[Posted on 5 December, 2017 by Christopher Gillberg]
When Hans Asperger talked to his colleagues in the 1930’s about ”autistic personality disorder” (Autistische Psychopathie, he was convinced that ”his” condition usually had hereditary causes, but that it also might, in some cases, arise due to brain damage. Asperger was a paediatrician and very interested in educational methods in the treatment of young people with mental problems. There is some documentation to suggest that Leo Kanner, a psychiatrist heavily influenced by psychoanalysis, and to this day described as “the man behind autism in children”, actually discovered autism through one of Asperger’s students, but Kanner never mentioned Asperger and acted as though he had never heard about or read any of the 300 papers that Asperger authored over the course of his life. Asperger, however, frequently referred to Kanner in his articles.
Asperger’s syndrome is no longer considered a separately coded category in the DSM, and will likely not be considered as such in the ICD either, once the eleventh edition of this diagnostic classification is published (probably sometime in 2018). Does this mean that Asperger’s syndrome does not exist? How can a diagnosis “received” by millions of people across lots of countries worldwide just up and vanish?
The truth is of course that Asperger’s syndrome remains both in most of those who have been diagnosed with it at some point and as a mental image of the typical “autistic personality”. In clinical contexts one can continue using the diagnosis in cases where the symptoms and personality traits correlate with Asperger’s own description (and which can be found in condensed form in the diagnostic criteria that Carina Gillberg and I published in 1989, and elaborated in Gillberg 1991).
One way of summarising the research results in the field of autism/Asperger’s is that the core of the autistic condition is the personality type that Asperger described. Given the extremely high rate of a few or even multiple symptoms of autism/Asperger’s in the so-called normal population, it is reasonable to consider autism a personality trait rather than an illness or a disorder in itself. “Pure Asperger’s” is likely a primarily genetically based personality type akin to “obsessive-compulsive”, “pedantic”, “introverted” or “extroverted”. However, the concurrent presence of genetic dispositions, variants or mutations, brain injuries due to various kinds of illnesses, or other psychiatric syndromes (e.g. depression, anxiety, ADHD, language disorder, learning difficulties), may result in symptoms and difficulties requiring a diagnosis, one which might match the criteria for Asperger’s syndrome or autism.
Hans Asperger was right, Kanner was wrong: autism/Asperger’s is caused by genes and/or brain damage and not by affective relationship disorders between mother and child. Therefore, if anything, all childhood onset autism should reasonably be called Asperger’s syndrome (not Kanner’s syndrome). Or, perhaps even more appropriately, it should all be called Ssucharewa’s syndrome, after the Russian neurologist who, even before Asperger (and of course long before Kanner) described the condition using the term “schizoid”.
It is unlikely that Asperger’s syndrome will disappear from our clinical reality. DSM and ICD are influential diagnostic manuals, but one cannot simply wave a wand (or pen, if you will) and make Aspies go away. The fact that Asperger’s syndrome no longer has its own diagnostic code should not prevent anyone from still making the diagnosis (using the code for autism).