Certain people are born with physical traits, behaviors, and communication patterns that differ from those typical of the average person. Over the years, various terms have described these individuals, though they would often change as our understanding of these traits and their causes improved. Most people would recognize this condition as autism, though even that term is now outdated. Experts instead use the umbrella diagnosis of autism spectrum disorder (ASD) to fully cover a range of extremely similar conditions, such as autism and Asperger's syndrome. The signs and symptoms that once fell under those individual terms now belong to ASD.
At its core, ASD is a neurodevelopmental disorder that stems from differences in the brain. ASD affects the way a person behaves, interacts, learns, and thinks, leading to significant differences from the average person. As an umbrella diagnosis, symptoms can vary dramatically from person to person. Additionally, there is still much that remains unknown about ASD and its related issues.
Despite the changes, there are historical differences between autism and Asperger's. Many people received diagnoses for these conditions that are now technically outdated. Learning the history of autism and Asperger's is important to understanding why they are now both part of ASD.
The first use of the term "autism" comes from Swiss psychiatrist Eugen Bleuler in his definition of schizophrenia. At that point in the time, the diagnosis of schizophrenia was much broader, and children with autism often received diagnoses for schizophrenia instead. To Bleuler, autism was a withdrawal from reality. Several decades later, physician Leo Kanner adopted the term to describe children with a "powerful desire for aloneness" and "an obsessive insistence of persistent sameness." He recognized the condition as featuring poor social skills, developmental struggles, and restricted interests—though he felt the condition was distinct from schizophrenia. Around that same time, Hans Asperger recognized similar symptoms but without atypical social behaviors and learning issues, which experts would later name Asperger's syndrome. Over time, autism became detached from schizophrenia, and Asperger's received a reputation as a "less severe" version of autism. As of 2015, both terms became outdated, and ASD became the preferred diagnosis in the DSM-5, while the same occurred in the ICD in 2021. Because of the potential for confusion, many refer to this archaic view of autism as "classic autism."
Though classic autism and Asperger's syndrome were extremely similar, there were clear diagnostic differences. Both conditions require specific behavioral symptoms for proper diagnosis. For classic autism, the ICD-10 required impaired development to be present before age three in social communication, developing relationships, or in play. Children also needed to show at least six other symptoms involving impairment in social interactions, communication, language development, patterns of behavior, activities, and interests. The ICD-10 also classified cases as high-functioning or low-functioning autism, depending on the level of intellectual disability. Asperger's syndrome was similar but specifically required there to be no significant delays in language or cognitive development. The DSM-IV-TR split with the international diagnostic criteria, including significant impairment in day-to-day functioning in its requirements.
One of the hallmarks that differentiates classic autism and Asperger's is the difficulty of language development. Children with classic autism would typically babble less frequently and with less diverse sounds than other children. In the coming years, various words, consonants, and word combinations are also less varied. Most cases of Asperger's did not feature these same developmental delays. However, some people may have had these issues and still fell under the Asperger's diagnostic criteria rather than classic autism due to healthy cognitive development.
Many of the conditions that now fall under the ASD diagnosis feature social interaction issues—including classic autism and Asperger's syndrome. In general, people with both conditions tend to struggle with the core elements of social interaction. They may avoid eye contact, make inappropriate facial expressions or gestures, or adopt atypical postures. Those with classic autism are far more likely to be nonverbal or repeat certain phrases. Much of this is due to missing social cues that typical people automatically notice. Many people compare social interactions to playing a game without knowing the rules. However, because ASD and its related conditions are so variable, each person will likely have their own social issues—if they have any at all.
While classic autism typically features delays in cognitive development, people with Asperger's develop at a typical rate. In fact, children with Asperger's may have a far more sophisticated vocabulary than other children and excel in areas of school requiring logic, like math or science. Along with this, however, they may struggle in areas that feature figurative, metaphorical, or nonliteral language and thoughts. Classic autism, as it was understood, usually featured just poor cognitive development and not a boost in logical ability. However, some experts recognized that certain people developed "splinter skills" such as perfect memorization of trivia or an extreme talent with music, math, or a similar skill.
Both classic autism and Asperger's featured unique sensory symptoms. Individuals with these conditions were often far more sensitive to auditory and visual stimuli, meaning they could notice certain changes or details that others could not. However, this also means that bright lights and loud noises were far more distressing. Additionally, people with classic autism tended to be more sensitive to other stimuli, such as certain food textures, human touch or smells. This often meant that these stimuli would disturb them.
Many people viewed Asperger's as a "less serious" form of autism, but this is an inaccurate and incomplete view of two very complex issues. Just as a person with autism is perfectly capable of living a fulfilling daily life without issues, a person with Asperger's may struggle significantly. Ultimately, it is up to their specific symptoms, upbringing, support structures, and other life factors. Because classic autism often featured more cognitive issues, these individuals may have required additional care to perform certain functions, but this is not universally true.
Yet another reason that both classic autism and Asperger's now fall under the ASD umbrella is that both conditions may require unique educational needs and approaches. However, there is no universal approach that caters to each person with autism or each individual who has Asperger's. Each specific person may require an approach that is unique to their needs and symptoms. Examples of this include learning in a darker room to avoid sensory issues or perhaps finding ways to make figurative language seem more logical. Ultimately, these are complicated conditions that are not always easy to address.
Both Asperger's and classic autism tend to involve a "lack" of emotions. However, this is only the case from an outside view. Studies show that people with either condition are perfectly capable of feeling emotion. However, they may have difficulty reciprocating the emotions that other people feel. Additionally, many people with Asperger's also have alexithymia, meaning they struggle to identify and describe their emotions. Classic autism also traditionally had a connection to emotional outbursts and aggression, while Asperger's did not.
Because classic autism typically involved much more "obvious" behaviors and was an older diagnosis, it had higher diagnostic rates than Asperger's. However, its definition has changed many times over the years. Asperger's syndrome was both newer, less understood, and less noticeable, leading to fewer overall diagnoses. Both conditions, however, were likely severely underdiagnosed, and many adults did not receive their diagnoses until much later—if at all. There are now many resources and medical centers focusing on identifying the different forms of ASD in adults, though it can be hard to detect. Adults with these conditions have likely learned certain behaviors or skills that allow them to mask or manage their symptoms.
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