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 between them.

 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:

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, 1995).    

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 recognized.

Asperger Syndrome

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, 4^th 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 and HFA.

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:

             Bauer, S. (1996). Asperger syndrome. The O.A.S.I.S. (Online Asperger Syndrome Information and Support) Web Page. Available:
http://www.udel.edu/bkirby/asperger.

             Forrest, B. The Boundaries between Asperger and Nonverbal Learning Disability Syndromes Available: http://www.nldline.com/bonny_forrest_asvsnld.htm.

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