Asperger's Disorder PDF

Preface

We're not broken in need of fixing. We're different in need of acceptance.

A post by morning_after on WrongPlanet.net, an Asperger's website

Although we were commissioned to write on Asperger's disorder, several of our contributors weighed in favor of titling our book Asperger's Syndrome instead. Prof. Baron-Cohen argued that "syndrome" (a group of symptoms) is a "more neutral terminology," suggesting that the term "syndrome" is one more respectful of those with the condition than is the term "disorder" (a disturbance of function or structure).

The question about the book's title was within the context of a field's nosology like the Tower of Babel. Diverse, often strongly held views on nomenclature were, and are, pervasive. Our contributors, as it turned out, were a representative sample. Preferred nomenclature includes the DSM-IV term "Asperger's disorder" and the ICD-10 term "Asperger's syndrome"; "Asperger syndrome" is just as popular. Moreover, others prefer to discuss the topic of high-functioning autism, or autistic spectrum disorder.

With the original contributions of Lorna Wing, Asperger syndrome is now very well recognized and defined as an identity that came into existence only after Hans Asperger described his case series. One ardent lay advocate speaker lecturer prompted consideration as to whether the initial definition created a condition despite the historical precedence of people with similar symptomatology (see, for example, Autism in History by Houston and Frith).

This connection between history and phenomenology exemplifies how definitions are framed by a vocabulary and set of thinking that emphasize observation and sensory experience. The advancement of DSM-III from DSM-II was primarily to empirically define clusters of behavioral symptoms devoid of causal inference. The "neuroses" disappeared from the DSM as it progressed to empirical observation and classification of observed behavioral symptoms. Classifications based on theoretical causality that could be directly observed were considered an impediment to scientific empiricism at the time.

Pavlov and his successor Skinner founded behavioral science through strict empiricism. Data in test of a scientific or clinical hypothesis were to be observed without inference, without mixing the hypothetical inference with the data used to test it. However, one should remember that empiricism descriptive of populations need not presume such determinism for a given individual. After all, there is a large amount of behavioral variability within the naturalistic setting, and many complex traits typically occur within a spectrum linking extremes of severity and normality.

The need for clarification and distinction of these terms that could be served by our book became immediately apparent, yet still left us with two questions. What should we title a book about Asperger's disorder if the term itself is perceived to be disrespectful or pejorative within a contingent of the Asperger's community? Second, once deciding on terminology, what should we do about standardizing it in our text, among contributors who present interesting and cogent arguments to the alternatives, and thus enrich the discussion and give dimension to contemporary debate?

A study of the arguments against using the term "disorder" reveals objection to application of the term to those without disturbance of function, albeit those with a cluster of Aspergian symptoms, but without impairment in social or occupational functioning. Folks in this category could understandably object to their unique, unimpaired differences being considered psychopathology. DSM-IV would not qualify such individuals for Asperger's disorder pathology either.

Freud originally defined for us the hallmark of psychopathology: an impairment in the ability to love and (or) work (P. 26), now termed "impairment in social or occupational functioning." As medical professionals, our attention is not sought except for concern of pathology, and our publisher's commission was to write a medical text. This book is written to inform professionals and the public on current understanding and care of a condition for which people seek treatment and understanding.

Thus the title was resolved. But secondly, how could the text maintain standardized nomenclature? Some contributors presented interesting and cogent arguments to the alternatives thus enriching the discussion and giving dimension to contemporary debate.

Consequently, we chose to leave the nosological terminology what each author contributed. As a result, there is information as several variants of the Asperger's phenotype contained within.

It is said in medical schools that patients are often the best teachers, and it was evident in our association with the Asperger's community that there is a strong sense that diagnostic criteria alone do not convey what Asperger's is. We are fortunate to have, in addition to our clinical science chapters, both a patient and a teacher tell of their Asperger's experience, providing us with a more pictorial image of the condition, appealing to other aspects of our sense of it.

The possibility that human naı¨vete´ or ignorance could inhibit the unfolding of development calls for close examination of this issue of diagnostic clarity and stigmatization. Empirical investigation increases strength and resiliency of the individual and society and may assist societal accommodations for those with Asperger's. The book, at least for those of us writing it, might have been titled Asperger's Discovery. We hope the reader will find it an Asperger's discovery as well.