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Asperger: Disability or Difference?
There is considerable debate regarding the
categorization of Asperger Syndrome (AS) and High Functioning Autism (HFA).
Some experts suggest they are one and the same. Others believe that AS
should not be considered a form of Autism but rather, a disorder in and of
itself. Still others believe that AS is not a disorder at all, but rather, a
difference. Some researchers have suggested that
the basic neuropsychological deficit is different for the two conditions,
but others have been unconvinced that any meaningful distinction can be made
In fact, it is likely that
there may be multiple underlying subtypes and mechanisms behind the broad
clinical picture of AS. This leaves room for some confusion regarding
diagnostic terms and it is likely that quite similar children across the
country have been diagnosed with AS, HFA, or PDD, depending upon by whom or
where they are evaluated.
Since AS itself shows a
range or spectrum of symptom severity, many less impaired children who might
meet criteria for that diagnosis receive no diagnosis at all and are viewed
as "unusual" or "just different," or are misdiagnosed with conditions such
as Attention Deficit Disorder, emotional disturbance, etc. Many in the field
believe that there is no clear boundary separating AS from children who are
"normal but different." There has been some discussion to list AS as a
separate category in the next DSM, and for the criteria to be more detailed
in order to facilitate diagnosis
A comparison of individuals with NLD and AS revealed
that they shared 20 of 21 similarities, including having higher verbal
skills and spatial discrepancies (Klin, et al., 1995). Stephen Bauer, M.D.,
M.P.H., Director, The Developmental Unit, The Genesee Hospital, Rochester,
New York, writes:
“It is not at all clear
that Asperger syndrome is just a milder
form of autism or that the conditions are linked by anything
more than their broad clinical similarities."
While researcher Uta Frith, describes individuals with
AS as "having a dash of autism" (Frith, 1991), Klin and his colleagues
demonstrate that the cognitive profiles of people with Autism and Asperger
Syndrome differ significantly (Klin, Volkmar, Sparrow, Cicchetti, & Rourke,
High Functioning Autism
Autism was first recognized
in the 1940s so it has been recognized for a long time. The essential
features of Autism is the presence of markedly abnormal impaired development
in social interaction and communication and a markedly restricted repertoire
of activity and interests (DSM-IV, 1994).
Autism is diagnosed on the basis of abnormalities in
the areas of social development, communicative development, and imagination,
together with marked repetitive or obsessive behavior or unusual, narrow
interests. Individuals with Autism may have an IQ at any level. If an
individual with Autism has an IQ in the normal range (or above), they are
said to have 'High-Functioning Autism' (HFA). There is no actual category in
the DSM-IV for HFA. This is simply a term that began to circulate as AS more
Asperger Syndrome (AS) (also
called Asperger disorder) is a relatively new category of developmental
disorder. The term has only come into more general use over the past fifteen
years. Asperger Syndrome was recognized by the Diagnostic and Statistical
Manual of Mental Disorders, 4th Edition (DSM-IV) for the first
time in 1994 although the disorder was described as far by as the 1940s by a
Viennese pediatrician, Hans Asperger (Bauer, 1996).
Asperger Syndrome is the
term applied to the mildest and highest functioning end of what is known as
the spectrum of Pervasive Developmental Disorders (or Autism spectrum). Like
all conditions along that spectrum it is felt to represent a
neurologically-based disorder of development, most often of unknown cause,
in which there are deviations or abnormalities in three broad aspects of
development: 1) social relatedness and social skills, 2) the use of language
for communicative purposes and 3) certain behavioral and stylistic
characteristics involving repetitive or perseverative features and a limited
but intense range of interests.
These three categories of
dysfunction can range from mild to severe and this continuum of symptoms is
important to consider when trying to understand AS because it is not clear
whether AS is a mild form of Autism or Pervasive Developmental Disorder (PDD)
or something entirely different.
Asperger Syndrome represents
that portion of the PDD continuum which is characterized by higher cognitive
abilities (e.g., at least normal IQ by definition and sometimes ranging up
into the very superior range) and by more normal language function compared
to other disorders of the spectrum. In fact, the presence of normal basic
language skills is now felt to be one of the criteria for the diagnosis of
AS, although there are nearly always more subtle difficulties with
pragmatic/social language (Bauer, 1996).
Many researchers feel it is
these two areas of relative strength that distinguish AS from other forms of
Autism and PDD and account for the better prognosis in AS. Developmentalists
have not reached consensus as to whether there is any difference between AS
The existence of AS as a separate diagnostic entity
from HFA remains controversial (Forrest, 2005). Much of this controversy
stems from the presence of children who have social deficits characteristic
of Autism but exhibit lesser degrees of language impairment. Part of the
argument is that it is difficult to diagnose a young child that does not
have language yet or has limited language. What might look like Autism may
look more like Asperger once the child develops language.
Other characteristics that differentiate
AS from HFA include:
The onset of symptoms occur earlier in HFA,
The outcome is usually more positive for AS than HFA,
Social and communication deficits are less severe in AS,
Intense interests are less prominent in AS,
Verbal IQ is higher than performance for AS,
Verbal IQ is lower and performance higher for HFA,
Clumsiness is seen more in AS,
Family history is more frequently positive with AS, and,
Neurological disorders are less common with AS.
(1996). Asperger syndrome. The O.A.S.I.S. (Online Asperger Syndrome
Information and Support) Web Page. Available:
Forrest, B. The Boundaries
between Asperger and Nonverbal Learning Disability Syndromes Available:
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