History of Asperger syndrome

Two subtypes of autism were described between 1943 and 1944 by two Austrian researchers working independently—Austrian-born Asperger and child psychiatrist Leo Kanner (1894–1981). Kanner emigrated to the United States in 1924;[1] he described a similar syndrome in 1943, known as "classic autism" or "Kannerian autism", characterized by significant cognitive and communicative deficiencies, including delayed or absent language development.[10] Kanner's descriptions were influenced by the developmental approach of Arnold Gesell, while Asperger was influenced by accounts of schizophrenia and personality disorders.[11] Asperger's frame of reference was Eugen Bleuler's typology, which Christopher Gillberg has described as "out of keeping with current diagnostic manuals", adding that Asperger's descriptions are "penetrating but not sufficiently systematic".[12] Asperger was unaware of Kanner's description published a year before his;[11] the two researchers were separated by an ocean and a raging war, and Asperger's descriptions were unnoticed in the United States.[6] During his lifetime, Asperger's work, in German, remained largely unknown outside the German-speaking world.[1]

According to Ishikawa and Ichihashi in the Japanese Journal of Clinical Medicine, the first author to use the term Asperger's syndrome in the English-language literature was the German physician, Gerhard Bosch.[13] Between 1951 and 1962, Bosch worked as a psychiatrist at Frankfurt University. In 1962, he published a monograph detailing five case histories of individuals with PDD[14] that was translated into English eight years later,[15] becoming one of the first to establish German research on autism, and attracting attention outside the German-speaking world.[16]

Lorna Wing coined the term Asperger's syndrome in 1976[17] and is also credited with widely popularizing the term in the English-speaking medical community in her February 1981 publication[18][19][20] of a series of case studies of children showing similar symptoms.[1] Wing also placed AS on the autism spectrum, although Asperger was uncomfortable characterizing his patient on the continuum of autistic spectrum disorders.[6] She chose "Asperger's syndrome" as a neutral term to avoid the misunderstanding equated by the term autistic psychopathy with sociopathic behavior.[21] Wing's publication effectively introduced the diagnostic concept into American psychiatry and renamed the condition as Asperger's;[22] however, her accounts blurred some of the distinctions between Asperger's and Kanner's descriptions because she included some mildly retarded children and some children who presented with language delays early in life.[11]

The first systematic studies appeared in the late 1980s in publications by Tantam (1988) in the UK, Gillberg and Gilbert in Sweden (1989), and Szatmari, Bartolucci and Bremmer (1989) in North America.[1] The diagnostic criteria for AS were outlined by Gillberg and Gillberg in 1989; Szatmari also proposed criteria in 1989.[21] Asperger's work became more widely available in English when Uta Frith, an early researcher of Kannerian autism, translated his original paper in 1991.[1] AS became a distinct diagnosis in 1992, when it was included in the 10th published edition of the World Health Organization’s diagnostic manual, International Classification of Diseases (ICD-10); in 1994, it was added to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as Asperger's Disorder.[7] When Hans Asperger observed the autistic like symptoms and behaviors in boys through their social and communication skills, many professionals felt like Asperger's syndrome was just a less severe form of autism. Uta Frith was one of these professionals who had this opinion. She was a professor at the Institute of Cognitive Neuroscience of University College London, and was also an editor of Autism and Asperger Syndrome. She said that individuals with Asperger's had a "dash of autism". She was one of the first scientists who recognized autism and related disorders as the result of a condition of the brain instead of the outcome of detached parenting.

Less than two decades after the widespread introduction of AS to English-speaking audiences, there are hundreds of books, articles and websites describing it; prevalence estimates have increased dramatically for ASD, with AS recognized as an important subgroup.[1] However, questions remain concerning many aspects of AS; whether it should be a separate condition from high-functioning autism is a fundamental issue requiring further study.[6] The diagnostic validity of Asperger syndrome is tentative, there is little consensus among clinical researchers about the usage of the term "Asperger's syndrome", and there are questions about the empirical validation of the DSM-IV and ICD-10 criteria.[11] It is likely that the definition of the condition will change as new studies emerge[11] and it will eventually be understood as a multifactorial heterogeneous neurodevelopmental disorder involving a catalyst that results in prenatal or perinatal changes in brain structures.[6]

There is uncertainty regarding the gender gap between males and females with AS. A person with Asperger's is often remarked as possessing masculine traits like emotional distance from the inability to empathize, and far more boys than girls are diagnosed with Asperger's.[23] Most studies on the syndrome were derived from research on males, neglecting specific attention to females with AS who often go misdiagnosed. For the most part, studies on girls with Asperger's are anecdotal.[23]

In 1994, Asperger's Syndrome was added to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The DSM-V made a new, broad diagnosis in 2013 of autism spectrum disorder (ASD). This category contains the previous individual diagnoses of Autistic Disorder, Asperger's Syndrome, and other related developmental disorders. ASD is rated on levels of severity on a scale ranging from severe, through moderate, to mild based on clinical presentation.[24] The levels are determined by the amount of support the individual requires. Due to the change, individuals who were previously diagnosed with Asperger's Syndrome were re-diagnosed within the umbrella of ASD due to the DSM revision.