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Whatever happened to the diagnosis of Asperger's Disorder, and how is it diagnosed instead now? Let's take a look!

While Asperger's Disorder (also called Asperger's Syndrome) is no longer officially a diagnosis in the United States, it won't take you more than a minute of Googling to realize that plenty of people still identify as "Aspies", and the symptoms that once formed a coherent list of diagnostic criteria still exist. What does "Asperger's" mean in today's world, and what should you know about it?

Asperger's autism: A quick history

Novel and exciting back in 1994 when it came out, the fourth version of the so-called "psychiatry bible", the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV) featured a new diagnosis — "Asperger's Disorder". Sharing much in common with classic autism, the diagnostic criteria were:
  • "Severe and sustained impairment in social interaction." This included difficulty with eye contact, facial expressions and gestures that were deemed odd, finding it hard to develop close relationships with peers, and, in short, general challenges in interacting with (neurotypical) people. 
  • "The development of restricted, repetitive patterns of behavior, interests, and activities." This included special interests (or obsessions, if you like), a strong need for routines, and physical movements now referred to as "stimming" — hand-flapping and rocking, for instance. 
  • These symptoms "must cause clinically significant impairment in social, occupational, or other important areas of functioning"
  • The main differences between Asperger's Disorder and classic autism, then officially called "Autistic Disorder", were that Asperger's caused "no clinically significant delays in language" and "no clinically significant delays in cognitive development" or the development of curiosity, self-help skills, or adaptive behavior

The entity called "Asperger's Disorder" was, then, a subtype of autism that denoted externally observable normal intelligence and speech. Its name came from the person who first "discovered" it — Hans Asperger, an Austrian pediatrician who described these features back in 1944. He described boys who displayed little empathy, were physically clumsy, had trouble maintaining friendships and holding back-and-forth conversations, but who could talk about their favorite subjects at great length and in great depth. 

Where did Asperger's go in the DSM-5?

Though the diagnosis is still included in the eleventh and current version of the World Health Organization's own diagnostic manual, the ICD-11 (International Classification of Diseases), the next version of the DSM, the DSM-5, instead absorbed Asperger's Disorder into the wider diagnosis of Autism Spectrum Disorder

A more comprehensive and modern document, the 2013 version of the DSM introduced slightly different diagnostic criteria:

  • "Persistent deficits in social communication and social interaction" — marked, for instance, by difficulty with eye contact, an unusual way of interacting with people, unusual social skills, flat facial expressions, and difficulty understanding some aspects of verbal and non-verbal communication. 
  • "Restricted, repetitive patterns of behavior, interests, or activities", which can include "stereotyped" repetitive movements, repeating phrases other people say, lining up objects, a strong need for routines and rituals, strong interests, and very strong reactions to certain impulses, like sounds, smells, lights, and textures. 
  • Symptoms should be present in early childhood (though they may not be identified as belonging to the autistic spectrum until later), can't better be explained by another diagnosis, and cause significant difficulties in daily functioning. 

In the DSM-5, these symptoms of autism can occur with or without language delays and with or without intellectual impairment. Depending on how severely the symptoms impact daily functioning, autism spectrum disorder is also divided into three levels in this latest version of the DSM:

  • Level 1 autism means people will require "some support" to function optimally. 
  • Level 2 means requiring "substantial support". 
  • Level 3 means a person will require "very substantial support". 
People who would formerly have been diagnosed with Asperger's Disorder are, as such, likely to now get a diagnosis of autism spectrum disorder without language delays and without intellectual impairment, and will usually be said to have "Level 1" autism. 

Plenty of autistic people take issue with these levels, which may be a bit on the arbitrary side — a person's daily functioning and support needs can change over time and even from one day to the next, and while someone said to have "Level 3" autism may be seen as incapable of making their own decisions because of this label, someone with "Level 1" autism may erroneously be deemed to be fully capable of functioning just like a neurotypical person would. 

The diagnosis formerly called "Asperger's Disorder" still exists, in other words, but it's now officially called something else. Though lots of autistic people still identify as Aspies and the term certainly very much remains a part of popular culture, some welcome the change for two reasons.

  • Firstly, a unified diagnosis of ASD removes what some see as artificial barriers between those who have language delays and those who don't.
  • Secondly, and very importantly, the man after whom Asperger's Disorder was named — an Austrian pediatrician in 1944, remember? — has since been found to have collaborated with the Nazis in making the murder of children with disabilities possible. Some autistic people really don't want to be associated with such a man, and are glad to simply be "autistic" instead. 

A final word

Whether you're an adult who believes they have "Aspie" traits and is on a quest to find out if they fall on the spectrum, or a parent whose child may be autistic, the same characteristics that were once labeled Asperger's are still very much around, just in a new jacket, as it were. Once diagnosed with ASD, some people will choose to use this label, while others prefer to simply call themselves autistic. 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
  • (1994). Diagnostic and statistical manual of mental disorders : DSM-IV. Washington, DC :American Psychiatric Association,
  • Photo courtesy of SteadyHealth

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