What is the difference between Autism and Aspergers?
11th September 2020
Simple question. Complicated answer, but please bear with me: our job is to make it easy to understand.
The first thing to know is that ‘Autism’ and ‘Aspergers’ do not actually exist anymore as separate diagnoses: it is now all Autism Spectrum Disorder (ASD).
Actually, if it was up to Aspiedent, there would be a completely different system of diagnosis: one that looks at the actual underlying difficulties rather than just the outward symptoms. This is what Aspiedent are trying to move towards, but we are just one small voice amongst many – and there are many vested interests.
A bit of Necessary History
So how did we get where we are now regarding ‘Autism’ and ‘Aspergers’?
The reason for two separate diagnoses is mainly historical and concerns two Doctors, Dr Leo Kanner in the US, and Dr Hans Asperger in Austria, who separately considered groups of children with unusual symptoms.
Both published their work in the 1940s during the second world war, although the work of Hans Asperger was not translated into English until the early 1990s.
Although sharing some characteristics comprising the ‘triad of impairments’ associated with ASD (difficulties with social communication, interaction and imagination), there appeared to be key differences between the Doctor’s descriptions of these children:
- Those with Autism either did not speak at all, or did not use what language they did have to interact with people, whereas those with Asperger Syndrome spoke fluently and did attempt to interact with people.
- Those with Autism appeared to have learning disabilities whereas those with Asperger Syndrome had normal or often above normal intelligence. Some with Asperger Syndrome have been described as “little professors”.
- Those with Asperger Syndrome had good fine motor control whereas those with Autism were seen as being clumsy.
The triad of impairments united these descriptions. Essentially, all these children did not interact with others in the normal way, had difficulty making friends (or were just not interested), and did not engage in make believe play.
Consequently, Autism was considered to be at the severe end of the ‘autism spectrum’ and Asperger Syndrome at the milder end (and in some ways still is). There was actually another diagnosis: PDD-NOS or Pervasive Development Disorder Not Otherwise Specified, which has also been combined with the current diagnosis of Autism Spectrum Disorder.
Moving into Present Day
The problem then was that when clinicians were diagnosing children who were not behaving or developing normally, it was difficult to tell the two groups, (’Autistic’ and ‘Aspergers’), apart. It became even harder as the children turned into adults, resulting in adults mainly being diagnosed with Asperger Syndrome. PDD-NOS was diagnosed when children did not quite fit into either category.
A study published in 2012 showed that which diagnosis was given, depended more than anything else on the particular clinic.
Essentially, it was too difficult for clinicians to distinguish between the different diagnoses reliably between clinics!
There was also the issue that given two young children, neither of whom speak, it is virtually impossible to accurately predict how they would turn out as adults. For example, some children never learn to speak. Others do learn to speak, but many years later than non-autistic children. Some of these then appear to catch up and match the description of ‘Asperger Syndrome’, more than ‘Autism’.
So the diagnoses Autism, Asperger Syndrome, and PDD– NOS have been combined into one: Autism Spectrum Disorder.
In relation to this, there is great unrest between ‘Neurodiversity’ Activists who were diagnosed with ‘Asperger Syndrome’, but who can now claim the diagnosis of autism’, and parents of non-verbal autistic children who are profoundly disabled.
These parents feel side-lined and are convinced that ‘high functioning autistic individuals’, who for example have families and who can speak and write articulately, have nothing in common with their autistic children.
Just to add to the confusion, some non-verbal autistic children labelled with severe autism and even learning disability in early childhood, have learned to point to a letter board and/or type and communicate in this way. Examples of non-verbal autistic people who are clearly highly intelligent and sufficiently articulate to write books about their experiences are Tito Mukhopadhyay, Ido Kedar, and Naoki Higashida.
In addition, there is even a lot of friction between some ‘high functioning autistic individuals’ and Neurodiversity Activists. These ‘high functioning individuals’ can generally live independently, with some support, but feel significantly disabled by their autism. It is often these individuals who try to build bridges with parents of autistic people, but who are often rebuffed by parents because of the conflict with Neurodiversity Activists.
The problem is that there is a lot of overlap in the underlying issues between all these groups. Sensory issues, unusual perception, processing issues, differences with focus and interest, and extreme ways of thinking are found in each group.
There is no easy way to draw lines between them! But we do need a better way forward.
Finally, it does not help that over time there has been something called ‘threshold creep’ in the diagnostic system. This means that the differences between the general population and those with the ‘mildest’ autism is gradually reducing.
This is easy to understand if you consider two children with similar levels of difficulties who fall either side of what appears to be an arbitrary threshold. In these circumstances, Clinicians will have compassion and include both children and so over time the threshold moves.
At the moment there are a cacaphony of voices all clamouring to be heard, and all wanting a slice of the limited funding.
Is there any wonder that Aspiedent feel it is important to start again with the diagnoses of autism; holding off from making diagnoses so early (as children develop and change), and identifying different groups based on the underlying difficulties rather than the ‘symptoms’?
However in order to do this, there needs to be adequate funding and support for all children, regardless of any diagnosis, as they progress through the stages of their development and education.