Does DSM-IV Asperger's Disorder Exist?

Journal of Abnormal Child Psychology,  June, 2001  by Susan Dickerson Mayes,  Susan L. Calhoun,  Dana L. Crites

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Susan Dickerson Mayes [1,2]

Susan L. Calhoun [1]

Dana L. Crites [1]

DSM-IV criteria for autistic and Asperger's disorders were applied to 157 children with clinical diagnoses of autism or Asperger's disorder. All children met the DSM-IV criteria for autistic disorder and none met criteria for Asperger's disorder, including those with normal intelligence and absence of early speech delay. The reason for this was that all children had social impairment and restricted and repetitive behavior and interests (required DSM-IV symptoms for both autistic and Asperger's disorders) and all had a DSM-IV communication impairment (which then qualified them for a diagnosis of autistic disorder and not Asperger's disorder). Communication problems exhibited by all children were impaired conversational speech or repetitive, stereotyped, or idiosyncratic speech (or both), which are DSM-IV criteria for autism. These findings are consistent with those of 5 other studies and indicate that a DSM-IV diagnosis of Asperger's disorder is unlikely or impossible.

KEY WORDS: Asperger's disorder or syndrome; autism; DSM-IV.

INTRODUCTION

Much controversy exists regarding the definition of Asperger's syndrome or disorder, both in clinical practice and in research studies. Further, there is not yet agreement that Asperger's disorder is indeed separate and distinct from high-functioning autism. Our paper provides an historical review of the origin and evolution of Asperger's syndrome, and our study attempts to investigate the validity of Asperger's disorder as defined by DSM-IV.

Asperger's Original Paper

"Autistic Psychopathy in Childhood" by Hans Asperger was published in 1944 in German and was translated into English in 1991 (Asperger, 1944/1991). Asperger's description of "autistic psychopathy" is similar to Kanner's (Kanner, 1943) "early infantile autism" (Frith, 1991; Wing, 1981). Symptoms described by Asperger (1944/1991) include the DSM-IV's three diagnostic criteria for autism: "impairment in social interaction," "impairments in communication," and "restricted, repetitive, and stereotyped patterns of behavior, interests, and activities" (American Psychiatric Association, 1994, pp. 70, 71), as well as symptoms considered by the DSM-IV to be associated features of autism.

Asperger's narrative description and case presentations are entirely consistent with DSM-IV autistic disorder, as follows: (1) Impairment in social interaction: Hans Asperger stated that "the fundamental disorder of autistic individuals is the limitation of their social relationships" (1944/1991, p. 77). According to Asperger, these individuals are socially isolated and have poor eye contact. (2) Impairment in communication: Asperger stated that there are "abnormalities in the language of autistic individuals" (1944/1992, p. 70), including idiosyncratic or unusual use of speech and problems with conversational speech. (3) Restricted and repetitive behavior and interests: Asperger (1944/1992) reported that his cases had "special interests" (p. 67), "abnormal fixations" (p. 81), "stereotypic" play and movements, such as rocking, (pp. 69, 78), and ritualized behaviors (p. 78). (4) Associated features: Additional symptoms described by Asperger are consistent with DSM-IV associated features of autism. These inclu de unusual sensory responses (e.g., dislike of particular foods, tactile sensations, and sounds), difficulty with attention, behavior problems, and special abilities. (5) Intelligence: According to Asperger, his cases encompassed "all levels of ability from the highly original genius ... to the ... mentally retarded individual" (1944/1991, p. 74). The DSM-IV also notes that children with autism can have above to below normal intelligence (p. 67).

Introduction of the Term "Asperger's Syndrome"

Asperger's 1944 publication received little attention outside of Germany and was overshadowed by Kanner's (Kanner, 1943) description of autism (Wing, 1981). In the English literature, Lorna Wing from the Institute of Psychiatry in London was the first to use the term "Asperger's syndrome" (Wing, 1976), which she defined and popularized in a 1981 publication (Wing, 1981). Wing's description of Asperger's syndrome differed in some respects from Asperger's original case reports (Wing, 1981, p. 117). Wing recommended that "Asperger's syndrome" be used for "children and adults who have autistic features, but who talk grammatically and who are not socially aloof" (1981, p. 124).

Pre-DSM-IV Definitions

Preceding the appearance of Asperger's disorder in the DSM-IV, all definitions of Asperger's syndrome included impaired social interaction, restricted and repetitive behavior and interests, and communication impairment (Ghaziuddin, Tsai, & Ghaziuddin 1992a; Gillberg, 1985, 1989, 1991; Gillberg & Gillberg, 1989; Klin, 1994; Szatmari, 1991; Szatmari, Tuff, Finlayson, & Bartolucci, 1990; Tantam, 1988; Wing, 1981). Proponents of Asperger's syndrome maintained that individuals with Asperger's syndrome often, but not always, had normal IQs (Gillberg & Gillberg, 1989; Klin, 1994; Szatmari, 1991; Tantam, 1988; Wing, 1981, 1991) and speech milestones (Wing, 1981, 1991). Gross motor clumsiness was included as a symptom of Asperger's syndrome by some (Gillberg, 1991; Gillberg & Gillberg, 1989; Tantam, 1988; Wing, 1981; 1991). Others claimed that gross motor incoordination was an associated but not an essential feature (Ghaziuddin et al., 1992a, 1992b; Klin, 1994; Szatmari, 1991). Proposed differences between Asperger's syndrome and autism were that individuals with Asperger's syndrome (vs. autism) had (1) better social and language abilities (Frith, 1991; Gillberg, 1985; Klin, 1994; Szatmari, 1991; Tantam, 1988; Wing, 1991), (2) more unusual or conspicuous interests or preoccupations (Klin, 1994; Wing, 1981), (3) fewer stereotypies (Klin, 1994; Szatmari, 1991), (4) fewer or no sensory abnormalities (Szatmari, 1991; Wing, 1981, 1991), (5) higher, though not necessarily normal, IQs (Gillberg, 1985; Gillberg & Gillberg, 1989; Klin, 1994; Tantam, 1988; Wing, 1991), and (6) more motor incoordination (Gillberg, 1991; Gillberg & Gillberg, 1989; Klin, 1994; Wing, 1981, 1991).