High-functioning autism and Asperger’s Syndrome are both part of the autism spectrum. There are a few differences. In the language development dept., people with Asperger syndrome will not have had delayed language development when younger. Sometimes, the two diagnoses are given on an almost interchangeable basis.
The term ‘autism’ has an unusual history. It was originally coined by a psychiatrist Eugen Bleuler in 1911 to describe what he perceived as one of the key symptoms of schizophrenia, that of social withdrawal. Autism, literally meaning ‘selfism’, seemed to him to describe the active detachment which affected many of his patients. In the 1940s, when Leo Kanner in America and Hans Asperger in Austria were both beginning to identify the existence of autism they separately stumbled on this term which they felt described what they were witnessing in the children they were treating. Kanner started from the premise that these children were experiencing childhood schizophrenia. In time, he became aware that they were not exhibiting all the symptoms of schizophrenia and used the phrase ‘infantile autism’ to describe their condition. Asperger identified a personality disorder affecting some of the children referred to his child psychiatry clinic which he felt was described, albeit imperfectly, by the term autism. His acute identification of autism was extraordinarily ahead of its time considering he was among the first people to chart it. Unlike schizophrenic patients, children with autism do not show a disintegration of personality. They are not psychotic; instead they show a greater or lesser degree of autism.
Kanner, an American, wrote in English. His paper was published in the UK where it gained a lot of attention. The term ‘infantile autism’ became increasingly widely used in the 1950s and 60s, more and more children were diagnosed with the condition. In the English-speaking world, the work of Hans Asperger was largely ignored. However, in Europe, he continued to conduct research and have an influence over child psychiatry.
We don’t know if Kanner was ever aware of the work of Asperger, but we do know that Asperger in later years read about the work of Leo Kanner. He argued, albeit unconvincingly, that they had identified separate syndromes with a great overlap. Other academics began to argue that Asperger’s and Kanner’s autism were the same syndrome. Most notably Judith Gould and Lorna Wing in their ground-breaking study in Camberwell in the late 1970s came to the conclusion that autism existed on a continuum. In 1981, Lorna Wing used the phrase ‘Asperger syndrome’ in a research paper to describe a distinct sub-group of patients that she had been seeing. The term became much more widely used in the English-speaking world as a result. Some professionals have felt that Asperger syndrome is a more acceptable diagnosis from the point of view of parents. They argue that there is a social stigma attached to autism which is not attached to the term Asperger syndrome.
- Level of cognitive functioning: The view that Asperger syndrome is autism without any additional learning disability is helpful from the diagnostic point of view as it is fairly easy to make a distinction in these circumstances. However, Asperger himself said that there might be unusual circumstances where a person could present the symptoms of Asperger syndrome with additional learning disability. It is widely recognized that high-functioning autism cannot occur in someone with an IQ below 65-70.
- Motor skills: In recent years, the view that Asperger syndrome can only occur when there are additional difficulties with motor skills has become more prominent. Certainly Asperger himself was well aware of the prevalence of motor skill problems in the group of people he tried to describe. It seems likely that most children with Asperger syndrome experience poor co-ordination and difficulties with fine motor control. However, many children with higher functioning autism will also have difficulties in these areas.
- Language development: This is the area that probably causes the greatest controversy. Both ICD-10 and DSM-IV1 state that for a diagnosis of Asperger syndrome, spoken language development must be normal. Children with high-functioning autism may have had significant language delay. However, Asperger’s original descriptions of the condition stated that speech and language peculiarities are a key feature of Asperger syndrome. Often diagnoses of Asperger syndrome are made when a child is quite old and they or their parents may have difficulty remembering the details of their language development.
- Age of onset: A diagnosis of high-functioning autism and one of Asperger syndrome can be made in the same individual at different stages of development. Occasionally, a child has been diagnosed with high-functioning autism in early childhood and this diagnosis has been changed to Asperger syndrome when they started school. Some diagnosticians are clearly of the view that Asperger syndrome cannot be diagnosed before a child starts school. However, this is largely because areas such as social skills deficits may not become apparent until a child spends a lot of time in social settings.
- Both people with high-functioning autism and Asperger syndrome are affected by the ‘triad of impairments’ common to all people with autism.
- Both groups are likely to be of average or above average intelligence.
- The debate as to whether we need two diagnostic terms is ongoing.
- However, there may be features such as age of onset and motor skill deficits which differentiate the two conditions.If you or your son or daughter has recently been given a diagnosis of either high-functioning autism or Asperger syndrome then it is worth checking what criteria the diagnostician was using.
- Although it is frustrating to be given a diagnosis which has yet to be clearly defined it is worth remembering that the fundamental presentation of the two conditions is largely the same. This means that treatments, therapies and educational approaches should also be largely similar. At the same time, all people with autism or Asperger syndrome are unique and have their own special skills and abilities. These deserve as much recognition as the areas they have difficulty in.
- What distinguishes Asperger’s syndrome from autism is the severity of the symptoms and the absence of language delays. Children with Asperger’s syndrome may be only mildly affected and frequently have good language and cognitive skills. To the untrained observer, a child with Asperger’s syndrome may just seem like a normal child behaving differently.
- Children with autism are frequently seen as aloof and uninterested in others. This is not the case with Asperger’s syndrome. Individuals with Asperger’s syndrome usually want to fit in and have interaction with others; they simply don’t know how to do it. They may be socially awkward, not understand conventional social rules, or may show a lack of empathy. They may have limited eye contact, seem to be unengaged in a conversation, and not understand the use of gestures. However, the fact that some persons with Asperger’s may make eye contact does not rule out the diagnosis for them. Therefore, a child who can make eye contact could still have Asperger’s syndrome.
- Interests in a particular subject may border on the obsessive. Children with Asperger’s syndrome frequently like to collect categories of things, such as rocks or bottle caps. They may be proficient in knowing categories of information, such as baseball statistics or Latin names of flowers.While they may have good rote memory skills, they may have difficulty with abstract concepts.
- One of the major differences between Asperger’s syndrome and autism is that, by definition, there is no speech delay in Asperger’s. In fact, children with Asperger’s syndrome frequently have a large vocabulary and can talk a lot; they simply use language in different ways. Speech patterns may be unusual, lack inflection, or have a rhythmic nature or they may be formal, but too loud, too quiet, or high pitched. Sometimes their speech can be informal when it needs to be formal, or vice versa. They also may not be able to communicate the message that is most important, especially when they are stressed or upset.
- Children with Asperger’s may not understand the subtleties of language, such as irony and humor, or they may not understand the give and take nature of a conversation. Another distinction between Asperger’s syndrome and autism concerns cognitive ability. While some individuals with autism experience cognitive delay, by definition a person with Asperger’s cannot possess a “clinically significant” cognitive delay and most possess an average to above average intelligence. While motor difficulties are not a specific criteria for Asperger’s, children with Asperger’s syndrome frequently have motor skill delays and may appear clumsy or awkward.