Asperger and Autism Spectrum Disorders: Separate or Part of One Continuum?

By Andrew Evans, Psy.D.
February 26, 2010

In May of 2013, the American Psychiatric Association (APA) is planning to publish an updated Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the authoritative manual for identifying psychiatric conditions. One of the proposed changes for the DSM-V is to drop the diagnostic category of Asperger disorder. While first described by Viennese pediatrician Hans Asperger in the 1940s, the APA did not recognize Asperger disorder as a distinct diagnostic category until 1994. Since that time, the Asperger label has expanded people’s understanding and conceptualization of autism spectrum disorders (ASD) by highlighting a subgroup of individuals who do not exhibit language and cognitive delays that are typical of the majority of people with ASD. The inclusion of Asperger Disorder in the DSM-IV not only prompted more autism research, but enabled many people to access supports and services that were previously unavailable to them because they were not identified as having any disability.

While clinicians continue to debate the accuracy and utility of the Asperger diagnosis, a lot of people currently diagnosed with Asperger disorder are strongly against the proposal to eliminate it as a separate diagnostic category. Many people with Asperger disorder refer to themselves as “Aspies.” Aspies have developed an extensive cultural network where their differences from others are embraced and even celebrated. For many Aspies, the APA proposal to eliminate Asperger disorder feels like an attack on their identity. Others argue that eliminating Asperger disorder and Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS), another diagnostic subgroup often ascribed to people with autistic tendencies, would reduce the confusion and inconsistency in applying diagnostic criteria. Reducing this confusion, they feel, would improve research and treatment service delivery

Currently, the APA has posted their proposed revisions online and encouraged public discussion via their website http://www.DSM5.org. The APA has identified three major questions areas that, with feedback, will influence whether they choose to eliminate Asperger disorder as a separate diagnostic category. These questions include:

1. Have the DSM-IV diagnostic criteria for Asperger disorder worked?
2. Does the existing research literature allow us to suggest new criteria to diagnose Asperger disorder in contrast to Autistic Disorder/ASD?
3. If Asperger disorder does not appear in DSM-V as a separate diagnostic category, how will continuity and clarity be maintained for those with the diagnosis?

In addition to providing a public forum to discuss the issues, the APA has provided an extensive list of past and current research regarding autism and Asperger disorder. The APA summarizes their rationale for proposing the elimination Asperger disorder.

Current opinion seems to be divided predominantly between those who have, or are closely associated with people who have, a diagnosis of Asperger disorder, and those professionals who are trying to accurately utilize diagnostic criteria to facilitate research and treatment objectives. Many of those with Asperger disorder feel there is an enormous difference between themselves and others who are more classically autistic, while scientists are not finding consistent reliable differences between people diagnosed with Asperger disorder verses those with mild autism, often referred to as High Functioning Autism (HFA).

Regardless of your own opinions, the fate of the Asperger disorder diagnosis is likely to remain one of the most debated proposed changes for the DSM-V. The APA is only accepting direct feedback on their website until April 20, 2010, so if you have a strong opinion, now is the time to let them know.

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