin". They may be poorly coordinated, or have an odd or bouncy gait or posture, poor handwriting, or problems with visual-motor integration.<ref name="McPartland"/><ref name="Klin"/> They may show problems with [[proprioception]] (sensation of body position) on measures of [[apraxia]] (motor planning disorder), balance, [[tandem gait]], and finger-thumb apposition. There is no evidence that these motor skills problems differentiate AS from other high-functioning ASDs.<ref name= "McPartland"/>
-Children with AS are more likely to have sleep problems, including difficulty in falling asleep, frequent [[middle-of-the-night insomnia|nocturnal awakenings]], and early morning awakenings.<ref>{{cite journal |journal= J Intellect Disabil Res |year=2005 |volume=49 |issue=4 |pages=260–8 |title= A survey of sleep problems in autism, Asperger's disorder and typically developing children |author= Polimeni MA, Richdale AL, Francis AJ |doi=10.1111/j.1365-2788.2005.00642.x |pmid=15816813}}</ref><ref name=Tani/> AS is also associated with high levels of [[alexithymia]], which is difficulty in identifying and describing one's emotions.<ref>Alexithymia and AS:
+Children with AS are more likely to have sleep problems, including difficulty in falling asleep, frequent [[middle-of-the-night insomnia|nocturnal awakenings]], and early morning awakenings.<ref>{{cite journal |journal= J Intellect Disabil Res |year=2005 |volume=49 |issue=4 |pages=260–268 |title= A survey of sleep problems in autism, Asperger's disorder and typically developing children |author= Polimeni MA, Richdale AL, Francis AJ |doi=10.1111/j.1365-2788.2005.00642.x |pmid=15816813}}</ref><ref name=Tani/> AS is also associated with high levels of [[alexithymia]], which is difficulty in identifying and describing one's emotions.<ref>Alexithymia and AS:
-*{{cite journal |author= Fitzgerald M, Bellgrove MA |title= The overlap between alexithymia and Asperger's syndrome |journal= J Autism Dev Disord |volume=36 |issue=4 |pages=573–6 |year=2006 |pmid=16755385 |doi=10.1007/s10803-006-0096-z |pmc= 2092499}}
+*{{cite journal |author= Fitzgerald M, Bellgrove MA |title= The overlap between alexithymia and Asperger's syndrome |journal= J Autism Dev Disord |volume=36 |issue=4 |pages=573–576 |year=2006 |pmid=16755385 |doi=10.1007/s10803-006-0096-z |pmc= 2092499}}
-*{{cite journal |author= Hill E, Berthoz S |year=2006 |title= Response |journal= J Autism Dev Disord |volume=36 |issue=8 |pages=1143–5 |doi=10.1007/s10803-006-0287-7 |pmid=17080269}}
+*{{cite journal |author= Hill E, Berthoz S |year=2006 |title= Response |journal= J Autism Dev Disord |volume=36 |issue=8 |pages=1143–1145 |doi=10.1007/s10803-006-0287-7 |pmid=17080269}}
-*{{cite journal |journal= PLoS ONE |year=2007 |volume=2 |issue=9 |page=e883 |title= Self-referential cognition and empathy in autism |author= Lombardo MV, Barnes JL, Wheelwright SJ, Baron-Cohen S |doi=10.1371/journal.pone.0000883 |pmid=17849012 |url=http://www.plosone.org/article/fetchArticle.action?articleURI=info:doi/10.1371/journal.pone.0000883 |pmc= 1964804 }}</ref> Although AS, lower sleep quality, and alexithymia are associated, their causal relationship is unclear.<ref name=Tani>{{cite journal |author= Tani P, Lindberg N, Joukamaa M ''et al.'' |title= Asperger syndrome, alexithymia and perception of sleep |journal= Neuropsychobiology |volume=49 |issue=2 |pages=64–70 |year=2004 |pmid=14981336 |doi=10.1159/000076412}}</ref>
+*{{cite journal |journal= PLoS ONE |year=2007 |volume=2 |issue=9 |page=e883 |title= Self-referential cognition and empathy in autism |author= Lombardo MV, Barnes JL, Wheelwright SJ, Baron-Cohen S |doi=10.1371/journal.pone.0000883 |pmid=17849012 |url=http://www.plosone.org/article/fetchArticle.action?articleURI=info:doi/10.1371/journal.pone.0000883 |pmc= 1964804 |editor1-last= Zak |editor1-first= Paul }}</ref> Although AS, lower sleep quality, and alexithymia are associated, their causal relationship is unclear.<ref name=Tani>{{cite journal |author= Tani P |title= Asperger syndrome, alexithymia and perception of sleep |journal= Neuropsychobiology |volume=49 |issue=2 |pages=64–70 |year=2004 |pmid=14981336 |doi=10.1159/000076412 |author-separator= , |author2= Lindberg N |author3= Joukamaa M |display-authors= 3 |last4= Nieminen-Von Wendt |first4= Taina |last5= Von Wendt |first5= Lennart |last6= Appelberg |first6= Bj&Ouml;rn |last7= Rim&Oacute;n |first7= Ranan |last8= Porkka-Heiskanen |first8= Tarja}}</ref>
-As with other forms of ASD, parents of children with AS have higher levels of stress.<ref>{{cite journal |author= Epstein T, Saltzman-Benaiah J, O'Hare A, Goll JC, Tuck S |title= Associated features of Asperger Syndrome and their relationship to parenting stress |journal= Child Care Health Dev |volume=34 |issue=4 |pages=503–11 |year=2008 |pmid=19154552 |doi=10.1111/j.1365-2214.2008.00834.x}}</ref>
+As with other forms of ASD, parents of children with AS have higher levels of stress.<ref>{{cite journal |author= Epstein T, Saltzman-Benaiah J, O'Hare A, Goll JC, Tuck S |title= Associated features of Asperger Syndrome and their relationship to parenting stress |journal= Child Care Health Dev |volume=34 |issue=4 |pages=503–511 |year=2008 |pmid=19154552 |doi=10.1111/j.1365-2214.2008.00834.x}}</ref>
 ==Causes==
@@ Line 78: / Line 78: @@
 Hans Asperger described common symptoms among his patients' family members, especially fathers, and research supports this observation and suggests a genetic contribution to Asperger syndrome. Although no specific gene has yet been identified, multiple factors are believed to play a role in the [[Expressivity|expression]] of autism, given the [[phenotype|phenotypic]] variability seen in children with AS.<ref name=McPartland/><ref name="Foster"/> Evidence for a genetic link is the tendency for AS to run in families and an observed higher [[Incidence (epidemiology)|incidence]] of family members who have behavioral symptoms similar to AS but in a more limited form (for example, slight difficulties with social interaction, language, or reading).<ref name=NINDS>{{cite web |author= National Institute of Neurological Disorders and Stroke (NINDS) |date=2007-07-31 |url=http://www.ninds.nih.gov/disorders/asperger/detail_asperger.htm |accessdate=2007-08-24 |title= Asperger syndrome fact sheet}} NIH Publication No. 05-5624.</ref> Most research suggests that all [[Heritability of autism|autism spectrum disorders have shared genetic mechanisms]], but AS may have a stronger genetic component than autism.<ref name="McPartland"/> There is probably a common group of genes where particular [[allele]]s render an individual vulnerable to developing AS; if this is the case, the particular combination of alleles would determine the severity and symptoms for each individual with AS.<ref name=NINDS/>
-A few ASD cases have been linked to exposure to [[teratogen]]s (agents that cause [[birth defect]]s) during the first eight weeks from [[Human fertilization|conception]]. Although this does not exclude the possibility that ASD can be initiated or affected later, it is strong evidence that it arises very early in development.<ref name=Arndt>{{cite journal |journal= Int J Dev Neurosci |year=2005 |volume=23 |issue=2–3 |pages=189–99 |title= The teratology of autism |author= Arndt TL, Stodgell CJ, Rodier PM |doi=10.1016/j.ijdevneu.2004.11.001 |pmid=15749245}}</ref> Many [[environmental factors]] have been hypothesized to act after birth, but none has been confirmed by scientific investigation.<ref>{{cite journal |author= Rutter M |title= Incidence of autism spectrum disorders: changes over time and their meaning |journal= Acta Paediatr |volume=94 |issue=1 |year=2005 |pages=2–15 |pmid=15858952 |doi= 10.1111/j.1651-2227.2005.tb01779.x |authorlink= Michael Rutter}}</ref>
+A few ASD cases have been linked to exposure to [[teratogen]]s (agents that cause [[birth defect]]s) during the first eight weeks from [[Human fertilization|conception]]. Although this does not exclude the possibility that ASD can be initiated or affected later, it is strong evidence that it arises very early in development.<ref name=Arndt>{{cite journal |journal= Int J Dev Neurosci |year=2005 |volume=23 |issue=2–3 |pages=189–199 |title= The teratology of autism |author= Arndt TL, Stodgell CJ, Rodier PM |doi=10.1016/j.ijdevneu.2004.11.001 |pmid=15749245}}</ref> Many [[environmental factors]] have been hypothesized to act after birth, but none has been confirmed by scientific investigation.<ref>{{cite journal |author= Rutter M |title= Incidence of autism spectrum disorders: changes over time and their meaning |journal= Acta Paediatr |volume=94 |issue=1 |year=2005 |pages=2–15 |pmid=15858952 |doi= 10.1111/j.1651-2227.2005.tb01779.x |authorlink= Michael Rutter}}</ref>
 ==Mechanism==
 {{further|[[Autism#Mechanism|Mechanism of autism]]}}
-Asperger syndrome appears to result from developmental factors that affect many or all functional brain systems, as opposed to localized effects.<ref name=Mueller>{{cite journal |journal= Ment Retard Dev Disabil Res Rev |year=2007 |volume=13 |issue=1 |pages=85–95 |title= The study of autism as a distributed disorder |author= Müller RA |doi=10.1002/mrdd.20141 |pmid=17326118}}</ref> Although the specific underpinnings of AS or factors that distinguish it from other ASDs are unknown, and no clear pathology common to individuals with AS has emerged,<ref name=McPartland/> it is still possible that AS's mechanism is separate from other ASD.<ref>{{cite journal |journal= Aust N Z J Psychiatry |year=2002 |volume=36 |issue=6 |pages=762–70 |title= A clinical and neurobehavioural review of high-functioning autism and Asperger's disorder |author= Rinehart NJ, Bradshaw JL, Brereton AV, Tonge BJ |pmid=12406118 |doi=10.1046/j.1440-1614.2002.01097.x}}</ref> [[Neuroanatomy|Neuroanatomical]] studies and the associations with [[Teratology|teratogens]] strongly suggest that the mechanism includes alteration of brain development soon after conception.<ref name=Arndt/> Abnormal migration of embryonic cells during [[fetal development]] may affect the final structure and connectivity of the brain, resulting in alterations in the neural circuits that control thought and behavior.<ref>{{cite journal |author= Berthier ML, Starkstein SE, Leiguarda R |title= Developmental cortical anomalies in Asperger's syndrome: neuroradiological findings in two patients |journal= J Neuropsychiatry Clin Neurosci |volume=2 |issue=2 |pages=197–201 |year=1990 |pmid=2136076}}</ref> Several theories of mechanism are available; none are likely to provide a complete explanation.<ref>{{cite journal |author= Happé F, Ronald A, Plomin R |title= Time to give up on a single explanation for autism |journal= Nat Neurosci |year=2006 |volume=9 |issue=10 |pages=1218–20 |pmid=17001340 |doi=10.1038/nn1770}}</ref>
+Asperger syndrome appears to result from developmental factors that affect many or all functional brain systems, as opposed to localized effects.<ref name=Mueller>{{cite journal |journal= Ment Retard Dev Disabil Res Rev |year=2007 |volume=13 |issue=1 |pages=85–95 |title= The study of autism as a distributed disorder |author= Müller RA |doi=10.1002/mrdd.20141 |pmid=17326118}}</ref> Although the specific underpinnings of AS or factors that distinguish it from other ASDs are unknown, and no clear pathology common to individuals with AS has emerged,<ref name=McPartland/> it is still possible that AS's mechanism is separate from other ASD.<ref>{{cite journal |journal= Aust N Z J Psychiatry |year=2002 |volume=36 |issue=6 |pages=762–770 |title= A clinical and neurobehavioural review of high-functioning autism and Asperger's disorder |author= Rinehart NJ, Bradshaw JL, Brereton AV, Tonge BJ |pmid=12406118 |doi=10.1046/j.1440-1614.2002.01097.x}}</ref> [[Neuroanatomy|Neuroanatomical]] studies and the associations with [[Teratology|teratogens]] strongly suggest that the mechanism includes alteration of brain development soon after conception.<ref name=Arndt/> Abnormal migration of embryonic cells during [[fetal development]] may affect the final structure and connectivity of the brain, resulting in alterations in the neural circuits that control thought and behavior.<ref>{{cite journal |author= Berthier ML, Starkstein SE, Leiguarda R |title= Developmental cortical anomalies in Asperger's syndrome: neuroradiological findings in two patients |journal= J Neuropsychiatry Clin Neurosci |volume=2 |issue=2 |pages=197–201 |year=1990 |pmid=2136076}}</ref> Several theories of mechanism are available; none are likely to provide a complete explanation.<ref>{{cite journal |author= Happé F, Ronald A, Plomin R |title= Time to give up on a single explanation for autism |journal= Nat Neurosci |year=2006 |volume=9 |issue=10 |pages=1218–1220 |pmid=17001340 |doi=10.1038/nn1770}}</ref>
 [[File:FMRI.jpg|thumb|alt=Monochrome fMRI image of a horizontal cross-section of a human brain. A few regions, mostly to the rear, are highlighted in orange and yellow.|[[Functional magnetic resonance imaging]] provides some evidence for both underconnectivity and mirror neuron theories.<ref name=Just/><ref name=Iacoboni/>]]
-The underconnectivity theory hypothesizes underfunctioning high-level neural connections and synchronization, along with an excess of low-level processes.<ref name=Just>{{cite journal |journal= Cereb Cortex |year=2007 |volume=17 |issue=4 |pages=951–61 |title= Functional and anatomical cortical underconnectivity in autism: evidence from an FMRI study of an executive function task and corpus callosum morphometry |author= Just MA, Cherkassky VL, Keller TA, Kana RK, Minshew NJ |doi=10.1093/cercor/bhl006 |pmid=16772313 |url=http://cercor.oxfordjournals.org/cgi/content/full/17/4/951}}</ref> It maps well to general-processing theories such as [[weak central coherence theory]], which hypothesizes that a limited ability to see the big picture underlies the central disturbance in ASD.<ref>{{cite journal |author= Happé F, [[Uta Frith|Frith U]] |title= The weak coherence account: detail-focused cognitive style in autism spectrum disorders |journal= J Autism Dev Disord |year=2006 |volume=36 |issue=1 |pages=5–25 |doi=10.1007/s10803-005-0039-0 |pmid=16450045}}</ref> A related theory—enhanced perceptual functioning—focuses more on the superiority of locally oriented and [[perceptual]] operations in autistic individuals.<ref>{{cite journal |journal= J Autism Dev Disord |year=2006 |volume=36 |issue=1 |pages=27–43 |title= Enhanced perceptual functioning in autism: an update, and eight principles of autistic perception |author= Mottron L, [[Michelle Dawson|Dawson M]], Soulières I, Hubert B, Burack J |doi=10.1007/s10803-005-0040-7 |pmid=16453071}}</ref>
+The underconnectivity theory hypothesizes underfunctioning high-level neural connections and synchronization, along with an excess of low-level processes.<ref name=Just>{{cite journal |journal= Cereb Cortex |year=2007 |volume=17 |issue=4 |pages=951–961 |title= Functional and anatomical cortical underconnectivity in autism: evidence from an FMRI study of an executive function task and corpus callosum morphometry |author= Just MA, Cherkassky VL, Keller TA, Kana RK, Minshew NJ |doi=10.1093/cercor/bhl006 |pmid=16772313 |url=http://cercor.oxfordjournals.org/cgi/content/full/17/4/951}}</ref> It maps well to general-processing theories such as [[weak central coherence theory]], which hypothesizes that a limited ability to see the big picture underlies the central disturbance in ASD.<ref>{{cite journal |author= Happé F, [[Uta Frith|Frith U]] |title= The weak coherence account: detail-focused cognitive style in autism spectrum disorders |journal= J Autism Dev Disord |year=2006 |volume=36 |issue=1 |pages=5–25 |doi=10.1007/s10803-005-0039-0 |pmid=16450045}}</ref> A related theory—enhanced perceptual functioning—focuses more on the superiority of locally oriented and [[perceptual]] operations in autistic individuals.<ref>{{cite journal |journal= J Autism Dev Disord |year=2006 |volume=36 |issue=1 |pages=27–43 |title= Enhanced perceptual functioning in autism: an update, and eight principles of autistic perception |author= Mottron L, [[Michelle Dawson|Dawson M]], Soulières I, Hubert B, Burack J |doi=10.1007/s10803-005-0040-7 |pmid=16453071}}</ref>
-The [[Mirror neuron|mirror neuron system]] (MNS) theory hypothesizes that alterations to the development of the MNS interfere with imitation and lead to Asperger's core feature of social impairment.<ref name=Iacoboni>{{cite journal |journal= Nat Rev Neurosci |year=2006 |volume=7 |issue=12 |pages=942–51 |title= The mirror neuron system and the consequences of its dysfunction |author= Iacoboni M, Dapretto M |doi=10.1038/nrn2024 |pmid=17115076}}</ref><ref>{{cite journal |journal= Sci Am |year=2006 |volume=295 |issue=5 |pages=62–9 |title= Broken mirrors: a theory of autism |author= [[Vilayanur S. Ramachandran|Ramachandran VS]], Oberman LM |pmid=17076085 |url=http://cbc.ucsd.edu/pdf/brokenmirrors_asd.pdf |format=PDF |accessdate=2009-02-13 |doi= 10.1038/scientificamerican1106-62}}</ref> For example, one study found that activation is delayed in the core circuit for imitation in individuals with AS.<ref>{{cite journal |journal= Ann Neurol |year=2004 |volume=55 |issue=4 |pages=558–62 |title= Abnormal imitation-related cortical activation sequences in Asperger's syndrome |author= Nishitani N, Avikainen S, Hari R |doi=10.1002/ana.20031 |pmid=15048895}}</ref> This theory maps well to [[social cognition]] theories like the [[theory of mind]], which hypothesizes that autistic behavior arises from impairments in ascribing mental states to oneself and others,<ref>{{cite journal |author= Baron-Cohen S, Leslie AM, Frith U |title= Does the autistic child have a 'theory of mind'? |journal=Cognition |volume=21 |issue=1 |pages=37–46 |year=1985 |doi=10.1016/0010-0277(85)90022-8 |pmid=2934210 |url=http://ruccs.rutgers.edu/~aleslie/Baron-Cohen%20Leslie%20&%20Frith%201985.pdf |format=PDF |accessdate=2007-06-28}}</ref> or [[EQ SQ theory|hyper-systemizing]], which hypothesizes that autistic individuals can systematize internal operation to handle internal events but are less effective at [[Empathy|empathizing]] by handling events generated by other agents.<ref>{{cite journal |author= Baron-Cohen S |title= The hyper-systemizing, assortative mating theory of autism |journal= Prog Neuropsychopharmacol Biol Psychiatry |year=2006 |volume=30 |issue=5 |pages=865–72 |doi=10.1016/j.pnpbp.2006.01.010 |pmid=16519981 |url=http://autismresearchcentre.com/docs/papers/2006_BC_Neuropsychophamacology.pdf |format=PDF |accessdate=2009-06-08}}</ref>
+The [[Mirror neuron|mirror neuron system]] (MNS) theory hypothesizes that alterations to the development of the MNS interfere with imitation and lead to Asperger's core feature of social impairment.<ref name=Iacoboni>{{cite journal |journal= Nat Rev Neurosci |year=2006 |volume=7 |issue=12 |pages=942–951 |title= The mirror neuron system and the consequences of its dysfunction |author= Iacoboni M, Dapretto M |doi=10.1038/nrn2024 |pmid=17115076}}</ref><ref>{{cite journal |journal= Sci Am |year=2006 |volume=295 |issue=5 |pages=62–69 |title= Broken mirrors: a theory of autism |author= [[Vilayanur S. Ramachandran|Ramachandran VS]], Oberman LM |pmid=17076085 |url=http://cbc.ucsd.edu/pdf/brokenmirrors_asd.pdf |format=PDF |accessdate=2009-02-13 |doi= 10.1038/scientificamerican1106-62}}</ref> For example, one study found that activation is delayed in the core circuit for imitation in individuals with AS.<ref>{{cite journal |journal= Ann Neurol |year=2004 |volume=55 |issue=4 |pages=558–562 |title= Abnormal imitation-related cortical activation sequences in Asperger's syndrome |author= Nishitani N, Avikainen S, Hari R |doi=10.1002/ana.20031 |pmid=15048895}}</ref> This theory maps well to [[social cognition]] theories like the [[theory of mind]], which hypothesizes that autistic behavior arises from impairments in ascribing mental states to oneself and others,<ref>{{cite journal |author= Baron-Cohen S, Leslie AM, Frith U |title= Does the autistic child have a 'theory of mind'? |journal=Cognition |volume=21 |issue=1 |pages=37–46 |year=1985 |doi=10.1016/0010-0277(85)90022-8 |pmid=2934210 |url=http://ruccs.rutgers.edu/~aleslie/Baron-Cohen%20Leslie%20&%20Frith%201985.pdf |format=PDF |accessdate=2007-06-28}}</ref> or [[EQ SQ theory|hyper-systemizing]], which hypothesizes that autistic individuals can systematize internal operation to handle internal events but are less effective at [[Empathy|empathizing]] by handling events generated by other agents.<ref>{{cite journal |author= Baron-Cohen S |title= The hyper-systemizing, assortative mating theory of autism |journal= Prog Neuropsychopharmacol Biol Psychiatry |year=2006 |volume=30 |issue=5 |pages=865–872 |doi=10.1016/j.pnpbp.2006.01.010 |pmid=16519981 |url=http://autismresearchcentre.com/docs/papers/2006_BC_Neuropsychophamacology.pdf |format=PDF |accessdate=2009-06-08}}</ref>
-Other possible mechanisms include [[serotonin]] dysfunction<ref>{{cite journal |journal= Am J Psychiatry |year=2006 |volume=163 |issue=5 |pages=934–6 |title= Cortical serotonin 5-HT<sub>2A</sub> receptor binding and social communication in adults with Asperger's syndrome: an in vivo SPECT study |author= Murphy DG, Daly E, Schmitz N ''et al.'' |doi=10.1176/appi.ajp.163.5.934 |pmid=16648340 |url=http://ajp.psychiatryonline.org/cgi/content/full/163/5/934 }}</ref> and [[cerebellar]] dysfunction.<ref>{{cite journal |journal=Cerebellum |year=2005 |volume=4 |issue=4 |pages=279–89 |title= Behavioural aspects of cerebellar function in adults with Asperger syndrome |author= Gowen E, Miall RC |doi=10.1080/14734220500355332 |pmid=16321884}}</ref>
+Other possible mechanisms include [[serotonin]] dysfunction<ref>{{cite journal |journal= Am J Psychiatry |year=2006 |volume=163 |issue=5 |pages=934–936 |title= Cortical serotonin 5-HT<sub>2A</sub> receptor binding and social communication in adults with Asperger's syndrome: an in vivo SPECT study |author= Murphy DG |doi=10.1176/appi.ajp.163.5.934 |pmid=16648340 |url=http://ajp.psychiatryonline.org/cgi/content/full/163/5/934 |author-separator= , |author2= Daly E |author3= Schmitz N |display-authors= 3 |last4= Toal |first4= F. |last5= Murphy |first5= K. |last6= Curran |first6= S. |last7= Erlandsson |first7= K. |last8= Eersels |first8= J. |last9= Kerwin |first9= R. }}</ref> and [[cerebellar]] dysfunction.<ref>{{cite journal |journal=Cerebellum |year=2005 |volume=4 |issue=4 |pages=279–289 |title= Behavioural aspects of cerebellar function in adults with Asperger syndrome |author= Gowen E, Miall RC |doi=10.1080/14734220500355332 |pmid=16321884}}</ref>
 ==Screening==
-Parents of children with Asperger syndrome can typically trace differences in their children's development to as early as 30 months of age.<ref name=Foster/> Developmental screening during a routine [[check-up]] by a [[general practitioner]] or pediatrician may identify signs that warrant further investigation.<ref name=McPartland/><ref name=NINDS/> The diagnosis of AS is complicated by the use of several different screening instruments,<ref name=NINDS/><ref name=EhlGill/> including the Asperger Syndrome Diagnostic Scale (ASDS), Autism Spectrum Screening Questionnaire (ASSQ), Childhood Asperger Syndrome Test (CAST), [[Gilliam Asperger's Disorder Scale]] (GADS), Krug Asperger's Disorder Index (KADI),<ref>{{cite journal |journal= J Autism Dev Disord |year=2005 |volume=35 |issue=1 |pages=25–35 |title= Diagnostic assessment of Asperger's disorder: a review of five third-party rating scales |author= Campbell JM |doi=10.1007/s10803-004-1028-4 |pmid=15796119}}</ref> and the [[Autism Spectrum Quotient]] (AQ; with versions for children,<ref>{{cite journal |author=Auyeung B, Baron-Cohen S, Wheelwright S, Allison C |title= The Autism Spectrum Quotient: Children's Version (AQ-Child) |journal= J Autism Dev Disord |volume=38 |issue=7 |pages=1230–40 |year=2008 |pmid=18064550 |doi=10.1007/s10803-007-0504-z |url=http://autismresearchcenter.com/docs/papers/2008_Auyeung_etal_ChildAQ.pdf |format=PDF |accessdate=2009-01-02}}</ref> adolescents<ref>{{cite journal |author= Baron-Cohen S, Hoekstra RA, Knickmeyer R, Wheelwright S |title= The Autism-Spectrum Quotient (AQ)—adolescent version |journal= J Autism Dev Disord |volume=36 |issue=3 |pages=343–50 |year=2006 |pmid=16552625 |doi=10.1007/s10803-006-0073-6 |url=http://autismresearchcenter.com/docs/papers/2006_BC_Hoekstra_etal_AQ-adol.pdf |format=PDF |accessdate=2009-01-02}}</ref> and adults<ref>{{cite journal |journal= J Autism Dev Disord |year=2005 |volume=35 |issue=3 |pages=331–5 |title= Screening adults for Asperger Syndrome using the AQ: a preliminary study of its diagnostic validity in clinical practice |author= Woodbury-Smith MR, Robinson J, Wheelwright S, Baron-Cohen S |doi=10.1007/s10803-005-3300-7 |pmid=16119474 |url=http://autismresearchcentre.com/docs/papers/2005_Woodbury-Smith_etal_ScreeningAdultsForAS.pdf |format=PDF |accessdate=2009-01-02}}</ref>). None have been shown to reliably differentiate between AS and other ASDs.<ref name=McPartland/>
+Parents of children with Asperger syndrome can typically trace differences in their children's development to as early as 30 months of age.<ref name=Foster/> Developmental screening during a routine [[check-up]] by a [[general practitioner]] or pediatrician may identify signs that warrant further investigation.<ref name=McPartland/><ref name=NINDS/> The diagnosis of AS is complicated by the use of several different screening instruments,<ref name=NINDS/><ref name=EhlGill/> including the Asperger Syndrome Diagnostic Scale (ASDS), Autism Spectrum Screening Questionnaire (ASSQ), Childhood Asperger Syndrome Test (CAST), [[Gilliam Asperger's Disorder Scale]] (GADS), Krug Asperger's Disorder Index (KADI),<ref>{{cite journal |journal= J Autism Dev Disord |year=2005 |volume=35 |issue=1 |pages=25–35 |title= Diagnostic assessment of Asperger's disorder: a review of five third-party rating scales |author= Campbell JM |doi=10.1007/s10803-004-1028-4 |pmid=15796119}}</ref> and the [[Autism Spectrum Quotient]] (AQ; with versions for children,<ref>{{cite journal |author=Auyeung B, Baron-Cohen S, Wheelwright S, Allison C |title= The Autism Spectrum Quotient: Children's Version (AQ-Child) |journal= J Autism Dev Disord |volume=38 |issue=7 |pages=1230–1240 |year=2008 |pmid=18064550 |doi=10.1007/s10803-007-0504-z |url=http://autismresearchcenter.com/docs/papers/2008_Auyeung_etal_ChildAQ.pdf |format=PDF |accessdate=2009-01-02}}</ref> adolescents<ref>{{cite journal |author= Baron-Cohen S, Hoekstra RA, Knickmeyer R, Wheelwright S |title= The Autism-Spectrum Quotient (AQ)—adolescent version |journal= J Autism Dev Disord |volume=36 |issue=3 |pages=343–350 |year=2006 |pmid=16552625 |doi=10.1007/s10803-006-0073-6 |url=http://autismresearchcenter.com/docs/papers/2006_BC_Hoekstra_etal_AQ-adol.pdf |format=PDF |accessdate=2009-01-02}}</ref> and adults<ref>{{cite journal |journal= J Autism Dev Disord |year=2005 |volume=35 |issue=3 |pages=331–335 |title= Screening adults for Asperger Syndrome using the AQ: a preliminary study of its diagnostic validity in clinical practice |author= Woodbury-Smith MR, Robinson J, Wheelwright S, Baron-Cohen S |doi=10.1007/s10803-005-3300-7 |pmid=16119474 |url=http://autismresearchcentre.com/docs/papers/2005_Woodbury-Smith_etal_ScreeningAdultsForAS.pdf |format=PDF |accessdate=2009-01-02}}</ref>). None have been shown to reliably differentiate between AS and other ASDs.<ref name=McPartland/>
 ==Diagnosis==
 {{Main|Diagnosis of Asperger syndrome}}
-Standard diagnostic criteria require impairment in social interaction and repetitive and stereotyped patterns of behavior, activities and interests, without significant delay in language or cognitive development. Unlike the international standard,<ref name=ICD-10-F84.0/> U.S. criteria also require significant impairment in day-to-day functioning.<ref name=BehaveNet/> Other sets of diagnostic criteria have been proposed by [[Peter_Szatmari#Diagnostic criteria for Asperger Syndrome|Szatmari ''et al.'']]<ref>{{cite journal |journal= Can J Psychiatry |year=1989 |volume=34 |issue=6 |pages=554–60 |title= Asperger's syndrome: a review of clinical features |author= Szatmari P, Bremner R, Nagy J |pmid=2766209}}</ref> and by [[Christopher Gillberg#Gillberg's criteria for Asperger syndrome|Gillberg and Gillberg]].<ref name=Gill>{{cite journal |journal= J Child Psychol Psychiatry |year=1989 |volume=30 |issue=4 |pages=631–8 |title= Asperger syndrome—some epidemiological considerations: a research note |author= Gillberg IC, Gillberg C |doi=10.1111/j.1469-7610.1989.tb00275.x |pmid=2670981}}</ref>
+Standard diagnostic criteria require impairment in social interaction and repetitive and stereotyped patterns of behavior, activities and interests, without significant delay in language or cognitive development. Unlike the international standard,<ref name=ICD-10-F84.0/> U.S. criteria also require significant impairment in day-to-day functioning.<ref name=BehaveNet/> Other sets of diagnostic criteria have been proposed by [[Peter_Szatmari#Diagnostic criteria for Asperger Syndrome|Szatmari ''et al.'']]<ref>{{cite journal |journal= Can J Psychiatry |year=1989 |volume=34 |issue=6 |pages=554–60 |title= Asperger's syndrome: a review of clinical features |author= Szatmari P, Bremner R, Nagy J |pmid=2766209}}</ref> and by [[Christopher Gillberg#Gillberg's criteria for Asperger syndrome|Gillberg and Gillberg]].<ref name=Gill>{{cite journal |journal= J Child Psychol Psychiatry |year=1989 |volume=30 |issue=4 |pages=631–638 |title= Asperger syndrome—some epidemiological considerations: a research note |author= Gillberg IC, Gillberg C |doi=10.1111/j.1469-7610.1989.tb00275.x |pmid=2670981}}</ref>
-Diagnosis is most commonly made between the ages of four and eleven.<ref name="McPartland"/> A comprehensive assessment involves a multidisciplinary team<ref name="Baskin"/><ref name=NINDS/><ref name=Fitzgerald/> that observes across multiple settings,<ref name=McPartland/> and includes neurological and genetic assessment as well as tests for cognition, psychomotor function, verbal and nonverbal strengths and weaknesses, style of learning, and skills for independent living.<ref name=NINDS/> The "gold standard" in diagnosing ASDs combines clinical judgment with the [[Autism Diagnostic Interview-Revised]] (ADI-R)—a semistructured parent interview—and the [[Autism Diagnostic Observation Schedule]] (ADOS)—a conversation and play-based interview with the child.<ref name=Woodbury-Smith>{{cite journal |author=Woodbury-Smith MR, Volkmar FR |title=Asperger syndrome |journal=Eur Child Adolesc Psychiatry |volume=18 |issue=1 |pages=2–11 |year=2009 |month=January |pmid=18563474 |doi=10.1007/s00787-008-0701-0}}</ref> Delayed or mistaken diagnosis can be traumatic for individuals and families; for example, misdiagnosis can lead to medications that worsen behavior.<ref name=Fitzgerald/><ref name="leskovec">{{cite journal |author=Leskovec TJ, Rowles BM, Findling RL |title=Pharmacological treatment options for autism spectrum disorders in children and adolescents |journal=Harv Rev Psychiatry |volume=16 |issue=2 |pages=97–112 |year=2008 |pmid=18415882 |doi=10.1080/10673220802075852}}</ref> Many children with AS are initially misdiagnosed with [[attention-deficit hyperactivity disorder]] (ADHD).<ref name="McPartland"/> Diagnosing adults is more challenging, as standard diagnostic criteria are designed for children and the expression of AS changes with age;<ref>{{cite journal |author=Tantam D |title=The challenge of adolescents and adults with Asperger syndrome |journal=Child Adolesc Psychiatr Clin N Am |volume=12 |issue=1 |pages=143–63 |year=2003 |pmid=12512403 |url=http://www.childpsych.theclinics.com/article/PIIS1056499302000536/fulltext |doi=10.1016/S1056-4993(02)00053-6 }}</ref> adult diagnosis requires painstaking clinical examination and thorough [[medical history]] gained from both the individual and other people who know the person, focusing on childhood behavior.<ref name=ASAdulthood>{{cite journal |author=Roy M, Dillo W, Emrich HM, Ohlmeier MD |title=Asperger's syndrome in adulthood |journal=Dtsch Arztebl Int |volume=106 |issue=5 |pages=59–64 |year=2009 |pmid=19562011 |pmc=2695286 |doi=10.3238/arztebl.2009.0059 }}</ref> Conditions that must be considered in a [[differential diagnosis]] include other ASDs, the [[schizophrenia spectrum]], ADHD, [[obsessive compulsive disorder]], [[major depressive disorder]], [[semantic pragmatic disorder]], [[nonverbal learning disorder]],<ref name=Fitzgerald>{{cite journal |author=Fitzgerald M, Corvin A |year=2001 |doi=10.1192/apt.7.4.310 |url=http://apt.rcpsych.org/cgi/content/full/7/4/310 |title=Diagnosis and differential diagnosis of Asperger syndrome |journal=Adv Psychiatric Treat |volume=7 |issue=4 |pages=310–8 }}</ref> [[Tourette syndrome]],<ref name=RapinTS/> [[stereotypic movement disorder]] and [[bipolar disorder]].<ref name=Foster>{{cite journal |journal=Curr Opin Pediatr |year=2003 |volume=15 |issue=5 |pages=491–4 |title=Asperger syndrome: to be or not to be? |author=Foster B, King BH |pmid=14508298 |doi=10.1097/00008480-200310000-00008 }}</ref>
+Diagnosis is most commonly made between the ages of four and eleven.<ref name="McPartland"/> A comprehensive assessment involves a multidisciplinary team<ref name="Baskin"/><ref name=NINDS/><ref name=Fitzgerald/> that observes across multiple settings,<ref name=McPartland/> and includes neurological and genetic assessment as well as tests for cognition, psychomotor function, verbal and nonverbal strengths and weaknesses, style of learning, and skills for independent living.<ref name=NINDS/> The "gold standard" in diagnosing ASDs combines clinical judgment with the [[Autism Diagnostic Interview-Revised]] (ADI-R)—a semistructured parent interview—and the [[Autism Diagnostic Observation Schedule]] (ADOS)—a conversation and play-based interview with the child.<ref name=Woodbury-Smith>{{cite journal |author=Woodbury-Smith MR, Volkmar FR |title=Asperger syndrome |journal=Eur Child Adolesc Psychiatry |volume=18 |issue=1 |pages=2–11 |year=2009 |month=January |pmid=18563474 |doi=10.1007/s00787-008-0701-0}}</ref> Delayed or mistaken diagnosis can be traumatic for individuals and families; for example, misdiagnosis can lead to medications that worsen behavior.<ref name=Fitzgerald/><ref name="leskovec">{{cite journal |author=Leskovec TJ, Rowles BM, Findling RL |title=Pharmacological treatment options for autism spectrum disorders in children and adolescents |journal=Harv Rev Psychiatry |volume=16 |issue=2 |pages=97–112 |year=2008 |pmid=18415882 |doi=10.1080/10673220802075852}}</ref> Many children with AS are initially misdiagnosed with [[attention-deficit hyperactivity disorder]] (ADHD).<ref name="McPartland"/> Diagnosing adults is more challenging, as standard diagnostic criteria are designed for children and the expression of AS changes with age;<ref>{{cite journal |author=Tantam D |title=The challenge of adolescents and adults with Asperger syndrome |journal=Child Adolesc Psychiatr Clin N Am |volume=12 |issue=1 |pages=143–163 |year=2003 |pmid=12512403 |url=http://www.childpsych.theclinics.com/article/PIIS1056499302000536/fulltext |doi=10.1016/S1056-4993(02)00053-6 }}</ref> adult diagnosis requires painstaking clinical examination and thorough [[medical history]] gained from both the individual and other people who know the person, focusing on childhood behavior.<ref name=ASAdulthood>{{cite journal |author=Roy M, Dillo W, Emrich HM, Ohlmeier MD |title=Asperger's syndrome in adulthood |journal=Dtsch Arztebl Int |volume=106 |issue=5 |pages=59–64 |year=2009 |pmid=19562011 |pmc=2695286 |doi=10.3238/arztebl.2009.0059 }}</ref> Conditions that must be considered in a [[differential diagnosis]] include other ASDs, the [[schizophrenia spectrum]], ADHD, [[obsessive compulsive disorder]], [[major depressive disorder]], [[semantic pragmatic disorder]], [[nonverbal learning disorder]],<ref name=Fitzgerald>{{cite journal |author=Fitzgerald M, Corvin A |year=2001 |doi=10.1192/apt.7.4.310 |url=http://apt.rcpsych.org/cgi/content/full/7/4/310 |title=Diagnosis and differential diagnosis of Asperger syndrome |journal=Adv Psychiatric Treat |volume=7 |issue=4 |pages=310–318 }}</ref> [[Tourette syndrome]],<ref name=RapinTS/> [[stereotypic movement disorder]] and [[bipolar disorder]].<ref name=Foster>{{cite journal |journal=Curr Opin Pediatr |year=2003 |volume=15 |issue=5 |pages=491–494 |title=Asperger syndrome: to be or not to be? |author=Foster B, King BH |pmid=14508298 |doi=10.1097/00008480-200310000-00008 }}</ref>
-Underdiagnosis and overdiagnosis are problems in marginal cases. The cost and difficulty of screening and assessment can delay diagnosis. Conversely, the increasing popularity of drug treatment options and the expansion of benefits has motivated providers to overdiagnose ASD.<ref>{{cite journal |author= Shattuck PT, Grosse SD |title= Issues related to the diagnosis and treatment of autism spectrum disorders |journal= Ment Retard Dev Disabil Res Rev |year=2007 |volume=13 |issue=2 |pages=129–35 |doi=10.1002/mrdd.20143 |pmid=17563895}}</ref> There are indications AS has been diagnosed more frequently in recent years, partly as a residual diagnosis for children of normal intelligence who do not have autism but have social difficulties.<ref name=Klin-Volkmar/> In 2006, it was reported to be the fastest-growing psychiatric diagnosis in [[Silicon Valley]] children; also, there is a predilection for adults to self-diagnose it.<ref>{{cite news |author=Markel H |title=The trouble with Asperger's syndrome |work=Medscape Today |publisher=WebMD |date=2006-04-13 }}</ref> There are questions about the [[external validity]] of the AS diagnosis. That is, it is unclear whether there is a practical benefit in distinguishing AS from HFA and from PDD-NOS;<ref name=Klin-Volkmar>{{cite journal |journal= Child Adolesc Psychiatr Clin N Am |year=2003 |volume=12 |issue=1 |pages=1–13 |title= Asperger syndrome: diagnosis and external validity |author= Klin A, Volkmar FR |pmid=12512395 |url=http://www.childpsych.theclinics.com/article/PIIS1056499302000524/fulltext |doi=10.1016/S1056-4993(02)00052-4}}</ref> the same child can receive different diagnoses depending on the screening tool.<ref name="NINDS"/> The debate about distinguishing AS from HFA is partly due to a [[Tautology (rhetoric)|tautological dilemma]] where disorders are defined based on severity of impairment, so that studies that appear to confirm differences based on severity are to be expected.<ref>{{cite journal |author= Toth K, King BH |title= Asperger's syndrome: diagnosis and treatment |journal= Am J Psychiatry |volume=165 |issue=8 |pages=958–63 |year=2008 |pmid=18676600 |doi=10.1176/appi.ajp.2008.08020272 |url=http://ajp.psychiatryonline.org/cgi/content/full/165/8/958}}</ref>
+Underdiagnosis and overdiagnosis are problems in marginal cases. The cost and difficulty of screening and assessment can delay diagnosis. Conversely, the increasing popularity of drug treatment options and the expansion of benefits has motivated providers to overdiagnose ASD.<ref>{{cite journal |author= Shattuck PT, Grosse SD |title= Issues related to the diagnosis and treatment of autism spectrum disorders |journal= Ment Retard Dev Disabil Res Rev |year=2007 |volume=13 |issue=2 |pages=129–135 |doi=10.1002/mrdd.20143 |pmid=17563895}}</ref> There are indications AS has been diagnosed more frequently in recent years, partly as a residual diagnosis for children of normal intelligence who do not have autism but have social difficulties.<ref name=Klin-Volkmar/> In 2006, it was reported to be the fastest-growing psychiatric diagnosis in [[Silicon Valley]] children; also, there is a predilection for adults to self-diagnose it.<ref>{{cite news |author=Markel H |title=The trouble with Asperger's syndrome |work=Medscape Today |publisher=WebMD |date=2006-04-13 }}</ref> There are questions about the [[external validity]] of the AS diagnosis. That is, it is unclear whether there is a practical benefit in distinguishing AS from HFA and from PDD-NOS;<ref name=Klin-Volkmar>{{cite journal |journal= Child Adolesc Psychiatr Clin N Am |year=2003 |volume=12 |issue=1 |pages=1–13 |title= Asperger syndrome: diagnosis and external validity |author= Klin A, Volkmar FR |pmid=12512395 |url=http://www.childpsych.theclinics.com/article/PIIS1056499302000524/fulltext |doi=10.1016/S1056-4993(02)00052-4}}</ref> the same child can receive different diagnoses depending on the screening tool.<ref name="NINDS"/> The debate about distinguishing AS from HFA is partly due to a [[Tautology (rhetoric)|tautological dilemma]] where disorders are defined based on severity of impairment, so that studies that appear to confirm differences based on severity are to be expected.<ref>{{cite journal |author= Toth K, King BH |title= Asperger's syndrome: diagnosis and treatment |journal= Am J Psychiatry |volume=165 |issue=8 |pages=958–963 |year=2008 |pmid=18676600 |doi=10.1176/appi.ajp.2008.08020272 |url=http://ajp.psychiatryonline.org/cgi/content/full/165/8/958}}</ref>
 ==Management==
 {{See|Autism therapies}}
-Asperger syndrome treatment attempts to manage distressing symptoms and to teach age-appropriate social, communication and vocational skills that are not naturally acquired during development,<ref name="McPartland"/> with intervention tailored to the needs of the individual based on multidisciplinary assessment.<ref>{{cite journal |journal= Compr Psychiatry |year=2004 |volume=45 |issue=3 |pages=184–91 |title= Asperger's disorder: a review of its diagnosis and treatment |author= Khouzam HR, El-Gabalawi F, Pirwani N, Priest F |doi=10.1016/j.comppsych.2004.02.004 |pmid=15124148}}</ref> Although progress has been made, data supporting the efficacy of particular interventions are limited.<ref name="McPartland"/><ref>{{cite journal |author= Attwood T |title= Frameworks for behavioral interventions |journal= Child Adolesc Psychiatr Clin N Am |volume=12 |issue=1 |pages=65–86 |year=2003 |pmid=12512399 |url=http://www.childpsych.theclinics.com/article/PIIS1056499302000548/fulltext |doi= 10.1016/S1056-4993(02)00054-8}}</ref>
+Asperger syndrome treatment attempts to manage distressing symptoms and to teach age-appropriate social, communication and vocational skills that are not naturally acquired during development,<ref name="McPartland"/> with intervention tailored to the needs of the individual based on multidisciplinary assessment.<ref>{{cite journal |journal= Compr Psychiatry |year=2004 |volume=45 |issue=3 |pages=184–191 |title= Asperger's disorder: a review of its diagnosis and treatment |author= Khouzam HR, El-Gabalawi F, Pirwani N, Priest F |doi=10.1016/j.comppsych.2004.02.004 |pmid=15124148}}</ref> Although progress has been made, data supporting the efficacy of particular interventions are limited.<ref name="McPartland"/><ref>{{cite journal |author= Attwood T |title= Frameworks for behavioral interventions |journal= Child Adolesc Psychiatr Clin N Am |volume=12 |issue=1 |pages=65–86 |year=2003 |pmid=12512399 |url=http://www.childpsych.theclinics.com/article/PIIS1056499302000548/fulltext |doi= 10.1016/S1056-4993(02)00054-8}}</ref>
 ===Therapies===
 The ideal treatment for AS coordinates therapies that address core symptoms of the disorder, including poor communication skills and obsessive or repetitive routines. While most professionals agree that the earlier the intervention, the better, there is no single best treatment package.<ref name=NINDS/> AS treatment resembles that of other high-functioning ASDs, except that it takes into account the linguistic capabilities, verbal strengths, and nonverbal vulnerabilities of individuals with AS.<ref name=McPartland/> A typical program generally includes:<ref name=NINDS/>
-* The training of [[social skill]]s for more effective interpersonal interactions,<ref>{{cite journal |author= Krasny L, Williams BJ, Provencal S, Ozonoff S |title= Social skills interventions for the autism spectrum: essential ingredients and a model curriculum |journal= Child Adolesc Psychiatr Clin N Am |volume=12 |issue=1 |pages=107–22 |year=2003 |pmid=12512401 |url=http://www.childpsych.theclinics.com/article/PIIS1056499302000512/fulltext |doi=10.1016/S1056-4993(02)00051-2}}</ref>
+* The training of [[social skill]]s for more effective interpersonal interactions,<ref>{{cite journal |author= Krasny L, Williams BJ, Provencal S, Ozonoff S |title= Social skills interventions for the autism spectrum: essential ingredients and a model curriculum |journal= Child Adolesc Psychiatr Clin N Am |volume=12 |issue=1 |pages=107–122 |year=2003 |pmid=12512401 |url=http://www.childpsych.theclinics.com/article/PIIS1056499302000512/fulltext |doi=10.1016/S1056-4993(02)00051-2}}</ref>
-* [[Cognitive behavioral therapy]] to improve [[stress management]] relating to anxiety or explosive emotions,<ref name=Myles>{{cite journal |author= Myles BS |title= Behavioral forms of stress management for individuals with Asperger syndrome |journal= Child Adolesc Psychiatr Clin N Am |volume=12 |issue=1 |pages=123–41 |year=2003 |pmid=12512402 |url=http://www.childpsych.theclinics.com/article/PIIS1056499302000482/fulltext |doi=10.1016/S1056-4993(02)00048-2}}</ref> and to cut back on obsessive interests and repetitive routines,
+* [[Cognitive behavioral therapy]] to improve [[stress management]] relating to anxiety or explosive emotions,<ref name=Myles>{{cite journal |author= Myles BS |title= Behavioral forms of stress management for individuals with Asperger syndrome |journal= Child Adolesc Psychiatr Clin N Am |volume=12 |issue=1 |pages=123–141 |year=2003 |pmid=12512402 |url=http://www.childpsych.theclinics.com/article/PIIS1056499302000482/fulltext |doi=10.1016/S1056-4993(02)00048-2}}</ref> and to cut back on obsessive interests and repetitive routines,
 * [[Medication]], for coexisting conditions such as major depressive disorder and [[anxiety disorder]],<ref name=Towbin/>
 * [[Occupational therapy|occupational]] or [[physical therapy]] to assist with poor [[sensory integration]] and [[motor coordination]],
@@ Line 115: / Line 115: @@
 * The training and support of parents, particularly in behavioral techniques to use in the home.
-Of the many studies on behavior-based early intervention programs, most are [[case studies]] of up to five participants, and typically examine a few problem behaviors such as [[self-injury]], [[aggression]], noncompliance, [[Stereotypy|stereotypies<!--Not "stereotypes"-->]], or spontaneous language; unintended [[Adverse effect (medicine)|side effects]] are largely ignored.<ref name=interrev>{{cite journal |author= Matson JL |title= Determining treatment outcome in early intervention programs for autism spectrum disorders: a critical analysis of measurement issues in learning based interventions |journal= Res Dev Disabil |volume=28 |issue=2 |pages=207–18 |year=2007 |pmid=16682171 |doi=10.1016/j.ridd.2005.07.006}}</ref> Despite the popularity of social skills training, its effectiveness is not firmly established.<ref>{{cite journal |journal= J Autism Dev Disord |year=2008 |title= Social skills interventions for children with Asperger's syndrome or high-functioning autism: a review and recommendations |author= Rao PA, Beidel DC, Murray MJ |doi=10.1007/s10803-007-0402-4 |pmid=17641962 |volume=38 |issue=2 |pages=353–61}}</ref> A randomized controlled study of a model for training parents in problem behaviors in their children with AS showed that parents attending a one-day workshop or six individual lessons reported fewer behavioral problems, while parents receiving the individual lessons reported less intense behavioral problems in their AS children.<ref>{{cite journal |author= Sofronoff K, Leslie A, Brown W |title= Parent management training and Asperger syndrome: a randomized controlled trial to evaluate a parent based intervention |journal=Autism |volume=8 |issue=3 |pages=301–17 |year=2004 |pmid=15358872 |doi=10.1177/1362361304045215}}</ref> Vocational training is important to teach job interview etiquette and workplace behavior to older children and adults with AS, and organization software and personal data assistants can improve the work and life management of people with AS.<ref name="McPartland"/>
+Of the many studies on behavior-based early intervention programs, most are [[case studies]] of up to five participants, and typically examine a few problem behaviors such as [[self-injury]], [[aggression]], noncompliance, [[Stereotypy|stereotypies<!--Not "stereotypes"-->]], or spontaneous language; unintended [[Adverse effect (medicine)|side effects]] are largely ignored.<ref name=interrev>{{cite journal |author= Matson JL |title= Determining treatment outcome in early intervention programs for autism spectrum disorders: a critical analysis of measurement issues in learning based interventions |journal= Res Dev Disabil |volume=28 |issue=2 |pages=207–218 |year=2007 |pmid=16682171 |doi=10.1016/j.ridd.2005.07.006}}</ref> Despite the popularity of social skills training, its effectiveness is not firmly established.<ref>{{cite journal |journal= J Autism Dev Disord |year=2008 |title= Social skills interventions for children with Asperger's syndrome or high-functioning autism: a review and recommendations |author= Rao PA, Beidel DC, Murray MJ |doi=10.1007/s10803-007-0402-4 |pmid=17641962 |volume=38 |issue=2 |pages=353–361}}</ref> A randomized controlled study of a model for training parents in problem behaviors in their children with AS showed that parents attending a one-day workshop or six individual lessons reported fewer behavioral problems, while parents receiving the individual lessons reported less intense behavioral problems in their AS children.<ref>{{cite journal |author= Sofronoff K, Leslie A, Brown W |title= Parent management training and Asperger syndrome: a randomized controlled trial to evaluate a parent based intervention |journal=Autism |volume=8 |issue=3 |pages=301–317 |year=2004 |pmid=15358872 |doi=10.1177/1362361304045215}}</ref> Vocational training is important to teach job interview etiquette and workplace behavior to older children and adults with AS, and organization software and personal data assistants can improve the work and life management of people with AS.<ref name="McPartland"/>
 ===Medications===
 No medications directly treat the core symptoms of AS.<ref name=Towbin>{{cite journal |author= Towbin KE |title= Strategies for pharmacologic treatment of high functioning autism and Asperger syndrome |journal= Child Adolesc Psychiatr Clin N Am |volume=12 |issue=1 |pages=23–45 |year=2003 |pmid=12512397 |url=http://www.childpsych.theclinics.com/article/PIIS1056499302000494/fulltext |doi=10.1016/S1056-4993(02)00049-4}}</ref> Although research into the efficacy of pharmaceutical intervention for AS is limited,<ref name="McPartland"/> it is essential to diagnose and treat [[Comorbidity|comorbid]] conditions.<ref name="Baskin"/> Deficits in self-identifying emotions or in observing effects of one's behavior on others can make it difficult for individuals with AS to see why medication may be appropriate.<ref name=Towbin/> Medication can be effective in combination with behavioral interventions and environmental accommodations in treating comorbid symptoms such as anxiety disorder, major depressive disorder, inattention and aggression.<ref name="McPartland"/> The [[atypical antipsychotic]] medications [[risperidone]] and [[olanzapine]] have been shown to reduce the associated symptoms of AS;<ref name="McPartland"/> risperidone can reduce repetitive and self-injurious behaviors, aggressive outbursts and impulsivity, and improve stereotypical patterns of behavior and social relatedness. The [[selective serotonin reuptake inhibitor]]s (SSRIs) [[fluoxetine]], [[fluvoxamine]] and [[sertraline]] have been effective in treating restricted and repetitive interests and behaviors.<ref name="McPartland"/><ref name="Baskin"/><ref name="Foster"/>
-Care must be taken with medications, as side effects may be more common and harder to evaluate in individuals with AS, and tests of drugs' effectiveness against comorbid conditions routinely exclude individuals from the autism spectrum.<ref name=Towbin/> Abnormalities in [[metabolism]], [[Electrical conduction system of the heart|cardiac conduction]] times, and an increased risk of [[Diabetes mellitus type 2|type 2 diabetes]] have been raised as concerns with these medications,<ref name="Newcomer">{{cite journal |author= Newcomer JW |title= Antipsychotic medications: metabolic and cardiovascular risk |journal= J Clin Psychiatry |volume=68 |issue= suppl 4 |pages=8–13 |year=2007 |pmid=17539694 }}</ref><ref name="Chavez">{{cite journal |author= Chavez B, Chavez-Brown M, Sopko MA, Rey JA |title= Atypical antipsychotics in children with pervasive developmental disorders |journal= Pediatr Drugs |volume=9 |issue=4 |pages=249–66 |year=2007 |pmid=17705564 |doi= 10.2165/00148581-200709040-00006}}</ref> along with serious long-term neurological side effects.<ref name=interrev/> SSRIs can lead to manifestations of behavioral activation such as increased impulsivity, aggression and [[sleep disturbance]].<ref name="Foster"/> [[Weight gain]] and fatigue are commonly reported side effects of risperidone, which may also lead to increased risk for [[extrapyramidal symptoms]] such as restlessness and [[dystonia]]<ref name="Foster"/> and increased serum [[prolactin]] levels.<ref>{{cite journal |author= Staller J |title= The effect of long-term antipsychotic treatment on prolactin |journal= J Child Adolesc Psychopharmacol |volume=16 |issue=3 |pages=317–26 |year=2006 |pmid=16768639 |doi=10.1089/cap.2006.16.317}}</ref> Sedation and weight gain are more common with [[olanzapine]],<ref name="Chavez"/> which has also been linked with diabetes.<ref name="Newcomer"/> Sedative side-effects in school-age children<ref>{{cite journal |journal= Ann Pharmacother |year=2007 |volume=41 |issue=4 |pages=626–34 |title= Use of atypical antipsychotics in the treatment of autistic disorder |author= Stachnik JM, Nunn-Thompson C |doi=10.1345/aph.1H527 |pmid=17389666}}</ref> have ramifications for classroom learning. Individuals with AS may be unable to identify and communicate their internal moods and emotions or to tolerate side effects that for most people would not be problematic.<ref>{{cite journal |title= Asperger syndrome and high functioning autism: research concerns and emerging foci |journal= Curr Opin Psychiatry |volume=16 |issue=5 |pages=535–542 |year=2003 |author= Blacher J, Kraemer B, Schalow M |doi=10.1097/00001504-200309000-00008}}</ref>
+Care must be taken with medications, as side effects may be more common and harder to evaluate in individuals with AS, and tests of drugs' effectiveness against comorbid conditions routinely exclude individuals from the autism spectrum.<ref name=Towbin/> Abnormalities in [[metabolism]], [[Electrical conduction system of the heart|cardiac conduction]] times, and an increased risk of [[Diabetes mellitus type 2|type 2 diabetes]] have been raised as concerns with these medications,<ref name="Newcomer">{{cite journal |author= Newcomer JW |title= Antipsychotic medications: metabolic and cardiovascular risk |journal= J Clin Psychiatry |volume=68 |issue= suppl 4 |pages=8–13 |year=2007 |pmid=17539694 }}</ref><ref name="Chavez">{{cite journal |author= Chavez B, Chavez-Brown M, Sopko MA, Rey JA |title= Atypical antipsychotics in children with pervasive developmental disorders |journal= Pediatr Drugs |volume=9 |issue=4 |pages=249–266 |year=2007 |pmid=17705564 |doi= 10.2165/00148581-200709040-00006}}</ref> along with serious long-term neurological side effects.<ref name=interrev/> SSRIs can lead to manifestations of behavioral activation such as increased impulsivity, aggression and [[sleep disturbance]].<ref name="Foster"/> [[Weight gain]] and fatigue are commonly reported side effects of risperidone, which may also lead to increased risk for [[extrapyramidal symptoms]] such as restlessness and [[dystonia]]<ref name="Foster"/> and increased serum [[prolactin]] levels.<ref>{{cite journal |author= Staller J |title= The effect of long-term antipsychotic treatment on prolactin |journal= J Child Adolesc Psychopharmacol |volume=16 |issue=3 |pages=317–326 |year=2006 |pmid=16768639 |doi=10.1089/cap.2006.16.317}}</ref> Sedation and weight gain are more common with [[olanzapine]],<ref name="Chavez"/> which has also been linked with diabetes.<ref name="Newcomer"/> Sedative side-effects in school-age children<ref>{{cite journal |journal= Ann Pharmacother |year=2007 |volume=41 |issue=4 |pages=626–634 |title= Use of atypical antipsychotics in the treatment of autistic disorder |author= Stachnik JM, Nunn-Thompson C |doi=10.1345/aph.1H527 |pmid=17389666}}</ref> have ramifications for classroom learning. Individuals with AS may be unable to identify and communicate their internal moods and emotions or to tolerate side effects that for most people would not be problematic.<ref>{{cite journal |title= Asperger syndrome and high functioning autism: research concerns and emerging foci |journal= Curr Opin Psychiatry |volume=16 |issue=5 |pages=535–542 |year=2003 |author= Blacher J, Kraemer B, Schalow M |doi=10.1097/00001504-200309000-00008}}</ref>
 ==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.<ref name=Woodbury-Smith/> 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.<ref name="Klin"/> Individuals with AS appear to have normal [[life expectancy]], but have an increased [[prevalence]] of [[comorbid]] [[Psychiatry|psychiatric]] conditions, such as major depressive disorder and anxiety disorder that may significantly affect [[prognosis]].<ref name="McPartland"/><ref name=Woodbury-Smith/> Although social impairment is lifelong, the outcome is generally more positive than with individuals with lower functioning autism spectrum disorders;<ref name="McPartland"/> for example, ASD symptoms are more likely to diminish with time in children with AS or HFA.<ref>{{cite journal |journal=Pediatrics |year=2005 |volume=116 |issue=1 |pages=117–22 |title= Modeling clinical outcome of children with autistic spectrum disorders |author= Coplan J, Jawad AF |doi=10.1542/peds.2004-1118 |pmid=15995041 |url=http://pediatrics.aappublications.org/cgi/content/full/116/1/117 |laysummary=http://stokes.chop.edu/publications/press/?ID=181 |laysource=press release |laydate=2005-07-05}}</ref> Although most students with AS/HFA have average mathematical ability and test slightly worse in mathematics than in general intelligence, some are gifted in mathematics<ref>{{cite journal |journal=Autism |year=2007 |volume=11 |issue=6 |pages=547–56 |title= Mathematical ability of students with Asperger syndrome and high-functioning autism |author= Chiang HM, Lin YH |doi=10.1177/1362361307083259 |pmid=17947290 |url=http://aut.sagepub.com/cgi/reprint/11/6/547 |format=PDF |accessdate=2009-03-06}}</ref> and AS has not prevented some adults from major accomplishments such as winning the [[Nobel Prize]].<ref>{{cite news |author= Herera S |title= Mild autism has 'selective advantages' |url=http://www.msnbc.msn.com/id/7030731/ |date=2005-02-25 |accessdate=2007-11-14 |publisher=CNBC}}</ref>
+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.<ref name=Woodbury-Smith/> 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.<ref name="Klin"/> Individuals with AS appear to have normal [[life expectancy]], but have an increased [[prevalence]] of [[comorbid]] [[Psychiatry|psychiatric]] conditions, such as major depressive disorder and anxiety disorder that may significantly affect [[prognosis]].<ref name="McPartland"/><ref name=Woodbury-Smith/> Although social impairment is lifelong, the outcome is generally more positive than with individuals with lower functioning autism spectrum disorders;<ref name="McPartland"/> for example, ASD symptoms are more likely to diminish with time in children with AS or HFA.<ref>{{cite journal |journal=Pediatrics |year=2005 |volume=116 |issue=1 |pages=117–122 |title= Modeling clinical outcome of children with autistic spectrum disorders |author= Coplan J, Jawad AF |doi=10.1542/peds.2004-1118 |pmid=15995041 |url=http://pediatrics.aappublications.org/cgi/content/full/116/1/117 |laysummary=http://stokes.chop.edu/publications/press/?ID=181 |laysource=press release |laydate=2005-07-05}}</ref> Although most students with AS/HFA have average mathematical ability and test slightly worse in mathematics than in general intelligence, some are gifted in mathematics<ref>{{cite journal |journal=Autism |year=2007 |volume=11 |issue=6 |pages=547–556 |title= Mathematical ability of students with Asperger syndrome and high-functioning autism |author= Chiang HM, Lin YH |doi=10.1177/1362361307083259 |pmid=17947290 |url=http://aut.sagepub.com/cgi/reprint/11/6/547 |format=PDF |accessdate=2009-03-06}}</ref> and AS has not prevented some adults from major accomplishments such as winning the [[Nobel Prize]].<ref>{{cite news |author= Herera S |title= Mild autism has 'selective advantages' |url=http://www.msnbc.msn.com/id/7030731/ |date=2005-02-25 |accessdate=2007-11-14 |publisher=CNBC}}</ref>
 Children with AS may require [[special education]] services because of their social and behavioral difficulties although many attend regular education classes.<ref name="Klin"/> Adolescents with AS may exhibit ongoing difficulty with [[self care]], organization and disturbances in social and romantic relationships; despite high cognitive potential, most young adults with AS remain at home, although some do marry and work independently.<ref name="McPartland"/> The "different-ness" adolescents experience can be traumatic.<ref name="Moran">{{cite journal |author= Moran M |url=http://pn.psychiatryonline.org/cgi/content/full/41/19/21 |title= Asperger's may be answer to diagnostic mysteries |journal= Psychiatr News |year=2006 |volume=41 |issue=19 |page=21 }}</ref> 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 [[Social anxiety|concern with failing in social encounters]];<ref name=McPartland/> the resulting stress may manifest as inattention, withdrawal, reliance on obsessions, hyperactivity, or aggressive or oppositional behavior.<ref name=Myles/> Depression is often the result of chronic frustration from repeated failure to engage others socially, and [[mood disorder]]s requiring treatment may develop.<ref name="McPartland"/> Clinical experience suggests the rate of suicide may be higher among those with AS, but this has not been confirmed by systematic empirical studies.<ref>{{cite book |title= Asperger's Disorder |editor= Rausch JL, Johnson ME, Casanova MF (eds.) |publisher= Informa Healthcare |year=2008 |chapter= Asperger syndrome—mortality and morbidity |author= Gillberg C |pages=63–80 |isbn=0-8493-8360-9}}</ref>
@@ Line 135: / Line 135: @@
 with the ratio of autism to Asperger syndrome ranging from 1.5:1 to 16:1;<ref>{{cite journal |journal= Child Adolesc Psychiatr Clin N Am |year=2003 |volume=12 |issue=1 |pages=15–21 |title= Epidemiologic data on Asperger disorder |author= [[Eric Fombonne|Fombonne E]], Tidmarsh L |pmid=12512396 |url=http://www.childpsych.theclinics.com/article/PIIS1056499302000500/fulltext |doi=10.1016/S1056-4993(02)00050-0}}</ref> combining the geometric mean ratio of 5:1 with a conservative prevalence estimate for autism of 1.3 per 1,000 suggests indirectly that the prevalence of AS might be around 0.26 per 1,000.<ref>{{cite book |chapter= Epidemiological surveys of pervasive developmental disorders |author= Fombonne E |pages=33–68 |title= Autism and Pervasive Developmental Disorders |edition=2nd |editor= Volkmar FR |publisher= Cambridge University Press |year=2007 |isbn=0-521-54957-4}}</ref> Part of the variance in estimates arises from [[Diagnosis of Asperger syndrome#Multiple sets of diagnostic criteria|differences in diagnostic criteria]]. For example, a relatively small 2007 study of 5,484 eight-year-old children in Finland found 2.9 children per 1,000 met the ICD-10 criteria for an AS diagnosis, 2.7 per 1,000 for Gillberg and Gillberg criteria, 2.5 for DSM-IV, 1.6 for Szatmari ''et al.'', and 4.3 per 1,000 for the union of the four criteria. Boys seem to be more likely to have AS than girls; estimates of the sex ratio range from 1.6:1 to 4:1, using the Gillberg and Gillberg criteria.<ref name=Mattila/>
-Anxiety disorder and major depressive disorder are the most common conditions seen at the same time; [[comorbidity]] of these in persons with AS is estimated at 65%.<ref name=McPartland/> Depression is common in adolescents and adults; children are likely to present with [[Attention-deficit hyperactivity disorder|ADHD]].<ref name=Ghaziuddin><!-- This article is not available online, even though all the other articles in that journal issue are online. What gives? Perhaps we can find a better source? -->{{cite journal |author= Ghaziuddin M, Weidmer-Mikhail E, Ghaziuddin N |title= Comorbidity of Asperger syndrome: a preliminary report |journal= J Intellect Disabil Res |volume=42 |issue=4 |pages=279–83 |year=1998 |pmid=9786442 |doi=  10.1111/j.1365-2788.1998.tb01647.x}}</ref> Reports have associated AS with [[medical conditions]] such as [[aminoaciduria]] and [[ligamentous laxity]], but these have been case reports or small studies and no factors have been associated with AS across studies.<ref name="McPartland"/> One study of males with AS found an increased rate of [[epilepsy]] and a high rate (51%) of [[nonverbal learning disorder]].<ref>{{cite journal |author= Cederlund M, Gillberg C |title= One hundred males with Asperger syndrome: a clinical study of background and associated factors |journal= Dev Med Child Neurol |volume=46 |issue=10 |pages=652–60 |year=2004 |doi=10.1111/j.1469-8749.2004.tb00977.x |pmid=15473168}}</ref> AS is associated with [[tic]]s, [[Tourette syndrome]], and [[bipolar disorder]], and the repetitive behaviors of AS have many similarities with the symptoms of [[obsessive-compulsive disorder]] and [[obsessive-compulsive personality disorder]].<ref>{{cite journal |author= Gillberg C, Billstedt E |title= Autism and Asperger syndrome: coexistence with other clinical disorders |journal= Acta Psychiatr Scand |volume=102 |issue=5 |pages=321–30 |year=2000 |doi=10.1034/j.1600-0447.2000.102005321.x |pmid=11098802}}</ref> However many of these studies are based on [[sampling bias|clinical samples]] or lack standardized measures; nonetheless, comorbid conditions are relatively common.<ref name=Woodbury-Smith/>
+Anxiety disorder and major depressive disorder are the most common conditions seen at the same time; [[comorbidity]] of these in persons with AS is estimated at 65%.<ref name=McPartland/> Depression is common in adolescents and adults; children are likely to present with [[Attention-deficit hyperactivity disorder|ADHD]].<ref name=Ghaziuddin><!-- This article is not available online, even though all the other articles in that journal issue are online. What gives? Perhaps we can find a better source? -->{{cite journal |author= Ghaziuddin M, Weidmer-Mikhail E, Ghaziuddin N |title= Comorbidity of Asperger syndrome: a preliminary report |journal= J Intellect Disabil Res |volume=42 |issue=4 |pages=279–283 |year=1998 |pmid=9786442 |doi=  10.1111/j.1365-2788.1998.tb01647.x}}</ref> Reports have associated AS with [[medical conditions]] such as [[aminoaciduria]] and [[ligamentous laxity]], but these have been case reports or small studies and no factors have been associated with AS across studies.<ref name="McPartland"/> One study of males with AS found an increased rate of [[epilepsy]] and a high rate (51%) of [[nonverbal learning disorder]].<ref>{{cite journal |author= Cederlund M, Gillberg C |title= One hundred males with Asperger syndrome: a clinical study of background and associated factors |journal= Dev Med Child Neurol |volume=46 |issue=10 |pages=652–660 |year=2004 |doi=10.1111/j.1469-8749.2004.tb00977.x |pmid=15473168}}</ref> AS is associated with [[tic]]s, [[Tourette syndrome]], and [[bipolar disorder]], and the repetitive behaviors of AS have many similarities with the symptoms of [[obsessive-compulsive disorder]] and [[obsessive-compulsive personality disorder]].<ref>{{cite journal |author= Gillberg C, Billstedt E |title= Autism and Asperger syndrome: coexistence with other clinical disorders |journal= Acta Psychiatr Scand |volume=102 |issue=5 |pages=321–330 |year=2000 |doi=10.1034/j.1600-0447.2000.102005321.x |pmid=11098802}}</ref> However many of these studies are based on [[sampling bias|clinical samples]] or lack standardized measures; nonetheless, comorbid conditions are relatively common.<ref name=Woodbury-Smith/>
 ==History==
@@ Line 141: / Line 141: @@
 Named after the Austrian pediatrician [[Hans Asperger]] (1906–1980), Asperger syndrome is a relatively new diagnosis in the field of autism.<ref name="What'sSpecial">{{cite journal |author= Baron-Cohen S, Klin A |title= What's so special about Asperger Syndrome? |journal= Brain Cogn |volume=61 |issue=1 |pages=1–4 |year=2006 |pmid=16563588 |doi=10.1016/j.bandc.2006.02.002 |url=http://www.elsevier.com/authored_subject_sections/S05/S05_360/pdf/klin.pdf |format=PDF}}</ref>
-As a child, Asperger appears to have exhibited some features of the very condition named after him, such as remoteness and talent in language.<ref>{{cite journal |journal=J Autism Dev Disord |year=2007 |title=Did Hans Asperger (1906–1980) have Asperger Syndrome? |author=Lyons V, Fitzgerald M |doi=10.1007/s10803-007-0382-4 |pmid=17917805 |volume=37 |pages=2020–1 |issue=10 }}</ref><ref>{{cite book |author=Osborne L |title=American Normal: The Hidden World of Asperger Syndrome |publisher=Copernicus |year=2002 |isbn=0-387-95307-8 |page=19}}</ref> In 1944, Asperger described four children in his practice<ref name=Baskin>{{cite journal |author= Baskin JH, Sperber M, Price BH |title= Asperger syndrome revisited |journal= Rev Neurol Dis |volume=3 |issue=1 |pages=1–7 |year=2006 |pmid=16596080}}</ref> who had difficulty in integrating themselves socially. The children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Asperger called the condition "autistic psychopathy" and described it as primarily marked by [[social isolation]].<ref name=NINDS/> Unlike today's AS, autistic psychopathy could be found in people of all levels of intelligence, including those with mental retardation.<ref>{{cite book |author= Wing L |chapter= The relationship between Asperger's syndrome and Kanner's autism |editor= Frith U |title= Autism and Asperger syndrome |year=1991 |publisher= Cambridge University Press |isbn=0-521-38608-X |pages=93–121}}</ref> In the context of the [[Nazi eugenics]] policy of sterilizing and killing social deviants and the mentally handicapped, Asperger 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."<ref name=ha/> Asperger also called his young patients "little professors",<ref name=ha>{{cite book |author= Asperger H; tr. and annot. Frith U |origyear=1944 |chapter= 'Autistic psychopathy' in childhood |editor= Frith U |title= Autism and Asperger syndrome |year=1991 |publisher= Cambridge University Press |isbn=0-521-38608-X |pages=37–92}}</ref> and believed some would be capable of exceptional achievement and original thought later in life.<ref name="Baskin"/> His paper was published during wartime and in German, so it was not widely read elsewhere.
+As a child, Asperger appears to have exhibited some features of the very condition named after him, such as remoteness and talent in language.<ref>{{cite journal |journal=J Autism Dev Disord |year=2007 |title=Did Hans Asperger (1906–1980) have Asperger Syndrome? |author=Lyons V, Fitzgerald M |doi=10.1007/s10803-007-0382-4 |pmid=17917805 |volume=37 |pages=2020–2021 |issue=10 }}</ref><ref>{{cite book |author=Osborne L |title=American Normal: The Hidden World of Asperger Syndrome |publisher=Copernicus |year=2002 |isbn=0-387-95307-8 |page=19}}</ref> In 1944, Asperger described four children in his practice<ref name=Baskin>{{cite journal |author= Baskin JH, Sperber M, Price BH |title= Asperger syndrome revisited |journal= Rev Neurol Dis |volume=3 |issue=1 |pages=1–7 |year=2006 |pmid=16596080}}</ref> who had difficulty in integrating themselves socially. The children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Asperger called the condition "autistic psychopathy" and described it as primarily marked by [[social isolation]].<ref name=NINDS/> Unlike today's AS, autistic psychopathy could be found in people of all levels of intelligence, including those with mental retardation.<ref>{{cite book |author= Wing L |chapter= The relationship between Asperger's syndrome and Kanner's autism |editor= Frith U |title= Autism and Asperger syndrome |year=1991 |publisher= Cambridge University Press |isbn=0-521-38608-X |pages=93–121}}</ref> In the context of the [[Nazi eugenics]] policy of sterilizing and killing social deviants and the mentally handicapped, Asperger 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."<ref name=ha/> Asperger also called his young patients "little professors",<ref name=ha>{{cite book |author= Asperger H; tr. and annot. Frith U |origyear=1944 |chapter= 'Autistic psychopathy' in childhood |editor= Frith U |title= Autism and Asperger syndrome |year=1991 |publisher= Cambridge University Press |isbn=0-521-38608-X |pages=37–92}}</ref> and believed some would be capable of exceptional achievement and original thought later in life.<ref name="Baskin"/> His paper was published during wartime and in German, so it was not widely read elsewhere.
-[[Lorna Wing]] popularized the term ''Asperger syndrome'' in the English-speaking medical community in her 1981 publication<ref>{{cite journal |author= Wing L |title= Asperger's syndrome: a clinical account |journal= Psychol Med |volume=11 |issue=1 |pages=115–29 |year=1981 |doi=10.1017/S0033291700053332 |pmid=7208735 |url=http://www.mugsy.org/wing2.htm |accessdate=2007-08-15}}</ref> of a series of case studies of children showing similar symptoms,<ref name="What'sSpecial"/> and [[Uta Frith]] translated Asperger's paper to English in 1991.<ref name=ha/> Sets of diagnostic criteria were outlined by Gillberg and Gillberg in 1989 and by Szatmari ''et al.'' in the same year.<ref name="Mattila">{{cite journal |author= Mattila ML, Kielinen M, Jussila K ''et al.'' |title= An epidemiological and diagnostic study of Asperger syndrome according to four sets of diagnostic criteria |journal= J Am Acad Child Adolesc Psychiatry |volume=46 |issue=5 |pages=636–46 |year=2007 |pmid=17450055 |doi=10.1097/chi.0b013e318033ff42}}</ref> AS became a standard diagnosis in 1992, when it was included in the tenth 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 [[American Psychiatric Association]]'s diagnostic reference, ''Diagnostic and Statistical Manual of Mental Disorders'' ([[DSM-IV]]).<ref name=NINDS/>
+[[Lorna Wing]] popularized the term ''Asperger syndrome'' in the English-speaking medical community in her 1981 publication<ref>{{cite journal |author= Wing L |title= Asperger's syndrome: a clinical account |journal= Psychol Med |volume=11 |issue=1 |pages=115–29 |year=1981 |doi=10.1017/S0033291700053332 |pmid=7208735 |url=http://www.mugsy.org/wing2.htm |accessdate=2007-08-15}}</ref> of a series of case studies of children showing similar symptoms,<ref name="What'sSpecial"/> and [[Uta Frith]] translated Asperger's paper to English in 1991.<ref name=ha/> Sets of diagnostic criteria were outlined by Gillberg and Gillberg in 1989 and by Szatmari ''et al.'' in the same year.<ref name="Mattila">{{cite journal |author= Mattila ML |title= An epidemiological and diagnostic study of Asperger syndrome according to four sets of diagnostic criteria |journal= J Am Acad Child Adolesc Psychiatry |volume=46 |issue=5 |pages=636–646 |year=2007 |pmid=17450055 |doi=10.1097/chi.0b013e318033ff42 |author-separator= , |author2= Kielinen M |author3= Jussila K |display-authors= 3 |last4= Linna |first4= Sirkka-Liisa |last5= Bloigu |first5= Risto |last6= Ebeling |first6= Hanna |last7= Moilanen |first7= Irma}}</ref> AS became a standard diagnosis in 1992, when it was included in the tenth 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 [[American Psychiatric Association]]'s diagnostic reference, ''Diagnostic and Statistical Manual of Mental Disorders'' ([[DSM-IV]]).<ref name=NINDS/>
 Hundreds of books, articles and websites now describe AS, and prevalence estimates have increased dramatically for ASD, with AS recognized as an important subgroup.<ref name="What'sSpecial"/> Whether it should be seen as distinct from high-functioning autism is a fundamental issue requiring further study,<ref name="Baskin"/> and there are questions about the [[empirical validation]] of the DSM-IV and ICD-10 criteria.<ref name="Klin"/>
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 {{See|Sociological and cultural aspects of autism}}
 People identifying with Asperger syndrome may refer to themselves in casual conversation as ''aspies'', coined by [[Liane Holliday Willey]] in 1999.<ref>{{cite book |author= Willey LH |title= Pretending to be Normal: Living with Asperger's Syndrome |publisher= Jessica Kingsley |year=1999 |isbn=1-85302-749-9}}</ref> The word ''[[neurotypical]]'' (abbreviated ''NT'') describes a person whose neurological development and state are typical, and is often used to refer to non-autistic people.
-The [[Internet]] has allowed individuals with AS to communicate and [[Autistic Pride Day|celebrate]] [[diversity]] with each other in a way that was not previously possible because of their rarity and geographic dispersal. A [[Sociological and cultural aspects of autism|subculture of aspies]] has formed. Internet sites like [[Wrong Planet]] have made it easier for individuals to connect.<ref name=Clarke>{{cite journal |journal= Disabil Soc |year=2007 |volume=22 |issue=7 |pages=761–76 |title= 'Surplus suffering': differences between organizational understandings of Asperger's syndrome and those people who claim the 'disorder' |author= Clarke J, van Amerom G |doi=10.1080/09687590701659618}}</ref>
+The [[Internet]] has allowed individuals with AS to communicate and [[Autistic Pride Day|celebrate]] [[diversity]] with each other in a way that was not previously possible because of their rarity and geographic dispersal. A [[Sociological and cultural aspects of autism|subculture of aspies]] has formed. Internet sites like [[Wrong Planet]] have made it easier for individuals to connect.<ref name=Clarke>{{cite journal |journal= Disabil Soc |year=2007 |volume=22 |issue=7 |pages=761–776 |title= 'Surplus suffering': differences between organizational understandings of Asperger's syndrome and those people who claim the 'disorder' |author= Clarke J, van Amerom G |doi=10.1080/09687590701659618}}</ref>
 Autistic people have advocated a shift in perception of autism spectrum disorders as complex [[syndrome]]s rather than diseases that must be cured. Proponents of this view reject the notion that there is an "ideal" brain configuration and that any deviation from the norm is [[Anatomical pathology|pathological]]; they promote tolerance for what they call [[neurodiversity]].<ref>{{cite book |author= Williams CC |chapter= In search of an Asperger |editor= Stoddart KP |title= Children, Youth and Adults with Asperger Syndrome: Integrating Multiple Perspectives |year=2005 |publisher= Jessica Kingsley |isbn=1-84310-319-2 |pages=242–52 |quote= The life prospects of people with AS would change if we shifted from viewing AS as a set of dysfunctions, to viewing it as a set of differences that have merit.}}</ref> These views are the basis for the [[Autism rights movement|autistic rights]] and [[Sociological and cultural aspects of autism#Autistic pride|autistic pride]] movements.<ref>{{cite book |author= Dakin CJ |chapter= Life on the outside: A personal perspective of Asperger syndrome |editor= Stoddart KP |title= Children, Youth and Adults with Asperger Syndrome: Integrating Multiple Perspectives |year=2005 |publisher= Jessica Kingsley |isbn=1-84310-319-2 |pages=352–61}}</ref> There is a contrast between the attitude of adults with self-identified AS, who typically do not want to be cured and are proud of their identity, and parents of children with AS, who typically seek assistance and a cure for their children.<ref>{{cite journal |author= Clarke J, van Amerom G |title= Asperger's syndrome: differences between parents' understanding and those diagnosed |journal= Soc Work Health Care |volume=46 |issue=3 |pages=85–106 |year=2008 |pmid=18551831 |doi=10.1300/J010v46n03_05}}</ref>
-Some researchers have argued that AS can be viewed as a different cognitive style, not a disorder or a disability,<ref name=Clarke/> and that it should be removed from the standard ''[[Diagnostic and Statistical Manual]]'', much as [[homosexuality]] was removed.<ref>{{cite journal |journal=Disabil Soc |year=2009 |volume=24 |issue=3 |pages=343–55 |title=Reframing Asperger syndrome: lessons from other challenges to the ''Diagnostic and Statistical Manual'' and ICIDH approaches |author=Allred S |doi=10.1080/09687590902789511 }}</ref> In a 2002 paper, [[Simon Baron-Cohen]] wrote of those with AS, "In the social world there is no great benefit to a precise eye for detail, but in the worlds of maths, computing, cataloguing, music, linguistics, engineering, and science, such an eye for detail can lead to success rather than failure." Baron-Cohen cited two reasons why it might still be useful to consider AS to be a disability: to ensure provision for legally required special support, and to recognize emotional difficulties from reduced empathy.<ref name=BaronCohen2002>{{cite journal |journal= Focus Autism Other Dev Disabl |year=2002 |volume=17 |issue=3 |pages=186–91 |title= Is Asperger syndrome necessarily viewed as a disability? |author= Baron-Cohen S |doi=10.1177/10883576020170030801}} A preliminary, freely readable draft, with slightly different wording in the quoted text, is in: {{cite web |url=http://autismresearchcentre.com/docs/papers/2002_BC_ASDisability.pdf |format=PDF |accessdate=2008-12-02 |year=2002 |author= Baron-Cohen S |title= Is Asperger's syndrome necessarily a disability? |publisher= Autism Research Centre |location= Cambridge}}</ref> It has been argued that the genes for Asperger's combination of abilities have operated throughout recent [[human evolution]] and have made remarkable contributions to human history.<ref>{{cite book |title= Foundations of Evolutionary Psychology |chapter= The evolution of brain mechanisms for social behavior |author= Baron-Cohen S |pages=415–32 |editor= Crawford C, Krebs D (eds.) |publisher= Lawrence Erlbaum |year=2008 |isbn=0-8058-5957-8}}</ref>
+Some researchers have argued that AS can be viewed as a different cognitive style, not a disorder or a disability,<ref name=Clarke/> and that it should be removed from the standard ''[[Diagnostic and Statistical Manual]]'', much as [[homosexuality]] was removed.<ref>{{cite journal |journal=Disabil Soc |year=2009 |volume=24 |issue=3 |pages=343–355 |title=Reframing Asperger syndrome: lessons from other challenges to the ''Diagnostic and Statistical Manual'' and ICIDH approaches |author=Allred S |doi=10.1080/09687590902789511 }}</ref> In a 2002 paper, [[Simon Baron-Cohen]] wrote of those with AS, "In the social world there is no great benefit to a precise eye for detail, but in the worlds of maths, computing, cataloguing, music, linguistics, engineering, and science, such an eye for detail can lead to success rather than failure." Baron-Cohen cited two reasons why it might still be useful to consider AS to be a disability: to ensure provision for legally required special support, and to recognize emotional difficulties from reduced empathy.<ref name=BaronCohen2002>{{cite journal |journal= Focus Autism Other Dev Disabl |year=2002 |volume=17 |issue=3 |pages=186–191 |title= Is Asperger syndrome necessarily viewed as a disability? |author= Baron-Cohen S |doi=10.1177/10883576020170030801}} A preliminary, freely readable draft, with slightly different wording in the quoted text, is in: {{cite web |url=http://autismresearchcentre.com/docs/papers/2002_BC_ASDisability.pdf |format=PDF |accessdate=2008-12-02 |year=2002 |author= Baron-Cohen S |title= Is Asperger's syndrome necessarily a disability? |publisher= Autism Research Centre |location= Cambridge}}</ref> It has been argued that the genes for Asperger's combination of abilities have operated throughout recent [[human evolution]] and have made remarkable contributions to human history.<ref>{{cite book |title= Foundations of Evolutionary Psychology |chapter= The evolution of brain mechanisms for social behavior |author= Baron-Cohen S |pages=415–32 |editor= Crawford C, Krebs D (eds.) |publisher= Lawrence Erlbaum |year=2008 |isbn=0-8058-5957-8}}</ref>
 {{portal|Pervasive Developmental Disorders}}

v t e Autism spectrum
Main	Causes Diagnosis Epidemiology Epigenetics Heritability History Memory Pathophysiology Sex and gender Societal and cultural aspects Therapies
Diagnoses	Pervasive developmental disorder Classic autism Asperger syndrome Pervasive developmental disorder not otherwise specified Childhood disintegrative disorder High-functioning autism
Associated conditions and phenomena	Alexithymia Autism and LGBT identities Autistic burnout Autistic catatonia Autistic masking Autistic meltdown Hyperlexia Late talker Monotropism Nonverbal autism Pathological demand avoidance Savant syndrome Special interests Stimming
Comorbid conditions	Avoidant/restrictive food intake disorder Attention deficit hyperactivity disorder Anxiety disorder obsessive–compulsive disorder Developmental coordination disorder Epilepsy Intellectual disability Sensory processing disorder Global developmental delay Verbal Dyspraxia
Associated syndromes	Fragile X syndrome Rett syndrome
Related issues	Autism rights movement Critical autism studies Double empathy problem Multiple complex developmental disorder Neurodiversity TEACCH program Violence and autism
Controversies	Facilitated communication Lancet MMR autism fraud MMR vaccine Rapid prompting method Thiomersal Chelation
Diagnostic scales	Autism Diagnostic Interview Autism Diagnostic Observation Schedule Autism-spectrum quotient Childhood Autism Rating Scale Gilliam Asperger's disorder scale
Lists	Autism-related topics Fictional characters Schools
Accommodations	Autism-friendly Sensory friendly