Experiencing & Validating

AS was considered milder than other diagnoses.

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.

struggled to form friendships, did not understand others' gestures or feelings, engaged in one-sided conversations about their favorite interests, and were clumsy.

With the publication of DSM-5 in 2013, the syndrome was removed, and the symptoms are now included within autism spectrum disorder along with classic autism and pervasive developmental disorder not otherwise specified (PDD-NOS).[5][15]

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".[20] According to the Royal College of Psychiatrists,[21] 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"

Autistic characteristics tend to become less obvious in adulthood,[21] but social and communication difficulties usually persist.[22]

The extent of the overlap between Asperger syndrome and other forms of autism, particularly what was sometimes called high-functioning autism is unclear.[30][31][32] The ASD classification is to some extent an artifact of how autism was discovered,[33] and it may not reflect the true nature of the spectrum;[34]

People with Asperger syndrome often display restricted or specialized interests, such as this boy's interest in stacking cans.

cans. 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.[40] 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.[30]

A lack of demonstrated empathy affects aspects of social relatability for persons with Asperger syndrome.[43] 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.[18]

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.[30] This social awkwardness has been called "active but odd".[18] 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.[30] 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.[44]

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.[18]

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.[49]

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."[50][51][52][53]

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.[40]

This behavior is usually apparent by age five or six.[18] 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.[30]

Stereotyped and repetitive motor behaviors, called stimming, are a core part of the diagnosis of AS and other ASDs.[54] Stims are believed to be used for self-soothing and regulate sensory input.[55]

for which several explanations have been put forward, including common genetic factors and dopamine, glutamate, or serotonin abnormalities.[60]

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.[61]

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.[18] Echolalia has also been observed in individuals with AS.[62] 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.[63] 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.[30]

Children with AS may have a sophisticated vocabulary at a young age and such children have often been colloquially called "little professors"[64] but have difficulty understanding figurative language and tend to use language literally.[18]

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.[65]

Individuals with AS often have excellent auditory and visual perception.[67] 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.[68] 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.[18] 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;[69] these sensory responses are found in other developmental disorders and are not specific to AS or to ASD.

Hans Asperger's initial accounts[18] and other diagnostic schemes[71] 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".

AS is also associated with high levels of alexithymia, which is difficulty in identifying and describing one's emotions.[74] Although AS, lower sleep quality, and alexithymia are associated with each other, their causal relationship is unclear.[73]

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.[79][86] One study found that activation is delayed in the core circuit for imitation in individuals with AS.[87] 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;[88] 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.[89]

This section's factual accuracy may be compromised due to out-of-date information. The reason given is: 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. Please help update this article to reflect recent events or newly available information. (January 2022)

social-cognitive deficits due to brain damage from alcohol use disorder,[98]

Different screening instruments are used to diagnose AS,[8][71] including the Asperger Syndrome Diagnostic Scale (ASDS); Autism Spectrum Screening Questionnaire (ASSQ); Childhood Autism Spectrum Test (CAST), previously called the Childhood Asperger Syndrome Test;[101] Gilliam Asperger's disorder scale (GADS); Krug Asperger's Disorder Index (KADI);[102] and the autism-spectrum quotient (AQ), with versions for children,[103] adolescents,[104] and adults.[105] None have been shown to reliably differentiate between AS and other ASDs.[18]

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.[108][109][110] 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.[111][112][113][114][115][116] The Autistic Self Advocacy Network campaigns against the use of ABA in autism.[117][118]

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.[119][120]

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.[76]

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.

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.[18] The atypical antipsychotic medications risperidone, olanzapine and aripiprazole have been shown to reduce the associated symptoms of AS;[18][129][130]

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,[18][43][75] while stimulant medication, such as methylphenidate, can reduce inattention.[131] 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.[76]

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.[22] 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.[30] 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.[18][22]

ASD symptoms are more likely to diminish with time in children with AS or forms of autism sometimes described as "high functioning".[137] Most students with AS and forms of autism sometimes seen as "high functioning"

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.[30] 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.[18] The "different-ness" adolescents experience can be traumatic.[140] 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;[18] the resulting stress may manifest as inattention, withdrawal, reliance on obsessions, hyperactivity, or aggressive or oppositional behavior.[123] Depression is often the result of chronic frustration from repeated failure to engage others socially, and mood disorders requiring treatment may develop.[18]

The repetitive behaviors of AS have many similarities with the symptoms of obsessive–compulsive disorder and obsessive–compulsive personality disorder,[59]

as such, Asperger's understanding of autistic pathology was more akin to what is known as the autism spectrum today.[157] 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."[14] Asperger also believed some would be capable of exceptional achievement and original thought later in life.[43]

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.[161][16][17] 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.[162] 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.[16]

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.[16]

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.[165][166]

Some researchers have argued that AS and other autism can be viewed as a different cognitive style, not a disorder,[170] and that it should be removed from psychiatric and medical manuals classifying diseases (ICD) or mental disorders (DSM), much as homosexuality was removed.[171]

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.[172] 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.[173]