Asperger Syndrome: History, Diagnosis and DSM-5 Changes

In 1944, Austrian pediatrician Hans Asperger identified four children with a specific pattern of behavior and abilities characterized by a lack of empathy, little ability to form friendships, one-sided conversations, intense absorption in a special interest, and clumsy movements.¹ Asperger called these children “little professors.”

These children differed from how Leo Kanner, the Austrian-American psychiatrist credited with laying the foundation for child and adolescent psychiatry, had described autism. In Asperger’s children, speech was less commonly delayed, motor deficits were more common, the onset appeared to be somewhat later, and all the initial cases occurred only in boys.² Asperger noticed that many of the children he identified as being autistic managed to use their special talents into adulthood and had excellent careers.

There was little acknowledgement of his 1944 research until 1991 when psychologist Uta Frith translated it into English in her book Autism and Asperger Syndrome. Though Asperger initially described the condition as autistic psychopathy in children, the term Asperger Syndrome (AS) was coined in an article by a British researcher Lorna Wing. “Asperger’s syndrome: a clinical account”³ was published in 1981 and challenged the previously accepted model of autism presented by Kanner. As a result, AS was included for the first time in 1994 as a diagnosis in DSM-IV.

As described in DSM-IV, AS is characterized by qualitative impairment in social interaction, restricted, repetitive and stereotyped patterns of behavior, interests and activities without significant delay in language, cognitive development, self help skills, adaptive behavior or curiosity about environment in childhood. Cognitive development is usually interpreted as having an IQ score above 70, and the language is specified as having single word use by two years of age and communicative phrases by three years of age.

Impairments of social interaction include deficits in use of multiple non-verbal behaviors (such as facial expression, eye-to-eye gaze), failure to develop peer relationships, lack of spontaneous seeking to share enjoyment or interests with others, and lack of social and emotional reciprocity. Behavioral manifestations include preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus, inflexible adherence to specific routines or rituals, stereotyped and repetitive motor mannerisms (e.g. hand flapping) or persistent preoccupation with parts of objects. These disturbances should cause impairment in functioning and criteria should not be met for another pervasive developmental disorder or schizophrenia.