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Medical Why is Asperger's considered a form of autism?

  1. Jun 2, 2010 #1
    How can it be autism? High functioning or not, it seems more like a learning disability, or something of the like more than autism.

    True autism has little to no normal social functioning, or self-realization. Asperger's simply has some trouble in social situations. (Depending on how mild to severe one's case is, I suppose) Asperger's patients realize they exist, and can eventually function like a totally normal person.

    How the hell is it classified as "autism"?
  2. jcsd
  3. Jun 2, 2010 #2
    I have to completely agree with you. It is inexplicable to me the two ever got confused, and that one is said to be a milder form of the other. There are overlaps, but the differences are huge and important.
  4. Jun 2, 2010 #3


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    (quoting myself from an earlier thread)........

    If you want to talk about the core neuro deficit in autism, it would seem to be a low-level perceptual integration issue. A difficulty sorting the flood of sensory data into a coherent state. Which itself is likely due to developmental synaptic pruning - wiring the brain via experience so as to chunk and categorise the flow of events.

    Serious autism is about a world that seems fragmented, too loud, too busy. And the behaviours follow from that.

    There are many autobiographical accounts that atest to this.

    Savants are those who can automate basic skills to a high level. So music, counting, drawing, memorising. Structured activities that can be mastered.

    Autism is then a spectrum complaint. Asperger's would be where the perceptual integration difficulties are minor and so only show as an impairment of perceptual integration at the highest level, at the end of the chain - such as face processing or getting the double meaning of jokes and metaphors.

    Asperger's people describe how they just can't read the facial expressions that would tell them what people are really thinking, which makes people unpredictable, frightening, to them. And why they miss ordinary social cues.
  5. Jun 2, 2010 #4
    But not all are that severe- some are not even that bad. I can attest to this. :tongue:

    So, if some forms of Asperger's are so mild that they can be somewhat corrected, it's not much of an autism- just an eccentricity. The only my friends can tell when I'm getting bad is when, well, my train of thought isn't exactly...followable. I expect people to have ESP, and I get so mad that people can't read my mind. After all, if they look at me and expect to read THEIR mind, they can at least do the same for me... :wink:
  6. Jun 2, 2010 #5


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    This would then make it a spectrum disorder, or even "disorder". In fact you will know Baron-Cohen and others have speculated that we are talking about a normal distribution in brain lateralisation or brain "maleness", so that asperger's would be an outlier of a distribution.

    The number of "very mild" aspies would thus be even greater in number and not that obvious from their behaviour.
  7. Jun 3, 2010 #6
    Thanks for your explanation. I have read similar ones before, and they are persuasive in that they make sense.

    The trouble starts for me when I encounter actual high functioning autistic people, and people with Asperger's in real life, and start to notice remarkable qualitative differences that don't get described when both conditions are put on paper. Clinical descriptions emphasize the apparent similarities, while avoiding the differences.

    Things I've noticed:

    Autistic people tend to speak with flat intonation. Asperger's people are either normal in intonation or above average in expressivity, often adopting the level of diction of professional public speakers. Aspie's seem to savor the act of speech, in and of itself. Autistic people, not.

    The sense of humor of HFA's is pretty basic, and on the heavy handed side. The sense of humor of Aspie's is alot more sophisticated. They do get double meanings and metaphors, and particularly like puns. They're more likely to overindulge in binges of joke telling than to avoid getting into humor.

    The HFA will try to stick to his field of interest in conversation, but will not dominate the conversation. You feel they are leaving space for responses. The Aspie, once they get started, will monologize non-stop and they are intuitive masters at not leaving gaps for responses.

    The HFA is generally not eager for social contact. Aspie's are enthusiastic about making contact with people and will initiate it, despite their confusion about many of it's aspects.

    Moonbear dug up this paper for another thread. Unfortunately you can only read the first page here, but the author starts talking about important qualitative differences:


    Reduced to a clinical, verbal description like this, we could confuse autism with agnosia. Did not The Man Who Mistook His Wife For A Hat suffer from the "core neuro deficit" of a "perceptual integration issue"? Somehow, no one makes the mistake of putting agnosia on the autistic spectrum, but lumping Asperger's with Autism has always struck me as nearly as big an error as that would be. HFA's and Aspie's both have trouble with non-verbal social cues, yes, but the actual nature of the trouble they have is quite different, it seems to me, and not enough effort has been made to distinguish between the nature of the problem. People with Geschwind's Syndrome also have trouble with social cues, and so, often, do drunk people, and people who hand out religious tracts. In all cases the particular quality of the trouble they have with social cues is different.
  8. Jun 3, 2010 #7

    Andy Resnick

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    Autism is considered a 'spectrum disorder'- there is a wide variability in severity. "Asperger's" is put on one end of the spectrum.

    That said, the reality is that autism/asperger's is currently a 'trendy' diagnosis, part of a larger swing towards defining 'normal' more and more narrowly.
  9. Jun 3, 2010 #8
    Since you have Asperger's you're not supposed to be able to crack a joke. Please delete that winking smilie, or you'll upset the foundations of the Psychiatric community.

    Yes, hmmmm, let's see. How is it normal people can tell you you don't "get" facial expressions and then turn around and not be able to read your mind?

    The thing we notice that Aspies seem to lack is actually termed "theory of mind".


    Expecting someone else to know what's in your mind is faulty logic: "I know what's in my mind, therefore everyone should know what's in my mind." In fact the logic should be: "I don't know exactly what they're thinking, therefore, if their mind is like mine, they shouldn't know exactly what I'm thinking." Likewise there's this faulty logic: "I enjoy what I'm interested in, I don't enjoy what other people are interested in, therefore everyone should enjoy what I'm interested in." In fact the logic should be "I enjoy what I'm interested in, and not what other people are interested in, therefore, other people, if their mind is like mine, should enjoy what they're interested in, and not what I'm interested in." In the latter two cases you demonstrate "theory of mind" you attribute the qualities of your own mind to other people's mind with proper logic.

    Even among "normies" theory of mind only goes so far. We often don't bother with it for a variety of reasons. Aspie's seem odd to us because they often don't seem capable of bothering with it even when it would be of great use to them to do so.
  10. Jun 3, 2010 #9


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    I only have a limited number of personal impressions to draw on. But I do work alongside someone I believe to be an aspie and he lacks some of the classic symptoms. So he does crack jokes (but kind of inappropriately all through a meeting). And he does get subtle metaphor (he is a prize winning book reviewer).

    However he is not exactly eager for social contact (he rarely replies to hellos and goodbyes, he will talk to only a very few people). He also has blunted affect. When his father died in a plane crash, his reaction was matter of fact. When his wife rang in a panic to say their infant daughter had gone missing (a daughter diagnosed as HFA), he again was unfazed.

    So just one data point, but I would agree that aspies, like everyone, are as varied as they are similar. And it is puzzling that a classic symptom is the inability to get metaphor and double meanings, yet this may instead be only an HFA trait.

    However, a low level perceptual integration issue is still my favoured hypothesis.

    One thing I note is that aspie symptoms seem more visual, the autist has aural and kinesthetic issues too. This could be a difference in where the developmental problems hit, or more likely in my view, again just down to the fact visual processing is a much more complex task involving many more tiers of processing. So a faint compromise will show up most in social visual tasks.

    This would account for the language skills difference you note perhaps.

    As for the social gregarity, again, I don't think autists lack a want of human contact. It is just that it is too scary and threatening due to perceptual scrambling.

    Aspies would then be seeking it, but might still prefer only certain kinds of contacts that are the most straightforward to comprehend.

    I notice that my colleague is most drawn to become friendly with people who have the same interests as himself (literature) or who are happy to talk all days about themselves, so make the least demands on social processing.

    The case of agnosia you mentioned would be different as autism/aspergers would be about a fine-grain developmental issues, whereas agnosias are about gross damage to established and normal neural circuits.

    It is quite possible of course that there are two distinct fine-grain developmental defects causing two separate kinds of syndromes.

    Noting your interest in synaethesia, I would take this as evidence that neural circuitry development can go wrong, or go different, in many ways for sure.

    The main reason actually I even assume it to be a neuro-developmental story (as opposed to a theory of mind module one, for instance) is that I take seriously the explanation that leaky guts and peptide poisoning could be responsible for the current epidemic of autism spectrum disorders.
  11. Jun 3, 2010 #10
    One possible explanation for your co-worker not seeming typical comes from a book I read about Asperger's which asserted it is very frequently co-morbid with either 1.) OCD, 2.) Seizures, 3.) ADD, or 4.) Tourettes. So, his blunted affect might possibly be the side effect of a med he takes for a co-morbid condition.

    I've met about a dozen people with Aspergers and none had a blunted affect. Three of them are rather more serious in demeanor than all the others: minimal joking, and one of them I never heard say anything intended to be amusing. The bulk of people with Aspergers learn quickly what others perceive to be their Aspie deficits and proclivities and work hard at covering them. It's not that rare to be surprised to find an Aspie seems to have no trouble looking you in the eye because many learn the trick of staring at a spot directly between your eyes, for example, or by taking off their glasses so they can't actually see your eyes that well, rendering them less disturbing. Many may also elect to hold their social curiosity in check, having been so often rebuffed for asking overly intimate questions of strangers. The original diagnosis very frequently comes in the aftermath of getting themselves into trouble with classmates at school by naively spouting very blunt things. In schools they often end up as flypaper for bullies.
    Personally, I don't have any favored explanation for either. My only contention is that, whatever is causing one, the cause of the other is different. Things that sound the same when reduced to clinical description on paper actually manifest in real life as qualitatively different.
  12. Jun 3, 2010 #11


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    Wait, why are they mutually exclusive? Isn't it possible that the developmental deficits are what lead to problems with theory of mind?
  13. Jun 3, 2010 #12


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    ToM as an ability is not the issue. It is the idea of a ToM module, or a purely biological explanation of ToM, or a conflation of ToM and self-awareness.

    So indeed, I would argue that low level developmental deficits would be why high level complex skills like ToM would fail to develop. But people who push ToM usually have a neuro-reductionist and modularity agenda. Their idea of the probable defect would thus be quite different.
  14. Jun 5, 2010 #13
    Indeed. It's remarkable to what extent scientific fluency within a given subfield depends on reasoning about scientists' agendas and recognizing their tribal affiliations.

    However, you should distinguish between cognitive and neural modularists. Cognitive modularists see modules at the functional, or information-processing, level of description. They do not necessarily think that this implies structural modularity (although they often do). So modularism does not necessarily entail neuro-reductionism. You'll find that many of the old-school functionalists think this way.

    I think what's often left out of this debate is the consideration that some of these DSM-IV categories might have multiple etiologies. These etiologies may overlap or they may not. This would not only account for the observed "family resemblance" or "fuzzy" structure of these categories, but explain the typically large variance in treatment efficacy for these disorders.

    There is also the possibility that a term like "autism" is similar to a term like "fever"--a descriptor of symptoms that result from some underlying problem or are adaptations to that problem, rather than constituting the disorder itself. The sensory approach to autism follows this schematic: social difficulties emerge from sensory dissonance.

    But this view seems incomplete in light of Baron-Cohen's findings. Why should "maleness" or brain lateralization be associated with sensory deficits? Why should sensory deficits entail social deficits while leaving abstract/logical/mathematical cognition relatively intact?

    One thing's for sure: a view of autism that DEPENDS on some sort of biological deficit common to all autistics is conceptually unhygienic. There is some truth to the view that psychiatric disorders are disorders of the brain, just as diabetes is a disorder of the kidney. There is no difference of KIND between the two. However, there is an enormous difference of degree between the two, in that not only do we have to contend with the brain's complexity (it is the most structurally and functionally complex object in the known universe), but we also have to contend with the effects of socialization and culture, both of which are not understood rigorously at present in terms of their effects on biology.

    In sum, a category like "autism," and its associated diagnostic prerequisites, is more like a legal category than a category like "gingivitis." On the one hand, it's motivated by intuitive insight: to paraphrase Potter Stewart, you know Asperger's when you see it. On the other hand, there is no indisputable, objective basis for determining whether or not somebody has Asperger's (as there is with gingivitis: the presence or absence of a certain kind of inflammation). The disease model is not necessarily applicable here.
  15. Jun 5, 2010 #14
    You almost sounded like you knew what you were talking about until this.
    Last edited: Jun 6, 2010
  16. Jun 5, 2010 #15
    I think Asperger's is one of those things that is awfully hard to set in diagnostic-set-criteria. Everyone's different.

    And, yes, sometimes disorders aren't really the biological disorder, but are compsenations for other disorders. That tends to complicate things.

    Things that Aspie's "have" that I disagree with:

    1. Lack of humor cognition. (Wtf? The humor is just slightly... twisted and/or wry. At least with many people I know, myself included.)
    2. Lack of emotional intelligence, and severe lack of an understanding of human behavior.

    My somewhat large rant on this:
    This is not true. I think we develop differently. When I was little, I knew there was something I wasn't getting. It wasn't that I didn't understand people's cue, looks, or such, but I just instinctively somehow ignored it- it made no meaning in my head. I didn't care that I knew the other kids didn't like me, I was too happy-go-lucky and blatantly ignorant. Realizing this when I was like, 12, I was determined to understand why, fully and completely people did things. I have it figured out.
    I just can't apply it to me- it's like I'm special or something, and those same learned lessons and observations can't reach my brain. I'm great at advising- sucky at reacting.

    There are some really, really bad and obvious things to pick up on, but some can be attributed to the fact I love science and math (yay stereotypes!) I'm so, SO scatterbrained, and my train of thought doesn't always... follow my thoughts. I'm the worst rambler. Ever. *points to epicly long post*
    I'm stupidly blunt (Why lie? Honestly... but I DO know when to shut up. Really. I promise.) and I'm oblivious.
    And obsessive. Not in a creepy way, but in a loyal, happy sorta way. Ask my ex-boyfriends.
  17. Jun 6, 2010 #16

    On the plus side, nowhere to go from here but up, right?

    Even if the analogy becomes diabetes:pancreas::autism/asperger's:brain, I think the broader argument (or impression, really) still stands. Or emphysema:lungs or whatever.
  18. Jun 6, 2010 #17


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    I agree this is a difficulty. So I would actually be doubtful that what goes wrong is "over-lateralisation" in a direct sense.

    I would say because social cognition is more difficult. And I would question the level of creative understanding as opposed to performing concrete skills like calculation and memorisation.
  19. Jun 6, 2010 #18
    Thanks for posting this. I think every Aspie has some objection to some part of the diagnosis and every explanation of a certain Asperger's behavior "from the inside" that I read makes the whole issue more interesting and vivid.

    What did you mean by this, though: "...sometimes disorders aren't really the biological disorder, but are compsenations for other disorders"?
  20. Jun 6, 2010 #19
    Perhaps this is why they started to look at autism as a spectrum disorder. The severity of distortion in social cognition, and the resulting impairment in social life may be quite different from person to person. So perhaps its more correct to think at those cases as ranges, as opposed to points on a the neuro-typical - autism line.
  21. Jun 6, 2010 #20
    That was a reply to somebody's post. oops. I thought I quoted.

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