The journey to understanding and diagnosing autism has been a complex and evolving process. Within this history, the recognition of what was once known as Asperger syndrome plays a significant role in our current understanding of the autism spectrum. In 1944, Hans Asperger, working in Vienna, documented a group of children who, while sharing similarities with what Leo Kanner described as early infantile autism, also presented with notable differences. These children possessed strong language skills, often grammatically advanced, and intellectual abilities that fell within or above the average range. The precise relationship between Asperger’s observations and Kanner’s syndrome has been debated extensively, but the shared core features are undeniable: impairments in social interaction, communication challenges, restricted and repetitive behaviors, and interests, often referred to as the triad of impairments (Wing, 1981; 1991).
In 1993, Stephan Ehlers and Christopher Gillberg conducted a pivotal study in Gothenburg, Sweden, focusing on children in mainstream educational settings. Their research aimed to determine the prevalence of Asperger syndrome and related autism profiles among children with an IQ of 70 or higher. Through their investigations, Ehlers and Gillberg estimated a rate of 36 per 10,000 children who definitively met the criteria for Asperger syndrome. Furthermore, they identified an additional 35 per 10,000 children exhibiting social difficulties who were also considered to be on the autism spectrum, even if they didn’t fully meet the diagnostic criteria for Asperger’s due to limited information. Importantly, teachers of these children had previously noted social and educational differences but lacked a framework to understand these variations. This study highlighted that autism spectrum conditions, including Asperger syndrome, were present in the mainstream population, often unrecognized.
The work of Sula Wolff in Edinburgh, spanning over three decades and focusing on children with average to high intelligence who struggled with social interaction but didn’t neatly fit the classic “triad of impairments,” further broadened the understanding of the autism spectrum. These individuals represented the more subtle end of the spectrum. Many of these children went on to live independent adult lives, form relationships, and some even demonstrated exceptional talents. Wolff argued for their inclusion within the autism spectrum because these children frequently experienced difficulties in school and required understanding and support from parents and educators. Crucially, the most effective approaches for these children were consistent with the recommendations for children diagnosed with Asperger syndrome and high-functioning autism (as it was termed at the time). Wolff referenced the prevalence figures from Ehlers and Gillberg’s research, suggesting that their combined rate of 71 per 10,000 likely encompassed the children she had studied, illustrating a broader spectrum of autistic conditions within the population.
These historical insights into Asperger syndrome have significantly shaped the evolution of autism diagnosis. While Asperger syndrome is no longer a separate diagnostic category in the most recent diagnostic manuals like the DSM-5, its recognition was instrumental in expanding the understanding of the autism spectrum. The history of Asperger syndrome’s diagnosis is integral to the larger narrative of how we understand and identify autism today, emphasizing the diverse presentations of autism and the importance of recognizing the spectrum nature of the condition.
