History of Asperger syndrome
Asperger syndrome (AS) is an autism spectrum disorder (ASD). It is a relatively new diagnosis in the field of autism. It was named in honor of Hans Asperger (1906–80), who was an Austrian psychiatrist and pediatrician. An English psychiatrist, Lorna Wing, popularized the term "Asperger's syndrome" in a 1981 publication; the first book in English on Asperger syndrome was written by Uta Frith in 1991 and the condition was subsequently recognized in formal diagnostic manuals later in the 1990s.
Discovery of autistic psychopathy
Hans Asperger was the director of the University of Vienna Children's Clinic. As a result, he spent most of his professional life in Vienna. Throughout Asperger's career, he was also a pediatrician, medical theorist, and medical professor. His works were published largely in German. He is most well known for his work with mental disorders, especially those in children. As a child, Asperger appeared to have exhibited some features of the very condition named after him, such as social remoteness and talent in language.
Asperger's 1944 work, Autistic psychopathy in childhood, found that four of the 200 children studied had difficulty with integrating themselves socially. Although their intelligence levels appeared normal, the children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Their verbal communication was either disjointed or overly formal, and their all-absorbing interest in a single topic dominated their conversations. Asperger named the condition "autistic psychopathy", and described it as primarily marked by social isolation. Asperger described those patients as like "little professors", and believed the individuals he described would be capable of exceptional achievement and original thought later in life. Asperger's paper defended the value of high-functioning autistic individuals, writing "We are convinced, then, that autistic people have their place in the organism of the social community. They fulfill 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." However, he also wrote concerning his other cases, "Unfortunately, in the majority of cases the positive aspects of autism do not outweigh the negative ones."
Relationship to Kanner's work
Two subtypes of autism were described between 1943 and 1944 by two Austrian researchers working independently—Austrian-born Asperger and child psychiatrist Leo Kanner (1894–1981). Kanner emigrated to the United States in 1924; he described a similar syndrome in 1943, known as "classic autism" or "Kannerian autism", characterized by significant cognitive and communicative deficiencies, including delayed or absent language development. Kanner's descriptions were influenced by the developmental approach of Arnold Gesell, while Asperger was influenced by accounts of schizophrenia and personality disorders. Asperger's frame of reference was Eugen Bleuler's typology, which Christopher Gillberg has described as "out of keeping with current diagnostic manuals", adding that Asperger's descriptions are "penetrating but not sufficiently systematic". Asperger was unaware of Kanner's description published a year before his; the two researchers were separated by an ocean and a raging war, and Asperger's descriptions were unnoticed in the United States. During his lifetime, Asperger's work, in German, remained largely unknown outside the German-speaking world.
According to Ishikawa and Ichihashi in the Japanese Journal of Clinical Medicine, the first author to use the term Asperger's syndrome in the English-language literature was the German physician, Gerhard Bosch. Between 1951 and 1962, Bosch worked as a psychiatrist at Frankfurt University. In 1962, he published a monograph detailing five case histories of individuals with PDD that was translated into English eight years later, becoming one of the first to establish German research on autism, and attracting attention outside the German-speaking world.
Lorna Wing is credited with widely popularizing the term "Asperger's syndrome" in the English-speaking medical community in her 1981 publication of a series of case studies of children showing similar symptoms. Wing also placed AS on the autism spectrum, although Asperger was uncomfortable characterizing his patient on the continuum of autistic spectrum disorders. She chose "Asperger's syndrome" as a neutral term to avoid the misunderstanding equated by the term autistic psychopathy with sociopathic behavior. Wing's publication effectively introduced the diagnostic concept into American psychiatry and renamed the condition as Asperger's; however, her accounts blurred some of the distinctions between Asperger's and Kanner's descriptions because she included some mildly retarded children and some children who presented with language delays early in life.
The first systematic studies appeared in the late 1980s in publications by Tantam (1988) in the UK, Gillberg and Gilbert in Sweden (1989), and Szatmari, Bartolucci and Bremmer (1989) in North America. The diagnostic criteria for AS were outlined by Gillberg and Gillberg in 1989; Szatmari also proposed criteria in 1989. Asperger's work became more widely available in English when Uta Frith, an early researcher of Kannerian autism, translated his original paper in 1991. AS became a distinct diagnosis in 1992, when it was included in the 10th published edition of the World Health Organization’s diagnostic manual, International Classification of Diseases (ICD-10); in 1994, it was added to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as Asperger's Disorder. When Hans Asperger observed the autistic like symptoms and behaviors in boys through their social and communication skills, many professionals felt like Asperger's syndrome was just a less severe form of autism. Uta Frith was one of these professionals who had this opinion. She was a professor at the Institute of Cognitive Neuroscience of University College London, and was also an editor of Autism and Asperger Syndrome. She said that individuals with Asperger's had a "dash of autism". She was one of the first scientists who recognized autism and related disorders as the result of a condition of the brain instead of the outcome of detached parenting.
Less than two decades after the widespread introduction of AS to English-speaking audiences, there are hundreds of books, articles and websites describing it; prevalence estimates have increased dramatically for ASD, with AS recognized as an important subgroup. However, questions remain concerning many aspects of AS; whether it should be a separate condition from high-functioning autism is a fundamental issue requiring further study. The diagnostic validity of Asperger syndrome is tentative, there is little consensus among clinical researchers about the usage of the term "Asperger's syndrome", and there are questions about the empirical validation of the DSM-IV and ICD-10 criteria. It is likely that the definition of the condition will change as new studies emerge and it will eventually be understood as a multifactorial heterogeneous neurodevelopmental disorder involving a catalyst that results in prenatal or perinatal changes in brain structures.
There is uncertainty regarding the gender gap between males and females with AS. A person with Asperger's is often remarked as possessing masculine traits like emotional distance from the inability to empathize, and far more boys than girls are diagnosed with Asperger's.[unreliable medical source?] Most studies on the syndrome were derived from research on males, neglecting specific attention to females with AS who often go misdiagnosed. For the most part, studies on girls with Asperger's are anecdotal.
Changes in DSM-5
In 1994, Asperger's Syndrome was added to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). In the DSM-IV, it was considered to be a separate disorder from autism. Just like in the 1940s, there are still many professionals that believe that Asperger's is just a less severe form of autism. The DSM-V made a new, broad diagnosis in 2013. It was the autism spectrum disorder. In this category is what was once Autistic Disorder, Asperger's Syndrome, and other developmental disorders that are related. There are different levels of severity now, rather than the different diagnoses. ASD is now rated on a scale ranging from severe, through moderate, to mild, based on clinical presentation. The levels are determined by the amount of support the individual requires. Due to the change, individuals who were previously diagnosed with Asperger's Syndrome most likely were re-diagnosed within the umbrella of the autism spectrum disorder because of the DSM changes and revisions.
- Baron-Cohen S, Klin A (2006). "What's so special about Asperger Syndrome?" (PDF). Brain and cognition. 61 (1): 1–4. doi:10.1016/j.bandc.2006.02.002. PMID 16563588.
- Hippler, Kathrin; Klicpera, Christian (2003-02-28). "A retrospective analysis of the clinical case records of 'autistic psychopaths' diagnosed by Hans Asperger and his team at the University Children's Hospital, Vienna". Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences. 358 (1430): 291–301. doi:10.1098/rstb.2002.1197. ISSN 0962-8436. PMC . PMID 12639327.
- Lyons V, Fitzgerald M (2007). "Did Hans Asperger (1906–1980) have Asperger Syndrome?". J Autism Dev Disord. 37 (10): 2020–1. doi:10.1007/s10803-007-0382-4. PMID 17917805.
- Asperger H; tr.; annot. Frith U (1991) . "'Autistic psychopathy' in childhood". In Frith U. Autism and Asperger syndrome. d Cambridge University Press. pp. 37–92. ISBN 0-521-38608-X.
- Baskin JH, Sperber M, Price BH (2006). "Asperger syndrome revisited". Rev Neurol Dis. 3 (1): 1–7. PMID 16596080.
- National Institute of Neurological Disorders and Stroke (NINDS) (July 31, 2007). Asperger Syndrome Fact Sheet. Retrieved 24 August 2007.
- Felder, edited by James C. McPartland, Ami Klin, Fred R. Volkmar ; foreword by Maria Asperger (2014). Asperger syndrome : assessing and treating high-functioning autism spectrum disorders (Second ed.). New York: Guilford. p. 5. ISBN 1462514146. Retrieved 13 December 2016.
- Manouilenko I, Bejerot S (31 March 2015). "Sukhareva—Prior to Asperger and Kanner". Nordic Journal of Psychiatry (Report). Taylor & Francis. 69 (6): 1761–4. doi:10.3109/08039488.2015.1005022. ISSN 1502-4725. PMID 25826582.
- Kanner L (1943). "Autistic disturbances of affective contact". Nerv Child. 2: 217–50. Reprint (1968) Acta Paedopsychiatr 35 (4): 100–36. PMID 4880460.
- Klin A (2006). "Autism and Asperger syndrome: an overview". Rev Bras Psiquiatr. 28 (suppl 1): S3–S11. doi:10.1590/S1516-44462006000500002. PMID 16791390.
- Ehlers S, Gillberg C (1993). "The epidemiology of Asperger's syndrome. A total population study". J Child Psychol Psychiat. 34 (8): 1327–50. doi:10.1111/j.1469-7610.1993.tb02094.x. PMID 8294522. "Truncated version". Archived from the original on 2008-07-19. Retrieved 2008-06-15.
- Ishikawa G, Ichihashi K (2007). "[Autistic psychopathy or pervasive developmental disorder: how has Asperger's syndrome changed in the past sixty years?]". Nippon Rinsho (in Japanese). 65 (3): 409–18. PMID 17354550.
- (in German) Bosch G (1962). Der frühkindliche Autismus - eine klinische und phänomenologisch-anthropologische. Untersuchung am Leitfaden der Sprache. Berlin: Springer.
- Bosch G (1970). Infantile autism – a clinical and phenomenological anthropological investigation taking language as the guide. Berlin: Springer.
- Bölte S, Bosch G. "Bosch's Cases: a 40 years follow-up of patients with infantile autism and Asperger syndrome" (PDF). Journal of Psychiatry. Archived from the original (PDF) on 2004-04-11. Retrieved 2007-08-20.
- Wing L (1981). "Asperger's syndrome: a clinical account". Psychol Med. 11 (1): 115–29. doi:10.1017/S0033291700053332. PMID 7208735. Retrieved 2007-08-15.
- Mattila ML, Kielinen M, Jussila K, et al. (2007). "An epidemiological and diagnostic study of Asperger syndrome according to four sets of diagnostic criteria". Journal of the American Academy of Child and Adolescent Psychiatry. 46 (5): 636–46. doi:10.1097/chi.0b013e318033ff42. PMID 17450055.
- McPartland J, Klin A (2006). "Asperger's syndrome". Adolesc Med Clin. 17 (3): 771–88. doi:10.1016/j.admecli.2006.06.010 (inactive 2017-01-16). PMID 17030291.
- Flora, Carlin (Nov–Dec 2006). "An Aspie in the City". Psychology Today. Retrieved 2008-08-19.
- Wallis C (2009-11-02). "A powerful identity, a vanishing diagnosis". New York Times.