Children diagnosed with Asperger’s syndrome are considered to be on the high functioning end of the autism spectrum. Under major diagnostic changes, children who previously may have been diagnosed with Asperger’s syndrome are now diagnosed with autism spectrum disorder (ASD), writes Karen Keast.

Asperger’s syndrome, also known as Asperger’s Disorder, was first identified in the 1940s by paediatrician Hans Asperger as a higher functioning type of autism.

Asperger’s syndrome became a diagnostic label when it was added to the diagnostic criteria that health professionals use, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), in 1994 as a separate disorder from autism.

The fourth edition of the manual categorised children with autism spectrum disorder (ASD) as having either Autistic Disorder, Asperger’s Disorder or Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS).

Under the new edition of the manual, the DSM-5, released in 2013, the three categories now fall under a single diagnosis of autism spectrum disorder with a severity ranking of levels one, two or three along the spectrum.

Children, young people and adults who already have a diagnosis of Asperger’s syndrome under the previous DSM retain their diagnosis and are not required to be re-assessed.

Asperger’s symptoms

Children diagnosed with Asperger’s syndrome have less severe autism symptoms and a normal IQ while many also experience sensory sensitivities.

Professor Sylvia Rodger, director of research and education for the Cooperative Research Centre for Living with Autism (Autism CRC), says many children diagnosed with Asperger’s syndrome were typically diagnosed after their early childhood years because of their competent language and cognitive skills.

“They often developed language and some of the language they used was a little bit disordered and they had difficulty with comprehension of language,” she says.

“They still had issues with social interaction, although they had language from an early age, and the persistent interests and rituals and routines and those sort of behavioural aspects were still present.

“Typically people who were diagnosed with Asperger’s under that old classification had average to above average intelligence and that’s where the sort of high functioning side of things came to be, because people were cognitively able but their social communication and behavioural issues were still extremely significant.”

      Communication and language

Children with Asperger’s syndrome often developed early language skills but use language differently. They usually have an average or higher than average vocabulary but their speech can be unusual - they may use a flat or monotone voice or have difficulty with language, such as taking someone’s words too literally and they may not understand jokes.

      Social interaction

Asperger’s symptoms are also found in children’s interactions with other people. They may interact with others, and often interact more easily with adults than other children, but be socially awkward - such as having limited eye contact, they may fail to understand gestures or conventional social rules and may also show a lack of empathy or emotion.

Other Asperger’s symptoms include initiating conversations where the individual with Asperger’s will talk about what they need or what interests them but may not engage in reciprocal conversation and may seem to be uninterested in other people.

      Fixated interests and repetitive behaviours

Children diagnosed with Asperger’s syndrome prefer the same routines and find it difficult to cope with changes in their daily activities.

Other Asperger’s symptoms include repetitive or persistent behaviours, such as obsessive interests in topics or collections, and they may collect items such as as bottle tops, toy trains or toy cars.

Assessment and diagnosis

There was no single test to diagnose Asperger’s syndrome.

Children diagnosed with Asperger’s syndrome were assessed under the DSM-IV, with health professionals taking into account their developmental history and observation.

Under changes in the DSM-5, children who may previously have been diagnosed with Asperger’s fall under the single diagnosis of autism spectrum disorder with a severity ranking.

The gold standard assessment for a diagnosis of autism spectrum disorder involves a multidisciplinary team of health professionals, including a paediatrician or a child psychiatrist along with a psychologist, speech pathologist or an occupational therapist.

The Autism CRC is examining diagnostic practices for autism spectrum disorder across Australia and aims to establish a baseline of current assessment processes as part of a move towards developing national standards for ASD diagnosis in Australia.

As part of its work to up-skill health professionals in improved, earlier and more accurate diagnosis, the Autism CRC has worked to develop a Graduate Certificate in Autism Diagnosis at the University of Western Australia.

In another milestone, the Autism CRC’s research partner, the Olga Tennison Autism Research Centre (OTARC) at La Trobe University, has developed a free smartphone ASDetect app enabling parents and health professionals to identify autism spectrum disorder earlier.

The app is not a diagnosis but provides an indication of whether parents should seek professional opinion.

Asperger’s syndrome identity

Professor Rodger says Asperger’s syndrome still exists for those children, young people and adults who received a diagnosis of Asperger’s under the previous diagnostic manual.

“I think one of the challenges for people with Asperger’s syndrome is that that diagnosis is very much their identity, that’s very much who they are and so they often dislike the fact that this classification is no longer acceptable,” she says.

“People who have been diagnosed with Asperger’s syndrome still exist - they are who they are. It’s just that that classification probably won’t be used much going forward.”

Professor Rodger says while Asperger’s syndrome is considered high functioning on the spectrum, people with the disorder still face significant challenges in their daily lives.

“For people who’ve been diagnosed with this condition it’s very real, their lives are complicated socially, there are complexities with sensory issues in managing routines and changes and transitions,” she says.

“A lot of these people still need enormous supports - at school, at university, in the workplace and just functioning in every day life.”

Adults with Asperger’s

Growing awareness about autism spectrum disorder in recent years has led to an increasing number of adults being diagnosed with Asperger’s syndrome.

After changes introduced in the DSM-5, adults are now being diagnosed under the single umbrella term of autism spectrum disorder.

While researchers have made headway into understanding more about young children with autism spectrum disorder, less is known about young people and adults on the spectrum.

Statistics show many young people with autism spectrum disorder are not going on to attend apprenticeships or tertiary education after completing school while others are not gaining full-time employment.

As part of a research program at the Autism CRC, researchers are working on improving higher education and employment opportunities for adults with autism spectrum disorder as well as identifying best practice in physical and mental health management for adults.

“A group of our researchers in the general practice/psychiatry area are working on supporting general practitioners and mental health professionals,” Professor Rodger says.

“They are developing tools and resources that will help health professionals better understand the health, oral health and mental health needs of people on the spectrum when they access GPs.

“We’ve really got quite a broad scope and our research has very much been informed by the needs of people on the spectrum and with input from them about where the priorities are.”

Dr Anne Chalfant, a clinical psychologist who specialises in autism and is director of Annie’s Centre, says teenagers and adults with an Asperger’s syndrome diagnosis can often require care for mental health conditions.

“We know that these days one of the most common difficulties actually for adults with possibly higher functioning on the autism spectrum is anxiety disorders and the presence of anxiety symptoms,” she says.

“The types of anxiety are to do with things like socialising because of their poorer social skills - so they have had less practice socially, they feel more awkward because they are higher functioning intellectually, they understand their limitations and therefore that creates more anxiety for them so it becomes a bit of a negative cycle.

“They may become socially phobic and struggle in those ways and so we might see them then presenting within the mental health system.”



About Asperger’s syndrome:

1. What is it? Asperger’s syndrome is a diagnostic label that was used from 1994 to 2013 as a separate disorder from autism. A single diagnosis of autism spectrum disorder now applies, with a severity ranking of levels one, two or three along the spectrum. Individuals who already have a diagnosis of Asperger’s syndrome retain their diagnosis and do not have to be re-assessed.

2. What causes Asperger’s syndrome? There is no known cause or cure. Researchers are examining whether there are multiple causes behind autism spectrum disorder.

3. What are Asperger’s symptoms? Children diagnosed with Asperger’s syndrome are considered to be higher functioning, with less severe autism symptoms and a normal IQ. They often have good language skills but experience difficulties with social interaction and repetitive or persistent behaviours, as well as sensory sensitivities.

4. What Asperger’s test is available? There is no test for Asperger’s syndrome. Under diagnostic changes, a multidisciplinary team of health professionals, including a paediatrician or a child psychiatrist along with a psychologist, speech pathologist or an occupational therapist, will make a diagnosis of autism spectrum disorder through behavioural observation and developmental history. Parents and health professionals can use the free smartphone ASDetect app to identify autism earlier.

5. How do I find out more? Autism spectrum disorder organisations have a wealth of information and resources for health professionals and families, including the Raising Children Network, Amaze, Autism Speaks, the Autism CRC and OTARC.