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Autism

The Difference Between Asperger's and Autism Spectrum Disorder

Why confusion still surrounds high-functioning autism and Asperger's.

Key points

  • "Asperger's syndrome" was introduced as a diagnostic category in the DSM-IV in 1994.
  • It was replaced in 2013 with the all-encompassing "autism spectrum disorder." Asperger's is analogous to "level 1 autism."
  • The term "Asperger's" is still commonly used by many people.
  • It may be that some people continue to use "Asperger's" because the broad category of autism does not represent their identity or experience.

The terminology related to autism can be confusing.

Hans Asperger, an Austrian psychiatrist and paediatrician, first identified a subset of children of average intelligence or above who otherwise displayed autism symptoms in the 1940s. His work gained popularity in the 1980s and a diagnosis known as “Asperger’s syndrome” was included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders between 1994 and 2013 (DSM-IV). By 2013, with the publication of DSM-5, Asperger’s syndrome had been dropped as a category and folded into the more general category of "autism spectrum disorder"; terms such as “level 1 autism” or, more colloquially, “high-functioning autism" are now more commonly used to describe what was once called Asperger's.

Peter Burdon, Unsplash
Source: Peter Burdon, Unsplash

What is Asperger’s Syndrome, Level 1 Autism, or High-Functioning Autism?

Autism is a developmental disorder, which means that people are born with it and tend to display symptoms early in life, often before the age of two. People with autism tend to display difficulties in the following areas:

People with level 1 autism (or what was previously categorised as Asperger’s syndrome) face those same difficulties, but are of average or above-average intelligence and can lead either independent lives or only require some support. This is in contrast to people with level 2 autism, who require "substantial" levels of support, and level 3 autism, which is characterised by severe deficits in verbal and non-verbal communication and where a "very substantial" level of support is also required. In simpler (though not entirely helpful) terms, level 1 is a milder form of autism and level 3 is the most severe form of autism.

Why Was Asperger’s Left Out of DSM-5?

Rather than continuing to view Asperger’s syndrome as a separate category, experts decided that with the publication of the DSM-5, autism should be considered a “spectrum disorder.” This distinction recognised the similarities between the causes and symptoms of autism, regardless of its severity. The different levels, therefore, were established to distinguish between presentations of varying severity.

This conception of autism was not entirely new. From its initial inclusion in the DSM-IV, some researchers were concerned about the Asperger’s diagnosis, as they felt it was simply a variation of autism.1

Was Asperger’s Linked with Nazism?

Some prominent historians have argued that Hans Asperger was complicit in Hitler’s regime of “euthanasia” in his bid to create a “genetically fit” German population.2 Psychiatrists and other physicians were involved in a Nazi programme that murdered children who were seen as either physically or mentally "inferior" or "undesirable." Asperger, along with some of his colleagues, attempted to mould certain autistic children into "productive" citizens. He was also responsible for sending others to the Spiegelgrund clinic, where they were starved or given lethal injections. Asperger's complicity in the death of neurodiverse children has fueled some calls to further abandon the Asperger's label, even in a colloquial sense.

How Have People Responded to the Change?

While shifting to "autism spectrum disorder" has generally received the support of the medical community, the revision of the term “Asperger’s syndrome” to “autism spectrum disorder” was met with uncertainty in the autism community.3 Although the change took place nearly ten years ago, many people with autism continue to refer to themselves as having “Asperger’s” or being “Aspies.”

Research shows that some autistic people strongly identified with an “Aspie” identity, and some viewed the diagnostic shift as “taking away our identity.”4 From celebrities such as Chris Packham and Elon Musk—who continue to refer to themselves as having Asperger’s—to the wide range of blogs and books which continue to use the term, it’s evident that for many, there is some kind of desire for this particular identity.

On the other hand, there are those who have been happy to be able to identify with the term "autism." Some of these people, however, dislike the distinction between level 1 and other types of autism; they may also reject terms such as "high-functioning," stressing the similarities between themselves and others with more severe, and limiting, types of autism.

Why Some People Continue to Use "Asperger's Syndrome"

One of the issues with letting go of Asperger’s may be that the category of autism spectrum disorder is very broad. It, perhaps, doesn’t speak specifically enough to people who might be leading independent lives, holding down jobs, and functioning at a high level. It may be difficult for some of these people to identify with a condition that is often linked to severe intellectual disability.

Those who identify as “Aspies” tend to consider themselves "quirky," "weird," or socially awkward, as well as highly intelligent and perhaps an expert in their field. It may be harder for them to find a positive identity in such a broad diagnostic category as "autism spectrum disorder." Some people who continue to use the term Asperger’s syndrome were likely also diagnosed with the condition prior to 2013, and may find it difficult to update their language or long-held self-image.

Where to Next?

My personal preference is for the term autism. Although language changes and takes on new meaning, and “Asperger’s” is a term that has taken on positive connotations for many, as soon as I found out about Asperger’s likely involvement in the Nazi eugenics movement, his was not a name I wanted associated with mine.

It could be that if celebrities who continue to use the term shifted to “level 1 autism” or publicly discussed why Asperger’s is no longer a recognised diagnosis, more people would drop it as a term. "High-functioning" is a term that sits comfortably with many autistic people in preference to "level 1," which may not seem to describe their experience. Some people, however, reject "high-functioning" as a term because it both downplays their difficulties, and acts as a judgement on others with more severe forms of autism. Whether or not “autism” is a term that those who enjoy being part of an “Aspie” community can embrace remains to be seen.

References

1. Rutter, M and Schopler, E (1992) Classification of pervasive developmental disorders: some concepts and practical considerations, Journal of Autism and Developmental Disorders, 22, 459-482

2. Scheffer, E (2018) Aspberger’s children: the origins of autism in Nazi Vienna.

3. Parsloe, SM & Babrow, AS (2016) Removal of Aspberger’s syndrome from the DSM V: community response to uncertainty, Journal of Health Communication, 31(4): 485-94

4. Giles, DC (2014) ‘DSM-V is taking away our identity’: the reaction of the online community to the proposed changes in the diagnosis of Aspberger’s disorder, Health, 18(2): 179-95

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