Asperger syndrome

Other names| Asperger's syndrome, Asperger disorder (AD), Asperger's
Restricted interests or repetitive behaviors, such as this boy's interest in playing with a toy model of molecules, may be features of Asperger's.
Pronunciation|

* /ˈæspɜːrɡərz/,[1] /-dʒərz/[2]

Specialty| Psychiatry
Symptoms| Problems with social interactions, restricted and repetitive behavior[3]
Usual onset| Before two years old[3]
Duration| Long term[3]
Causes| Unknown[3]
Treatment| Social skills training, cognitive behavioral therapy, physical therapy, speech therapy, parent training[4]
Frequency| 37.2 million (2015)[5]

Asperger syndrome (AS), also known as Asperger's, is a developmental disorder characterized by significant difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavior and interests.[3] As a milder autism spectrum disorder (ASD), it differs from other ASDs by relatively normal language and intelligence.[6] Although not required for diagnosis, physical clumsiness and unusual use of language are common.[7][8] Signs usually begin before two years old and typically last for a person's entire life.[3]

The exact cause of Asperger's is unknown.[3] While it is probably partly inherited, the underlying genetics have not been determined conclusively.[7][9] Environmental factors are also believed to play a role.[3] Brain imaging has not identified a common underlying problem.[7] The diagnosis of Asperger's was removed in the 2013 fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and people with these symptoms are now included within the autism spectrum disorder along with autism and pervasive developmental disorder not otherwise specified (PDD-NOS).[3][10] It remains within the tenth edition of the International Classification of Diseases (ICD-10) (As of 2015).[6]

There is no single treatment, and the effectiveness of particular interventions is supported by only limited data.[7] Treatment is aimed at improving poor communication skills, obsessive or repetitive routines and physical clumsiness.[4] 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.[4] Most children improve as they grow up, but social and communication difficulties usually persist.[11] Some researchers and people on the autism spectrum have advocated a shift in attitudes toward the view that autism spectrum disorder is a difference rather than a disease that must be treated or cured.[12][13]

In 2015, Asperger's was estimated to affect 37.2 million people globally.[5] The syndrome is named after the Austrian pediatrician Hans Asperger, who in 1944 described children in his practice who lacked nonverbal communication, had limited understanding of others' feelings, and were physically clumsy.[14] The modern conception of Asperger syndrome came into existence in 1981 and went through a period of popularization.[15][16][17] It became a standardized diagnosis in the early 1990s.[18] Many questions and controversies remain about aspects of the disorder.[11] There is doubt about whether it is distinct from high-functioning autism (HFA).[19] Partly because of this, the percentage of people affected is not firmly established.[7]

## Contents

* 1 Classification
* 2 Characteristics
* 2.1 Social interaction
* 2.1.1 Violent or criminal behavior
* 2.2 Restricted and repetitive interests and behavior
* 2.3 Speech and language
* 2.4 Motor and sensory perception
* 3 Causes
* 4 Mechanism
* 5 Diagnosis
* 5.1 Differential diagnosis
* 6 Screening
* 7 Management
* 7.1 Therapies
* 7.2 Medications
* 8 Prognosis
* 9 Epidemiology
* 10 History
* 11 Society and culture
* 12 References
* 13 External links

## Classification

The extent of the overlap between AS and high-functioning autism (HFA—autism unaccompanied by intellectual disability) is unclear.[19][20][21] The ASD classification is to some extent an artifact of how autism was discovered,[22] and may not reflect the true nature of the spectrum;[23] methodological problems have beset Asperger syndrome as a valid diagnosis from the outset.[24][25] In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in May 2013,[26] AS, as a separate diagnosis, was eliminated and folded into autism spectrum disorder.[27] Like the diagnosis of Asperger syndrome,[28] the change was controversial[28][29] and AS was not removed from the WHO's ICD-10.

The World Health Organization (WHO) defined Asperger syndrome (AS) as one of the autism spectrum disorders (ASD) or pervasive developmental disorders (PDD), which are a spectrum of psychological conditions 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 psychological development disorders, 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.[30] ASD, in turn, is a subset of the broader autism phenotype, which describes individuals who may not have ASD but do have autistic-like traits, such as social deficits.[31] Of the other four ASD forms, autism is the most similar to AS in signs and likely causes, but its diagnosis requires impaired communication and allows delay in cognitive development; Rett syndrome and childhood disintegrative disorder share several signs with autism but may have unrelated causes; and pervasive developmental disorder not otherwise specified (PDD-NOS) is diagnosed when the criteria for a more specific disorder are unmet.[32]

## Characteristics

People with Asperger syndrome often display restricted or specialized interests, such as this boy's interest in stacking 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.[33] 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.[19] Suicidal behavior appears to occur at rates similar to those without ASD.[34]

### Social interaction

A lack of demonstrated empathy affects aspects of communal living for persons with Asperger syndrome.[8] Individuals with AS 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 (for example, showing others objects of interest); a lack of social or emotional reciprocity (social "games" give-and-take mechanic); and impaired nonverbal behaviors in areas such as eye contact, facial expression, posture, and gesture.[7]

People with AS may not be as withdrawn around others, compared with those with other, more debilitating forms of autism; they approach others, even if awkwardly. For example, a person with AS 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.[19] This social awkwardness has been called "active but odd".[7] Such failures to react appropriately to social interaction may appear as disregard for other people's feelings and may come across as insensitive.[19] However, not all individuals with AS will approach others. Some of them may even display selective mutism, not speaking at all to most people and excessively to specific others. Some may choose only to talk to people they like.[35]

The cognitive ability of children with AS often allows them to articulate social norms in a laboratory context,[7] 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.[19] People with AS 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. Childhood desire for companionship can become numbed through a history of failed social encounters.[7]

#### Violent or criminal behavior

The hypothesis that individuals with AS are predisposed to violent or criminal behavior has been investigated, but is not supported by data.[7][36] More evidence suggests that children diagnosed with Asperger syndrome are victims rather than offenders.[37]

A 2008 review found that an overwhelming number of reported violent criminals with Asperger syndrome had also other coexisting psychotic psychiatric disorders such as schizoaffective disorder.[38]

### 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.[33]

Pursuit of specific and narrow areas of interest is one of the most striking among possible features of AS.[7] 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.[7][19] For example, a child might memorize camera model numbers while caring little about photography.[7] This behavior is usually apparent by age 5 or 6.[7] 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.[19]

Stereotyped and repetitive motor behaviors are a core part of the diagnosis of AS and other ASDs.[39] They include hand movements such as flapping or twisting, and complex whole-body movements.[33] These are typically repeated in longer bursts and look more voluntary or ritualistic than tics, which are usually faster, less rhythmical, and less often symmetrical.[40]

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.[41]

### Speech and language

Although individuals with Asperger syndrome acquire language skills without significant general delay and their speech typically lacks significant abnormalities, language acquisition and use is often atypical.[19] 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.[7] Echolalia has also been observed in individuals with AS.[42]

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. 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.[19]

Children with AS may have a sophisticated vocabulary at a young age and such children have often been colloquially called "little professors", but have difficulty understanding figurative language and tend to use language literally.[7] Children with AS appear to have particular weaknesses in areas of nonliteral language that include humor, irony, teasing, and sarcasm. Although individuals with AS usually understand the cognitive basis of humor, they seem to lack understanding of the intent of humor to share enjoyment with others.[20] 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.[43]

### Motor and sensory perception

Individuals with Asperger syndrome may have signs or symptoms that are independent of the diagnosis, but can affect the individual or the family.[44] These include differences in perception and problems with motor skills, sleep, and emotions.

Individuals with AS often have excellent auditory and visual perception.[45] 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.[46] 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.[7] 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;[47] these sensory responses are found in other developmental disorders and are not specific to AS or to ASD. There is little support for increased fight-or-flight response or failure of habituation in autism; there is more evidence of decreased responsiveness to sensory stimuli, although several studies show no differences.[48]

Hans Asperger's initial accounts[7] and other diagnostic schemes[49] 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". They may be poorly coordinated or have an odd or bouncy gait or posture, poor handwriting, or problems with motor coordination.[7][19] They may show problems with proprioception (sensation of body position) on measures of developmental coordination disorder (motor planning disorder), balance, tandem gait, and finger-thumb apposition. There is no evidence that these motor skills problems differentiate AS from other high-functioning ASDs.[7]

Children with AS are more likely to have sleep problems, including difficulty in falling asleep, frequent nocturnal awakenings, and early morning awakenings.[50][51] AS is also associated with high levels of alexithymia, which is difficulty in identifying and describing one's emotions.[52] Although AS, lower sleep quality, and alexithymia are associated with each other, their causal relationship is unclear.[51]

## Causes

Further information: Social:Causes of autism

Hans Asperger described common symptoms among his patients' family members, especially fathers, and research supports this observation and suggests a genetic contribution to Asperger syndrome. Although no specific gene has yet been identified, multiple factors are believed to play a role in the expression of autism, given the phenotypic variability seen in children with AS.[7][53] Evidence for a genetic link is the tendency for AS to run in families and an observed higher incidence of family members who have behavioral symptoms similar to AS but in a more limited form (for example, slight difficulties with social interaction, language, or reading).[4] Most behavioral genetic research suggests that all autism spectrum disorders have shared genetic mechanisms, but AS may have a stronger genetic component than autism.[7] There is probably a common group of genes where particular alleles render an individual vulnerable to developing AS; if this is the case, the particular combination of alleles would determine the severity and symptoms for each individual with AS.[4]

A few ASD cases have been linked to exposure to teratogens (agents that cause birth defects) during the first eight weeks from conception. Although this does not exclude the possibility that ASD can be initiated or affected later, it is strong evidence that ASD arises very early in development.[54] Many environmental factors have been hypothesized to act after birth, but none has been confirmed by scientific investigation.[55]

## Mechanism

Functional magnetic resonance imaging provides some evidence for both underconnectivity and mirror neuron theories.[56][57]

Asperger syndrome appears to result from developmental factors that affect many or all functional brain systems, as opposed to localized effects.[58] Although the specific underpinnings of AS or factors that distinguish it from other ASDs are unknown, and no clear pathology common to individuals with AS has emerged,[7] it is still possible that AS's mechanism is separate from other ASDs.[59] Neuroanatomical studies and the associations with teratogens strongly suggest that the mechanism includes alteration of brain development soon after conception.[54] Abnormal migration of embryonic cells during fetal development may affect the final structure and connectivity of the brain, resulting in alterations in the neural circuits that control thought and behavior.[60] Several theories of mechanism are available; none are likely to provide a complete explanation.[61]

The underconnectivity theory hypothesizes underfunctioning high-level neural connections and synchronization, along with an excess of low-level processes.[56] It maps well to general-processing theories such as weak central coherence theory, which hypothesizes that a limited ability to see the big picture underlies the central disturbance in ASD.[62] A related theory—enhanced perceptual functioning—focuses more on the superiority of locally oriented and perceptual operations in autistic individuals.[63]

The mirror neuron system (MNS) theory hypothesizes that alterations to the development of the MNS interfere with imitation and lead to Asperger's core feature of social impairment.[57][64] For example, one study found that activation is delayed in the core circuit for imitation in individuals with AS.[65] 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;[66] 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.[67]

## Diagnosis

Main page: Medicine:Diagnosis of Asperger syndrome

Standard diagnostic criteria require impairment in social interaction and repetitive and stereotyped patterns of behavior, activities, and interests, without significant delay in language or cognitive development. Unlike the international standard,[30] the DSM-IV-TR criteria also required significant impairment in day-to-day functioning;[33] DSM-5 eliminated AS as a separate diagnosis in 2013, and folded it into the umbrella of autism spectrum disorders.[27] Other sets of diagnostic criteria have been proposed by Szatmari et al.[68] and by Gillberg and Gillberg.[69]

Diagnosis is most commonly made between the ages of four and eleven.[7] A comprehensive assessment involves a multidisciplinary team[8][4][70] that observes across multiple settings,[7] and includes neurological and genetic assessment as well as tests for cognition, psychomotor function, verbal and nonverbal strengths and weaknesses, style of learning, and skills for independent living.[4] The "gold standard" in diagnosing ASDs combines clinical judgment with the Autism Diagnostic Interview-Revised (ADI-R), a semistructured parent interview; and the Autism Diagnostic Observation Schedule (ADOS), a conversation and play-based interview with the child.[11] Delayed or mistaken diagnosis can be traumatic for individuals and families; for example, misdiagnosis can lead to medications that worsen behavior.[70][71]

Underdiagnosis and overdiagnosis may be problems. The cost and difficulty of screening and assessment can delay diagnosis. Conversely, the increasing popularity of drug treatment options and the expansion of benefits has motivated providers to overdiagnose ASD.[72] There are indications AS has been diagnosed more frequently in recent years, partly as a residual diagnosis for children of normal intelligence who are not autistic but have social difficulties.[73]

There are questions about the external validity of the AS diagnosis. That is, it is unclear whether there is a practical benefit in distinguishing AS from HFA and from PDD-NOS;[73] the same child can receive different diagnoses depending on the screening tool.[4] The debate about distinguishing AS from HFA is partly due to a tautological dilemma where disorders are defined based on severity of impairment, so that studies that appear to confirm differences based on severity are to be expected.[74]

### Differential diagnosis

Many children with AS are initially misdiagnosed with attention deficit hyperactivity disorder (ADHD).[7] Diagnosing adults is more challenging, as standard diagnostic criteria are designed for children and the expression of AS changes with age.[75][76] Adult diagnosis requires painstaking clinical examination and thorough medical history gained from both the individual and other people who know the person, focusing on childhood behavior.[41]

Conditions that must be considered in a differential diagnosis along with ADHD include other ASDs, the schizophrenia spectrum, personality disorders, obsessive–compulsive disorder, major depressive disorder, semantic pragmatic disorder, nonverbal learning disorder, social anxiety disorder,[70][75] Tourette syndrome,[40] stereotypic movement disorder, bipolar disorder,[53] social-cognitive deficits due to brain damage from alcohol abuse,[77] and obsessive–compulsive personality disorder (OCPD).[78][79]

## Screening

Parents of children with Asperger syndrome can typically trace differences in their children's development to as early as 30 months of age.[53] Developmental screening during a routine check-up by a general practitioner or pediatrician may identify signs that warrant further investigation.[7][4] The United States Preventive Services Task Force in 2016 found it was unclear if screening was beneficial or harmful among children in whom there are no concerns.[80]

The diagnosis of AS is complicated by the use of several different screening instruments,[4][49] including the Asperger Syndrome Diagnostic Scale (ASDS); Autism Spectrum Screening Questionnaire (ASSQ); Childhood Autism Spectrum Test (CAST), previously called the Childhood Asperger Syndrome Test;[81] Gilliam Asperger's disorder scale (GADS); Krug Asperger's Disorder Index (KADI);[82] and the autism-spectrum quotient (AQ), with versions for children,[83] adolescents,[84] and adults.[85] None have been shown to reliably differentiate between AS and other ASDs.[7]

## Management

Further information: Medicine:Autism therapies

Asperger syndrome treatment attempts to manage distressing symptoms and to teach age-appropriate social, communication, and vocational skills that are not naturally acquired during development,[7] with intervention tailored to the needs of the individual based on multidisciplinary assessment.[86] Although progress has been made, data supporting the efficacy of particular interventions are limited.[7][87]

### Therapies

The ideal treatment for AS coordinates therapies that address core symptoms of the disorder, including poor communication skills and obsessive or repetitive routines. While most professionals agree that the earlier the intervention, the better, there is no single best treatment package.[4] AS treatment resembles that of other high-functioning ASDs, except that it takes into account the linguistic capabilities, verbal strengths, and nonverbal vulnerabilities of individuals with AS.[7] A typical program generally includes:[4]

* A positive behavior support procedure includes training and support of parents and school faculty in behavior management strategies to use in the home and school;
* An applied behavior analysis (ABA) technique called social skills training for more effective interpersonal interactions;[88]
* Cognitive behavioral therapy to improve stress management relating to anxiety or explosive emotions[89] and to cut back on obsessive interests and repetitive routines;
* Medication for coexisting conditions such as major depressive disorder and anxiety disorders;[90]
* Occupational or physical therapy to assist with poor sensory processing and motor coordination; and,
* Social communication intervention, which is specialized speech therapy to help with the pragmatics and give-and-take of normal conversation.[91]

Of the many studies on behavior-based early intervention programs, most are case reports of up to five participants and typically examine a few problem behaviors such as self-injury, aggression, noncompliance, stereotypies, or spontaneous language; unintended side effects are largely ignored.[92] Despite the popularity of social skills training, its effectiveness is not firmly established.[93] A randomized controlled study of a model for training parents in problem behaviors in their children with AS showed that parents attending a one-day workshop or six individual lessons reported fewer behavioral problems, while parents receiving the individual lessons reported less intense behavioral problems in their AS children.[94] Vocational training is important to teach job interview etiquette and workplace behavior to older children and adults with AS, and organization software and personal data assistants can improve the work and life management of people with AS.[7]

### Medications

No medications directly treat the core symptoms of AS.[90] Although research into the efficacy of pharmaceutical intervention for AS is limited,[7] it is essential to diagnose and treat comorbid conditions.[8] Deficits in self-identifying emotions or in observing effects of one's behavior on others can make it difficult for individuals with AS to see why medication may be appropriate.[90] 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.[7] The atypical antipsychotic medications risperidone, olanzapine and aripiprazole have been shown to reduce the associated symptoms of AS;[7][95][96] 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.[7][8][53]

Care must be taken with medications, as side effects may be more common and harder to evaluate in individuals with AS, and tests of drugs' effectiveness against comorbid conditions routinely exclude individuals from the autism spectrum.[90] Abnormalities in metabolism, cardiac conduction times, and an increased risk of type 2 diabetes have been raised as concerns with these medications,[97][98] along with serious long-term neurological side effects.[92] SSRIs can lead to manifestations of behavioral activation such as increased impulsivity, aggression, and sleep disturbance.[53] Weight gain and fatigue are commonly reported side effects of risperidone, which may also lead to increased risk for extrapyramidal symptoms such as restlessness and dystonia[53] and increased serum prolactin levels.[99] Sedation and weight gain are more common with olanzapine,[98] which has also been linked with diabetes.[97] Sedative side-effects in school-age children[100] have ramifications for classroom learning. Individuals with AS may be unable to identify and communicate their internal moods and emotions or to tolerate side effects that for most people would not be problematic.[101]

## Prognosis

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.[11] (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.[19] 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.[7][11] Although social impairment may be lifelong, the outcome is generally more positive than with individuals with lower-functioning autism spectrum disorders;[7] for example, ASD symptoms are more likely to diminish with time in children with AS or HFA.[102] Most students with AS and HFA have average mathematical ability and test slightly worse in mathematics than in general intelligence, but some are gifted in mathematics.[103] AS has potentially been linked to some accomplishments, such as Vernon L. Smith winning the Nobel Memorial Prize in Economic Sciences;[104] however, Smith is self-diagnosed.[105]

Although many attend regular education classes, some children with AS may utilize special education services because of their social and behavioral difficulties.[19] 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.[7] The "different-ness" adolescents experience can be traumatic.[106] 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;[7] the resulting stress may manifest as inattention, withdrawal, reliance on obsessions, hyperactivity, or aggressive or oppositional behavior.[89] Depression is often the result of chronic frustration from repeated failure to engage others socially, and mood disorders requiring treatment may develop.[7] Clinical experience suggests the rate of suicide may be higher among those with AS, but this has not been confirmed by systematic empirical studies.[107]

Education of families is critical in developing strategies for understanding strengths and weaknesses;[8] helping the family to cope improves outcomes in children.[37] Prognosis may be improved by diagnosis at a younger age that allows for early interventions, while interventions in adulthood are valuable but less beneficial.[8] There are legal implications for individuals with AS as they run the risk of exploitation by others and may be unable to comprehend the societal implications of their actions.[8]

## Epidemiology

Further information: Medicine:Conditions comorbid to autism spectrum disorders

Frequency estimates vary enormously. In 2015, it was estimated that 37.2 million people globally are affected.[5] A 2003 review of epidemiological studies of children found autism rates ranging from 0.03 to 4.84 per 1,000, with the ratio of autism to Asperger syndrome ranging from 1.5:1 to 16:1;[108] combining the geometric mean ratio of 5:1 with a conservative prevalence estimate for autism of 1.3 per 1,000 suggests indirectly that the prevalence of AS might be around 0.26 per 1,000.[109] Part of the variance in estimates arises from differences in diagnostic criteria. For example, a relatively small 2007 study of 5,484 eight-year-old children in Finland found 2.9 children per 1,000 met the ICD-10 criteria for an AS diagnosis, 2.7 per 1,000 for Gillberg and Gillberg criteria, 2.5 for DSM-IV, 1.6 for Szatmari et al., and 4.3 per 1,000 for the union of the four criteria. Boys seem to be more likely to have AS than girls; estimates of the sex ratio range from 1.6:1 to 4:1, using the Gillberg and Gillberg criteria.[110] Females with autism spectrum disorders may be underdiagnosed.[111]

Anxiety disorders and major depressive disorder are the most common conditions seen at the same time; comorbidity of these in persons with AS is estimated at 65%.[7] Reports have associated AS with medical conditions such as aminoaciduria and ligamentous laxity, but these have been case reports or small studies and no factors have been associated with AS across studies.[7] One study of males with AS found an increased rate of epilepsy and a high rate (51%) of nonverbal learning disorder.[112] AS is associated with tics, Tourette syndrome, and bipolar disorder, and the repetitive behaviors of AS have many similarities with the symptoms of obsessive–compulsive disorder and obsessive–compulsive personality disorder.[78] However many of these studies are based on clinical samples or lack standardized measures; nonetheless, comorbid conditions are relatively common.[11]

## History

Named after the Austrian pediatrician Hans Asperger (1906–1980), Asperger syndrome is a relatively new diagnosis in the field of autism,[113] though a syndrome like it was described as early as 1925 by Grunya Sukhareva (1891–1981).[114] As a child, Asperger appears to have exhibited some features of the very condition named after him, such as remoteness and talent in language.[115][116] In 1944, Asperger described four children in his practice[8] who had difficulty in integrating themselves socially. The children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Asperger called the condition "autistic psychopathy" and described it as primarily marked by social isolation.[4] Fifty years later, several standardizations of AS as a medical diagnosis were tentatively proposed, many of which diverge significantly from Asperger's original work.[117]

Unlike today's AS, autistic psychopathy could be found in people of all levels of intelligence, including those with intellectual disability.[118] Asperger defended the value of 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.[8] His paper was published during World War II and in German, so it was not widely read elsewhere.

Lorna Wing popularized the term Asperger syndrome in the English-speaking medical community in her 1981 publication[119] of a series of case studies of children showing similar symptoms,[113] and Uta Frith translated Asperger's paper to English in 1991.[14] Sets of diagnostic criteria were outlined by Gillberg and Gillberg in 1989 and by Szatmari et al. in the same year.[110] AS became a standard diagnosis in 1992, when it was included in the tenth 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 American Psychiatric Association's diagnostic reference, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).[4]

Hundreds of books, articles and websites now describe AS and prevalence estimates have increased dramatically for ASD, with AS recognized as an important subgroup.[113] Whether it should be seen as distinct from high-functioning autism is a fundamental issue requiring further study,[8] and there are questions about the empirical validation of the DSM-IV and ICD-10 criteria.[19] In 2013, DSM-5 eliminated AS as a separate diagnosis, folding it into the autism spectrum on a severity scale.[27]

## Society and culture

Students and families walk to support Autism Awareness Month.

People identifying with Asperger syndrome may refer to themselves in casual conversation as aspies (a term first used in print by Liane Holliday Willey in 1999).[120] The word neurotypical (abbreviated NT) describes a person whose neurological development and state are typical and is often used to refer to non-autistic (or allistic) people. The Internet has allowed individuals with AS to communicate with each other in a way that was not previously possible because of their rarity and geographic dispersal, forming a subculture composed of people with Asperger's. Internet sites like Wrong Planet have made it easier for individuals to connect.[12]

Some autistic people have advocated a shift in perception of autism spectrum disorders as complex syndromes rather than diseases that must be cured. Proponents of this view reject the notion that there is an "ideal" brain configuration and that any deviation from the norm is pathological; they promote tolerance for what they call neurodiversity.[121] These views are the basis for the autistic rights and autistic pride movements.[122] There is a contrast between the attitude of adults with self-identified AS, who typically do not want to be cured and are proud of their identity; and parents of children with AS, who typically seek assistance and a cure for their children.[123]

Some researchers have argued that AS can be viewed as a different cognitive style, not a disorder,[12] and that it should be removed from the standard Diagnostic and Statistical Manual, much as homosexuality was removed.[124] In a 2002 paper, 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.[13] Baron-Cohen argues that the genes for Asperger's combination of abilities have operated throughout recent human evolution and have made remarkable contributions to human history.[125]

By contrast, Pier Jaarsma and Welin wrote in 2011 that the "broad version of the neurodiversity claim, covering low-functioning as well as high-functioning autism, is problematic. Only a narrow conception of neurodiversity, referring exclusively to high-functioning autists, is reasonable."[126] They say that "higher functioning" individuals with autism may "not [be] benefited with such a psychiatric defect-based diagnosis [...] some of them are being harmed by it, because of the disrespect the diagnosis displays for their natural way of being", but "think that it is still reasonable to include other categories of autism in the psychiatric diagnostics. The narrow conception of the neurodiversity claim should be accepted but the broader claim should not."[126] Jonathan Mitchell, an autistic author and blogger who advocates a cure for autism, has described autism as having "prevented me from making a living or ever having a girlfriend. It's given me bad fine motor coordination problems where I can hardly write. I have an impaired ability to relate to people. I can't concentrate or get things done."[127] He describes neurodiversity as a "tempting escape valve".[128]

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3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 "Autism Spectrum Disorder". September 2015. http://www.nimh.nih.gov/health/publications/autism-spectrum-disorder-qf-15-5511/index.shtml.
4. ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 National Institute of Neurological Disorders and Stroke (NINDS) (31 July 2007). "Asperger syndrome fact sheet". http://www.ninds.nih.gov/disorders/asperger/detail_asperger.htm. NIH Publication No. 05-5624.
5. ↑ 5.0 5.1 5.2 "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet 388 (10053): 1545–1602. October 2016. doi:10.1016/S0140-6736(16)31678-6. PMID 27733282.
6. ↑ 6.0 6.1 "F84.5 Asperger syndrome". 2015. http://apps.who.int/classifications/icd10/browse/2015/en#/F84.5.
7. ↑ 7.00 7.01 7.02 7.03 7.04 7.05 7.06 7.07 7.08 7.09 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 7.19 7.20 7.21 7.22 7.23 7.24 7.25 7.26 7.27 7.28 7.29 7.30 7.31 7.32 7.33 7.34 7.35 7.36 7.37 7.38 7.39 7.40 7.41 7.42 "Asperger's syndrome". Adolescent Medicine Clinics 17 (3): 771–88; abstract xiii. October 2006. doi:10.1016/j.admecli.2006.06.010. PMID 17030291.
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9. ↑ "Genetics of autism spectrum disorder". European Journal of Human Genetics 14 (6): 714–20. June 2006. doi:10.1038/sj.ejhg.5201610. PMID 16721407.
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12. ↑ 12.0 12.1 12.2 "'Surplus suffering': differences between organizational understandings of Asperger's syndrome and those people who claim the 'disorder'". Disability & Society 22 (7): 761–76. 2007. doi:10.1080/09687590701659618.
13. ↑ 13.0 13.1 Baron-Cohen S (2002). "Is Asperger syndrome necessarily viewed as a disability?". Focus Autism Other Dev Disabl 17 (3): 186–91. doi:10.1177/10883576020170030801. A preliminary, freely readable draft, with slightly different wording in the quoted text, is in: Baron-Cohen S (2002). "Is Asperger's syndrome necessarily a disability?" (PDF). Cambridge: Autism Research Centre. http://autismresearchcentre.com/docs/papers/2002_BC_ASDisability.pdf.
14. ↑ 14.0 14.1 14.2 Frith, Uta (1991). "'Autistic psychopathy' in childhood". Autism and Asperger Syndrome. Cambridge: Cambridge University Press. pp. 37–92. ISBN 978-0-521-38608-1.
15. ↑ "Three diagnostic approaches to Asperger syndrome: implications for research". Journal of Autism and Developmental Disorders 35 (2): 221–34. April 2005. doi:10.1007/s10803-004-2001-y. PMID 15909408.
16. ↑ "The history of Asperger syndrome". Asperger syndrome or high-functioning autism?. New York: Plenum press. 1998. pp. 11–25. ISBN 978-0-306-45746-3. https://books.google.ca/books?id=jz_xbeWgG9AC&pg=PA11.
17. ↑ "Asperger's syndrome: a comparison of clinical diagnoses and those made according to the ICD-10 and DSM-IV". Journal of Autism and Developmental Disorders 35 (2): 235–40. April 2005. doi:10.1007/s10803-004-2002-x. PMID 15909409.
18. ↑ Baker, Linda (2004). Asperger's Syndrome: Intervening in Schools, Clinics, and Communities. Routledge. p. 44. ISBN 978-1-135-62414-9. https://books.google.ca/books?id=KiSRAgAAQBAJ&pg=PA44.
19. ↑ 19.00 19.01 19.02 19.03 19.04 19.05 19.06 19.07 19.08 19.09 19.10 19.11 19.12 19.13 "[Autism and Asperger syndrome: an overview"]. Revista Brasileira de Psiquiatria 28 Suppl 1 (suppl 1): S3–11. May 2006. doi:10.1590/S1516-44462006000500002. PMID 16791390. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462006000500002&lng=en&nrm=iso&tlng=en.
20. ↑ 20.0 20.1 "Current trends in psychological research on children with high-functioning autism and Asperger disorder". Current Opinion in Psychiatry 18 (5): 497–501. September 2005. doi:10.1097/01.yco.0000179486.47144.61. PMID 16639107.
21. ↑ "Examining the validity of autism spectrum disorder subtypes". Journal of Autism and Developmental Disorders 38 (9): 1611–24. October 2008. doi:10.1007/s10803-008-0541-2. PMID 18327636.
22. ↑ "Qualitative or quantitative differences between Asperger's disorder and autism? Historical considerations". Journal of Autism and Developmental Disorders 39 (11): 1560–7. November 2009. doi:10.1007/s10803-009-0798-0. PMID 19548078.
23. ↑ "The classification of autism, Asperger's syndrome, and pervasive developmental disorder". Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 45 (8): 731–8. October 2000. doi:10.1177/070674370004500806. PMID 11086556.
24. ↑ "History and development of autism spectrum disorders". Early intervention for autism spectrum disorders: a critical analysis. Amsterdam: Elsevier Science. 2006. p. 21. ISBN 978-0-08-044675-2. https://books.google.com/?id=XonQy12xCgEC&pg=PP2&dq=Early+intervention+for+autism+spectrum+disorders:+a+critical+analysis#v=onepage&q=Early intervention for autism spectrum disorders: a critical analysis&f=false.
25. ↑ "Premature popularization of Asperger syndrome". Asperger syndrome or high-functioning autism?. New York: Plenum press. 1998. pp. 388–90. ISBN 978-0-306-45746-3. https://books.google.com/?id=jz_xbeWgG9AC&printsec=frontcover&dq=Asperger+syndrome+or+high-functioning+autism#v=onepage&q=Asperger syndrome or high-functioning autism?&f=false.
26. ↑ "DSM-5 development". American Psychiatric Association. 2010. http://dsm5.org/Pages/Default.aspx.
27. ↑ 27.0 27.1 27.2 "299.80 Asperger's Disorder". DSM-5 Development. American Psychiatric Association. http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=97#.
28. ↑ 28.0 28.1 "Should the DSM V drop Asperger syndrome?". Journal of Autism and Developmental Disorders 40 (9): 1146–8. September 2010. doi:10.1007/s10803-010-0969-z. PMID 20151184.
29. ↑ "Autism spectrum disorders". Annals of Saudi Medicine 30 (4): 295–300. 2010. doi:10.4103/0256-4947.65261. PMID 20622347.
30. ↑ 30.0 30.1 World Health Organization (2006). "F84. Pervasive developmental disorders". International Statistical Classification of Diseases and Related Health Problems (10th (ICD-10) ed.). ISBN 978-92-4-154419-1. http://apps.who.int/classifications/apps/icd/icd10online/?gf80.htm+f840.
31. ↑ "Broader autism phenotype: evidence from a family history study of multiple-incidence autism families". The American Journal of Psychiatry 154 (2): 185–90. February 1997. doi:10.1176/ajp.154.2.185. PMID 9016266.
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33. ↑ 33.0 33.1 33.2 33.3 American Psychiatric Association (2000). "Diagnostic criteria for 299.80 Asperger's Disorder (AD)". Diagnostic and Statistical Manual of Mental Disorders (4th, text revision (DSM-IV-TR) ed.). ISBN 978-0-89042-025-6. http://www.behavenet.com/capsules/disorders/asperger.htm. Retrieved 28 June 2007.
34. ↑ "Suicidal behaviour in adolescents and young adults with ASD: findings from a systematic review". Clinical Psychology Review 33 (8): 1197–204. December 2013. doi:10.1016/j.cpr.2013.10.003. PMID 24201088.
35. ↑ Brasic JR (7 July 2010). "Asperger's Syndrome". Medscape eMedicine. http://emedicine.medscape.com/article/912296-overview.
36. ↑ "Offending behaviour in adults with Asperger syndrome". Journal of Autism and Developmental Disorders 38 (4): 748–58. April 2008. doi:10.1007/s10803-007-0442-9. PMID 17805955.
37. ↑ 37.0 37.1 "Outcome research in Asperger syndrome and autism". Child and Adolescent Psychiatric Clinics of North America 12 (1): 47–63, vi. January 2003. doi:10.1016/S1056-4993(02)00056-1. PMID 12512398.
38. ↑ "Violent crime in Asperger syndrome: the role of psychiatric comorbidity". Journal of Autism and Developmental Disorders 38 (10): 1848–52. November 2008. doi:10.1007/s10803-008-0580-8. PMID 18449633.
39. ↑ "Repetitive behavior profiles in Asperger syndrome and high-functioning autism". Journal of Autism and Developmental Disorders 35 (2): 145–58. April 2005. doi:10.1007/s10803-004-1992-8. PMID 15909401.
40. ↑ 40.0 40.1 "Autism spectrum disorders: relevance to Tourette syndrome". Advances in Neurology 85: 89–101. 2001. PMID 11530449.
41. ↑ 41.0 41.1 "Asperger's syndrome in adulthood". Deutsches Arzteblatt International 106 (5): 59–64. January 2009. doi:10.3238/arztebl.2009.0059. PMID 19562011.
42. ↑ "Social communication and its disorder in autism and Asperger syndrome". Journal of Psychopharmacology 10 (1): 48–53. January 1996. doi:10.1177/026988119601000108. PMID 22302727.
43. ↑ "Humor in autism and Asperger syndrome". Journal of Autism and Developmental Disorders 34 (5): 521–31. October 2004. doi:10.1007/s10803-004-2547-8. PMID 15628606.
44. ↑ "The screening and diagnosis of autistic spectrum disorders". Journal of Autism and Developmental Disorders 29 (6): 439–84. December 1999. doi:10.1023/A:1021943802493. PMID 10638459.
45. ↑ "Emanuel Miller lecture: confusions and controversies about Asperger syndrome". Journal of Child Psychology and Psychiatry, and Allied Disciplines 45 (4): 672–86. May 2004. doi:10.1111/j.1469-7610.2004.00262.x. PMID 15056300.
46. ↑ Volkmar FR, ed (2007). "Psychological factors in autism". Autism and Pervasive Developmental Disorders (2nd ed.). Cambridge University Press. pp. 69–128. ISBN 978-0-521-54957-8.
47. ↑ Sensory Perceptional Issues in Autism and Asperger Syndrome: Different Sensory Experiences, Different Perceptual Worlds. Jessica Kingsley. 2003. ISBN 978-1-84310-166-6.
48. ↑ "Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence". Journal of Child Psychology and Psychiatry, and Allied Disciplines 46 (12): 1255–68. December 2005. doi:10.1111/j.1469-7610.2005.01431.x. PMID 16313426.
49. ↑ 49.0 49.1 "The epidemiology of Asperger syndrome. A total population study". Journal of Child Psychology and Psychiatry, and Allied Disciplines 34 (8): 1327–50. November 1993. doi:10.1111/j.1469-7610.1993.tb02094.x. PMID 8294522.
50. ↑ "A survey of sleep problems in autism, Asperger's disorder and typically developing children". Journal of Intellectual Disability Research 49 (Pt 4): 260–8. April 2005. doi:10.1111/j.1365-2788.2005.00642.x. PMID 15816813.
51. ↑ 51.0 51.1 "Asperger syndrome, alexithymia and perception of sleep". Neuropsychobiology 49 (2): 64–70. 2004. doi:10.1159/000076412. PMID 14981336.
52. ↑ Alexithymia and AS:
* "The overlap between alexithymia and Asperger's syndrome". Journal of Autism and Developmental Disorders 36 (4): 573–6. May 2006. doi:10.1007/s10803-006-0096-z. PMID 16755385.
* "Response to "Letter to the Editor: The overlap between alexithymia and Asperger's syndrome", Fitzgerald and Bellgrove, Journal of Autism and Developmental Disorders, 36(4)". Journal of Autism and Developmental Disorders 36 (8): 1143–5. November 2006. doi:10.1007/s10803-006-0287-7. PMID 17080269.
* Zak, Paul, ed (September 2007). "Self-referential cognition and empathy in autism". PLOS One 2 (9): e883. doi:10.1371/journal.pone.0000883. PMID 17849012. Bibcode: 2007PLoSO...2..883L.
53. ↑ 53.0 53.1 53.2 53.3 53.4 53.5 "Asperger syndrome: to be or not to be?". Current Opinion in Pediatrics 15 (5): 491–4. October 2003. doi:10.1097/00008480-200310000-00008. PMID 14508298.
54. ↑ 54.0 54.1 "The teratology of autism". International Journal of Developmental Neuroscience 23 (2–3): 189–99. 2005. doi:10.1016/j.ijdevneu.2004.11.001. PMID 15749245.
55. ↑ "Incidence of autism spectrum disorders: changes over time and their meaning". Acta Paediatrica 94 (1): 2–15. January 2005. doi:10.1111/j.1651-2227.2005.tb01779.x. PMID 15858952.
56. ↑ 56.0 56.1 "Functional and anatomical cortical underconnectivity in autism: evidence from an FMRI study of an executive function task and corpus callosum morphometry". Cerebral Cortex 17 (4): 951–61. April 2007. doi:10.1093/cercor/bhl006. PMID 16772313.
57. ↑ 57.0 57.1 "The mirror neuron system and the consequences of its dysfunction". Nature Reviews. Neuroscience 7 (12): 942–51. December 2006. doi:10.1038/nrn2024. PMID 17115076.
58. ↑ "The study of autism as a distributed disorder". Mental Retardation and Developmental Disabilities Research Reviews 13 (1): 85–95. 2007. doi:10.1002/mrdd.20141. PMID 17326118.
59. ↑ "A clinical and neurobehavioural review of high-functioning autism and Asperger's disorder". The Australian and New Zealand Journal of Psychiatry 36 (6): 762–70. December 2002. doi:10.1046/j.1440-1614.2002.01097.x. PMID 12406118.
60. ↑ "Developmental cortical anomalies in Asperger's syndrome: neuroradiological findings in two patients". The Journal of Neuropsychiatry and Clinical Neurosciences 2 (2): 197–201. 1990. doi:10.1176/jnp.2.2.197. PMID 2136076.
61. ↑ "Time to give up on a single explanation for autism". Nature Neuroscience 9 (10): 1218–20. October 2006. doi:10.1038/nn1770. PMID 17001340.
62. ↑ "The weak coherence account: detail-focused cognitive style in autism spectrum disorders". Journal of Autism and Developmental Disorders 36 (1): 5–25. January 2006. doi:10.1007/s10803-005-0039-0. PMID 16450045.
63. ↑ "Enhanced perceptual functioning in autism: an update, and eight principles of autistic perception". Journal of Autism and Developmental Disorders 36 (1): 27–43. January 2006. doi:10.1007/s10803-005-0040-7. PMID 16453071.
64. ↑ "Broken mirrors: a theory of autism" (PDF). Scientific American 295 (5): 62–9. November 2006. doi:10.1038/scientificamerican1106-62. PMID 17076085. Bibcode: 2006SciAm.295e..62R. http://cbc.ucsd.edu/pdf/brokenmirrors_asd.pdf.
65. ↑ "Abnormal imitation-related cortical activation sequences in Asperger's syndrome". Annals of Neurology 55 (4): 558–62. April 2004. doi:10.1002/ana.20031. PMID 15048895.
66. ↑ "Does the autistic child have a "theory of mind"?". Cognition 21 (1): 37–46. October 1985. doi:10.1016/0010-0277(85)90022-8. PMID 2934210. Pdf.
67. ↑ "The hyper-systemizing, assortative mating theory of autism" (PDF). Progress in Neuro-Psychopharmacology & Biological Psychiatry 30 (5): 865–72. July 2006. doi:10.1016/j.pnpbp.2006.01.010. PMID 16519981. http://www.autismresearchcentre.com/docs/papers/2006_BC_Neuropsychophamacology.pdf.
68. ↑ "Asperger's syndrome: a review of clinical features". Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 34 (6): 554–60. August 1989. doi:10.1177/070674378903400613. PMID 2766209.
69. ↑ "Asperger syndrome--some epidemiological considerations: a research note". Journal of Child Psychology and Psychiatry, and Allied Disciplines 30 (4): 631–8. July 1989. doi:10.1111/j.1469-7610.1989.tb00275.x. PMID 2670981.
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71. ↑ "Pharmacological treatment options for autism spectrum disorders in children and adolescents". Harvard Review of Psychiatry 16 (2): 97–112. 2008. doi:10.1080/10673220802075852. PMID 18415882.
72. ↑ "Issues related to the diagnosis and treatment of autism spectrum disorders". Mental Retardation and Developmental Disabilities Research Reviews 13 (2): 129–35. 2007. doi:10.1002/mrdd.20143. PMID 17563895.
73. ↑ 73.0 73.1 "Asperger syndrome: diagnosis and external validity". Child and Adolescent Psychiatric Clinics of North America 12 (1): 1–13, v. January 2003. doi:10.1016/S1056-4993(02)00052-4. PMID 12512395.
74. ↑ "Asperger's syndrome: diagnosis and treatment". The American Journal of Psychiatry 165 (8): 958–63. August 2008. doi:10.1176/appi.ajp.2008.08020272. PMID 18676600.
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76. ↑ "The challenge of adolescents and adults with Asperger syndrome". Child and Adolescent Psychiatric Clinics of North America 12 (1): 143–63, vii–viii. January 2003. doi:10.1016/S1056-4993(02)00053-6. PMID 12512403.
77. ↑ "Social cognition in alcoholism: a link to prefrontal cortex dysfunction?". Addiction 103 (5): 726–35. May 2008. doi:10.1111/j.1360-0443.2008.02157.x. PMID 18412750.
78. ↑ 78.0 78.1 "Autism and Asperger syndrome: coexistence with other clinical disorders". Acta Psychiatrica Scandinavica 102 (5): 321–30. November 2000. doi:10.1034/j.1600-0447.2000.102005321.x. PMID 11098802.
79. ↑ "Diagnosis and differential diagnosis of Asperger syndrome". Advances in Psychiatric Treatment 7 (4): 310–318. 1 July 2001. doi:10.1192/apt.7.4.310.
80. ↑ "Screening for Autism Spectrum Disorder in Young Children: US Preventive Services Task Force Recommendation Statement". JAMA 315 (7): 691–6. February 2016. doi:10.1001/jama.2016.0018. PMID 26881372.
81. ↑ The CAST has been renamed from the Childhood Asperger Syndrome Test to the Childhood Autism Spectrum Test, reflecting the removal of Asperger's Syndrome from the DSM-5.
82. ↑ "Diagnostic assessment of Asperger's disorder: a review of five third-party rating scales". Journal of Autism and Developmental Disorders 35 (1): 25–35. February 2005. doi:10.1007/s10803-004-1028-4. PMID 15796119.
83. ↑ "The Autism Spectrum Quotient: Children's Version (AQ-Child)" (PDF). Journal of Autism and Developmental Disorders 38 (7): 1230–40. August 2008. doi:10.1007/s10803-007-0504-z. PMID 18064550. http://autismresearchcenter.com/docs/papers/2008_Auyeung_etal_ChildAQ.pdf.
84. ↑ "The Autism-Spectrum Quotient (AQ)--adolescent version" (PDF). Journal of Autism and Developmental Disorders 36 (3): 343–50. April 2006. doi:10.1007/s10803-006-0073-6. PMID 16552625. http://autismresearchcenter.com/docs/papers/2006_BC_Hoekstra_etal_AQ-adol.pdf.
85. ↑ "Screening adults for Asperger Syndrome using the AQ: a preliminary study of its diagnostic validity in clinical practice" (PDF). Journal of Autism and Developmental Disorders 35 (3): 331–5. June 2005. doi:10.1007/s10803-005-3300-7. PMID 16119474. http://autismresearchcentre.com/docs/papers/2005_Woodbury-Smith_etal_ScreeningAdultsForAS.pdf.
86. ↑ "Asperger's disorder: a review of its diagnosis and treatment". Comprehensive Psychiatry 45 (3): 184–91. 2004. doi:10.1016/j.comppsych.2004.02.004. PMID 15124148.
87. ↑ "Frameworks for behavioral interventions". Child and Adolescent Psychiatric Clinics of North America 12 (1): 65–86, vi. January 2003. doi:10.1016/S1056-4993(02)00054-8. PMID 12512399. http://www.childpsych.theclinics.com/article/PIIS1056499302000548/fulltext.
88. ↑ "Social skills interventions for the autism spectrum: essential ingredients and a model curriculum". Child and Adolescent Psychiatric Clinics of North America 12 (1): 107–22. January 2003. doi:10.1016/S1056-4993(02)00051-2. PMID 12512401.
89. ↑ 89.0 89.1 "Behavioral forms of stress management for individuals with Asperger syndrome". Child and Adolescent Psychiatric Clinics of North America 12 (1): 123–41. January 2003. doi:10.1016/S1056-4993(02)00048-2. PMID 12512402.
90. ↑ 90.0 90.1 90.2 90.3 "Strategies for pharmacologic treatment of high functioning autism and Asperger syndrome". Child and Adolescent Psychiatric Clinics of North America 12 (1): 23–45. January 2003. doi:10.1016/S1056-4993(02)00049-4. PMID 12512397. https://zenodo.org/record/1260194.
91. ↑ "Promoting social communication in high functioning individuals with autistic spectrum disorders". Child and Adolescent Psychiatric Clinics of North America 12 (1): 87–106, vi–vii. January 2003. doi:10.1016/S1056-4993(02)00047-0. PMID 12512400.
92. ↑ 92.0 92.1 "Determining treatment outcome in early intervention programs for autism spectrum disorders: a critical analysis of measurement issues in learning based interventions". Research in Developmental Disabilities 28 (2): 207–18. 2007. doi:10.1016/j.ridd.2005.07.006. PMID 16682171.
93. ↑ "Social skills interventions for children with Asperger's syndrome or high-functioning autism: a review and recommendations". Journal of Autism and Developmental Disorders 38 (2): 353–61. February 2008. doi:10.1007/s10803-007-0402-4. PMID 17641962.
94. ↑ "Parent management training and Asperger syndrome: a randomized controlled trial to evaluate a parent based intervention". Autism 8 (3): 301–17. September 2004. doi:10.1177/1362361304045215. PMID 15358872.
95. ↑ Hirsch, LE; Pringsheim, T (26 June 2016). "Aripiprazole for autism spectrum disorders (ASD).". The Cochrane Database of Systematic Reviews (6): CD009043. doi:10.1002/14651858.CD009043.pub3. PMID 27344135.
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99. ↑ "The effect of long-term antipsychotic treatment on prolactin". Journal of Child and Adolescent Psychopharmacology 16 (3): 317–26. June 2006. doi:10.1089/cap.2006.16.317. PMID 16768639.
100. ↑ "Use of atypical antipsychotics in the treatment of autistic disorder". The Annals of Pharmacotherapy 41 (4): 626–34. April 2007. doi:10.1345/aph.1H527. PMID 17389666.
101. ↑ "Asperger syndrome and high functioning autism: research concerns and emerging foci". Current Opinion in Psychiatry 16 (5): 535–542. 2003. doi:10.1097/00001504-200309000-00008.
102. ↑ "Modeling clinical outcome of children with autistic spectrum disorders". Pediatrics 116 (1): 117–22. July 2005. doi:10.1542/peds.2004-1118. PMID 15995041.
103. ↑ "Mathematical ability of students with Asperger syndrome and high-functioning autism: a review of literature". Autism 11 (6): 547–56. November 2007. doi:10.1177/1362361307083259. PMID 17947290. (Subscription content?)
104. ↑ Herera S (25 February 2005). "Mild autism has 'selective advantages'". CNBC. http://www.msnbc.msn.com/id/7030731/.
105. ↑ Wallace B. "Autism Spectrum: Are You On It?". https://nymag.com/nymag/features/autism-spectrum-2012-11/index4.html.
106. ↑ Moran M (2006). "Asperger's may be answer to diagnostic mysteries". Psychiatric News 41 (19): 21–36. doi:10.1176/pn.41.19.0021.
107. ↑ Gillberg C (2008). "Asperger syndrome—mortality and morbidity". Asperger's Disorder. Informa Healthcare. pp. 63–80. ISBN 978-0-8493-8360-1.
108. ↑ "Epidemiologic data on Asperger disorder". Child and Adolescent Psychiatric Clinics of North America 12 (1): 15–21, v–vi. January 2003. doi:10.1016/S1056-4993(02)00050-0. PMID 12512396.
109. ↑ Fombonne E (2007). "Epidemiological surveys of pervasive developmental disorders". Autism and Pervasive Developmental Disorders (2nd ed.). Cambridge University Press. pp. 33–68. ISBN 978-0-521-54957-8.
110. ↑ 110.0 110.1 "An epidemiological and diagnostic study of Asperger syndrome according to four sets of diagnostic criteria". Journal of the American Academy of Child and Adolescent Psychiatry 46 (5): 636–46. May 2007. doi:10.1097/chi.0b013e318033ff42. PMID 17450055.
111. ↑ Galanopoulos, Anastasios; Robertson, Dene; Woodhouse, Emma (4 January 2016). "The assessment of autism spectrum disorders in adults". Advances in Autism 2 (1): 31–40. doi:10.1108/AIA-09-2015-0017.
112. ↑ "One hundred males with Asperger syndrome: a clinical study of background and associated factors". Developmental Medicine and Child Neurology 46 (10): 652–60. October 2004. doi:10.1111/j.1469-8749.2004.tb00977.x. PMID 15473168.
113. ↑ 113.0 113.1 113.2 "What's so special about Asperger Syndrome?". Brain and Cognition 61 (1): 1–4. June 2006. doi:10.1016/j.bandc.2006.02.002. PMID 16563588.
114. ↑ "Sukhareva—Prior to Asperger and Kanner". Nordic Journal of Psychiatry 69 (6): 479–82. August 2015. doi:10.3109/08039488.2015.1005022. PMID 25826582.
115. ↑ "Did Hans Asperger (1906–1980) have Asperger syndrome?". Journal of Autism and Developmental Disorders 37 (10): 2020–1. November 2007. doi:10.1007/s10803-007-0382-4. PMID 17917805.
116. ↑ American Normal: The Hidden World of Asperger Syndrome. Copernicus. 2002. p. 19. ISBN 978-0-387-95307-6.
117. ↑ "A retrospective analysis of the clinical case records of 'autistic psychopaths' diagnosed by Hans Asperger and his team at the University Children's Hospital, Vienna". Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences 358 (1430): 291–301. February 2003. doi:10.1098/rstb.2002.1197. PMID 12639327.
118. ↑ Frith U, ed (1991). "The relationship between Asperger's syndrome and Kanner's autism". Autism and Asperger syndrome. Cambridge University Press. pp. 93–121. ISBN 978-0-521-38608-1.
119. ↑ "Asperger's syndrome: a clinical account". Psychological Medicine 11 (1): 115–29. February 1981. doi:10.1017/S0033291700053332. PMID 7208735. http://www.mugsy.org/wing2.htm.
120. ↑ Pretending to be Normal: Living with Asperger's Syndrome. Jessica Kingsley. 1999. pp. 71, 104. ISBN 978-1-85302-749-9.
121. ↑ "In search of an Asperger". Children, Youth and Adults with Asperger Syndrome: Integrating Multiple Perspectives. Jessica Kingsley. 2005. pp. 242–52. ISBN 978-1-84310-319-6. "The life prospects of people with AS would change if we shifted from viewing AS as a set of dysfunctions, to viewing it as a set of differences that have merit."
122. ↑ Stoddart KP, ed (2005). "Life on the outside: A personal perspective of Asperger syndrome". Children, Youth and Adults with Asperger Syndrome: Integrating Multiple Perspectives. Jessica Kingsley. pp. 352–61. ISBN 978-1-84310-319-6.
123. ↑ "Asperger's syndrome: differences between parents' understanding and those diagnosed". Social Work in Health Care 46 (3): 85–106. 2008. doi:10.1300/J010v46n03_05. PMID 18551831.
124. ↑ Allred S (2009). "Reframing Asperger syndrome: lessons from other challenges to the Diagnostic and Statistical Manual and ICIDH approaches". Disability & Society 24 (3): 343–55. doi:10.1080/09687590902789511.
125. ↑ "The evolution of brain mechanisms for social behavior". Foundations of Evolutionary Psychology. Lawrence Erlbaum. 2008. pp. 415–32. ISBN 978-0-8058-5957-7.
126. ↑ 126.0 126.1 "Autism as a natural human variation: reflections on the claims of the neurodiversity movement" (PDF). Health Care Analysis 20 (1): 20–30. March 2012. doi:10.1007/s10728-011-0169-9. PMID 21311979. http://www.imh.liu.se/avd_halsa_samhalle/filarkiv1/1.264263/JaarsmaWelin2011Autismasanaturalvariation.pdf.
127. ↑ Hamilton, Jon. "Shortage of Brain Tissue Hinders Autism Research". https://www.npr.org/blogs/health/2013/02/04/170835708/shortage-of-brain-tissue-sets-autism-research-back.
128. ↑ Solomon A (25 May 2008). "The autism rights movement". New York. http://nymag.com/news/features/47225/.

## External links

Classification|

* ICD-10: F84.5
* ICD-9-CM: 299.80
* OMIM: 608638
* DiseasesDB: 31268

|

External resources|

* MedlinePlus: 001549
* eMedicine: ped/147

* Asperger's Syndrome at Curlie

* v
* t
* e

Pervasive developmental disorders and autism spectrum (F84, 299)

Main|

* Causes
* Comorbid conditions
* Epidemiology
* Heritability
* Societal and cultural aspects
* Medical model
* Therapies

Diagnoses|

* Autism spectrum (High-functioning autism
* Classic Autism
* Asperger syndrome
* Pervasive developmental disorder not otherwise specified
* Childhood disintegrative disorder
* Rett syndrome)

Related conditions|

* Alexithymia
* Attention deficit hyperactivity disorder
* Anxiety disorder (obsessive–compulsive disorder)
* Late talker
* Epilepsy
* Fragile X syndrome
* Hyperlexia
* Savant syndrome
* Sensory processing disorder
* Intellectual disability
* Developmental coordination disorder
* Multiple complex developmental disorder

Controversies|

* Autism rights movement
* Autistic enterocolitis
* Facilitated communication
* MMR vaccine
* Rapid prompting method
* Thiomersal (Chelation)

Diagnostic scales|

* Gilliam Asperger's disorder scale
* Autism Diagnostic Observation Schedule
* Autism Diagnostic Interview
* Autism-spectrum quotient
* Childhood Autism Rating Scale

Lists|

* Autism-related topics
* Fictional characters
* Schools

* v
* t
* e

Mental and behavioral disorders (F00–F99 & 290–319)

Adult personality and behavior

| Gender dysphoria|

* Ego-dystonic sexual orientation
* Paraphilia
* Fetishism
* Voyeurism
* Sexual maturation disorder
* Sexual relationship disorder

|

Other|

* Factitious disorder
* Munchausen syndrome
* Impulse control disorder
* Dermatillomania
* Kleptomania
* Pyromania
* Trichotillomania
* Personality disorder

Childhood and learning

| Emotional and behavioral|

* ADHD
* Conduct disorder
* ODD
* Emotional and behavioral disorders
* Separation anxiety disorder
* Movement disorders
* Stereotypic
* Social functioning
* DAD
* RAD
* Selective mutism
* Speech
* Stuttering
* Cluttering
* Tic disorder
* Tourette syndrome

|

Intellectual disability|

* X-linked intellectual disability
* Lujan–Fryns syndrome

Psychological development
(developmental disabilities)|

* Pervasive
* Specific

Mood (affective)

* Bipolar
* Bipolar I
* Bipolar II
* Bipolar NOS
* Cyclothymia
* Depression
* Atypical depression
* Dysthymia
* Major depressive disorder
* Melancholic depression
* Seasonal affective disorder
* Mania

Neurological and symptomatic

| Autism spectrum|

* Autism
* Asperger syndrome
* High-functioning autism
* PDD-NOS
* Savant syndrome

|

Dementia|

* AIDS dementia complex
* Alzheimer's disease
* Creutzfeldt–Jakob disease
* Frontotemporal dementia
* Huntington's disease
* Mild cognitive impairment
* Parkinson's disease
* Pick's disease
* Sundowning
* Vascular dementia
* Wandering

Other|

* Delirium
* Organic brain syndrome
* Post-concussion syndrome

Neurotic, stress-related and somatoform

| Adjustment|

* Adjustment disorder with depressed mood

|

Anxiety|

| Phobia|

* Agoraphobia
* Social anxiety
* Social phobia
* Anthropophobia
* Specific social phobia
* Specific phobia
* Claustrophobia

|

Other|

* Generalized anxiety disorder
* OCD
* Panic attack
* Panic disorder
* Stress
* Acute stress reaction
* PTSD

Dissociative|

* Depersonalization disorder
* Dissociative identity disorder
* Fugue state
* Psychogenic amnesia

Somatic symptom|

* Body dysmorphic disorder
* Conversion disorder
* Ganser syndrome
* Globus pharyngis
* Da Costa's syndrome
* Hypochondriasis
* Mass psychogenic illness
* Neurasthenia
* Nosophobia
* Psychalgia
* Somatization disorder

Physiological and physical behavior

| Eating|

* Anorexia nervosa
* Bulimia nervosa
* Rumination syndrome
* Other specified feeding or eating disorder

|

Nonorganic
sleep|

* Hypersomnia
* Insomnia
* Parasomnia
* Night terror
* Nightmare
* REM sleep behavior disorder

Postnatal|

* Postpartum depression
* Postpartum psychosis

Sexual dysfunction|

| Arousal|

* Erectile dysfunction
* Female sexual arousal disorder

|

Desire|

* Hypersexuality
* Hypoactive sexual desire disorder

Orgasm|

* Anorgasmia
* Delayed ejaculation
* Premature ejaculation
* Sexual anhedonia

Pain|

* Nonorganic dyspareunia
* Nonorganic vaginismus

Psychoactive substances, substance abuse and substance-related

* Drug overdose
* Intoxication
* Physical dependence
* Rebound effect
* Stimulant psychosis
* Substance dependence
* Withdrawal

Schizophrenia, schizotypal and delusional

| Delusional|

* Delusional disorder
* Folie à deux

|

Psychosis and
schizophrenia-like|

* Brief reactive psychosis
* Schizoaffective disorder
* Schizophreniform disorder

Schizophrenia|

* Childhood schizophrenia
* Disorganized (hebephrenic) schizophrenia
* Paranoid schizophrenia
* Pseudoneurotic schizophrenia
* Simple-type schizophrenia

Symptoms and uncategorized

* Catatonia
* False pregnancy
* Intermittent explosive disorder
* Klüver–Bucy syndrome
* Psychogenic non-epileptic seizures
* Psychomotor agitation
* Stereotypy

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