Separating Autism from Asperger's Syndrome - Research Paper Example

 Background Asperger’s Syndrome has been characterized as a high functioning version of autism that afflicts individuals of all ages, genders, and races although the problem needs needs to start in childhood for the diagnostic criteria to be met. With as many as 1 in every 1,000 individuals having the disorder, it is one of the most pervasive mental disorders in the general population (Firth 1991). The disorder is characterized by impairments in social functioning and in-depth interests. It’s been speculated that many famous individuals have exhibited traits of Asperger’s Syndrome, including Leonardo da Vinci and Albert Einstein, leading many to question the means to which it should be classified (Fattig 2008). While the disorder is widely prevalent, it hasremained controversial among researchers. Asperger’s Syndrome has been characterized as a pervasive developmental disorder (PDD). These are psychological disorders that affect social functioning. These disorders also affect the individual’s thought processes, and this is seen in Asperger’s Syndrome as many patients diagnosed with the disorder exhibit very involved interests, often for short periods of time before moving on to another interest (NINDS 2007). While Hans Asperger first noted these characteristics in 1944, it wasn’t until nearly fifty years later that this complex of symptoms became an official diagnosis (Kilin 2006). Today psychologists continue to debate the exact classifications of the disorder, with some researchers contending it is a disorder unto itself, while others contend that it is a version of high-functioning autism (H.F.A.) and argue that it should not be considered a separate disorder, but should instead be included on the autism spectrum. Still, others contend that it isn’t a disorder at all and rather a personality characteristic; these individuals point to the number of highly productive and famous individuals with the disorder and argue that its existence this late in the scale of human evolution indicates that a number of traits associated with it are actually beneficial to humanity (Clarke 2007). There are a number of studies that examine the specific correlations between Asperger's Syndrome and Autism. Sanders (2009) examined the qualitative and quantitative differences between the two disorders. Within this context a number of points are notable. It's noted that in considering the current medical criteria distinguishing Asperger's from high functioning Autism is that Asperger's patients are not supposed to exhibit delayed language or cognitive functioning. For high functioning autism, a delay in in cognitive functioning should not be present, however a language delay would be present. It follows then that for patients with Asperger's instead of high functioning autism, there should exist a significant level of language skill as compared to the autistic individual. Howlin (2003, pg. 5) indicates that, “with AD appear on par with HFA groups in cognitive and some language abilities, but significantly lower than controls in language expression and comprehension, especially in studies that use older children, adolescents, and adults as the sample.” In these regards, there is notable qualitative support for a differentiation between the disorders. Within the distinguishing feature of language delay between Asperger's and high functioning autism, there are further elements that must be considered. One such instance is the timing of the exact occurrence of the language delay within the disorders. This is also one of the categorical distinctions that is noted. Howlin (2003) notes that a child will only be categorized as having asperger's syndrome, instead of autism if they do not exhibit any delayed language symptoms after a specific age. It's indicated that within this realm of categorization elements become complicated as diagnosis is slanted towards labeling children autistic. The example given describes a child who does not exhibit any delayed language symptoms passed age two, however does exhibit difficulty with phrases at age three; in this example the child is labeled autistic. In these regards, Howlin (2003) argues that even insignificant delays in language development, or slight learning disabilities are oftentimes misinterpreted by psychiatrists as having autistic tendencies, resulting in the labeling of the child autistic. One also notes that in the original categorization of Asperger's Syndrome by Hans Asperger's there was noted language delay that contributed to his distinction of his specific patients as aspies. One questions the logic then behind placing such distinguishing emphasis on these features of language delay, when some of the very foundational elements rooted in the articulation of Asperger's disorder were identified within this categorical distinction. Considered from the cognitive spectrum there exists a variety of opinions on the nature of the disorder. Sanders (2009) notes that differences in cognitive functioning between the two disorders may not be significant to the extent that it qualitatively distinguished them from each other. Mayes and Calhoun (2004) argued that cognitive functioning was a notable distinguishing feature in that lowered IQ and social impairment was generally correlated with patients diagnosed with a degree of high functioning autism. Interestingly, Mayer and Calhoun (2004) demonstrated that age was a pervading factor, effecting the diagnosis, and when it was removed from the equation cognitive functioning became designated as less qualitatively significant when distinguishing between the two disorders. This last point is notable as one begins to question the nature of a disorder that is effected by the age of the patient. In some regards, one can consider that it is possible for the individual to grow out of their Asperger's symptoms and lead what is considered a normal functioning lifestyle. It will later be considered that this is one of the notable reasons why a categorical distinction should be made between the two mental disorders. Asperger's and Autism Categorization While Asperger’s Syndrome is currently classified as a separate mental disorder, there areformal propositions for the Diagnostic and Statistical Manual of Mental Disorders (DSM)-V to alter the classification so that it is known as a version of high-functioning autism (Carey 2010). Ultimately, classification criteria for Asperger’s Syndrome are a relatively recent phenomenon. It wasn’t until 1981 that Lorna Wing popularized the term Asperger’s Syndrome in a number of scientific papers, and only in 1991 were these papers translated into English and popularized among the United States medical community (Baskin 2006). Since then it has remained a uniquely classified disorder. Thus, there is recent precedent for significant classification changes to be made in regards to the disorder, and its recent adoption the scientific community leads some to believe that the disorder hasn’t been fully understood and its reclassification constitutes a part of its evolutionary process in this regard. Indeed, they believe this is a necessary part of the progression of classification of the disorder and that with the additional evidence that has accrued we’re just now fully understanding where Aspereger’s Syndrome belongs. Some individuals argue that to more accurately diagnose Asperger’s Syndrome there needs to be a more specific classificatory process. The disadvantages of leaving Asperger’s Syndrome as a vaguely defined disability within the DSM, it is argued, is that this further perpetuates misdiagnosis and subsequent improper treatment. This argument proceeds that Asperger’s and Autism are fundamentally linked and it would thus more appropriate to classify Asperger’s Syndrome as belonging to the Autism spectrum. What has been determined is that Asperger’s Syndrome has many traits associated with Autism Spectrum Disorder. Other similarities between traditionally characterized autism and Asperger’s Syndrome include impaired cognitive development, Rett Syndrome, and childhood disintegrative disorder. Ultimately, this argument is extremely simple in that it contends that the similarities between Asperger’s Syndrome and Autism mean they should be classified together. Why Revising Asperger’s Syndrome in the DSM-V is Ultimately Misguided Even as there are significant reasons for the proposed DSM revision, a careful consideration of both sides of the argument reveals that revising Asperger’s Syndrome to fall into the category Autism Spectrum Disorder is misguided. While there are tremendous similarities, there are also elements that distinguish Asperger’s Syndrome from traditional autism and these distinctions form a significant enough boundary that the logistic and diagnostic effects of including Asperger’s as an individual diagnosis outweigh the categorization benefits that would be gained from including it along the Autism Spectrum. Autism is generally characterized by severe social dysfunction and mental retardation, while those diagnosed with Asperger’s Syndrome exhibit social problems, in most instances they are able to lead functioning lives, and remain employable for long periods. There is also a lack of delayed speaking. They are also capable of having children and maintaining regular familial relations. Other salient distinguishing features from individuals with Asperger’s Syndrome are consistently detected higher IQ rates among individuals with Asperger’s Syndrome than those with Autism Spectrum Disorder. In terms of treatment options, individuals with Asperger’s Syndrome stand at a stark contrast from those requiring the more complex care and attention requisite of an Autism Spectrum Disorder. While this isn’t true of all people with Autism Spectrum disorder, the symptoms are markedly unique within Asperger’s Syndrome patients such that an entirely unique category has developed to distinguish it from other forms of high functioning autism. While Autism has no medical ‘cure’ the high levels of dysfunction, including delayed speech and motor skills, is such that it requires more stringently arranged medical practices; such treatment, includes high dosages of Selective Serotonin Reuptake Inhibitors (SSRIs) and substantial cognitive and behavioral therapy (‘Treatment for Autism, Autism Prognosis’ 2000). The risk ofgrouping individuals with Asperger’s Syndrome into the Autism Spectrum involves the possibility for over-treatment and over-compensation for a personality idiosyncrasy that is neither significantly disabling nor arguably even markedly different from typical neurological functioning. In this regard, it’s clear that there is a need for a separate categorization of Asperger’s to aid in its diagnosis, as grouping the two disorders as one runs the risk of overcompensation in treatment, as well as creating an inordinate sense of helplessness in individuals that possess the ability to live full and entirely functional lives. Arguing that the treatment should be tailored to the unique needs of the patients is a noble claim, but in practice psychiatric diagnosis is often influenced by DSM-V categorization and as such it’s highly important to make certain that disorders are classified to the most accurate ability. Especially compelling are reports that individuals have been understood to ‘grow’ out of Asperger’s Syndrome (Wallis 2009). Studies show that as many as 20% of individuals diagnosed with Asperger’s Syndrome in childhood no longer met the criteria as adults (Wallis 2009). It’s with this understanding that too stringently linking Asperger’s Syndrome with Autism Spectrum Disorder can potentially further compel individuals with such social impairment to believe that their condition is a core part of their being rather than learning and formulating the social skills necessary to live more functional lives. Another important consideration is the relative levels of stigma that are associated with a diagnosis of Autism Spectrum Disorder compared with Asperger’s Syndrome. Currently, Autism Spectrum Disorder has the connotation of being a form of mental retardation among the general public, with few individuals readily wanting to admit to possessing Autism. Asperger’s Syndrome affects individuals of all genders and races, with the disorder slightly more prevalent in males than females. Estimates of the number of individuals with Asperger’s vary with different reports placing the figure at .26 per 1,000 individuals to as high as 4.28 to every 1,000, general figures estimate the number of be around 1 to every 1,000 members of the population with Asperger’s Syndrome (Klinn 2006). These statistics are relevant because with such a relatively common rate of diagnosis, Asperger’s Syndrome has become a an accepted characteristic among members of the population. Indeed, a 2009 movie titled Adam depicted an individual with Asperger’s Syndrome in a romantic context and highly functional light; in more stringently linking Asperger’s Syndrome to Autism Asperger’s patients believe that the previous public perceptions of the disorder would be too firmly linked altered. While many psychiatrists and researchers may not agree with this argument, they are a fact of public perception, of which DSM-V categorization indirectly affects. Similarly, large support groups of individuals with Asperger’s Syndrome have organized; referring to themselves as ‘aspies’ these individuals are oftentimes proud of their diagnosis of Asperger’s Syndrome. It follows that changing the diagnostic categorization from Asperger’s Syndrome to Autism Spectrum Disorder would result in a decreased number of individuals willing to readily admit to possessing the disorder, a fact that would result less individuals seeking treatment options. The point being that these individuals would be less willing to accept their categorization as Autistic. Conclusion In conclusion, it's clear that there are a number of distinguishing elements between Asperger's Syndrome and autism. While there are a wide-variety of features, it's demonstrated that most scientific research identifies the most prevalent features within the realms of cognitive functioning and language delay. The research contained herein demonstrates substantial reasons why there should continue to be separate diagnostic criteria for these two disorders. Ultimately, it is necessary to recognize the symptoms of Asperger’s Syndrome as they can pose a significant challenge for the individual and the individual’s family. The patient’s lack of empathy and intense interests can pose a social challenge for family members and by recognizing these challenges in the individual family members can aid them in their social discomfort. While there is no outright cure for the disorder, with understanding family members, medicine, and a positive and proactive approach to life the individual can in most instances live a full and happy existence. It’s for these reasons it is important for all people to be open and accepting of Asperger’s Syndrome, and altering the diagnostic criteria to fall under Autism Spectrum Disorder runs the risk of creating misdiagnosis and increasing stigma. References Asperger H; tr. and annot. Frith U (1991) [1944]. "'Autistic psychopathy' in childhood". in Frith U. Autism and Asperger syndrome. Cambridge University Press. pp. 37–92. Baskin JH, Sperber M, Price BH (2006). "Asperger syndrome revisited". Rev Neurol Dis 3 (1): 1–7. Carey, B. "Revising Book on Disorders of the Mind ." New York Times 10 Febraury 2010. Clarke J, van Amerom G (2007). "'Surplus suffering': differences between organizational understandings of Asperger's syndrome and those people who claim the 'disorder'". Disabil Soc 22 (7): 761–76. Fattig, M. (2008) ‘Famous People with Asperger’s Syndrome. Disabled Word. http://www.disabled-world.com/artman/publish/article_2086.shtml Howlin, P. (2003). Outcome in high-functioning adults with autism with and without early language delays: Implications for the differentiation between autism and Asperger syndrome. Journal of Autism and Developmental Disorders, 33(1), 3. Klin A (2006). "Autism and Asperger syndrome: an overview". Rev Bras Psiquiatr 28 (suppl 1): S3–S11. National Institute of Neurological Disorders and Stroke (NINDS) (2007-07-31). "Asperger syndrome fact sheet". http://www.ninds.nih.gov/disorders/asperger/detail_asperger.htm. Piven J, Palmer P, Jacobi D, Childress D, Arndt S (1997). "Broader autism phenotype: evidence from a family history study of multiple-incidence autism families" (PDF). Am J Psychiatry 154 (2): 185–90. PMID 9016266. http://ajp.psychiatryonline.org/cgi/reprint/154/2/185.pdf.  Sanders, J. (2009). Qualitative or Quantitative Differences Between Asperger’s Disorder and Autism? Historical Considerations. Journal of Autism & Developmental Disorders, 39(11), ‘Treatment for Autism, Autism Prognosis’ (2000). HealthCommunities.com. http://www.neurologychannel.com/autism/treatment.shtml Wallis C (2009-11-02). "A powerful identity, a vanishing diagnosis". The New York Times. http://www.nytimes.com/2009/11/03/health/03asperger.html. Read More