This is an extract from the book - Asperger Syndrome. A Practical Guide for Teachers. By Cumine, Leach and Stevenson. Published by David Fulton. ISBN 1-85346-499-6

Hans Asperger (1906-1980) lived and worked in Vienna. He qualified as a doctor and specialised in paediatrics. His work brought him into contact with a number of boys who found it difficult to 'fit in' socially. In addition to their poor social interaction skills, the boys had difficulties with the social use of language, together with a limited ability to use and understand gesture and facial expression. Also evident were repetitive, stereotypical behaviours, often with 'abnormal fixations' on certain objects.

Having noted the similarities in the behaviour of a number of these boys, Asperger (1944) wrote and presented his paper 'Autistic psychopathies in childhood'. He recognised how severely the boys' difficulties affected their everyday lives, commenting, 'they made their. parents' lives miserable and drove their teachers to despair'. He was also aware of the boys' many positive features - they often had a high level of independent thinking, together with a capacity for special achievements - but he didn't underestimate the impact of their individuality on others with whom they came into contact, and he noted their vulnerability to teasing and bullying.

Asperger's paper was written in German towards the end of World War II and for this reason reached only a limited readership. It only became widely accessible in the early 1980s when it was first translated into English and referred to by Lorna Wing in her own research into autism and related conditions. It was felt that the term 'Autistic psychopathy' sounded too negative, and 'Asperger syndrome' was suggested as a more acceptable alternative.

At the same time as Asperger was doing his research in Vienna, the child psychiatrist Leo Kanner was working in Boston, USA. He saw a similar cluster of behaviours in a number of children whom he went on to describe as 'autistic' - using the same descriptor which Asperger had used for his research group. Both Kanner and Asperger had referred to the work of Bleuler (1911) when choosing the word 'autism'. However, Bleuler had used the term to describe children who had withdrawn from participation in the social world. Kanner stressed that the children he was describing had never been participants in that social world, whilst Asperger felt that the coining of the word 'autism' was 'one of the great linguistic and conceptual creations in medical nomenclature'.

For Kanner, 'early childhood autism', on which he wrote his (1943) paper 'Autistic disturbance of affective contact', had a number of defining features, including:

	a profound autistic withdrawal;
	an obsessive desire for the preservation of sameness;
	a good rote memory;
	an intelligent and pensive expression;
	mutism, or language without real communicative intent;
	over-sensitivity to stimuli;
	a skilful relationship to objects.

	impairment of social interaction;
	impairment of social communication;
	impairment of social imagination, flexible thinking and imaginative play.

Wing and Gould noted that there were many children who did not exactly fit Kanner's description of 'early childhood autism', but who, nevertheless, had significant difficulties within the areas of the triad. This led Wing (1981a) to use the term 'Autistic continuum' and later (Wing 1996) 'the Autistic spectrum', allowing for a broader definition of autism based on the triad.

Diagnostic criteria

There is acceptance that autism is characterised by the co-occurrence of impairments in social interaction, social communication and social imagination, and diagnostic criteria are agreed on the basis of the triad.

In 1981, as a result of examining Asperger's original paper, Lorna Wing (1981a) outlined the following criteria for Asperger syndrome:

	impairment of two-way social interaction and general social ineptitude;
	speech which is odd and pedantic, stereotyped in content, but which is not delayed;
	limited non-verbal communication skills - little facial expression or gesture;
	resistance to change and enjoyment of repetitive activities;
	circumscribed special interests and good rote memory;
	poor motor coordination, with odd gait and posture and some motor stereotypies.

	Asperger syndrome is a condition which is thought to fall within the spectrum of autism - with enough distinct features to warrant its own label.
	It was first described in 1944 by the Austrian Hans Asperger, whose work was first published in English in 1991.
	It is characterised by subtle impairments in three areas of development: social communication, social interaction and social imagination. There are, in some cases, additional motor coordination and organisational problems.
	It affects people in the average to above-average ability range.
	The prevalence is thought to be in the region of 36 per 10,000.
	Boys are more likely to be affected than girls, with a probable ratio of 10 boys to every girl.

Asperger syndrome is characterised by subtle impairments in three areas

of development. There are, in some cases, additional motor coordination problems. Typical features include:

The child with Asperger syndrome:

	will be socially isolated, but may not be worried about it;
	may become tense and distressed trying to cope with the approaches and social demands of others;
	begins to realise that his peers have friendships, particularly when he reaches adolescence. He may then want friends of his own, but lack strategies for developing and sustaining friendships;
	will find it difficult to pick up on social cues;
	may behave in a socially inappropriate way - singing along to songs from 'Oliver!' is fine when you're listening to a tape, but embarrassing for your parents when you sing along during a performance at the London Palladium.

	may have superficially perfect spoken language, but it tends to be formal and pedantic. 'How do you do? My name is Jan-de' may be a typical greeting from an Asperger syndrome teenager - but it is one which sets him apart from his peers, marking him out for ridicule.
	often has a voice which lacks expression. He may also have difficulty in interpreting the different tones of voice of others. Most of us can tell if someone is angry, or bored, or delighted - just from tone of voice. The child with Asperger syndrome often cannot make these judgements. This can lead to some tricky situations. One teacher had to give a student a prearranged visual signal, 'When I take my glasses off, you will know that I am cross with you.' Raising his voice had had no effect on the boy.
	may also have difficulty using and interpreting non-verbal communication such as: body language, gesture and facial expression.
	may understand others in a very literal way. As Grandma dried four-year-old Ryan after his bath, she commented on his 'lovely bare feet'. Ryan became distressed and screamed, 'I'm not a bear!'
	fails to grasp the implied meanings of language. He would take a statement such as, 'It's hot in here' at face value - where the rest of us would take the hint and open a window.

	often has an all-absorbing interest which his peers find unusual; & may insist that certain routines are adhered to;
	is limited in his ability to think and play creatively; often has problems transferring skills from one setting to another.

	may be awkward and gauche in his movements;
	often has organisational problems - unable to find his way around, or collect together the equipment he needs;
	finds it hard to write and draw neatly, and tasks are often unfinished.

Diagnostic Criteria for Asperger Syndrome

A. A lack of any clinically significant delay in language or cognitive development.

Diagnosis requires that single words should have developed by two years of age or earlier and that communicative phrases be used by three years of age or earlier. Self-help skills, adaptive behaviour and curiosity about the environment during the first three years should be at a level consistent with normal intellectual development. However, motor milestones may be somewhat delayed and motor clumsiness is usual (although not a necessary diagnostic feature). Isolated special skills, often related to abnormal preoccupations, are common, but are not required for diagnosis.

B. Qualitative impairments in reciprocal social interaction (criteria as for autism).

Diagnosis requires demonstrable abnormalities in at least 3 out of the following 5 areas:

	failure adequately to use eye-to-eye gaze, facial expression, body posture and gesture to regulate social interaction;
	failure to develop (in a manner appropriate to mental age, and despite ample opportunities) peer relationships that involve a mutual sharing of interests, activities and emotions;
	rarely seeking and using other people for comfort and affection at times of stress or distress and/or offering comfort and affection to others when they are showing distress or unhappiness;
	lack of shared enjoyment in terms of vicarious pleasure in other people's happiness and/or a spontaneous seeking to share their own enjoyment through joint involvement with others;
	a lack of socio-emotional reciprocity as shown by an impaired or deviant response to other people's emotions; and/or lack of modulation of behaviour according to social context, and/or a weak integration of social, emotional and communicative behaviours.

C. Restricted, repetitive and stereotyped patterns of behaviour, interests and activities.

(Criteria as for autism; however it would be less usual for these to include either motor mannerisms or preoccupations with part-objects or non-functional elements of play materials).

Diagnosis requires demonstrable abnormalities in at least 2 out of the following 6 areas:

	an encompassing preoccupation with stereotyped and restricted patterns of interest;
	specific attachments to unusual objects;
	apparently compulsive adherence to specific, non-functional, routines or rituals;
	stereotyped and repetitive motor mannerisms that involve either hand/finger flapping or twisting, or complex whole body movement;
	preoccupations with part-objects or non-functional elements of play materials (such as their odour, the feel of their surface/ or the noise/vibration that they generate);
	distress over changes in small, non-functional, details of the environment.

D. The disorder is not attributable to the other varieties of pervasive developmental disorder; schizotypal disorder; simple schizophrenia; reactive and disinhibited attachment disorder of childhood; obsessional personality disorder; obsessive compulsive disorder.