Asperger syndrome

The extent of the overlap between Asperger syndrome and other forms of autism, particularly what was sometimes called high-functioning autism is unclear.{{cite journal | vauthors = Klin A | s2cid = 34035031 | title = Autismo e síndrome de Asperger: uma visão geral | trans-title = Autism and Asperger syndrome: an overview | journal = Revista Brasileira de Psiquiatria | volume = 28 | issue = Suppl 1 | pages = S3–11 | date = May 2006 | language = pt-br | pmid = 16791390 | doi = 10.1590/S1516-44462006000500002 | doi-access = free}}{{cite journal | vauthors = Kasari C, Rotheram-Fuller E | title = Current trends in psychological research on children with high-functioning autism and Asperger disorder | journal = Current Opinion in Psychiatry | volume = 18 | issue = 5 | pages = 497–501 | date = September 2005 | pmid = 16639107 | doi = 10.1097/01.yco.0000179486.47144.61 | s2cid = 20438728}}{{cite journal | vauthors = Witwer AN, Lecavalier L | s2cid = 5316399 | title = Examining the validity of autism spectrum disorder subtypes | journal = Journal of Autism and Developmental Disorders | volume = 38 | issue = 9 | pages = 1611–24 | date = October 2008 | pmid = 18327636 | doi = 10.1007/s10803-008-0541-2}} The ASD classification is to some extent an artifact of how autism was discovered,{{cite journal | vauthors = Sanders JL | s2cid = 26351778 | title = Qualitative or quantitative differences between Asperger's disorder and autism? Historical considerations | journal = Journal of Autism and Developmental Disorders | volume = 39 | issue = 11 | pages = 1560–67 | date = November 2009 | pmid = 19548078 | doi = 10.1007/s10803-009-0798-0}} and it may not reflect the true nature of the spectrum;{{cite journal | vauthors = Szatmari P | title = The classification of autism, Asperger's syndrome, and pervasive developmental disorder | journal = Canadian Journal of Psychiatry | volume = 45 | issue = 8 | pages = 731–38 | date = October 2000 | pmid = 11086556 | doi = 10.1177/070674370004500806 | s2cid = 37243752 | doi-access = free}} methodological problems have beset Asperger syndrome as a valid diagnosis from the outset.{{cite book|chapter=History and development of autism spectrum disorders|year=2006|publisher=Elsevier Science|title=Early intervention for autism spectrum disorders: a critical analysis|page=21|isbn=978-0-08-044675-2|location=Amsterdam|chapter-url=https://books.google.com/books?id=XonQy12xCgEC&q=Early+intervention+for+autism+spectrum+disorders:+a+critical+analysis&pg=PP2|vauthors=Matson JL, Minshawi NF}}{{cite book|title=Asperger syndrome or high-functioning autism?|veditors=Schopler E, Mesibov GB, Kunce LJ|publisher=Plenum press|location=New York|year=1998|chapter=Premature popularization of Asperger syndrome|vauthors=Schopler E|pages=388–90|isbn=978-0-306-45746-3|chapter-url=https://books.google.com/books?id=jz_xbeWgG9AC&q=Asperger+syndrome+or+high-functioning+autism}} As noted above, in the 2010s, Asperger syndrome, as a separate diagnosis, was eliminated and folded into autism spectrum disorder in the DSM-5 and the ICD-11. Like the diagnosis of Asperger syndrome,{{cite journal | vauthors = Ghaziuddin M | s2cid = 7490308 | title = Should the DSM V drop Asperger syndrome? | journal = Journal of Autism and Developmental Disorders | volume = 40 | issue = 9 | pages = 1146–48 | date = September 2010 | pmid = 20151184 | doi = 10.1007/s10803-010-0969-z}} the change was controversial.{{cite journal | vauthors = Faras H, Al Ateeqi N, Tidmarsh L | title = Autism spectrum disorders | journal = Annals of Saudi Medicine | volume = 30 | issue = 4 | pages = 295–300 | year = 2010 | pmid = 20622347 | pmc = 2931781 | doi = 10.4103/0256-4947.65261 | doi-access = free }}

The World Health Organization (WHO) previously defined Asperger syndrome (AS) as one of the pervasive developmental disorders (PDD), which are a spectrum of psychological disorders that are characterized by abnormalities of social interaction and communication that pervade the individual's functioning, and by restricted and repetitive interests and behavior. Like other neurodevelopmental conditions, ASD begins in infancy or childhood, has a steady course without remission or relapse, and has impairments that result from maturation-related changes in various systems of the brain.{{cite book|chapter-url=http://apps.who.int/classifications/apps/icd/icd10online/?gf80.htm+f840|year=2006|title=International Statistical Classification of Diseases and Related Health Problems|edition=10th (ICD-10)|author=World Health Organization|chapter=F84. Pervasive developmental disorders|publisher=World Health Organization |isbn=978-92-4-154419-1}}

File:Autism-stacking-cans 2nd edit.jpg

As a pervasive developmental disorder, Asperger syndrome is distinguished by a pattern of symptoms rather than a single symptom. It is characterized by qualitative impairment in social interaction, by stereotyped and restricted patterns of behavior, activities, and interests, and by no clinically significant delay in cognitive development or general delay in language.{{cite book|title=Diagnostic and Statistical Manual of Mental Disorders|edition=4th, text revision (DSM-IV-TR)|author=American Psychiatric Association|year=2000|isbn=978-0-89042-025-6|chapter=Diagnostic criteria for 299.80 Asperger's Disorder (AD) |publisher=American Psychiatric Association|location=Arlington, VA}} Intense preoccupation with a narrow subject, one-sided verbosity, restricted prosody, and physical clumsiness are typical of the condition, but are not required for diagnosis.

Suicidal thoughts and behaviors are a serious concern within the autistic population. One study found that adults with Asperger syndrome exhibited suicidal thoughts at 9 times the rate of the general population. Of autistic study participants, 66% had experienced suicidal ideation, while 35% had planned or attempted suicide.{{cite journal | pmid = 26360578 | date = 2014 | last1 = Cassidy | first1 = S. | last2 = Bradley | first2 = P. | last3 = Robinson | first3 = J. | last4 = Allison | first4 = C. | last5 = McHugh | first5 = M. | last6 = Baron-Cohen | first6 = S. | title = Suicidal ideation and suicide plans or attempts in adults with Asperger's syndrome attending a specialist diagnostic clinic: A clinical cohort study | journal = The Lancet. Psychiatry | volume = 1 | issue = 2 | pages = 142–147 | doi = 10.1016/S2215-0366(14)70248-2 }}{{cite journal | vauthors = Newell V, Phillips L, Jones C, Townsend E, Richards C, Cassidy S | title = A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability | journal = Molecular Autism | volume = 14 | issue = 1 | pages = 12 | date = March 2023 | pmid = 36922899 | pmc = 10018918 | doi = 10.1186/s13229-023-00544-7 | doi-access = free }}

{{Further|Asperger syndrome and interpersonal relationships}}

A lack of demonstrated empathy affects aspects of social relatability for persons with Asperger syndrome.{{cite journal |vauthors=Baskin JH, Sperber M, Price BH |year=2006 |title=Asperger syndrome revisited |journal=Reviews in Neurological Diseases |volume=3 |issue=1 |pages=1–7 |pmid=16596080}} Individuals with Asperger syndrome experience difficulties in basic elements of social interaction, which may include a failure to develop friendships or to seek shared enjoyments or achievements with others (e.g., showing others objects of interest); a lack of social or emotional reciprocity; and impaired nonverbal behaviors in areas such as eye contact, facial expression, posture, and gesture.

People with Asperger syndrome may not be as withdrawn around others, compared with those with other forms of autism; they approach others, even if awkwardly. For example, a person with Asperger syndrome may engage in a one-sided, long-winded speech about a favorite topic, while misunderstanding or not recognizing the listener's feelings or reactions, such as a wish to change the topic of talk or end the interaction. This social awkwardness has been called "active but odd". Such failures to react appropriately to social interaction may appear as disregard for other people's feelings and may come across as rude or insensitive. However, not all individuals with Asperger syndrome will approach others. Some may even display selective mutism, not speaking at all to most people and excessively to specific others.{{cite web|url=http://emedicine.medscape.com/article/912296-overview|work=Medscape eMedicine|title=Asperger's Syndrome| vauthors = Brasic JR|date=7 July 2010|access-date=25 November 2010|url-status=live|archive-url= https://web.archive.org/web/20101223170232/http://emedicine.medscape.com/article/912296-overview |archive-date=23 December 2010}}

The cognitive ability of children with Asperger syndrome often allows them to articulate social norms in a laboratory context, where they may be able to show a theoretical understanding of other people's emotions; however, they typically have difficulty acting on this knowledge in fluid, real-life situations. People with Asperger syndrome may analyze and distill their observations of social interaction into rigid behavioral guidelines and apply these rules in awkward ways, such as forced eye contact, resulting in a demeanor that appears rigid or socially naïve. A history of failed attempts to establish reciprocal social relationships can cause autistic individuals to isolate themselves and cease attempts to engage; however, autistic people overwhelmingly report a desire for social contact and friendship.

The hypothesis that individuals with Asperger syndrome are predisposed to violent or criminal behavior has been investigated but is unsupported by data.{{cite journal | vauthors = Allen D, Evans C, Hider A, Hawkins S, Peckett H, Morgan H | title = Offending behaviour in adults with Asperger syndrome | journal = Journal of Autism and Developmental Disorders | volume = 38 | issue = 4 | pages = 748–58 | date = April 2008 | pmid = 17805955 | doi = 10.1007/s10803-007-0442-9 | s2cid = 12999370 }}{{cite journal |title=Violent behavior in autism spectrum disorders: Who's at risk? |journal=Aggression and Violent Behavior |year=2018 | vauthors = Del Pozzo J, Roché M, Silverstein S |volume=39 |pages=53–60 |doi=10.1016/j.avb.2018.01.007 }} More evidence suggests that children diagnosed with Asperger syndrome are more likely to be victims, rather than offenders.{{cite journal | vauthors = Tsatsanis KD | title = Outcome research in Asperger syndrome and autism | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 12 | issue = 1 | pages = 47–63, vi | date = January 2003 | pmid = 12512398 | doi = 10.1016/S1056-4993(02)00056-1 }}

A 2008 review found that about 80% of reported violent criminals with Asperger syndrome also had other coexisting psychotic psychiatric disorders such as schizoaffective disorder. The sample size of this review was small (n = 37).{{cite journal | vauthors = Newman SS, Ghaziuddin M | s2cid = 207158193 | title = Violent crime in Asperger syndrome: the role of psychiatric comorbidity | journal = Journal of Autism and Developmental Disorders | volume = 38 | issue = 10 | pages = 1848–52 | date = November 2008 | pmid = 18449633 | doi = 10.1007/s10803-008-0580-8}}

People with an Asperger profile might not be recognized for their empathetic qualities, due to variation in the ways empathy is felt and expressed. Some people feel deep empathy, but do not outwardly communicate these sentiments through facial expressions or language. Some people come to empathy through intellectual processes, using logic and reasoning to arrive at the feelings. People with Asperger profiles may be bullied or excluded by peers, and might as a result be guarded around people, which could appear as lack of empathy. People with Asperger profiles can still be caring individuals; indeed, it is particularly common for those with the profile to feel and exhibit deep concern for individual rights, human welfare, animal rights, environmental protection, and other global and humanitarian causes.{{Cite news | vauthors = Rourke A |date=2019-09-02 |title=Greta Thunberg responds to Asperger's critics: 'It's a superpower' |language=en-GB |work=The Guardian |url=https://www.theguardian.com/environment/2019/sep/02/greta-thunberg-responds-to-aspergers-critics-its-a-superpower |access-date=2023-02-02 |issn=0261-3077}}

Evidence suggests that in the "double empathy problem model, autistic people have a unique interaction style which is significantly more readable by other autistic people, compared to non-autistic people."{{Cite web |date=2016-03-29 |title=We May Have Been Wrong About Autism And Empathy |url=https://www.huffpost.com/entry/autism-empathy-brain-research_n_56f92575e4b014d3fe237413 |access-date=2022-04-08 |website=HuffPost UK |language=en}}{{Cite web |date=2016-07-29 |title=Asperger Profiles: Emotions and Empathy |url=https://www.aane.org/emotions-and-empathy/ |access-date=2022-04-08 |website=The Asperger / Autism Network (AANE) |language=en-US}}{{cite journal | vauthors = Patil I, Melsbach J, Hennig-Fast K, Silani G | title = Divergent roles of autistic and alexithymic traits in utilitarian moral judgments in adults with autism | journal = Scientific Reports | volume = 6 | issue = 1 | pages = 23637 | date = March 2016 | pmid = 27020307 | pmc = 4810325 | doi = 10.1038/srep23637 | bibcode = 2016NatSR...623637P }}{{cite journal | vauthors = Mitchell P, Sheppard E, Cassidy S | title = Autism and the double empathy problem: Implications for development and mental health | journal = The British Journal of Developmental Psychology | volume = 39 | issue = 1 | pages = 1–18 | date = March 2021 | pmid = 33393101 | doi = 10.1111/bjdp.12350 | s2cid = 230489027 | doi-access = free }}

People with Asperger syndrome can display behavior, interests, and activities that are restricted and repetitive and are sometimes abnormally intense or focused. They may stick to inflexible routines, move in stereotyped and repetitive ways, preoccupy themselves with parts of objects, or engage in compulsive behaviors like lining objects up to form patterns.

The pursuit of specific and narrow areas of interest is one of the most striking among possible features of AS. Individuals with AS may collect volumes of detailed information on a relatively narrow topic such as weather data or star names without necessarily having a genuine understanding of the broader topic. For example, a child might memorize camera model numbers while caring little about photography. This behavior is usually apparent by age five or six. Although these special interests may change from time to time, they typically become more unusual and narrowly focused and often dominate social interaction so much that the entire family may become immersed. Because narrow topics often capture the interest of children, this symptom may go unrecognized.

Stereotyped and repetitive motor behaviors, called stimming, are a core part of the diagnosis of AS and other ASDs.{{cite journal | vauthors = South M, Ozonoff S, McMahon WM | s2cid = 36078197 | title = Repetitive behavior profiles in Asperger syndrome and high-functioning autism | journal = Journal of Autism and Developmental Disorders | volume = 35 | issue = 2 | pages = 145–58 | date = April 2005 | pmid = 15909401 | doi = 10.1007/s10803-004-1992-8}} Stims are believed to be used for self-soothing and regulate sensory input.{{Cite book |last=Foley |first=Valerie |url=https://books.google.com/books?id=FGO8S2RmckEC |title=The Autism Experience: International Perspectives on Autism Parenting |date=October 2011 |publisher=ReadHowYouWant.com |isbn=978-1-4587-9728-5 |language=en}} They include hand movements such as flapping or twisting, and complex whole-body movements. These are typically repeated in longer bursts and look more voluntary or ritualistic than tics, which are usually faster, less rhythmical, and less often symmetrical.{{cite journal | vauthors = Rapin I | title = Autism spectrum disorders: relevance to Tourette syndrome | journal = Advances in Neurology | volume = 85 | pages = 89–101 | year = 2001 | pmid = 11530449}} Stimming may have a connection with tics, and studies have reported a consistent comorbidity between AS and Tourette syndrome in the range of 8–20%,{{cite journal|vauthors=Steyaert JG, De la Marche W|year=2008|title=What's new in autism?|url=https://www.academia.edu/24262348|journal=Eur J Pediatr|volume=167|issue=10|pages=1091–101|doi=10.1007/s00431-008-0764-4|pmid=18597114|s2cid=11831418}}{{cite journal | vauthors = Mazzone L, Ruta L, Reale L | title = Psychiatric comorbidities in asperger syndrome and high functioning autism: diagnostic challenges | journal = Annals of General Psychiatry | volume = 11 | issue = 1 | pages = 16 | date = June 2012 | pmid = 22731684 | pmc = 3416662 | doi = 10.1186/1744-859X-11-16 | doi-access = free }} with one figure as high as 80% for tics of some kind or another, for which several explanations have been put forward, including common genetic factors and dopamine, glutamate, or serotonin abnormalities.{{cite journal | vauthors = Zafeiriou DI, Ververi A, Vargiami E | title = Childhood autism and associated comorbidities | journal = Brain & Development | volume = 29 | issue = 5 | pages = 257–72 | date = June 2007 | pmid = 17084999 | doi = 10.1016/j.braindev.2006.09.003 | s2cid = 16386209}}

According to the Adult Asperger Assessment (AAA) diagnostic test, a lack of interest in fiction and a positive preference towards non-fiction is common among adults with AS.

Although individuals with Asperger syndrome acquire language skills without significant general delay and their speech typically lacks significant abnormalities, language acquisition and use is often atypical. Abnormalities include verbosity; abrupt transitions; literal interpretations and miscomprehension of nuance; use of metaphor meaningful only to the speaker; auditory perception deficits; unusually pedantic, formal, or idiosyncratic speech; and oddities in loudness, pitch, intonation, prosody, and rhythm. Echolalia has also been observed in individuals with AS.{{cite journal | vauthors = Frith U | s2cid = 978233 | title = Social communication and its disorder in autism and Asperger syndrome | journal = Journal of Psychopharmacology | volume = 10 | issue = 1 | pages = 48–53 | date = January 1996 | pmid = 22302727 | doi = 10.1177/026988119601000108}}

Three aspects of communication patterns are of clinical interest: poor prosody, tangential and circumstantial speech, and marked verbosity. Although inflection and intonation may be less rigid or monotonic than in classic autism, people with AS often have a limited range of intonation: speech may be unusually fast, jerky, or loud. Speech may convey a sense of incoherence; the conversational style often includes monologues about topics that bore the listener, fails to provide context for comments, or fails to suppress internal thoughts. Individuals with AS may fail to detect whether the listener is interested or engaged in the conversation. The speaker's conclusion or point may never be made, and attempts by the listener to elaborate on the speech's content or logic, or to shift to related topics, are often unsuccessful.

Children with AS may have a sophisticated vocabulary at a young age and such children have often been colloquially called "little professors"{{cite web|url=https://archive.nytimes.com/www.nytimes.com/library/magazine/home/20000618mag-asperger.html|title=The Little Professor Syndrome | vauthors = Osborne L |work=The New York Times|date=18 June 2000}} but have difficulty understanding figurative language and tend to use language literally. Children with AS appear to have particular weaknesses in areas of nonliteral language that include humor, irony, teasing, and sarcasm. Although individuals with AS usually understand the cognitive basis of humor, they seem to lack understanding of the intent of humor to share the enjoyment with others. Despite strong evidence of impaired humor appreciation, anecdotal reports of humor in individuals with AS seem to challenge some psychological theories of AS and autism.{{cite journal | vauthors = Lyons V, Fitzgerald M | s2cid = 22187553 | title = Humor in autism and Asperger syndrome | journal = Journal of Autism and Developmental Disorders | volume = 34 | issue = 5 | pages = 521–31 | date = October 2004 | pmid = 15628606 | doi = 10.1007/s10803-004-2547-8}}

Individuals with Asperger syndrome may have signs or symptoms that are independent of the diagnosis but can affect the individual or the family.{{cite journal | vauthors = Filipek PA, Accardo PJ, Baranek GT, Cook EH, Dawson G, Gordon B, Gravel JS, Johnson CP, Kallen RJ, Levy SE, Minshew NJ, Ozonoff S, Prizant BM, Rapin I, Rogers SJ, Stone WL, Teplin S, Tuchman RF, Volkmar FR | s2cid = 145113684 | title = The screening and diagnosis of autistic spectrum disorders | journal = Journal of Autism and Developmental Disorders | volume = 29 | issue = 6 | pages = 439–84 | date = December 1999 | pmid = 10638459 | doi = 10.1023/A:1021943802493}} These include differences in perception and problems with motor skills, sleep, and emotions.

Individuals with AS often have excellent auditory and visual perception.{{cite journal | vauthors = Frith U | title = Emanuel Miller lecture: confusions and controversies about Asperger syndrome | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 45 | issue = 4 | pages = 672–86 | date = May 2004 | pmid = 15056300 | doi = 10.1111/j.1469-7610.2004.00262.x| doi-access = free }} Children with ASD often demonstrate enhanced perception of small changes in patterns such as arrangements of objects or well-known images; typically this is domain-specific and involves processing of fine-grained features.{{cite book|chapter=Psychological factors in autism |vauthors=Prior M, Ozonoff S|pages=69–128|title=Autism and Pervasive Developmental Disorders|edition=2nd| veditors = Volkmar FR |publisher=Cambridge University Press|year=2007|isbn=978-0-521-54957-8}} Conversely, compared with individuals with high-functioning autism, individuals with AS have deficits in some tasks involving visual-spatial perception, auditory perception, or visual memory. Many accounts of individuals with AS and ASD report other unusual sensory and perceptual skills and experiences. They may be unusually sensitive or insensitive to sound, light, and other stimuli;{{cite book|vauthors=Bogdashina O|title=Sensory Perceptional Issues in Autism and Asperger Syndrome: Different Sensory Experiences, Different Perceptual Worlds|publisher=Jessica Kingsley|year=2003|isbn=978-1-84310-166-6}} these sensory responses are found in other developmental disorders and are not specific to AS or to ASD. There is little support for increased fight-or-flight response or failure of habituation in autism; there is more evidence of decreased responsiveness to sensory stimuli, although several studies show no differences.{{cite journal | vauthors = Rogers SJ, Ozonoff S | title = Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 46 | issue = 12 | pages = 1255–68 | date = December 2005 | pmid = 16313426 | doi = 10.1111/j.1469-7610.2005.01431.x}}

Hans Asperger's initial accounts and other diagnostic schemes{{cite journal | vauthors = Ehlers S, Gillberg C | title = The epidemiology of Asperger syndrome. A total population study | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 34 | issue = 8 | pages = 1327–50 | date = November 1993 | pmid = 8294522 | doi = 10.1111/j.1469-7610.1993.tb02094.x}} include descriptions of physical clumsiness. Children with AS may be delayed in acquiring skills requiring dexterity, such as riding a bicycle or opening a jar, and may seem to move awkwardly or feel "uncomfortable in their own skin". They may be poorly coordinated or have an odd or bouncy gait or posture, poor handwriting, or problems with motor coordination. They may show problems with proprioception (sensation of body position) on measures of developmental coordination disorder (motor planning disorder), balance, tandem gait, and finger-thumb apposition. There is no evidence that these motor skills problems differentiate AS from other high-functioning ASDs.

Children with AS are more likely to have sleep problems, including difficulty in falling asleep, frequent nocturnal awakenings, and early morning awakenings.{{cite journal | vauthors = Polimeni MA, Richdale AL, Francis AJ | title = A survey of sleep problems in autism, Asperger's disorder and typically developing children | journal = Journal of Intellectual Disability Research | volume = 49 | issue = Pt 4 | pages = 260–68 | date = April 2005 | pmid = 15816813 | doi = 10.1111/j.1365-2788.2005.00642.x}} AS is also associated with high levels of alexithymia, which is difficulty in identifying and describing one's emotions.Alexithymia and AS:

• {{cite journal | vauthors = Fitzgerald M, Bellgrove MA | title = The overlap between alexithymia and Asperger's syndrome | journal = Journal of Autism and Developmental Disorders | volume = 36 | issue = 4 | pages = 573–76 | date = May 2006 | pmid = 16755385 | pmc = 2092499 | doi = 10.1007/s10803-006-0096-z}}
• {{cite journal | vauthors = Hill EL, Berthoz S | s2cid = 28686022 | title = Response to "Letter to the Editor: The overlap between alexithymia and Asperger's syndrome", Fitzgerald and Bellgrove, Journal of Autism and Developmental Disorders, 36(4) | journal = Journal of Autism and Developmental Disorders | volume = 36 | issue = 8 | pages = 1143–45 | date = November 2006 | pmid = 17080269 | doi = 10.1007/s10803-006-0287-7}}
• {{cite journal | vauthors = Lombardo MV, Barnes JL, Wheelwright SJ, Baron-Cohen S | title = Self-referential cognition and empathy in autism | journal = PLOS ONE | volume = 2 | issue = 9 | pages = e883 | date = September 2007 | pmid = 17849012 | pmc = 1964804 | doi = 10.1371/journal.pone.0000883 | veditors = Zak P | bibcode = 2007PLoSO...2..883L| doi-access = free }} Although AS, lower sleep quality, and alexithymia are associated with each other, their causal relationship is unclear.{{cite journal | vauthors = Tani P, Lindberg N, Joukamaa M, Nieminen-von Wendt T, von Wendt L, Appelberg B, Rimón R, Porkka-Heiskanen T | s2cid = 45311366 | title = Asperger syndrome, alexithymia and perception of sleep | journal = Neuropsychobiology | volume = 49 | issue = 2 | pages = 64–70 | year = 2004 | pmid = 14981336 | doi = 10.1159/000076412}}

{{Further|Causes of autism}}

Hans Asperger described common traits among his patients' family members, especially fathers, and research supports this observation and suggests a genetic contribution to Asperger syndrome. Although no specific genetic factor has yet been identified, multiple factors are believed to play a role in the expression of autism, given the variability in symptoms seen in children. Hundreds of genes have been linked to AS, and these genes play crucial role in a multitude of biological processes, exerting influence over the maturation and functioning of the brain.{{cite journal | vauthors = Motlani V, Motlani G, Thool A | title = Asperger Syndrome (AS): A Review Article | journal = Cureus | volume = 14 | issue = 11 | pages = e31395 | date = November 2022 | pmid = 36514569 | pmc = 9742637 | doi = 10.7759/cureus.31395 | doi-access = free }} Evidence for a genetic link is that AS tends to run in families where more family members have limited behavioral symptoms similar to AS (for example, some problems with social interaction, or with language and reading skills). Most behavioral genetic research suggests that all autism spectrum disorders have shared genetic mechanisms. There may be shared genes in which particular alleles make an individual vulnerable, and varying combinations result in differing severity and symptoms in each person with AS.

A few ASD cases have been linked to exposure to teratogens (agents that cause birth defects) during the first eight weeks from conception. Although this does not exclude the possibility that ASD can be initiated or affected later, it is strong evidence that ASD arises very early in development.{{cite journal | vauthors = Arndt TL, Stodgell CJ, Rodier PM | s2cid = 17797266 | title = The teratology of autism | journal = International Journal of Developmental Neuroscience | volume = 23 | issue = 2–3 | pages = 189–99 | year = 2005 | pmid = 15749245 | doi = 10.1016/j.ijdevneu.2004.11.001}} Many environmental factors have been hypothesized to act after birth, but none has been confirmed by scientific investigation.{{cite journal | vauthors = Rutter M | title = Incidence of autism spectrum disorders: changes over time and their meaning | journal = Acta Paediatrica | volume = 94 | issue = 1 | pages = 2–15 | date = January 2005 | pmid = 15858952 | doi = 10.1111/j.1651-2227.2005.tb01779.x | s2cid = 79259285 | author-link = Michael Rutter}} These environmental elements can act as independent and significant risk factors, or they can potentially influence pre-existing genetic factors in people who have a genetic predisposition.

== Mechanism ==

{{Further|Autism#Mechanism}}

File:Functional magnetic resonance imaging.jpg provides some evidence for mirror neuron theory.]]

Asperger syndrome appears to result from developmental factors that affect many or all functional brain systems, as opposed to localized effects.{{cite journal | vauthors = Müller RA | title = The study of autism as a distributed disorder | journal = Developmental Disabilities Research Reviews | volume = 13 | issue = 1 | pages = 85–95 | year = 2007 | pmid = 17326118 | pmc = 3315379 | doi = 10.1002/mrdd.20141}}

Although the specific underpinnings of AS or factors that distinguish it from other ASDs are unknown, and no clear pathology common to individuals with AS has emerged, it is still possible that AS's mechanism is separate from other ASDs.{{cite journal | vauthors = Rinehart NJ, Bradshaw JL, Brereton AV, Tonge BJ | s2cid = 563134 | title = A clinical and neurobehavioural review of high-functioning autism and Asperger's disorder | journal = The Australian and New Zealand Journal of Psychiatry | volume = 36 | issue = 6 | pages = 762–70 | date = December 2002 | pmid = 12406118 | doi = 10.1046/j.1440-1614.2002.01097.x}}

Neuroanatomical studies and the associations with teratogens strongly suggest that the mechanism includes alteration of brain development soon after conception. Abnormal fetal development may affect the final structure and connectivity of the brain, resulting in altered neural circuits controlling thought and behavior.{{cite journal | vauthors = Berthier ML, Starkstein SE, Leiguarda R | title = Developmental cortical anomalies in Asperger's syndrome: neuroradiological findings in two patients | journal = The Journal of Neuropsychiatry and Clinical Neurosciences | volume = 2 | issue = 2 | pages = 197–201 | year = 1990 | pmid = 2136076 | doi = 10.1176/jnp.2.2.197}} Several theories of mechanism are available; none are likely to provide a complete explanation.{{cite journal | vauthors = Happé F, Ronald A, Plomin R | s2cid = 18697986 | title = Time to give up on a single explanation for autism | journal = Nature Neuroscience | volume = 9 | issue = 10 | pages = 1218–20 | date = October 2006 | pmid = 17001340 | doi = 10.1038/nn1770}}

One general-processing theory is weak central coherence theory, which hypothesizes that a limited ability to see the big picture underlies the central disturbance in ASD.{{cite journal | vauthors = Happé F, Frith U | s2cid = 14999943 | title = The weak coherence account: detail-focused cognitive style in autism spectrum disorders | journal = Journal of Autism and Developmental Disorders | volume = 36 | issue = 1 | pages = 5–25 | date = January 2006 | pmid = 16450045 | doi = 10.1007/s10803-005-0039-0}} A related theory—enhanced perceptual functioning—focuses more on the superiority of locally oriented and perceptual operations in autistic individuals.{{cite journal | vauthors = Mottron L, Dawson M, Soulières I, Hubert B, Burack J | s2cid = 327253 | title = Enhanced perceptual functioning in autism: an update, and eight principles of autistic perception | journal = Journal of Autism and Developmental Disorders | volume = 36 | issue = 1 | pages = 27–43 | date = January 2006 | pmid = 16453071 | doi = 10.1007/s10803-005-0040-7}}

{{Update section|date=January 2022|reason=There have been almost 4 decades since some of the material cited here was published, and current consensus in ASD is less straightforward than depicted here|inaccurate=yes}}

The mirror neuron system (MNS) theory hypothesizes that alterations to the development of the MNS interfere with imitation and lead to Asperger syndrome's core feature of social impairment.{{cite journal | vauthors = Iacoboni M, Dapretto M | s2cid = 9463011 | title = The mirror neuron system and the consequences of its dysfunction | journal = Nature Reviews. Neuroscience | volume = 7 | issue = 12 | pages = 942–51 | date = December 2006 | pmid = 17115076 | doi = 10.1038/nrn2024}}{{cite journal | vauthors = Ramachandran VS, Oberman LM | title = Broken mirrors: a theory of autism | journal = Scientific American | volume = 295 | issue = 5 | pages = 62–69 | date = November 2006 | pmid = 17076085 | doi = 10.1038/scientificamerican1106-62 | url = http://cbc.ucsd.edu/pdf/brokenmirrors_asd.pdf | archive-url = https://web.archive.org/web/20090205170827/http://cbc.ucsd.edu/pdf/brokenmirrors_asd.pdf | url-status = live | archive-date = 5 February 2009 | bibcode = 2006SciAm.295e..62R}} One study found that activation is delayed in the core circuit for imitation in individuals with AS.{{cite journal | vauthors = Nishitani N, Avikainen S, Hari R | title = Abnormal imitation-related cortical activation sequences in Asperger's syndrome | journal = Annals of Neurology | volume = 55 | issue = 4 | pages = 558–62 | date = April 2004 | pmid = 15048895 | doi = 10.1002/ana.20031 | s2cid = 43913942}} This theory maps well to social cognition theories like the theory of mind, which hypothesizes that autistic behavior arises from impairments in ascribing mental states to oneself and others;{{cite journal | vauthors = Baron-Cohen S, Leslie AM, Frith U | s2cid = 14955234 | title = Does the autistic child have a "theory of mind"? | journal = Cognition | volume = 21 | issue = 1 | pages = 37–46 | date = October 1985 | pmid = 2934210 | doi = 10.1016/0010-0277(85)90022-8| citeseerx = 10.1.1.704.4721 }} [https://web.archive.org/web/20170928145836/http://ruccs.rutgers.edu/images/personal-alan-leslie/publications/Baron-Cohen%20Leslie%20%26%20Frith%201985.pdf Pdf.] or hyper-systemizing, which hypothesizes that autistic individuals can systematize internal operation to handle internal events but are less effective at empathizing when handling events generated by other agents.{{cite journal | vauthors = Baron-Cohen S | title = The hyper-systemizing, assortative mating theory of autism | journal = Progress in Neuro-Psychopharmacology & Biological Psychiatry | volume = 30 | issue = 5 | pages = 865–72 | date = July 2006 | pmid = 16519981 | doi = 10.1016/j.pnpbp.2006.01.010 | s2cid = 13271448 | url = http://www.autismresearchcentre.com/docs/papers/2006_BC_Neuropsychophamacology.pdf | archive-url = https://web.archive.org/web/20070614091839/http://www.autismresearchcentre.com/docs/papers/2006_BC_Neuropsychophamacology.pdf | url-status = dead | archive-date = 14 June 2007}}

Standard diagnostic criteria require impairment in social interaction and repetitive and stereotyped patterns of behavior, activities, and interests, without significant delay in language or cognitive development. Unlike the international standard, the DSM-IV-TR criteria also required significant impairment in day-to-day functioning; As noted above, in the 2010s, Asperger syndrome, as a separate diagnosis, was eliminated and folded into autism spectrum disorder in the DSM-5 and the ICD-11. Other sets of diagnostic criteria have been proposed by Szatmari et al.{{cite journal | vauthors = Szatmari P, Bremner R, Nagy J | s2cid = 45611340 | title = Asperger's syndrome: a review of clinical features | journal = Canadian Journal of Psychiatry | volume = 34 | issue = 6 | pages = 554–60 | date = August 1989 | pmid = 2766209 | doi = 10.1177/070674378903400613}} and by Gillberg and Gillberg.{{cite journal | vauthors = Gillberg IC, Gillberg C | title = Asperger syndrome – some epidemiological considerations: a research note | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 30 | issue = 4 | pages = 631–38 | date = July 1989 | pmid = 2670981 | doi = 10.1111/j.1469-7610.1989.tb00275.x}}

Diagnosis of ASD (and previously AS) is most commonly made between the ages of four and eleven. A comprehensive assessment involves a multidisciplinary team that observes across multiple settings, and includes neurological and genetic assessment as well as tests for cognition, psychomotor function, verbal and nonverbal strengths and weaknesses, style of learning, and skills for independent living. The "gold standard" in diagnosing ASDs combines clinical judgment with the Autism Diagnostic Interview-Revised (ADI-R), a semistructured parent interview; and the Autism Diagnostic Observation Schedule (ADOS), a conversation and play-based interview with the child. Delayed or mistaken diagnosis can be traumatic for individuals and families; for example, misdiagnosis can lead to medications that worsen behavior.{{cite journal | vauthors = Leskovec TJ, Rowles BM, Findling RL | title = Pharmacological treatment options for autism spectrum disorders in children and adolescents | journal = Harvard Review of Psychiatry | volume = 16 | issue = 2 | pages = 97–112 | year = 2008 | pmid = 18415882 | doi = 10.1080/10673220802075852 | s2cid = 26112061}}

Underdiagnosis and overdiagnosis may be problems. The cost and difficulty of screening and assessment can delay diagnosis. Conversely, the increasing popularity of drug treatment options and the expansion of benefits has motivated providers to overdiagnose ASD.{{cite journal | vauthors = Shattuck PT, Grosse SD | title = Issues related to the diagnosis and treatment of autism spectrum disorders | journal = Developmental Disabilities Research Reviews | volume = 13 | issue = 2 | pages = 129–35 | year = 2007 | pmid = 17563895 | doi = 10.1002/mrdd.20143}} There are indications AS has been diagnosed more frequently in recent years, partly as a residual diagnosis for children of normal intelligence who are not autistic but have social difficulties.

There are questions about the external validity of the AS diagnosis. That is, it is unclear whether there is a practical benefit in distinguishing AS from autism or PDD-NOS;{{cite journal | vauthors = Klin A, Volkmar FR | title = Asperger syndrome: diagnosis and external validity | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 12 | issue = 1 | pages = 1–13, v | date = January 2003 | pmid = 12512395 | doi = 10.1016/S1056-4993(02)00052-4}} different screening tools may render different diagnoses for the same person.

Many children with AS are initially misdiagnosed with attention deficit hyperactivity disorder (ADHD). Diagnosing adults is more challenging, as standard diagnostic criteria are designed for children and the expression of AS changes with age.{{cite journal | vauthors = Tantam D | title = The challenge of adolescents and adults with Asperger syndrome | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 12 | issue = 1 | pages = 143–63, vii–viii | date = January 2003 | pmid = 12512403 | doi = 10.1016/S1056-4993(02)00053-6}} Adult diagnosis requires painstaking clinical examination and thorough medical history gained from both the individual and other people who know the person, focusing on childhood behavior.{{cite journal | vauthors = Roy M, Dillo W, Emrich HM, Ohlmeier MD | title = Asperger's syndrome in adulthood | journal = Deutsches Ärzteblatt International | volume = 106 | issue = 5 | pages = 59–64 | date = January 2009 | pmid = 19562011 | pmc = 2695286 | doi = 10.3238/arztebl.2009.0059}}

Conditions that must be considered in a differential diagnosis along with ADHD include other ASDs, the schizophrenia spectrum, personality disorders, obsessive–compulsive disorder, major depressive disorder, semantic pragmatic disorder, nonverbal learning disorder, social anxiety disorder,{{cite journal|vauthors=Fitzgerald M, Corvin A|year=2001|url=http://apt.rcpsych.org/cgi/content/full/7/4/310|title=Diagnosis and differential diagnosis of Asperger syndrome|journal=Advances in Psychiatric Treatment |volume=7|issue=4|pages=310–18|url-status=live|archive-url=https://web.archive.org/web/20070910134556/http://apt.rcpsych.org/cgi/content/full/7/4/310|archive-date=10 September 2007|doi=10.1192/apt.7.4.310|doi-access=free}}{{cite journal | vauthors = Lehnhardt FG, Gawronski A, Pfeiffer K, Kockler H, Schilbach L, Vogeley K | title = The investigation and differential diagnosis of Asperger syndrome in adults | journal = Deutsches Ärzteblatt International | volume = 110 | issue = 45 | pages = 755–63 | date = November 2013 | pmid = 24290364 | pmc = 3849991 | doi = 10.3238/arztebl.2013.0755}} Tourette syndrome, stereotypic movement disorder, bipolar disorder,{{cite journal | vauthors = Foster B, King BH | title = Asperger syndrome: to be or not to be? | journal = Current Opinion in Pediatrics | volume = 15 | issue = 5 | pages = 491–94 | date = October 2003 | pmid = 14508298 | doi = 10.1097/00008480-200310000-00008 | s2cid = 21415556}} social-cognitive deficits due to brain damage from alcohol use disorder,{{cite journal | vauthors = Uekermann J, Daum I | title = Social cognition in alcoholism: a link to prefrontal cortex dysfunction? | journal = Addiction | volume = 103 | issue = 5 | pages = 726–35 | date = May 2008 | pmid = 18412750 | doi = 10.1111/j.1360-0443.2008.02157.x}} and obsessive–compulsive personality disorder (OCPD).{{cite journal | vauthors = Gillberg C, Billstedt E | title = Autism and Asperger syndrome: coexistence with other clinical disorders | journal = Acta Psychiatrica Scandinavica | volume = 102 | issue = 5 | pages = 321–30 | date = November 2000 | pmid = 11098802 | doi = 10.1034/j.1600-0447.2000.102005321.x | s2cid = 40070782}}{{cite journal|vauthors=Fitzgerald M|s2cid=3814840|title=Diagnosis and differential diagnosis of Asperger syndrome|journal=Advances in Psychiatric Treatment|date=1 July 2001|volume=7|issue=4|pages=310–18|doi=10.1192/apt.7.4.310|doi-access=free}}

Parents of children with Asperger syndrome can typically trace differences in their children's development to as early as 30 months of age. Developmental screening during a routine check-up by a general practitioner or pediatrician may identify signs that warrant further investigation. The United States Preventive Services Task Force in 2016 found it was unclear if screening was beneficial or harmful among children in whom there are no concerns.{{cite journal | vauthors = Siu AL, Bibbins-Domingo K, Grossman DC, Baumann LC, Davidson KW, Ebell M, García FA, Gillman M, Herzstein J, Kemper AR, Krist AH, Kurth AE, Owens DK, Phillips WR, Phipps MG, Pignone MP | title = Screening for Autism Spectrum Disorder in Young Children: US Preventive Services Task Force Recommendation Statement | journal = JAMA | volume = 315 | issue = 7 | pages = 691–96 | date = February 2016 | pmid = 26881372 | doi = 10.1001/jama.2016.0018 | doi-access = free}}

Different screening instruments are used to diagnose AS, including the Asperger Syndrome Diagnostic Scale (ASDS); Autism Spectrum Screening Questionnaire (ASSQ); Childhood Autism Spectrum Test (CAST), previously called the Childhood Asperger Syndrome Test;The CAST has been renamed from the Childhood Asperger Syndrome Test to the [http://psychology-tools.com/cast/ Childhood Autism Spectrum Test], reflecting the removal of Asperger's Syndrome from the DSM-5. {{webarchive|url=https://web.archive.org/web/20130703115109/http://psychology-tools.com/cast/|date=3 July 2013}} Gilliam Asperger's disorder scale (GADS); Krug Asperger's Disorder Index (KADI);{{cite journal | vauthors = Campbell JM | s2cid = 16437469 | title = Diagnostic assessment of Asperger's disorder: a review of five third-party rating scales | journal = Journal of Autism and Developmental Disorders | volume = 35 | issue = 1 | pages = 25–35 | date = February 2005 | pmid = 15796119 | doi = 10.1007/s10803-004-1028-4}} and the autism-spectrum quotient (AQ), with versions for children,{{cite journal | vauthors = Auyeung B, Baron-Cohen S, Wheelwright S, Allison C | title = The Autism Spectrum Quotient: Children's Version (AQ-Child) | journal = Journal of Autism and Developmental Disorders | volume = 38 | issue = 7 | pages = 1230–40 | date = August 2008 | pmid = 18064550 | doi = 10.1007/s10803-007-0504-z | s2cid = 12682486 | url = http://autismresearchcenter.com/docs/papers/2008_Auyeung_etal_ChildAQ.pdf | archive-url = https://web.archive.org/web/20090205170722/http://autismresearchcenter.com/docs/papers/2008_Auyeung_etal_ChildAQ.pdf | url-status = live | archive-date = 5 February 2009}} adolescents,{{cite journal | vauthors = Baron-Cohen S, Hoekstra RA, Knickmeyer R, Wheelwright S | title = The Autism-Spectrum Quotient (AQ)--adolescent version | journal = Journal of Autism and Developmental Disorders | volume = 36 | issue = 3 | pages = 343–50 | date = April 2006 | pmid = 16552625 | doi = 10.1007/s10803-006-0073-6 | url = http://autismresearchcenter.com/docs/papers/2006_BC_Hoekstra_etal_AQ-adol.pdf | url-status = live | archive-url = https://web.archive.org/web/20090205170712/http://autismresearchcenter.com/docs/papers/2006_BC_Hoekstra_etal_AQ-adol.pdf | archive-date = 5 February 2009 | citeseerx = 10.1.1.654.1966 | s2cid = 12934864}} and adults.{{cite journal | vauthors = Woodbury-Smith MR, Robinson J, Wheelwright S, Baron-Cohen S | title = Screening adults for Asperger Syndrome using the AQ: a preliminary study of its diagnostic validity in clinical practice | journal = Journal of Autism and Developmental Disorders| url = http://autismresearchcentre.com/docs/papers/2005_Woodbury-Smith_etal_ScreeningAdultsForAS.pdf | volume = 35 | issue = 3 | pages = 331–35 | date = June 2005 | pmid = 16119474 | doi = 10.1007/s10803-005-3300-7 | archive-url = https://web.archive.org/web/20081217140624/http://autismresearchcentre.com/docs/papers/2005_Woodbury-Smith_etal_ScreeningAdultsForAS.pdf | url-status = dead | archive-date = 17 December 2008 | citeseerx = 10.1.1.653.8639 | s2cid = 13013701}} None have been shown to reliably differentiate between AS and other ASDs.

{{Further|Autism therapies}}

Treatment attempts to manage distressing symptoms and to teach age-appropriate social, communication, and vocational skills that are not naturally acquired during development. Intervention is tailored to the needs of the individual based on multidisciplinary assessment.{{cite journal | vauthors = Khouzam HR, El-Gabalawi F, Pirwani N, Priest F | title = Asperger's disorder: a review of its diagnosis and treatment | journal = Comprehensive Psychiatry | volume = 45 | issue = 3 | pages = 184–91 | year = 2004 | pmid = 15124148 | doi = 10.1016/j.comppsych.2004.02.004}} Although progress has been made, data supporting the efficacy of particular interventions are limited.{{cite journal | vauthors = Attwood T | title = Frameworks for behavioral interventions | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 12 | issue = 1 | pages = 65–86, vi | date = January 2003 | pmid = 12512399 | doi = 10.1016/S1056-4993(02)00054-8}}

Managing ASD may involve multiple therapies that address core symptoms of the disorder. While many professionals agree that the earlier the professional support the better, there is no combination that is recommended above others. Professional support for ASD varies depending on the individual; it takes into account the linguistic capabilities, verbal strengths, and nonverbal vulnerabilities of individuals.

Many of those diagnosed with ASD or similar disorders advocate against behavioral therapies, like Applied behavior analysis (ABA) and Cognitive behavioral therapy (CBT), often as part of the autism rights movement, on the grounds that these approaches frequently reinforce the demand on autistic people to mask their neurodivergent characteristics or behaviors to favor a more 'neurotypical' and narrow conception of normality.{{Cite web |title=Commentary: The autistic community is having a reckoning with ABA therapy. We should listen |url=https://fortune.com/2022/05/13/autistic-community-reckoning-aba-therapy-rights-autism-insurance-private-equity-ariana-cernius/ |access-date=2023-10-31 |website=Fortune |language=en}}{{Cite journal | vauthors = McGill O, Robinson A |date=2020-01-01 |title="Recalling hidden harms": autistic experiences of childhood applied behavioural analysis (ABA) |journal=Advances in Autism |volume=7 |issue=4 |pages=269–282 |doi=10.1108/AIA-04-2020-0025 |s2cid=225282499 |issn=2056-3868|url=https://strathprints.strath.ac.uk/73753/1/McGill_Robinson_AA_2020_autistic_experiences_of_childhood_Applied_Behavioural_Analysis.pdf }}{{cite journal | vauthors = Hull L, Petrides KV, Allison C, Smith P, Baron-Cohen S, Lai MC, Mandy W | title = "Putting on My Best Normal": Social Camouflaging in Adults with Autism Spectrum Conditions | journal = Journal of Autism and Developmental Disorders | volume = 47 | issue = 8 | pages = 2519–2534 | date = August 2017 | pmid = 28527095 | pmc = 5509825 | doi = 10.1007/s10803-017-3166-5 }} ABA has faced a great deal of criticism over the years. Recently, studies have shown that ABA may be abusive and can increase PTSD symptoms in patients.{{Cite journal | vauthors = Kupferstein H |date=2018-01-02 |title=Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis |url=https://www.emerald.com/insight/content/doi/10.1108/AIA-08-2017-0016/full/html |journal=Advances in Autism |language=en |volume=4 |issue=1 |pages=19–29 |doi=10.1108/AIA-08-2017-0016 |issn=2056-3868 |s2cid=4638346|url-access=subscription }}{{Cite journal | vauthors = Sandoval-Norton AH, Shkedy G, Shkedy D |date=2019-01-01 | veditors = Rushby JA |title=How much compliance is too much compliance: Is long-term ABA therapy abuse? |journal=Cogent Psychology |language=en |volume=6 |issue=1 |pages=1641258 |doi=10.1080/23311908.2019.1641258 |issn=2331-1908 |s2cid=199041640 |doi-access=free}}{{cite journal | vauthors = Wilkenfeld DA, McCarthy AM | title = Ethical Concerns with Applied Behavior Analysis for Autism Spectrum "Disorder" | journal = Kennedy Institute of Ethics Journal | volume = 30 | issue = 1 | pages = 31–69 | date = 2020 | pmid = 32336692 | doi = 10.1353/ken.2020.0000 | s2cid = 216557299 }}{{cite journal | vauthors = Bottema-Beutel K, Crowley S, Sandbank M, Woynaroski TG | title = Research Review: Conflicts of Interest (COIs) in autism early intervention research - a meta-analysis of COI influences on intervention effects | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 62 | issue = 1 | pages = 5–15 | date = January 2021 | pmid = 32353179 | pmc = 7606324 | doi = 10.1111/jcpp.13249 }}{{Cite journal | vauthors = McGill O, Robinson A |date=2021-10-26 |title="Recalling hidden harms": autistic experiences of childhood applied behavioural analysis (ABA) |url=https://www.emerald.com/insight/content/doi/10.1108/AIA-04-2020-0025/full/html |journal=Advances in Autism |language=en |volume=7 |issue=4 |pages=269–282 |doi=10.1108/AIA-04-2020-0025 |issn=2056-3868 |s2cid=225282499}}{{Cite journal | vauthors = Shkedy G, Shkedy D, Sandoval-Norton AH |date=June 2021 |title=Long-term ABA Therapy Is Abusive: A Response to Gorycki, Ruppel, and Zane |journal=Advances in Neurodevelopmental Disorders |language=en |volume=5 |issue=2 |pages=126–134 |doi=10.1007/s41252-021-00201-1 |issn=2366-7532 |doi-access=free}} The Autistic Self Advocacy Network campaigns against the use of ABA in autism.{{cite web |author=Autistic Self Advocacy Network |title=Autistic Self Advocacy Network – Nothing About Us Without Us |url=http://www.autisticadvocacy.org/ |website=www.autisticadvocacy.org}}{{cite web |date=2016-08-11 |title=Is the Most Common Therapy for Autism Cruel? |url=https://www.theatlantic.com/health/archive/2016/08/aba-autism-controversy/495272/ |website=The Atlantic |vauthors=DeVita-Raeburn E}}

In the case of CBT and talking therapies, the effectiveness varies, with many reporting that they appeared 'too self-aware' to gain significant benefit, as the therapy was designed with neurotypical people in mind.{{Cite web | vauthors = Nicholls A |date=2021-10-14 |title=Why Doesn't Standard Talking Therapy Work for Autistic People? |url=https://www.dralicenicholls.com/why-doesnt-standard-talking-therapy-work-for-autistic-people/ |access-date=2023-11-03 |website=Dr Alice Nicholls |language=en-GB}}{{Cite web |title=Is CBT effective when working with autistic people? |url=https://www.counselling-directory.org.uk/memberarticles/is-cbt-effective-when-working-with-people-with-autism |access-date=2023-11-03 |website=www.counselling-directory.org.uk |language=en-GB}} In autistic children, specifically, they also report that it is only mildly beneficial in aiding with their anxieties.{{Cite web |date=2021-11-16 |title=Cognitive behavioral therapy may be only mildly effective for anxious, autistic children |url=https://www.spectrumnews.org/news/cognitive-behavioral-therapy-may-be-only-mildly-effective-for-anxious-autistic-children/ |access-date=2023-11-03 |website=Spectrum {{!}} Autism Research News |language=en-US}}

A typical program of professional support generally includes:

• Applied behavior analysis (ABA) procedures, including positive behavior support (PBS)—or training and support of parents and school faculty in behavior management strategies to use in the home and school, and social skills training for more effective interpersonal interactions.{{cite journal | vauthors = Krasny L, Williams BJ, Provencal S, Ozonoff S | title = Social skills interventions for the autism spectrum: essential ingredients and a model curriculum | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 12 | issue = 1 | pages = 107–22 | date = January 2003 | pmid = 12512401 | doi = 10.1016/S1056-4993(02)00051-2}} The Autistic Self Advocacy Network campaigns against the use of ABA in autism;
• Cognitive behavioral therapy to improve stress management relating to anxiety or explosive emotions{{cite journal | vauthors = Myles BS | title = Behavioral forms of stress management for individuals with Asperger syndrome | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 12 | issue = 1 | pages = 123–41 | date = January 2003 | pmid = 12512402 | doi = 10.1016/S1056-4993(02)00048-2}} and to help reduce obsessive interests (although this may produce negative impact by demonising special interests) and repetitive routines;
• Medication for coexisting conditions such as major depressive disorder and anxiety disorders;
• Occupational or physical therapy to assist with poor sensory processing and motor coordination; and,
• Social communication intervention, which is specialized speech therapy to help with the pragmatics and give-and-take of normal conversation.{{cite journal | vauthors = Paul R | title = Promoting social communication in high functioning individuals with autistic spectrum disorders | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 12 | issue = 1 | pages = 87–106, vi–vii | date = January 2003 | pmid = 12512400 | doi = 10.1016/S1056-4993(02)00047-0}}

Of the many studies on behavior-based early intervention programs, most are case reports of up to five participants and typically examine a few problem behaviors such as self-injury, aggression, noncompliance, stereotypies, or spontaneous language; unintended side effects are largely ignored.{{cite journal | vauthors = Matson JL | title = Determining treatment outcome in early intervention programs for autism spectrum disorders: a critical analysis of measurement issues in learning based interventions | journal = Research in Developmental Disabilities | volume = 28 | issue = 2 | pages = 207–18 | year = 2007 | pmid = 16682171 | doi = 10.1016/j.ridd.2005.07.006}} Despite the popularity of social skills training, its effectiveness is not firmly established.{{cite journal | vauthors = Rao PA, Beidel DC, Murray MJ | s2cid = 2507088 | title = Social skills interventions for children with Asperger's syndrome or high-functioning autism: a review and recommendations | journal = Journal of Autism and Developmental Disorders | volume = 38 | issue = 2 | pages = 353–61 | date = February 2008 | pmid = 17641962 | doi = 10.1007/s10803-007-0402-4}} A randomized controlled study of a model for training parents in problem behaviors in their children with AS showed that parents attending a one-day workshop or six individual lessons reported fewer behavioral problems, while parents receiving the individual lessons reported less intense behavioral problems in their AS children.{{cite journal | vauthors = Sofronoff K, Leslie A, Brown W | title = Parent management training and Asperger syndrome: a randomized controlled trial to evaluate a parent based intervention | journal = Autism | volume = 8 | issue = 3 | pages = 301–17 | date = September 2004 | pmid = 15358872 | doi = 10.1177/1362361304045215 | s2cid = 23763353}} Vocational training may be important to teach job interview etiquette and workplace behavior to older children and adults with AS, and organization software and personal data assistants can improve the work and life management of people with AS.

Fecal Microbiota Transplantation (FMT) is an innovative therapy for AS that aims to restore microbial balance in the patient's gastrointestinal tract by introducing healthy fecal microbiota acquired from people with a diverse microbial composition. This approach attempts to reconstruct the patient's gut microbiota by taking into account the intricate interactions between the human gut and the central nervous system via the gut-brain axis (GBA). Any disruption in gut health has been linked to an increased susceptibility to diverse neurodevelopmental disorders.

It is vital to remember that research of AS specifically operates upon the out-dated classification of this syndrome as external to ASD (Autism Spectrum Disorder). Similarly, we should also note that ASD is a spectrum and support varies dramatically depending on the individual.

No medications directly treat the core symptoms of AS.{{cite journal | vauthors = Towbin KE | title = Strategies for pharmacologic treatment of high functioning autism and Asperger syndrome | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 12 | issue = 1 | pages = 23–45 | date = January 2003 | pmid = 12512397 | doi = 10.1016/S1056-4993(02)00049-4 | url = https://zenodo.org/record/1260194}} Although research into the efficacy of pharmaceutical intervention for AS is limited, it is essential to diagnose and treat comorbid conditions. Deficits in self-identifying emotions or in observing effects of one's behavior on others can make it difficult for individuals with AS to see why medication may be appropriate. Medication can be effective in combination with behavioral interventions and environmental accommodations in treating comorbid symptoms such as anxiety disorders, major depressive disorder, inattention, and aggression. The atypical antipsychotic medications risperidone, olanzapine and aripiprazole have been shown to reduce the associated symptoms of AS;{{cite journal | vauthors = Hirsch LE, Pringsheim T | title = Aripiprazole for autism spectrum disorders (ASD) | journal = The Cochrane Database of Systematic Reviews | issue = 6 | pages = CD009043 | date = June 2016 | volume = 2016 | pmid = 27344135 | doi = 10.1002/14651858.CD009043.pub3 | pmc = 7120220}}{{cite journal | vauthors = Blankenship K, Erickson CA, Stigler KA, Posey DJ, McDougle CJ | title = Aripiprazole for irritability associated with autistic disorder in children and adolescents aged 6–17 years | journal = Pediatric Health | volume = 4 | issue = 4 | pages = 375–81 | date = September 2010 | pmid = 21359119 | pmc = 3043611 | doi = 10.2217/phe.10.45}} risperidone can reduce repetitive and self-injurious behaviors, aggressive outbursts, and impulsivity, and improve stereotypical patterns of behavior and social relatedness. The selective serotonin reuptake inhibitors (SSRIs) fluoxetine, fluvoxamine, and sertraline have been effective in treating restricted and repetitive interests and behaviors, while stimulant medication, such as methylphenidate, can reduce inattention.{{cite journal | vauthors = Myers SM, Johnson CP | title = Management of children with autism spectrum disorders | journal = Pediatrics | volume = 120 | issue = 5 | pages = 1162–82 | date = November 2007 | pmid = 17967921 | doi = 10.1542/peds.2007-2362 | doi-access = free}} In addition, scientists have made a noteworthy finding that oxytocin, a hormone, plays a significant role in shaping human social behavior and the formation of interpersonal connections.

Care must be taken with medications, as side effects may be more common and harder to evaluate in individuals with AS, and tests of drugs' effectiveness against comorbid conditions routinely exclude individuals from the autism spectrum. Abnormalities in metabolism, cardiac conduction times, and an increased risk of type 2 diabetes have been raised as concerns with antipsychotic medications,{{cite journal | vauthors = Newcomer JW | title = Antipsychotic medications: metabolic and cardiovascular risk | journal = The Journal of Clinical Psychiatry | volume = 68 | issue = Suppl 4 | pages = 8–13 | year = 2007 | pmid = 17539694}}{{cite journal | vauthors = Chavez B, Chavez-Brown M, Sopko MA, Rey JA | title = Atypical antipsychotics in children with pervasive developmental disorders | journal = Paediatric Drugs | volume = 9 | issue = 4 | pages = 249–66 | year = 2007 | pmid = 17705564 | doi = 10.2165/00148581-200709040-00006 | citeseerx = 10.1.1.659.4150 | s2cid = 6690106}} along with serious long-term neurological side effects. SSRIs can lead to manifestations of behavioral activation such as increased impulsivity, aggression, and sleep disturbance. Weight gain and fatigue are commonly reported side effects of risperidone, which may also lead to increased risk for extrapyramidal symptoms such as restlessness and dystonia and increased serum prolactin levels.{{cite journal | vauthors = Staller J | title = The effect of long-term antipsychotic treatment on prolactin | journal = Journal of Child and Adolescent Psychopharmacology | volume = 16 | issue = 3 | pages = 317–26 | date = June 2006 | pmid = 16768639 | doi = 10.1089/cap.2006.16.317}} Sedation and weight gain are more common with olanzapine, which has also been linked with diabetes. Sedative side-effects in school-age children{{cite journal | vauthors = Stachnik JM, Nunn-Thompson C | s2cid = 31715163 | title = Use of atypical antipsychotics in the treatment of autistic disorder | journal = The Annals of Pharmacotherapy | volume = 41 | issue = 4 | pages = 626–34 | date = April 2007 | pmid = 17389666 | doi = 10.1345/aph.1H527}} have ramifications for classroom learning. Individuals with AS may be unable to identify and communicate their internal moods and emotions or to tolerate side effects that for most people would not be problematic.{{cite journal|title=Asperger syndrome and high functioning autism: research concerns and emerging foci|journal=Current Opinion in Psychiatry|volume=16|issue=5|pages=535–42|year=2003|vauthors=Blacher J, Kraemer B, Schalow M|doi=10.1097/00001504-200309000-00008|s2cid=146839394}}

There is some evidence that children with AS may see a lessening of symptoms; up to 20% of children may no longer meet the diagnostic criteria as adults, although social and communication difficulties may persist. {{As of|2006}}, no studies addressing the long-term outcome of individuals with Asperger syndrome are available and there are no systematic long-term follow-up studies of children with AS. Individuals with AS appear to have normal life expectancy, but have an increased prevalence of comorbid psychiatric conditions, such as major depressive disorder and anxiety disorders that may significantly affect prognosis. Although social impairment may be lifelong, the outcome is generally more positive than with individuals with lower-functioning autism spectrum disorders; for example, ASD symptoms are more likely to diminish with time in children with AS or forms of autism sometimes described as "high functioning".{{cite journal | vauthors = Coplan J, Jawad AF | title = Modeling clinical outcome of children with autistic spectrum disorders | journal = Pediatrics | volume = 116 | issue = 1 | pages = 117–22 | date = July 2005 | pmid = 15995041 | doi = 10.1542/peds.2004-1118 | s2cid = 8440775}} Most students with AS and forms of autism sometimes seen as "high functioning" have average mathematical ability and test slightly worse in mathematics than in general intelligence.{{cite journal | vauthors = Chiang HM, Lin YH | title = Mathematical ability of students with Asperger syndrome and high-functioning autism: a review of literature | journal = Autism | volume = 11 | issue = 6 | pages = 547–56 | date = November 2007 | pmid = 17947290 | doi = 10.1177/1362361307083259 | s2cid = 37125753 | via = SAGE Journals}} However, mathematicians are at least three times more likely to have autism-spectrum traits than the general population, and are more likely to have family members with autism.{{cite journal | vauthors = Baron-Cohen S, Wheelwright S, Burtenshaw A, Hobson E | title = Mathematical Talent is Linked to Autism | journal = Human Nature | volume = 18 | issue = 2 | pages = 125–131 | date = June 2007 | pmid = 26181845 | doi = 10.1007/s12110-007-9014-0 | s2cid = 11021156 }}

Although many attend regular education classes, some children with AS may attend special education classes such as separate classroom and resource room because of their social and behavioral difficulties. Adolescents with AS may exhibit ongoing difficulty with self-care or organization, and disturbances in social and romantic relationships. Despite high cognitive potential, most young adults with AS remain at home, yet some do marry and work independently. The "different-ness" adolescents experience can be traumatic.{{cite journal| vauthors = Moran M |title=Asperger's may be answer to diagnostic mysteries|journal=Psychiatric News|year=2006|volume=41|issue=19|pages=21–36|doi=10.1176/pn.41.19.0021}} Anxiety may stem from preoccupation over possible violations of routines and rituals, from being placed in a situation without a clear schedule or expectations, or from concern with failing in social encounters; the resulting stress may manifest as inattention, withdrawal, reliance on obsessions, hyperactivity, or aggressive or oppositional behavior. Depression is often the result of chronic frustration from repeated failure to engage others socially, and mood disorders requiring treatment may develop. Clinical experience suggests the rate of suicide may be higher among those with AS, but this has not been confirmed by systematic empirical studies.{{cite book|title=Asperger's Disorder|veditors=Rausch JL, Johnson ME, Casanova MF|publisher=Informa Healthcare|year=2008|chapter=Asperger syndrome – mortality and morbidity| vauthors = Gillberg C|pages=63–80|isbn=978-0-8493-8360-1}}

Education of families is critical in developing strategies for understanding strengths and weaknesses; helping the family to cope improves outcomes in children. Prognosis may be improved by diagnosis at a younger age that allows for early interventions, while interventions in adulthood are valuable but less beneficial. There are legal implications for individuals with AS as they run the risk of exploitation by others and may be unable to comprehend the societal implications of their actions.

{{main|Epidemiology of autism}}

Frequency estimates vary enormously. In 2015, it was estimated that 37.2 million people globally are affected. A 2003 review of epidemiological studies of children found autism rates ranging from 0.03 to 4.84 per 1,000, with the ratio of autism to Asperger syndrome ranging from 1.5:1 to 16:1;{{cite journal | vauthors = Fombonne E, Tidmarsh L | title = Epidemiologic data on Asperger disorder | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 12 | issue = 1 | pages = 15–21, v–vi | date = January 2003 | pmid = 12512396 | doi = 10.1016/S1056-4993(02)00050-0}} combining the geometric mean ratio of 5:1 with a conservative prevalence estimate for autism of 1.3 per 1,000 suggests indirectly that the prevalence of AS might be around 0.26 per 1,000.{{cite book|chapter=Epidemiological surveys of pervasive developmental disorders| vauthors = Fombonne E |pages=33–68|title=Autism and Pervasive Developmental Disorders|edition=2nd|veditors=Volkmar FR|publisher=Cambridge University Press|year=2007|isbn=978-0-521-54957-8}} Part of the variance in estimates arises from differences in diagnostic criteria. For example, a relatively small 2007 study of 5,484 eight-year-old children in Finland found 2.9 children per 1,000 met the ICD-10 criteria for an AS diagnosis, 2.7 per 1,000 for Gillberg and Gillberg criteria, 2.5 for DSM-IV, 1.6 for Szatmari et al., and 4.3 per 1,000 for the union of the four criteria. Boys seem to be more likely to have AS than girls; estimates of the sex ratio range from 1.6:1 to 4:1, using the Gillberg and Gillberg criteria. Females with autism spectrum disorders may be underdiagnosed.{{cite journal | vauthors = Galanopoulos A, Robertson D, Woodhouse E | title = The assessment of autism spectrum disorders in adults |journal=Advances in Autism |date=4 January 2016 |volume=2 |issue=1 |pages=31–40 |doi=10.1108/AIA-09-2015-0017}}

{{Main|Conditions comorbid to autism spectrum disorders}}

Anxiety disorders and major depressive disorder are the most common conditions seen at the same time; comorbidity of these in persons with AS is estimated at 65%. Reports have associated AS with medical conditions such as aminoaciduria and ligamentous laxity, but these have been case reports or small studies and no factors have been associated with AS across studies. One study of males with AS found an increased rate of epilepsy and a high rate (51%) of nonverbal learning disorder.{{cite journal | vauthors = Cederlund M, Gillberg C | title = One hundred males with Asperger syndrome: a clinical study of background and associated factors | journal = Developmental Medicine and Child Neurology | volume = 46 | issue = 10 | pages = 652–60 | date = October 2004 | pmid = 15473168 | doi = 10.1111/j.1469-8749.2004.tb00977.x | s2cid = 5931902| doi-access = free }} AS is associated with tics, Tourette syndrome and bipolar disorder. The repetitive behaviors of AS have many similarities with the symptoms of obsessive–compulsive disorder and obsessive–compulsive personality disorder, and 26% of a sample of young adults with AS were found to meet the criteria for schizoid personality disorder (which is characterised by severe social seclusion and emotional detachment), more than any other personality disorder in the sample.{{cite journal | vauthors = Lugnegård T, Hallerbäck MU, Gillberg C | title = Personality disorders and autism spectrum disorders: what are the connections? | journal = Comprehensive Psychiatry | volume = 53 | issue = 4 | pages = 333–40 | date = May 2012 | pmid = 21821235 | doi = 10.1016/j.comppsych.2011.05.014}}{{cite journal | vauthors = Tantam D | title = Lifelong eccentricity and social isolation. II: Asperger's syndrome or schizoid personality disorder? | journal = The British Journal of Psychiatry | volume = 153 | pages = 783–91 | date = December 1988 | issue = 6 | pmid = 3256377 | doi = 10.1192/bjp.153.6.783| s2cid = 39433805 }}{{Cite book|title=Integrated Treatment for Co-Occurring Disorders: Personality Disorders and Addiction | vauthors = Ekleberry SC |publisher=Routledge|year=2008|isbn=978-0789036933|pages=31–32|chapter=Cluster A – Schizoid Personality Disorder and Substance Use Disorders|chapter-url=https://books.google.com/books?id=O5HY1xcfjEcC&pg=PA31}} However many of these studies are based on clinical samples or lack standardized measures; nonetheless, comorbid conditions are relatively common.

Research indicates that individuals with Aspergers have significantly higher rates of LGBT identities and feelings{{What|date=March 2025}} than the general population.{{cite journal | vauthors = Graham Holmes L, Ames JL, Massolo ML, Nunez DM, Croen LA | title = Improving the Sexual and Reproductive Health and Health Care of Autistic People | journal = Pediatrics | volume = 149 | issue = Suppl 4 | pages = e2020049437J | date = April 2022 | pmid = 35363286 | doi = 10.1542/peds.2020-049437J | publisher = American Academy of Pediatrics | quote = A substantial proportion of autistic adolescents and adults are LGBTQIA+. Autistic people are more likely to be transgender or gender nonconforming compared with non-autistic people, and findings from a recent autism registry study suggest that among autistic people able to self-report on a survey, up to 18% of men and 43% of women may be sexual minorities. | doi-access = free }} They are also significantly more likely to be non-theistic.{{cite journal | vauthors = Norenzayan A, Gervais WM, Trzesniewski KH | title = Mentalizing deficits constrain belief in a personal God | journal = PLOS ONE | volume = 7 | issue = 5 | pages = e36880 | date = 2012 | pmid = 22666332 | pmc = 3364254 | doi = 10.1371/journal.pone.0036880 | doi-access = free | bibcode = 2012PLoSO...736880N }}

{{Main|History of Asperger syndrome}}

Asperger syndrome was named after the Austrian pediatrician Hans Asperger (1906–1980), but not coined by him. Asperger syndrome was a relatively new diagnosis in the field of autism,{{cite journal | vauthors = Baron-Cohen S, Klin A | s2cid = 12554302 | title = What's so special about Asperger Syndrome? | journal = Brain and Cognition | volume = 61 | issue = 1 | pages = 1–4 | date = June 2006 | pmid = 16563588 | doi = 10.1016/j.bandc.2006.02.002}} though a syndrome like it was described as early as 1925 by Soviet child psychiatrist Grunya Sukhareva (1891–1981),{{cite book |author=Sukhareva GE |translator=Rebecchi K |title=Autistic Children |publisher=Amazon |date=2022 |isbn=978-169098676-8}} As a child, Asperger appears to have exhibited some features of the very condition named after him, such as remoteness and talent in language.{{cite journal | vauthors = Lyons V, Fitzgerald M | s2cid = 21595111 | title = Did Hans Asperger (1906–1980) have Asperger syndrome? | journal = Journal of Autism and Developmental Disorders | volume = 37 | issue = 10 | pages = 2020–21 | date = November 2007 | pmid = 17917805 | doi = 10.1007/s10803-007-0382-4}}{{cite book|vauthors=Osborne L|title=American Normal: The Hidden World of Asperger Syndrome|url=https://archive.org/details/americannormalhi00osbo|url-access=limited|publisher=Copernicus|year=2002|isbn=978-0-387-95307-6|page=[https://archive.org/details/americannormalhi00osbo/page/n35 19]}} In 1944, Asperger gave detailed descriptions of four representative children in his practice who had difficulty in integrating themselves socially and showing empathy towards peers. They also lacked nonverbal communication skills and were physically clumsy. Asperger described this "autistic psychopathy" as social isolation. Fifty years later, several standardizations of AS as a medical diagnosis were tentatively proposed, many of which diverge significantly from Asperger's original work.{{cite journal | vauthors = Hippler K, Klicpera C | title = A retrospective analysis of the clinical case records of 'autistic psychopaths' diagnosed by Hans Asperger and his team at the University Children's Hospital, Vienna | journal = Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences | volume = 358 | issue = 1430 | pages = 291–301 | date = February 2003 | pmid = 12639327 | pmc = 1693115 | doi = 10.1098/rstb.2002.1197}}

Unlike what became known as AS, Asperger believed autistic psychopathy could be found in people of all levels of intelligence, including those with intellectual disability: as such, Asperger's understanding of autistic pathology was more akin to what is known as the autism spectrum today.{{cite book|vauthors=Wing L|chapter=The relationship between Asperger's syndrome and Kanner's autism| veditors = Frith U|title=Autism and Asperger syndrome|year=1991|publisher=Cambridge University Press|isbn=978-0-521-38608-1|pages=93–121}} Asperger defended the value of so-called "high-functioning" autistic individuals, writing: "We are convinced, then, that autistic people have their place in the organism of the social community. They fulfill their role well, perhaps better than anyone else could, and we are talking of people who as children had the greatest difficulties and caused untold worries to their care-givers." Asperger also believed some would be capable of exceptional achievement and original thought later in life.

Asperger's paper was published during World War II and in German, so it was not widely read elsewhere. Lorna Wing used the term Asperger syndrome in 1976,{{cite web|url=https://guidingpathways.com.au/2018/01/24/what-is-aspergers-syndrome/|title=What is Asperger's Syndrome|publisher=Guiding Pathways header logo | vauthors = Cole C | date=24 January 2018|access-date=21 July 2019}} and popularized it to the English-speaking medical community in her February 1981 publication{{cite journal|vauthors=Wing L|author-link=Lorna Wing|year=1981|title=Asperger's Syndrome: A Clinical Account|url=https://ndclibrary.sjc1.vultrobjects.com/lorna-wing-asperger-clinical-account.pdf|journal=Psychological Medicine|volume=11|issue=1|pages=115{{ndash}}129|doi=10.1017/S0033291700053332|pmid=7208735|s2cid=16046498}}{{cite news|url=https://www.nytimes.com/2018/06/18/books/review/aspergers-children-edith-sheffer.html|title=Asperger's Children|work=The New York Times | vauthors = Mnookin S |date=18 June 2018|access-date=22 July 2019}} of case studies of children showing the symptoms described by Asperger, and Uta Frith translated Asperger's paper to English in 1991. Sets of diagnostic criteria were outlined by Gillberg and Gillberg in 1989 and by Szatmari et al. in the same year.{{cite journal | vauthors = Mattila ML, Kielinen M, Jussila K, Linna SL, Bloigu R, Ebeling H, Moilanen I | title = An epidemiological and diagnostic study of Asperger syndrome according to four sets of diagnostic criteria | journal = Journal of the American Academy of Child and Adolescent Psychiatry | volume = 46 | issue = 5 | pages = 636–46 | date = May 2007 | pmid = 17450055 | doi = 10.1097/chi.0b013e318033ff42| s2cid = 28596939 }} AS became a standard diagnosis when it was included in the tenth edition of the World Health Organization's diagnostic manual, International Classification of Diseases (ICD-10), published in 1990 and coming into effect in 1993; and in the fourth edition of the American Psychiatric Association's diagnostic reference, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published in 1994.

Hundreds of books, articles, and websites later described AS and prevalence estimates increased dramatically for ASD, with AS recognized as an important subgroup. Whether AS should be seen as distinct from autism, particularly forms of autism sometimes described as "high functioning", became an issue receiving significant attention and disagreement, along with questions about the empirical validation of the DSM-IV and ICD-10 criteria.

With the publication of the next major editions of the DSM and ICD, the DSM-5 (published in 2013) and the ICD-11 (published in 2018, coming into effect in 2022), AS was eliminated as a separate diagnosis and folded into the autism spectrum.{{cite web|title=299.80 Asperger's Disorder|work=DSM-5 Development|publisher=American Psychiatric Association|access-date=21 December 2010|url=http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=97|archive-url=https://web.archive.org/web/20101225152454/http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=97|archive-date=25 December 2010|url-status=live}} A scale of "severity" levels was included in the DSM-5, whereby most people previously diagnosed with AS would have been classified as "level 1"; but these levels are widely opposed by the autistic community and are not included in the ICD-11.{{cite journal |last1=Kapp |first1=Steven K. |title=Profound Concerns about "Profound Autism": Dangers of Severity Scales and Functioning Labels for Support Needs |journal=Education Sciences |date=19 January 2023 |volume=13 |issue=2 |pages=106 |doi=10.3390/educsci13020106 |doi-access=free }} The ICD-11 characterizes ASD with qualifiers describing the presence of disorders of intellectual development and the degree of functional language impairment; the former diagnosis of Asperger syndrome is characterized as autism spectrum disorder without disorder of intellectual development and with mild or no impairment of functional language.

{{See also|Societal and cultural aspects of autism|Neurodiversity movement|Disability rights movement}}

File:Students, families walk to support Autism Awareness Month 140404-M-ZZ999-331.jpg

People identifying with Asperger syndrome may refer to themselves in casual conversation as aspies (a term first used in print in the Boston Globe in 1998).{{cite book|vauthors=Willey LH|title=Pretending to be Normal: Living with Asperger's Syndrome|url=https://archive.org/details/pretendingtobeno00will|url-access=limited|publisher=Jessica Kingsley|pages=[https://archive.org/details/pretendingtobeno00will/page/n71 71], 104|year=1999|isbn=978-1-85302-749-9}}{{Cite OED|term=Aspie|id=392643|access-date=29 May 2021}} Some autistic people have advocated a shift in perception of autism spectrum disorders as complex syndromes, neurodivergences, and/or neurominority cognitive styles rather than diseases that must be cured. Proponents of this neurodiversity paradigm reject the notion that there is an "ideal" brain configuration and that any deviation from the norm is pathological; they promote tolerance of neurodiversity.{{cite web |last1=Walker |first1=Nick |title=Neurodiversity: Some Basic Terms & Definitions |url=https://neuroqueer.com/neurodiversity-terms-and-definitions/ |website=Neuroqueer: The writings of Nick Walker |access-date=22 November 2024 |date=2014}}{{cite web |last1=Walker |first1=Nick |title=Throw Away the Master's Tools: Liberating Ourselves from the Pathology Paradigm |url=https://neuroqueer.com/throw-away-the-masters-tools/ |website=Neuroqueer: The Writings of Nick Walker |access-date=22 November 2024 |date=2013}}{{cite book|vauthors=Williams CC|chapter=In search of an Asperger|veditors=Stoddart KP|title=Children, Youth and Adults with Asperger Syndrome: Integrating Multiple Perspectives|year=2005|publisher=Jessica Kingsley|isbn=978-1-84310-319-6|pages=[https://archive.org/details/childrenyouthadu00kevi/page/242 242–52]|quote=The life prospects of people with AS would change if we shifted from viewing AS as a set of dysfunctions, to viewing it as a set of differences that have merit.|chapter-url=https://archive.org/details/childrenyouthadu00kevi/page/242}} These views are the basis for the autistic rights and autistic pride movements, within the broader neurodiversity movement.{{cite book|vauthors=Dakin CJ|chapter=Life on the outside: A personal perspective of Asperger syndrome| veditors = Stoddart KP|title=Children, Youth and Adults with Asperger Syndrome: Integrating Multiple Perspectives|year=2005|publisher=Jessica Kingsley|isbn=978-1-84310-319-6|pages=[https://archive.org/details/childrenyouthadu00kevi/page/352 352–61]|chapter-url=https://archive.org/details/childrenyouthadu00kevi/page/352}} There is a contrast between the attitude of people with AS, who typically do not want to be cured and are proud of their identity; and parents of children with AS, who more often seek a "cure" of their children's autism.{{cite journal | vauthors = Clarke J, van Amerom G | title = Asperger's syndrome: differences between parents' understanding and those diagnosed | journal = Social Work in Health Care | volume = 46 | issue = 3 | pages = 85–106 | year = 2008 | pmid = 18551831 | doi = 10.1300/J010v46n03_05 | s2cid = 10181053}}

Some researchers have argued that AS and other autism can be viewed as a different cognitive style, not a disorder,{{cite journal|journal=Disability & Society|year=2007|volume=22|issue=7|pages=761–76|title='Surplus suffering': differences between organizational understandings of Asperger's syndrome and those people who claim the 'disorder'|vauthors=Clarke J, van Amerom G|doi=10.1080/09687590701659618|s2cid=145736625}} and that it should be removed from psychiatric and medical manuals classifying diseases (ICD) or mental disorders (DSM), much as homosexuality was removed.{{cite journal|journal=Disability & Society|year=2009|volume=24|issue=3|pages=343–55|title=Reframing Asperger syndrome: lessons from other challenges to the Diagnostic and Statistical Manual and ICIDH approaches| vauthors = Allred S|doi=10.1080/09687590902789511|s2cid=144506657}}

Even some people typically associated with a pathology paradigm for autism are willing to consider AS a neutral difference. For example, in 2002, Simon Baron-Cohen wrote of those with AS: "In the social world, there is no great benefit to a precise eye for detail, but in the worlds of maths, computing, cataloging, music, linguistics, engineering, and science, such an eye for detail can lead to success rather than failure." Baron-Cohen cited two reasons why it might still be useful to consider AS to be a disability: to ensure provision for legally required special support, and to recognize emotional difficulties from reduced empathy, which was commonly associated with autism during that time but has since lost support.{{cite journal|journal=Focus Autism Other Dev Disabl|year=2002|volume=17|issue=3|pages=186–91|title=Is Asperger syndrome necessarily viewed as a disability?| vauthors = Baron-Cohen S |doi=10.1177/10883576020170030801|s2cid=145629311}} A preliminary, freely readable draft, with slightly different wording in the quoted text, is in: {{cite web|url=http://autismresearchcentre.com/docs/papers/2002_BC_ASDisability.pdf|access-date=2 December 2008|year=2002| vauthors = Baron-Cohen S|title=Is Asperger's syndrome necessarily a disability?|publisher=Autism Research Centre|location=Cambridge|archive-url=https://web.archive.org/web/20081217140628/http://autismresearchcentre.com/docs/papers/2002_BC_ASDisability.pdf|archive-date=17 December 2008|url-status=dead}} Baron-Cohen argues that the genes for ASD's combination of abilities have operated throughout recent human evolution and have made remarkable contributions to human history.{{cite book|title=Foundations of Evolutionary Psychology|chapter=The evolution of brain mechanisms for social behavior|vauthors=Baron-Cohen S|pages=415–32| veditors = Crawford C, Krebs D |publisher=Lawrence Erlbaum|year=2008|isbn=978-0-8058-5957-7}}

By contrast, Pier Jaarsma and Welin wrote in 2011 that the "broad version of the neurodiversity claim, covering low-functioning as well as high-functioning autism, is problematic. Only a narrow conception of neurodiversity, referring exclusively to high-functioning autists, is reasonable."{{cite journal | vauthors = Jaarsma P, Welin S | url = http://www.imh.liu.se/avd_halsa_samhalle/filarkiv1/1.264263/JaarsmaWelin2011Autismasanaturalvariation.pdf | title = Autism as a natural human variation: reflections on the claims of the neurodiversity movement | journal = Health Care Analysis | volume = 20 | issue = 1 | pages = 20–30 | date = March 2012 | pmid = 21311979 | doi = 10.1007/s10728-011-0169-9 | s2cid = 18618887 | archive-url = https://web.archive.org/web/20131101015957/http://www.imh.liu.se/avd_halsa_samhalle/filarkiv1/1.264263/JaarsmaWelin2011Autismasanaturalvariation.pdf | url-status = dead | archive-date = 1 November 2013}} They say that "higher functioning" individuals with autism may "not [be] benefited with such a psychiatric defect-based diagnosis ... some of them are being harmed by it, because of the disrespect the diagnosis displays for their natural way of being", but "think that it is still reasonable to include other categories of autism in the psychiatric diagnostics. The narrow conception of the neurodiversity claim should be accepted but the broader claim should not."

{{Reflist}}

{{Spoken Wikipedia|asperger syndrome.ogg|date=19 October 2016}}

{{Commons}}

• Autistic Empire, [https://www.autisticempire.com/are-you-autistic-take-the-test/ Are you Autistic? Take the test] – an online version of the Adult Asperger's Assessment developed by Cohen, S. et al. (2005) (see Woodbury-Smith MR, "Screening adults for Asperger Syndrome using the AQ: a preliminary study of its diagnostic validity in clinical practice", in §References).
• {{cite journal | vauthors = Hus V, Lord C | title = The autism diagnostic observation schedule, module 4: revised algorithm and standardized severity scores | journal = Journal of Autism and Developmental Disorders | volume = 44 | issue = 8 | pages = 1996–2012 | date = August 2014 | pmid = 24590409 | pmc = 4104252 | doi = 10.1007/s10803-014-2080-3 }} A public paper re-calibrating the Autism Diagnostic Observation Schedule for appropriate assessment of autistic adults, who typically score lower on measures of impairment than autistic children due to compensatory strategies.
• Royal College of Psychiatrists (2017), [https://www.rcpsych.ac.uk/docs/default-source/members/sigs/neurodevelopmental-psychiatry-special-interest-group-ndpsig/ndpsig-autism-diagnostic-interview-guide-2.pdf?sfvrsn=1dc6557_2 Interview Guide for the Diagnostic Assessment of Able Adults with Autistic Spectrum Disorder] – based on the Autism Diagnostic Interview-Revised (ADI-R)

{{Medical condition classification and resources

|DiseasesDB=31268

|ICD10={{ICD10|F|84|5|f|80}}

|ICD9={{ICD9|299.80}}

|OMIM=608638

|MedlinePlus=001549

|eMedicineSubj=ped

|eMedicineTopic=147

|MeshName=Asperger+syndrome

|MeshNumber=F03.550.325.100

|ICD11={{ICD11|6A02.0}}

|Curlie=Health/Mental_Health/Disorders/Neurodevelopmental/Autism_Spectrum/Asperger%27s_Syndrome

}}

{{Pervasive developmental disorders}}

{{Mental and behavioral disorders|selected=childhood}}

{{Nonverbal communication}}

{{Authority control}}

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Category:1976 neologisms

Category:Neurogenetic disorders

Category:Neurological disorders

Category:Obsolete terms for mental disorders

Category:Neurological disorders in children

Category:Wikipedia medicine articles ready to translate

Category:Wikipedia neurology articles ready to translate