Asperger syndrome (AS), also known as Asperger's syndrome or Asperger's, is a formerly used diagnostic category for a condition characterized by significant difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavior and interests. It ceased to be a distinct diagnosis when it was merged into autism spectrum disorder (ASD) in the DSM-5 (2013) and ICD-11 (2022). Previously, it had been classified as a pervasive developmental disorder.
AS was considered milder than other diagnoses. This change reflected a shift toward a unified understanding of autism-related conditions rather than a judgment about individuals previously diagnosed with AS. Despite its removal from contemporary medical classification systems, many people continued to identify with the term Asperger's because of its long-standing use, personal relevance, and the way it shaped their diagnostic history and community identity. However, self-identification using the Asperger label became much rarer (going from 51 percent in 2018 to 19 percent in 2022, according to one set of polls) following the publication of the 2018 Edith Sheffer book Asperger's Children. The book revealed that the label's namesake was complicit in the Nazis' murder of disabled children.
The syndrome was named in 1976 by English psychiatrist Lorna Wing after the Austrian pediatrician Hans Asperger, who in 1944 described children in his care who struggled to form friendships, did not understand others' gestures or feelings, engaged in one-sided conversations about their favorite interests, and were clumsy. In 1990 (coming into effect in 1993), the diagnosis of Asperger syndrome was included in the tenth edition (ICD-10) of the World Health Organization's International Classification of Diseases, and in 1994 it was also included in the fourth edition (DSM-4) of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. With the publication of DSM-5 in 2013, the syndrome was removed, and the symptoms regarded as an autism spectrum disorder along with classic autism and pervasive developmental disorder not otherwise specified (PDD-NOS). It was similarly merged into autism spectrum disorder in the International Classification of Diseases (ICD-11) in 2018 (published, came into effect in 2022).
The cause of autism, including what was formerly called Asperger syndrome, is not well understood. While it has high heritability, the underlying genetics have not been determined conclusively. Environmental factors are also believed to play a role. Brain imaging has not identified a common underlying condition. There is no single treatment, and the UK's National Health Service (NHS) guidelines suggest that "treatment" of any form of autism should not be a goal, since autism is not "a disease that can be removed or cured". According to the Royal College of Psychiatrists, while co-occurring conditions might require treatment, "management of autism itself is chiefly about the provision of the education, training, and social support/care required to improve the person's ability to function in the everyday world". The effectiveness of particular interventions for autism is supported by only limited data. Interventions may include social skills training, cognitive behavioral therapy, physical therapy, speech therapy, parent training, and medications for associated problems, such as mood or anxiety. NIH Publication No. 05-5624. Autistic characteristics tend to become less obvious in adulthood, but social and communication difficulties usually persist.
In 2015, Asperger syndrome was estimated to affect 37.2 million people globally, or about 0.5% of the population. The exact percentage of people affected has still not been firmly established. Autism spectrum disorder is diagnosed in males more often than females, and females are typically diagnosed at a later age. The modern conception of Asperger syndrome came into existence in 1981 and went through a period of popularization. It became a standardized diagnosis in the 1990s, and was merged into ASD in 2013. Many questions about the condition remain.
Classification The extent of the overlap between Asperger syndrome and other forms of autism, particularly what was sometimes called high-functioning autism is unclear. The ASD classification is to some extent an artifact of how autism was discovered, and it may not reflect the true nature of the spectrum; methodological problems have beset Asperger syndrome as a valid diagnosis from the outset. 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, the change was controversial.
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.
Characteristics
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. 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.
Social interaction
A lack of demonstrated empathy affects aspects of social relatability for persons with Asperger syndrome. 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.
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.
Violent or criminal behavior The hypothesis that individuals with Asperger syndrome are predisposed to violent or criminal behavior has been investigated but is unsupported by data. More evidence suggests that children diagnosed with Asperger syndrome are more likely to be victims, rather than offenders.
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).
Empathy 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.
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."
Restricted and repetitive interests and behavior
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.