Asperger's Syndrome Is No Longer an Official Diagnosis

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Asperger's syndrome, also known as Asperger's disorder or simply Asperger's, is a developmental disorder affecting social skills and interactions and involving repetitive patterns of behavior. It was previously used as a diagnosis at the highest-functioning end of the autism spectrum.

Once regarded as one of the distinct types of autism, Asperger's syndrome was retired in 2013 with the publication of the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It is no longer used by clinicians as an official diagnosis.

Even so, the term is still used in some circumstances and by some practitioners, although people who were once regarded as having Asperger's syndrome would today be diagnosed as having level one autism spectrum disorder (ASD) per the revisions in the DSM-5.

Asperger's Syndrome

No longer an official diagnosis, Asperger's syndrome is an autism spectrum disorder in which a person has normal language and cognitive development, yet there are impairments in social interactions and repetitive patterns of behavior and interests.

Individuals may struggle with conversational skills and nonverbal communication (eye contact, facial expression, body postures). They may also have a narrow or intense focus on select fields of interest and above-average performance within these fields of interest.

History

Asperger's syndrome was named for an Austrian pediatrician, Hans Asperger, who in 1944 described four children who were highly intelligent but socially awkward and physically clumsy. However, he did not coin the term. It was a British psychiatrist, Lorna Wing, who in 1981 grouped together the symptoms under the diagnosis, naming it Asperger's syndrome. It was added to the DSM-IV in 1994.

The term was eliminated along with the other autism types in the DSM-5. Per the DSM-5, all people with autism receive a diagnosis of autism spectrum disorder.

Asperger's gained some notoriety in 2001 thanks to an article in Wired magazine titled "The Geek Syndrome,” where it was described as the "milder cousin" of autism. At the time, people with Asperger's often were regarded as being quirky, creative, anxious, and socially challenged.

Levels of ASD

The change to the DSM entry for Asperger's is somewhat controversial, as people who are not severely autistic and may have been previously diagnosed as having Asperger's now receive the same diagnosis as those who are non-verbal, intellectually challenged, and in need of significant daily support for basic life skills.

For clarity and to alleviate confusion, the DSM-5 describes three distinct levels of ASD based on the amount of support a person needs. The new definition of autism describes people as having a severity level between one, two, or three, based on how much support they need.

Level one is referred to as "requiring support," level two as "requiring substantial support," and level three as "requiring very substantial support."

Virtually everyone with a prior Asperger's syndrome diagnosis qualifies for a level one diagnosis, defined as “in need of a relatively low level of support.” Individuals presenting for the first time with relatively mild symptoms of autism will receive a first-time diagnosis of level one autism spectrum disorder as well, though this may be reassessed over time.

Level One

Those with level one ASD can speak in full sentences and engage in communication but they may struggle with back-and-forth conversation. In addition, their attempts to make friends may appear odd and are typically unsuccessful.

Social communication is categorized as follows for level one ASD:

  • Without supports in place, deficits in social communication cause noticeable impairments.
  • The person has difficulty initiating social interactions and shows atypical or unsuccessful responses to social cues.
  • They may appear to have decreased interest in social interactions.

For level two, deficits are apparent even with supports in place, and for level three, severe deficits cause severe impairments in functioning.

Restricted, repetitive behaviors for level one ASD include:

  • Inflexibility of behavior causes significant interference with functioning in one or more contexts.
  • The person has difficulty switching between activities.
  • Problems of organization and planning hamper independence.

For level two, restricted or repetitive behaviors appear frequently enough to be noticeable and interfere with functioning in a variety of contexts. For level three, the behaviors are severe and interfere in all contexts.

Continued Use of the Name

Despite being excluded from the DSM-5, Asperger's syndrome sometimes is still used in both the United States and in other countries. A common reason for this is that a diagnosis of ASD can carry stigma, and people who were previously diagnosed with Asperger's syndrome may still identify with the term and prefer it.

A 2017 study analyzing the effect of removing Asperger's syndrome from the DSM found the change "has the potential to threaten the identity of those affected," citing autism as a stigmatizing diagnostic label. Some advocacy groups and organizations continue to use the term as well, at least in part because some people continue to identify as having Asperger's, not autism.

Even so, medical consensus continues to move away from the Asperger's syndrome diagnosis. Following the DSM's lead, the 11th revision of the International Classification of Diseases (ICD-11), to take effect on January 1, 2022, has moved Asperger's syndrome under the autism spectrum disorder umbrella. The ICD-11 will be used by all World Health Organization member states.

A Word From Verywell

If you or a loved one has been diagnosed with level one autism spectrum disorder and/or your physician mentioned Asperger's syndrome, there are many supportive therapies and services, such as social skills trainings and cognitive behavioral therapy, that can be helpful.

You may also want to join a support group, such as the Asperger's/Autism Network's online support groups and discussion forums, to connect with other people and share experiences and resources.

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