Addictive personality

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Addictive_personality 

The term "addictive personality" refers to a proposed set of personality traits that may increase an individual's risk of developing addictive behaviors. While it is not formally recognized in diagnostic manuals like the DSM-5, this concept suggests that traits such as impulsivity, sensation-seeking, and emotional dysregulation may contribute to the development or maintenance of addiction. These behaviors extend beyond substance use to gambling, internet use, compulsive eating, and shopping.

The validity of addictive personality as a construct remains controversial, with some researchers arguing that these traits may emerge as a consequence of addiction rather than serve as predictors, and that the term itself lacks a consistent definition. Despite this controversial status, studies have found links between certain personality profiles and specific types of addiction, suggesting that a more nuanced relationship exists. Genetic factors are also recognized as significant contributors to addiction vulnerability, with research estimating that 40% to 70% of individual variation in addiction risk is heritable.

Etiology

The following factors are believed to influence addiction susceptibility.

Psychological factors

• Impulsivity
• Sensation seeking
• Nonconformity combined with weak commitment to socially valued goals for achievement
• Social alienation and tolerance for deviance
• Heightened stress coupled with lack of coping skills.

Some claim the existence of "addictive beliefs" in people more likely to develop addictions, such as "I cannot make an impact on my world" or "I am not good enough", which may lead to developing traits associated with addiction, such as depression and emotional insecurity. People who strongly believe that they control their own lives and are mostly self-reliant in learning information (rather than relying on others) are less likely to become addicted. However, it is unclear whether these traits are causes, results or merely associated coincidentally. For example, depression due to physical disease can cause feelings of hopelessness that are mitigated after successful treatment of the underlying condition, and addiction can increase dependence on others. Certain psychological disorders such as panic attacks, depressive disorders, and generalized anxiety disorder have been related to addiction. The addicted person, who struggles with reality and feels negative feelings, such as anxiety and depression, will seek out ways to help them avoid such feelings. A study based on social cognitive theories, included a personality-targeted intervention that was shown to help treat substance addiction. It is feasible that by changing certain elements of one's personality, one can gain a step in the right direction towards changing their addictive personality.

Genetic and biological factors

Research has explored possible biological and genetic contributions that are often linked to a vulnerability to addiction. Twin and adoption studies have shown that genetic factors may account for 40-60% of the risk for alcoholism and other substance-related disorders, with environmental influences playing a stronger role in early adolescence and diminishing over time.

Certain personality traits associated with addictive behaviors such as impulsivity, emotional dysregulation, and sensation-seeking have been linked to genes receptive of dopamine and nicotine, including DRD2 and CHRNA5. For example, the CHRNA5 gene has been associated with a reduced aversion to nicotine, possibly due to its impact on the brain's habenula region. This may reinforce the continued consumption of nicotine products by reducing the negative sensory experience of early use.

Biological factors have also been found through experimentation on rats. Rats with higher locomotor responses to novel environments were found to be more likely to self-administer stimulant drugs in laboratory settings, indicating a possible genetic predisposition toward drug reinforcement behaviors.

Recent research has further highlighted the role that genetic and biological factors play in traits such as impulsivity and reward sensitivity. A 2023 study by the National Institutes of Health identified shared genetic markers across a variety of substance use disorders, emphasizing how involved genes are in regulating dopamine signaling pathways. Further studies have implicated the CADM2 gene in impulsivity and reward-related behaviors. Variants in this gene have been associated with increased risk-taking and sensation-seeking traits, which are considered potential risk factors for developing addictive behaviors.

Environmental factors

Studies have found numerous environmental factors that correlate with addiction. Exposure to sustained stress in childhood, such as physical or sexual abuse, especially accompanied by unpredictable parental behavior strongly correlates with drug addiction and overeating in adulthood. Children who tend to react to distress in a more rash way have been linked to becoming more likely to drink and smoke in their adolescence. Results from this research found that this was because the reaction to distress affected psychosocial learning, which led to increased expectancy to drink or smoke. A lack of social interaction has also been shown to correlate with addictive tendencies; rats reared in isolation were quicker to develop a pattern of cocaine self-administration than rats reared in groups. There is a gene/environment connection in that individuals with particular personality traits may self-select into different environments, e.g., they may seek out work environments where addictive substances are more readily available.

Description

Addiction can be defined as an excessive amount of time and resources spent in engaging in an activity or an experience that somehow affects the person's quality of life. An addictive personality is when those addictive behaviors progress and change as the individual seeks to produce the desired mood.

People that face this issue are currently defined to have a brain disease as promoted by the National Institute on Drug Abuse and other authorities. People who experience addictive personality disorders typically act on impulses and cannot deal with delayed gratification. At the same time, people with this type of personality tend to believe that they do not fit into societal norms and therefore, acting on impulses, deviate from conformity to rebel. People with addictive personalities are very sensitive to emotional stress. They have trouble handling situations that they deem frustrating, even if the event is for a very short duration. The combination of low self-esteem, impulsivity and low tolerance for stress causes these individuals to have frequent mood swings and often struggle with depression. A coping mechanism to deal with their conflicting personality becomes their addiction and the addiction acts as something that the person can control when they find it difficult to control their personality traits.

People with addictive personalities typically switch from one addiction to the next. These individuals may show impulsive behavior such as excessive caffeine consumption, Internet use, eating chocolate or other sugar-laden foods, television watching, or even running.

Extraversion, self-monitoring, and loneliness are also common characteristics found in those who have addiction. Individuals who score high on self-monitoring are more prone to developing an addiction. High self-monitors are sensitive to social situations; they act how they think others expect them to act. They wish to fit in, hence they are very easily influenced by others. Likewise, those who have low self-esteem also seek peer approval; therefore, they participate in "attractive" activities such as smoking or drinking to try to fit in.

People with addictive personalities find it difficult to manage their stress levels. In fact, lack of stress tolerance is a telltale sign of the disorder. They find it difficult to face stressful situations and fight hard to get out of such conditions. Long-term goals prove difficult to achieve because people with addictive personalities usually focus on the stress that comes with getting through the short-term goals. Such personalities will often switch to other enjoyable activities the moment that they are deprived of enjoyment in their previous addiction.

Addictive individuals feel highly insecure when it comes to relationships. They may often find it difficult to make commitments in relationships or trust their beloved because of the difficulty they find in achieving long-term goals. They constantly seek approval of others and as a result, these misunderstandings may contribute to the destruction of relationships. People suffering from addictive personality disorder tend to also have depression and anxiety, managing their emotions by developing addiction to alcohol, other types of drugs, or other pleasurable activities.

An addict is more prone to depression, anxiety, and anger. Both the addict's environment, genetics and biological tendency contribute to their addiction. People with very severe personality disorders are more likely to become addicts. Addictive substances usually stop primary and secondary neuroses, meaning people with personality disorders like the relief from their pain.

Personality traits and addiction

Addiction is defined by scholars as "a biopsychosocial disorder characterized by persistent use of drugs (including alcohol) despite substantial harm and adverse consequences". Substance-based addictions are those based upon the release of dopamine in the brain, upon which the range of sensations produced by the euphoric event in the brain changes the brain's immediate behavior, causing more susceptibility for future addictions. Behavior-based addictions, on the other hand, are those that are not linked to neurological behavior as much and are thus thought to be linked to personality traits; it is this type of addiction that combines a behavior with a mental state and the repeated routine is therefore associated with the mental state.

Drug addiction

A group of British forensic psychologists and data scientists analysed a new large database of users of psychoactive substances. To analyse the predisposition to drug use, they utilized 7 psychological traits, the Five Factor Model supplemented by Impulsivity and Sensation seeking:

• N Neuroticism is a long-term tendency to experience negative emotions such as nervousness, tension, anxiety and depression (associated adjectives: anxious, self-pitying, tense, touchy, unstable, and worrying);
• E Extraversion is manifested in outgoing, warm, active, assertive, talkative, cheerful characters, often in search of stimulation (associated adjectives: active, assertive, energetic, enthusiastic, outgoing, and talkative);
• O Openness to experience is a general appreciation for art, unusual ideas, and imaginative, creative, unconventional, and wide interests (associated adjectives: artistic, curious, imaginative, insightful, original, and wide interest);
• A Agreeableness is a dimension of interpersonal relations, characterized by altruism, trust, modesty, kindness, compassion and cooperativeness (associated adjectives: appreciative, forgiving, generous, kind, sympathetic, and trusting);
• C Conscientiousness is a tendency to be organized and dependable, strong-willed, persistent, reliable, and efficient (associated adjectives: efficient, organized, reliable, responsible, and thorough);
• Imp Impulsivity is defined as a tendency to act without adequate forethought;
• SS Sensation Seeking is defined by the search for experiences and feelings, that are varied, novel, complex and intense, and by the readiness to take risks for the sake of such experiences.

These factors are not statistically independent but the condition number of the correlation matrix is less than 10 and the multicollinearity effects are not expected to be strong.

The results of the detailed analysis of modern data support partially the hypothesis about psychological predisposition to addiction. The group of users of illicit drugs differs from the group of non-users for N, O, A, C, Imp, and SS. Symbolically, this difference can be illustrated as follows:

${\displaystyle \mathrm{N}\Uparrow ,\mathrm{O}\Uparrow ,\mathrm{A}\Downarrow ,\mathrm{C}\Downarrow ,\mathrm{I}\mathrm{m}\mathrm{p}\Uparrow ,\mathrm{S}\mathrm{S}\Uparrow }$

(N, O, Imp, and SS scores are higher for users; A and C scores are lower for users).

The hypothesis about importance of E for addiction was not supported by this aggregated analysis of use of all illicit drugs.

Analysis of consumption of different drugs separately demonstrated that predisposition to use of different drugs is different. For all illicit drugs groups of their users have the following common properties:

${\displaystyle \mathrm{O}\Uparrow ,\mathrm{C}\Downarrow ,\mathrm{I}\mathrm{m}\mathrm{p}\Uparrow ,\mathrm{S}\mathrm{S}\Uparrow }$

(O, Imp, and SS scores are higher for users and C score is lower for users).

Deviation of N, E, and A scores for users of different drugs can be different. For example, heroin users have average profile

${\displaystyle \mathrm{N}\Uparrow ,\mathrm{E}\Downarrow ,\mathrm{O}\Uparrow ,\mathrm{A}\Downarrow ,\mathrm{C}\Downarrow ,\mathrm{I}\mathrm{m}\mathrm{p}\Uparrow ,\mathrm{S}\mathrm{S}\Uparrow ,}$

whereas for LSD and Ecstasy (the latter being a so-called "Party drug") users N has no significant deviation from the population level and E can be higher.

Several personality profiles of risky behaviour were identified by various researchers, for example ${\displaystyle \mathrm{N}\Uparrow ,\mathrm{C}\Downarrow }$ (Insecures) and ${\displaystyle \mathrm{E}\Uparrow ,\mathrm{C}\Downarrow }$(Impulsives, Hedonists). Various types of addictive personality have in common low C.

Internet addiction

Internet addiction is associated with higher scores in neuroticism and lower scores in extraversion and conscientiousness. One explanation for this association is that virtual environments may feel safer and more comfortable for individuals with lower self-esteem and increased emotional sensitivity compared to real-life environments. Similarly, individuals with low extraversion that desire social interaction but are averse to face-to-face interaction may find the opportunity for online communication attractive. Research indicates that social media platforms utilize algorithmic designs such as infinite scrolling and personalized content recommendations to maximize user engagement, fostering an environment where compulsive usage patterns form among users.

Social media addiction is currently not recognized as a formal psychiatric disorder; however, with over 5 billion people spending an average of 2 hours and 29 minutes a day on social media in 2024, there are many concerns about the impact that social media has on mental health and the daily lives of people. Several mental health consequences have been linked to excessive social media usage, such as increased social media usage being linked to increased levels of stress, insomnia, and suicide-related outcomes.

Traits associated with addictive personality, such as impulsivity and emotional dysregulation, have been proposed as potential risk factors for problematic internet use. The compulsive nature of digital engagement, reinforced by algorithmic content delivery, is thought to contribute to patterns similar to those seen in substance-related addictions.

Personality theories of addiction

Personality theories of addiction are psychological models that associate personality traits or modes of thinking (i.e., affective states) with an individual's proclivity for developing an addiction. Models of addiction risk that have been proposed in psychology literature include an affect dysregulation model of positive and negative psychological affects, the reinforcement sensitivity theory model of impulsiveness and behavioral inhibition, and an impulsivity model of reward sensitization and impulsiveness.

Food addiction

While food addiction is widely considered not to be a medical disorder, there is still controversy as to whether food can be addictive as it is necessary for survival. Research has shown that foods can have the same chemical reactions in the brain as addictive chemicals or drugs (e.g. brain reward pathways). Furthermore, certain foods that have a higher level of sweeteners or fats have been found to demonstrate a higher addictive potential. More research is needed to determine the relation between food and addiction. Recent studies have attempted to find correlations between humans and animals, but no general consensus has been reached.

Cultural correlates of personality

The concept of enduring personality traits that predispose individuals to addictive behaviors, which is often referred to as the "addictive personality", has been examined not only in clinical psychology but increasingly through a cross-cultural lens. Although not formally recognized in diagnostic manuals like the DSM-5, traits such as impulsivity, sensation-seeking, and high neuroticism have consistently been associated with increased vulnerability to addiction. Cross-cultural studies using the Five-Factor Model of personality have found that these traits, especially neuroticism and low conscientiousness, are predictive of substance use disorders across diverse populations. This suggests a level of universality in the personality–addiction link, even as cultural norms and expressions of addiction vary widely.

Recent work in cultural psychology and behavioral genetics has further emphasized that while the core traits may be consistent, cultural factors shape how addictive behaviors manifest and are treated. For example, societal attitudes toward alcohol, coping mechanisms, and stress vary across countries, influencing how personality traits interact with environmental factors. As research becomes more data-driven and global in scope, scholars are moving away from older psychoanalytic models toward integrated frameworks that consider both individual personality traits and cultural dimensions. These new approaches provide a richer understanding of addiction risk that respects both universal psychological patterns and culturally specific contexts.

Co-occurring disorders

Traits commonly associated with addictive personality, such as high impulsivity, emotional dysregulation, and sensation-seeking, have been proposed as underlying vulnerabilities contributing to both addictive behaviors and other psychiatric conditions. Research has also linked these traits to increased risks for anxiety disorders, depressive disorders, and impulse control disorders. Additionally, related neurobiological mechanisms, specifically pertaining to emotional regulation and impulsivity, have been noted across addictive behaviors and other forms of psychopathology.

The prevalence of co-occurrences between substance use disorders and various other mental health disorders does not necessarily point to a specific directionality. The risk of developing both substance use disorders and other mental disorders can increase with similar external factors, such as exposure to trauma or stress. While pre-existing mental disorders can lead to substance use, substance use disorders can also lead to the onset of mental health issue, making it hard to determine causality.

The National Institute of Mental Health highlights that co-occurring mental disorders, such as depression and anxiety, are common among those with substance use disorders, underscoring the need for integrated treatment approaches . Furthermore, the concept of "dual diagnosis" refers to the coexistence of substance use disorders and mental illnesses, emphasizing the complexity of treatment and the necessity for comprehensive care strategies.

Treatments and intervention methods

Individuals exhibiting traits associated with an "addictive personality," such as impulsivity, sensation-seeking, and emotional instability, can benefit from a range of evidence-based therapeutic approaches and prevention strategies. Cognitive Behavioral Therapy (CBT) is one of the most commonly used treatments, helping individuals recognize and change maladaptive thought patterns and behaviors related to addiction. Dialectical Behavior Therapy (DBT), which focuses on improving emotional regulation and interpersonal skills, has also shown effectiveness in treating individuals with high emotional dysregulation, often present in those with addictive behaviors. Another approach, Motivational Interviewing (MI), targets uncertainty and enhances motivation to change, making it particularly useful in the early stages of treatment.

Prevention strategies often focus on fostering resilience and emotional regulation skills to reduce the risk of developing addictive behaviors. Programs that teach coping mechanisms for stress, as well as the development of strong social support networks, have been shown to be effective in preventing substance use disorders. Additionally, community-based programs like those focused on improving self-regulation and peer support have shown positive outcomes in reducing harmful behaviors related to addiction.

These therapeutic interventions and prevention strategies collectively address the complex relationship between personality traits and addictive behaviors, supporting individuals in achieving recovery and maintaining long-term abstinence.

Community support groups

The community aspect of peer run groups can reduce stigma and help those in recovery feel less alone. Community-based programs may follow a 12 step spiritual based protocol, encouraging abstinence from all substances, or be non-spiritual and encourage utilization of therapeutic coping skills and harm reduction. Self-Management Recovery Training (SMART Recovery), is one example of a non-spiritual program. SMART Recovery meetings are run by trained facilitators and incorporate aspects of Cognitive Behavioral Therapy. Alcoholics Anonymous (AA), founded in 1935, is a 12 step spiritual program that facilitated by fellow members. The 12 step modality encourages community, sponsorship, total abstinence from substances, and completion of the 12 steps. Another 12 step option is Narcotics Anonymous (NA), which was founded in 1953 as an offshoot of AA for those struggling with drugs addiction. Both NA and AA have similar models of encouraging total abstinence, fellowship, sponsorship, and step completion.

Criticism

There is an ongoing debate about the question of whether an addictive personality really exists. The assumption that personality might be to blame for an addicted person, who is in need of rehabilitation due to drug and alcohol addictions, can have great negative impacts from its supporting a homogeneous answer to a heterogeneous issue in question. These people run the risk of being stigmatized and incorrectly marginalized, and these misjudgments of personality may then lead to poor mental, medical, and social health practices. There are two sides of this argument, each with many levels and variations. One side believes that there are certain traits and dimensions of personality that, if existent in a person, cause the person to be more prone to developing addictions throughout their life. The other side argues that addiction is in chemistry, as in how the brain's synapses respond to neurotransmitters and is therefore not affected by personality. A major argument in favor of defining and labeling an addictive personality has to do with the human ability to make decisions and the notion of free will. This argument suggests human beings are aware of their actions and what the consequences of their own actions are and many choose against certain things because of this. This can be seen in that people are not forced to drink excessively or smoke every day, but it is within the reach of their own free will that some may choose to do so. Therefore, those with addictive personalities are high in neuroticism and hence choose to engage in riskier behaviors. The theory of addictive personalities agrees that there are two types of people: risk-takers and risk-averse. Risk-takers enjoy challenges, new experiences and want instant gratification. These people enjoy the excitement of danger and trying new things. On the other hand, risk-averse are those who are by nature cautious in what they do and the activities they involve themselves in. It is the personality traits of individuals that combine to create either a risk-taker or risk-averse person.

Another important concern is the lack of evidence supporting the addictive personality label and the possibility of stigma. While there is a medical consensus surrounding the genetic components of addiction, there is no such consensus supporting the idea that specific personality types have a tendency towards addictive behaviors. In fact, continued use of this term in the absence of clear evidence could be damaging to the people who believe they have an addictive personality.

Asperger syndrome

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Asperger_syndrome

 

Asperger syndrome
Other names	Asperger's syndrome, Asperger disorder (AD), Asperger's, Sukhareva's syndrome, schizoid disorder of childhood, autistic psychopathy
Restricted interests or repetitive behavior may be features of Asperger syndrome; this boy is playing with a magnetic construction toy.

Asperger syndrome (AS), also known as Asperger's syndrome or Asperger's, is a formerly used diagnostic category for a condition characterized by significant difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavior and interests. It ceased to be a distinct diagnosis when it was merged into autism spectrum disorder (ASD) in the DSM-5 (2013) and ICD-11 (2022). Previously, it had been classified as a pervasive developmental disorder.

AS was considered milder than other diagnoses. This change reflected a shift toward a unified understanding of autism-related conditions rather than a judgment about individuals previously diagnosed with AS. Despite its removal from contemporary medical classification systems, many people continued to identify with the term Asperger's because of its long-standing use, personal relevance, and the way it shaped their diagnostic history and community identity. However, self-identification using the Asperger label became much rarer (going from 51 percent in 2018 to 19 percent in 2022, according to one set of polls) following the publication of the 2018 Edith Sheffer book Asperger's Children. The book revealed that the label's namesake was complicit in the Nazis' murder of disabled children.

The syndrome was named in 1976 by English psychiatrist Lorna Wing after the Austrian pediatrician Hans Asperger, who in 1944 described children in his care who struggled to form friendships, did not understand others' gestures or feelings, engaged in one-sided conversations about their favorite interests, and were clumsy. In 1990 (coming into effect in 1993), the diagnosis of Asperger syndrome was included in the tenth edition (ICD-10) of the World Health Organization's International Classification of Diseases, and in 1994 it was also included in the fourth edition (DSM-4) of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. With the publication of DSM-5 in 2013, the syndrome was removed, and the symptoms regarded as an autism spectrum disorder along with classic autism and pervasive developmental disorder not otherwise specified (PDD-NOS). It was similarly merged into autism spectrum disorder in the International Classification of Diseases (ICD-11) in 2018 (published, came into effect in 2022).

The cause of autism, including what was formerly called Asperger syndrome, is not well understood. While it has high heritability, the underlying genetics have not been determined conclusively. Environmental factors are also believed to play a role. Brain imaging has not identified a common underlying condition. There is no single treatment, and the UK's National Health Service (NHS) guidelines suggest that "treatment" of any form of autism should not be a goal, since autism is not "a disease that can be removed or cured". According to the Royal College of Psychiatrists, while co-occurring conditions might require treatment, "management of autism itself is chiefly about the provision of the education, training, and social support/care required to improve the person's ability to function in the everyday world". The effectiveness of particular interventions for autism is supported by only limited data. Interventions may include social skills training, cognitive behavioral therapy, physical therapy, speech therapy, parent training, and medications for associated problems, such as mood or anxiety. Autistic characteristics tend to become less obvious in adulthood, but social and communication difficulties usually persist.

In 2015, Asperger syndrome was estimated to affect 37.2 million people globally, or about 0.5% of the population. The exact percentage of people affected has still not been firmly established. Autism spectrum disorder is diagnosed in males more often than females, and females are typically diagnosed at a later age. The modern conception of Asperger syndrome came into existence in 1981 and went through a period of popularization. It became a standardized diagnosis in the 1990s, and was merged into ASD in 2013. Many questions about the condition remain.

Classification

The extent of the overlap between Asperger syndrome and other forms of autism, particularly what was sometimes called high-functioning autism is unclear. The ASD classification is to some extent an artifact of how autism was discovered, and it may not reflect the true nature of the spectrum; methodological problems have beset Asperger syndrome as a valid diagnosis from the outset. As noted above, in the 2010s, Asperger syndrome, as a separate diagnosis, was eliminated and folded into autism spectrum disorder in the DSM-5 and the ICD-11. Like the diagnosis of Asperger syndrome, the change was controversial.

The World Health Organization (WHO) previously defined Asperger syndrome (AS) as one of the pervasive developmental disorders (PDD), which are a spectrum of psychological disorders that are characterized by abnormalities of social interaction and communication that pervade the individual's functioning, and by restricted and repetitive interests and behavior. Like other neurodevelopmental conditions, ASD begins in infancy or childhood, has a steady course without remission or relapse, and has impairments that result from maturation-related changes in various systems of the brain.

Characteristics

People with Asperger syndrome often display restricted or specialized interests, such as this boy's interest in stacking cans.

As a pervasive developmental disorder, Asperger syndrome is distinguished by a pattern of symptoms rather than a single symptom. It is characterized by qualitative impairment in social interaction, by stereotyped and restricted patterns of behavior, activities, and interests, and by no clinically significant delay in cognitive development or general delay in language. Intense preoccupation with a narrow subject, one-sided verbosity, restricted prosody, and physical clumsiness are typical of the condition, but are not required for diagnosis.

Suicidal thoughts and behaviors are a serious concern within the autistic population. One study found that adults with Asperger syndrome exhibited suicidal thoughts at 9 times the rate of the general population. Of autistic study participants, 66% had experienced suicidal ideation, while 35% had planned or attempted suicide.

Social interaction

Further information: Asperger syndrome and interpersonal relationships

A lack of demonstrated empathy affects aspects of social relatability for persons with Asperger syndrome. Individuals with Asperger syndrome experience difficulties in basic elements of social interaction, which may include a failure to develop friendships or to seek shared enjoyments or achievements with others (e.g., showing others objects of interest); a lack of social or emotional reciprocity; and impaired nonverbal behaviors in areas such as eye contact, facial expression, posture, and gesture.

People with Asperger syndrome may not be as withdrawn around others, compared with those with other forms of autism; they approach others, even if awkwardly. For example, a person with Asperger syndrome may engage in a one-sided, long-winded speech about a favorite topic, while misunderstanding or not recognizing the listener's feelings or reactions, such as a wish to change the topic of talk or end the interaction. This social awkwardness has been called "active but odd". Such failures to react appropriately to social interaction may appear as disregard for other people's feelings and may come across as rude or insensitive. However, not all individuals with Asperger syndrome will approach others. Some may even display selective mutism, not speaking at all to most people and excessively to specific others.

The cognitive ability of children with Asperger syndrome often allows them to articulate social norms in a laboratory context, where they may be able to show a theoretical understanding of other people's emotions; however, they typically have difficulty acting on this knowledge in fluid, real-life situations. People with Asperger syndrome may analyze and distill their observations of social interaction into rigid behavioral guidelines and apply these rules in awkward ways, such as forced eye contact, resulting in a demeanor that appears rigid or socially naïve. A history of failed attempts to establish reciprocal social relationships can cause autistic individuals to isolate themselves and cease attempts to engage; however, autistic people overwhelmingly report a desire for social contact and friendship.

Violent or criminal behavior

The hypothesis that individuals with Asperger syndrome are predisposed to violent or criminal behavior has been investigated but is unsupported by data. More evidence suggests that children diagnosed with Asperger syndrome are more likely to be victims, rather than offenders.

A 2008 review found that about 80% of reported violent criminals with Asperger syndrome also had other coexisting psychotic psychiatric disorders such as schizoaffective disorder. The sample size of this review was small (n = 37).

Empathy

People with an Asperger profile might not be recognized for their empathetic qualities, due to variation in the ways empathy is felt and expressed. Some people feel deep empathy, but do not outwardly communicate these sentiments through facial expressions or language. Some people come to empathy through intellectual processes, using logic and reasoning to arrive at the feelings. People with Asperger profiles may be bullied or excluded by peers, and might as a result be guarded around people, which could appear as lack of empathy. People with Asperger profiles can still be caring individuals; indeed, it is particularly common for those with the profile to feel and exhibit deep concern for individual rights, human welfare, animal rights, environmental protection, and other global and humanitarian causes.

Evidence suggests that in the "double empathy problem model, autistic people have a unique interaction style which is significantly more readable by other autistic people, compared to non-autistic people."

Restricted and repetitive interests and behavior

People with Asperger syndrome can display behavior, interests, and activities that are restricted and repetitive and are sometimes abnormally intense or focused. They may stick to inflexible routines, move in stereotyped and repetitive ways, preoccupy themselves with parts of objects, or engage in compulsive behaviors like lining objects up to form patterns.

The pursuit of specific and narrow areas of interest is one of the most striking among possible features of AS. Individuals with AS may collect volumes of detailed information on a relatively narrow topic such as weather data or star names without necessarily having a genuine understanding of the broader topic. For example, a child might memorize camera model numbers while caring little about photography. This behavior is usually apparent by age five or six. Although these special interests may change from time to time, they typically become more unusual and narrowly focused and often dominate social interaction so much that the entire family may become immersed. Because narrow topics often capture the interest of children, this symptom may go unrecognized.

Stereotyped and repetitive motor behaviors, called stimming, are a core part of the diagnosis of AS and other ASDs. Stims are believed to be used for self-soothing and regulate sensory input. They include hand movements such as flapping or twisting, and complex whole-body movements. These are typically repeated in longer bursts and look more voluntary or ritualistic than tics, which are usually faster, less rhythmical, and less often symmetrical. Stimming may have a connection with tics, and studies have reported a consistent comorbidity between AS and Tourette syndrome in the range of 8–20%, with one figure as high as 80% for tics of some kind or another, for which several explanations have been put forward, including common genetic factors and dopamine, glutamate, or serotonin abnormalities.

According to the Adult Asperger Assessment (AAA) diagnostic test, a lack of interest in fiction and a positive preference towards non-fiction is common among adults with AS.

Speech and language

Although individuals with Asperger syndrome acquire language skills without significant general delay and their speech typically lacks significant abnormalities, language acquisition and use is often atypical. Abnormalities include verbosity, abrupt transitions, literal interpretations and miscomprehension of nuance, use of metaphor meaningful only to the speaker, auditory perception deficits; unusually pedantic, formal, or idiosyncratic speech; and oddities in loudness, pitch, intonation, prosody, and rhythm. Echolalia has also been observed in individuals with AS.

Three aspects of communication patterns are of clinical interest: poor prosody, tangential and circumstantial speech, and marked verbosity. Although inflection and intonation may be less rigid or monotonic than in classic autism, people with AS often have a limited range of intonation: speech may be unusually fast, jerky, or loud. Speech may convey a sense of incoherence; the conversational style often includes monologues about topics that bore the listener, fails to provide context for comments, or fails to suppress internal thoughts. Individuals with AS may fail to detect whether the listener is interested or engaged in the conversation. The speaker's conclusion or point may never be made, and attempts by the listener to elaborate on the speech's content or logic, or to shift to related topics, are often unsuccessful.

Children with AS may have a sophisticated vocabulary at a young age and such children have often been colloquially called "little professors" but have difficulty understanding figurative language and tend to use language literally. Children with AS appear to have particular weaknesses in areas of nonliteral language that include humor, irony, teasing, and sarcasm. Although individuals with AS usually understand the cognitive basis of humor, they seem to lack understanding of the intent of humor to share the enjoyment with others. Despite strong evidence of impaired humor appreciation, anecdotal reports of humor in individuals with AS seem to challenge some psychological theories of AS and autism.

Motor and sensory perception

Individuals with Asperger syndrome may have signs or symptoms that are independent of the diagnosis but can affect the individual or the family. These include differences in perception and problems with motor skills, sleep, and emotions.

Individuals with AS often have excellent auditory and visual perception. Children with ASD often demonstrate enhanced perception of small changes in patterns such as arrangements of objects or well-known images; typically this is domain-specific and involves processing of fine-grained features. Conversely, compared with individuals with high-functioning autism, individuals with AS have deficits in some tasks involving visual-spatial perception, auditory perception, or visual memory. Many accounts of individuals with AS and ASD report other unusual sensory and perceptual skills and experiences. They may be unusually sensitive or insensitive to sound, light, and other stimuli; these sensory responses are found in other developmental disorders and are not specific to AS or to ASD. There is little support for increased fight-or-flight response or failure of habituation in autism; there is more evidence of decreased responsiveness to sensory stimuli, although several studies show no differences.

Hans Asperger's initial accounts and other diagnostic schemes include descriptions of physical clumsiness. Children with AS may be delayed in acquiring skills requiring dexterity, such as riding a bicycle or opening a jar, and may seem to move awkwardly or feel "uncomfortable in their own skin". They may be poorly coordinated or have an odd or bouncy gait or posture, poor handwriting, or problems with motor coordination. They may show problems with proprioception (sensation of body position) on measures of developmental coordination disorder (motor planning disorder), balance, tandem gait, and finger-thumb apposition. There is no evidence that these motor skills problems differentiate AS from other high-functioning ASDs.

Children with AS are more likely to have sleep problems, including difficulty in falling asleep, frequent nocturnal awakenings, and early morning awakenings. AS is also associated with high levels of alexithymia, which is difficulty in identifying and describing one's emotions. Although AS, lower sleep quality, and alexithymia are associated with each other, their causal relationship is unclear.

Causes

Further information: Causes of autism

Hans Asperger described common traits among his patients' family members, especially fathers, and research supports this observation and suggests a genetic contribution to Asperger syndrome. Although no specific genetic factor has yet been identified, multiple factors are believed to play a role in the expression of autism, given the variability in symptoms seen in children. Hundreds of genes have been linked to AS, and these genes play crucial role in a multitude of biological processes, exerting influence over the maturation and functioning of the brain. Evidence for a genetic link is that AS tends to run in families where more family members have limited behavioral symptoms similar to AS (for example, some problems with social interaction, or with language and reading skills). Most behavioral genetic research suggests that all autism spectrum disorders have shared genetic mechanisms. There may be shared genes in which particular alleles make an individual vulnerable, and varying combinations result in differing severity and symptoms in each person with AS.

A few ASD cases have been linked to exposure to teratogens (agents that cause birth defects) during the first eight weeks from conception. Although this does not exclude the possibility that ASD can be initiated or affected later, it is strong evidence that ASD arises very early in development. Many environmental factors have been hypothesized to act after birth, but none has been confirmed by scientific investigation. These environmental elements can act as independent and significant risk factors, or they can potentially influence pre-existing genetic factors in people who have a genetic predisposition.

Mechanism

Functional magnetic resonance imaging provides some evidence for mirror neuron theory.

Asperger syndrome appears to result from developmental factors that affect many or all functional brain systems, as opposed to localized effects.

Although the specific underpinnings of AS or factors that distinguish it from other ASDs are unknown, and no clear pathology common to individuals with AS has emerged, it is still possible that AS's mechanism is separate from other ASDs.

Neuroanatomical studies and the associations with teratogens strongly suggest that the mechanism includes alteration of brain development soon after conception. Abnormal fetal development may affect the final structure and connectivity of the brain, resulting in altered neural circuits controlling thought and behavior. Several theories of mechanism are available; none are likely to provide a complete explanation.

General-processing theories

One general-processing theory is weak central coherence theory, which hypothesizes that a limited ability to see the big picture underlies the central disturbance in ASD. A related theory—enhanced perceptual functioning—focuses more on the superiority of locally oriented and perceptual operations in autistic individuals.

Mirror neuron system (MNS) theory

Upon the discovery of mirror neurons, it was proposed that alterations to mirror neuron development interfere with imitation and lead to Asperger syndrome's core feature of social impairment. The theory has since been criticised, with subsequent studies showing contradictory evidence to support claims that autism is associated with mirror neuron dysfunction.

Two other models of mirror neuron system dysfunction have been proposed, known as the emulation and planning model (EP-M), and social top-down response modulation (STORM) model. In summary, the EP-M proposes that the process of mimicry is impaired within individuals with autism, so individuals would struggle to imitate an observed action without understanding the underlying goal (for example, an autistic child being less able to spontaneously imitate a meaningless gesture or facial expression). The STORM model proposes that the processing of executed/observed actions and the social significance of the actions is impaired/reduced within people with autism. Both of these models conflict with the idea that the mirror neuron system in autistic people is 'broken'. Both the STORM and EP-M models reflect the differences between neurotypical individuals and autistic individuals better than the mirror neuron system theory regarding both imitation and motor functions.

The broken mirror hypothesis of autism aligns with social cognition theories like the theory of mind, which hypothesizes that autistic behavior arises from impairments in ascribing mental states to oneself and others; or hyper-systemizing, which hypothesizes that autistic individuals can systematize internal operations to handle internal events but are less effective at empathizing when handling events generated by other agents.

Diagnosis

Standard diagnostic criteria require impairment in social interaction and repetitive and stereotyped patterns of behavior, activities, and interests, without significant delay in language or cognitive development. Unlike the international standard, the DSM-IV-TR criteria also required significant impairment in day-to-day functioning; As noted above, in the 2010s, Asperger syndrome, as a separate diagnosis, was eliminated and folded into autism spectrum disorder in the DSM-5 and the ICD-11. Other sets of diagnostic criteria have been proposed by Szatmari et al. and by Gillberg and Gillberg.

Diagnosis of ASD (and previously AS) is most commonly made between the ages of four and eleven. A comprehensive assessment involves a multidisciplinary team that observes across multiple settings, and includes neurological and genetic assessment as well as tests for cognition, psychomotor function, verbal and nonverbal strengths and weaknesses, style of learning, and skills for independent living. The "gold standard" in diagnosing ASDs combines clinical judgment with the Autism Diagnostic Interview-Revised (ADI-R), a semistructured parent interview; and the Autism Diagnostic Observation Schedule (ADOS), a conversation and play-based interview with the child. Delayed or mistaken diagnosis can be traumatic for individuals and families; for example, misdiagnosis can lead to medications that worsen behavior.

Underdiagnosis and overdiagnosis may be problems. The cost and difficulty of screening and assessment can delay diagnosis. Conversely, the increasing popularity of drug treatment options and the expansion of benefits has motivated providers to overdiagnose ASD. There are indications AS has been diagnosed more frequently in recent years, partly as a residual diagnosis for children of normal intelligence who are not autistic but have social difficulties.

There are questions about the external validity of the AS diagnosis. That is, it is unclear whether there is a practical benefit in distinguishing AS from autism or PDD-NOS; different screening tools may render different diagnoses for the same person.

Differential diagnosis

Many children with AS are initially misdiagnosed with attention deficit hyperactivity disorder (ADHD). Diagnosing adults is more challenging, as standard diagnostic criteria are designed for children and the expression of AS changes with age. Adult diagnosis requires painstaking clinical examination and thorough medical history gained from both the individual and other people who know the person, focusing on childhood behavior.

Conditions that must be considered in a differential diagnosis along with ADHD include other ASDs, the schizophrenia spectrum, personality disorders, obsessive–compulsive disorder, major depressive disorder, semantic pragmatic disorder, nonverbal learning disorder, social anxiety disorder,Tourette syndrome, stereotypic movement disorder, bipolar disorder, social-cognitive deficits due to brain damage from alcohol use disorder, and obsessive–compulsive personality disorder (OCPD).

Screening

Parents of children with Asperger syndrome can typically trace differences in their children's development to as early as 30 months of age. Developmental screening during a routine check-up by a general practitioner or pediatrician may identify signs that warrant further investigation. The United States Preventive Services Task Force in 2016 found it was unclear if screening was beneficial or harmful among children in whom there are no concerns.

Different screening instruments are used to diagnose AS, including the Asperger Syndrome Diagnostic Scale (ASDS); Autism Spectrum Screening Questionnaire (ASSQ); Childhood Autism Spectrum Test (CAST), previously called the Childhood Asperger Syndrome Test; Gilliam Asperger's disorder scale (GADS); Krug Asperger's Disorder Index (KADI); and the autism-spectrum quotient (AQ), with versions for children, adolescents, and adults. None have been shown to reliably differentiate between AS and other ASDs.

Management

Further information: Autism therapies

Treatment attempts to manage distressing symptoms and to teach age-appropriate social, communication, and vocational skills that are not naturally acquired during development. Intervention is tailored to the needs of the individual based on multidisciplinary assessment. Although progress has been made, data supporting the efficacy of particular interventions are limited.

Therapies

Managing ASD may involve multiple therapies that address core symptoms of the disorder. While many professionals agree that the earlier the professional support the better, there is no combination that is recommended above others. Professional support for ASD varies depending on the individual; it takes into account the linguistic capabilities, verbal strengths, and nonverbal vulnerabilities of individuals.

Many of those diagnosed with ASD or similar disorders advocate against behavioral therapies, like applied behavior analysis (ABA) and cognitive behavioral therapy (CBT), often as part of the autism rights movement, on the grounds that these approaches frequently reinforce the demand on autistic people to mask their neurodivergent characteristics or behaviors to favor a more 'neurotypical' and narrow conception of normality. ABA has faced a great deal of criticism over the years. Recently, studies have shown that ABA may be abusive and can increase PTSD symptoms in patients. The Autistic Self Advocacy Network campaigns against the use of ABA in autism.

In the case of CBT and talking therapies, the effectiveness varies, with many reporting that they appeared 'too self-aware' to gain significant benefit, as the therapy was designed with neurotypical people in mind. In autistic children, specifically, they also report that it is only mildly beneficial in aiding with their anxieties.

A typical program of professional support generally includes:

• Applied behavior analysis (ABA) procedures, including positive behavior support (PBS)—or training and support of parents and school faculty in behavior management strategies to use in the home and school, and social skills training for more effective interpersonal interactions. The Autistic Self Advocacy Network campaigns against the use of ABA in autism;
• Cognitive behavioral therapy to improve stress management relating to anxiety or explosive emotions and to help reduce obsessive interests (although this may produce negative impact by demonising special interests) and repetitive routines;
• Medication for coexisting conditions such as major depressive disorder and anxiety disorders;
• Occupational or physical therapy to assist with poor sensory processing and motor coordination; and,
• Social communication intervention, which is specialized speech therapy to help with the pragmatics and give-and-take of normal conversation.

Of the many studies on behavior-based early intervention programs, most are case reports of up to five participants and typically examine a few problem behaviors such as self-injury, aggression, noncompliance, stereotypies, or spontaneous language; unintended side effects are largely ignored. Despite the popularity of social skills training, its effectiveness is not firmly established. A randomized controlled study of a model for training parents in problem behaviors in their children with AS showed that parents attending a one-day workshop or six individual lessons reported fewer behavioral problems, while parents receiving the individual lessons reported less intense behavioral problems in their AS children. Vocational training may be important to teach job interview etiquette and workplace behavior to older children and adults with AS, and organization software and personal data assistants can improve the work and life management of people with AS.

Medications

No medications directly treat the core symptoms of AS. Although research into the efficacy of pharmaceutical intervention for AS is limited, it is essential to diagnose and treat comorbid conditions. Deficits in self-identifying emotions or in observing effects of one's behavior on others can make it difficult for individuals with AS to see why medication may be appropriate. Medication can be effective in combination with behavioral interventions and environmental accommodations in treating comorbid symptoms such as anxiety disorders, major depressive disorder, inattention, and aggression. The atypical antipsychotic medications risperidone, olanzapine and aripiprazole have been shown to reduce the associated symptoms of AS; risperidone can reduce repetitive and self-injurious behaviors, aggressive outbursts, and impulsivity, and improve stereotypical patterns of behavior and social relatedness. The selective serotonin reuptake inhibitors (SSRIs) fluoxetine, fluvoxamine, and sertraline have been effective in treating restricted and repetitive interests and behaviors, while stimulant medication, such as methylphenidate, can reduce inattention. In addition, scientists have made a noteworthy finding that oxytocin, a hormone, plays a significant role in shaping human social behavior and the formation of interpersonal connections.

Care must be taken with medications, as side effects may be more common and harder to evaluate in individuals with AS, and tests of drugs' effectiveness against comorbid conditions routinely exclude individuals from the autism spectrum. Abnormalities in metabolism, cardiac conduction times, and an increased risk of type 2 diabetes have been raised as concerns with antipsychotic medications, along with serious long-term neurological side effects. SSRIs can lead to manifestations of behavioral activation such as increased impulsivity, aggression, and sleep disturbance. Weight gain and fatigue are commonly reported side effects of risperidone, which may also lead to increased risk for extrapyramidal symptoms such as restlessness and dystonia and increased serum prolactin levels. Sedation and weight gain are more common with olanzapine, which has also been linked with diabetes. Sedative side-effects in school-age children have ramifications for classroom learning. Individuals with AS may be unable to identify and communicate their internal moods and emotions or to tolerate side effects that for most people would not be problematic.

Prognosis

There is some evidence that children with AS may see a lessening of symptoms; up to 20% of children may no longer meet the diagnostic criteria as adults, although social and communication difficulties may persist. As of 2006, no studies addressing the long-term outcome of individuals with Asperger syndrome are available and there are no systematic long-term follow-up studies of children with AS. Individuals with AS appear to have normal life expectancy, but have an increased prevalence of comorbid psychiatric conditions, such as major depressive disorder and anxiety disorders that may significantly affect prognosis. Although social impairment may be lifelong, the outcome is generally more positive than with individuals with lower-functioning autism spectrum disorders; for example, ASD symptoms are more likely to diminish with time in children with AS or forms of autism sometimes described as "high functioning". Most students with AS and forms of autism sometimes seen as "high functioning" have average mathematical ability and test slightly worse in mathematics than in general intelligence. However, mathematicians are at least three times more likely to have autism-spectrum traits than the general population, and are more likely to have family members with autism.

Although many attend regular education classes, some children with AS may attend special education classes such as separate classroom and resource room because of their social and behavioral difficulties. Adolescents with AS may exhibit ongoing difficulty with self-care or organization, and disturbances in social and romantic relationships. Despite high cognitive potential, most young adults with AS remain at home, yet some do marry and work independently. The "different-ness" adolescents experience can be traumatic. Anxiety may stem from preoccupation over possible violations of routines and rituals, from being placed in a situation without a clear schedule or expectations, or from concern with failing in social encounters; the resulting stress may manifest as inattention, withdrawal, reliance on obsessions, hyperactivity, or aggressive or oppositional behavior. Depression is often the result of chronic frustration from repeated failure to engage others socially, and mood disorders requiring treatment may develop. Clinical experience suggests the rate of suicide may be higher among those with AS, but this has not been confirmed by systematic empirical studies.

Education of families is critical in developing strategies for understanding strengths and weaknesses; helping the family to cope improves outcomes in children. Prognosis may be improved by diagnosis at a younger age that allows for early interventions, while interventions in adulthood are valuable but less beneficial. There are legal implications for individuals with AS as they run the risk of exploitation by others and may be unable to comprehend the societal implications of their actions.

Epidemiology

Main article: Epidemiology of autism

Frequency estimates vary enormously. In 2015, it was estimated that 37.2 million people globally are affected. A 2003 review of epidemiological studies of children found autism rates ranging from 0.03 to 4.84 per 1,000, with the ratio of autism to Asperger syndrome ranging from 1.5:1 to 16:1; combining the geometric mean ratio of 5:1 with a conservative prevalence estimate for autism of 1.3 per 1,000 suggests indirectly that the prevalence of AS might be around 0.26 per 1,000. Part of the variance in estimates arises from differences in diagnostic criteria. For example, a relatively small 2007 study of 5,484 eight-year-old children in Finland found 2.9 children per 1,000 met the ICD-10 criteria for an AS diagnosis, 2.7 per 1,000 for Gillberg and Gillberg criteria, 2.5 for DSM-IV, 1.6 for Szatmari et al., and 4.3 per 1,000 for the union of the four criteria. Boys seem to be more likely to have AS than girls; estimates of the sex ratio range from 1.6:1 to 4:1, using the Gillberg and Gillberg criteria. Females with autism spectrum disorders may be underdiagnosed.

Comorbidities

Main article: Conditions comorbid to autism spectrum disorders

Anxiety disorders and major depressive disorder are the most common conditions seen at the same time; comorbidity of these in persons with AS is estimated at 65%. Reports have associated AS with medical conditions such as aminoaciduria and ligamentous laxity, but these have been case reports or small studies and no factors have been associated with AS across studies. One study of males with AS found an increased rate of epilepsy and a high rate (51%) of nonverbal learning disorder. AS is associated with tics, Tourette syndrome and bipolar disorder. The repetitive behaviors of AS have many similarities with the symptoms of obsessive–compulsive disorder and obsessive–compulsive personality disorder, and 26% of a sample of young adults with AS were found to meet the criteria for schizoid personality disorder (which is characterised by severe social seclusion and emotional detachment), more than any other personality disorder in the sample. However many of these studies are based on clinical samples or lack standardized measures; nonetheless, comorbid conditions are relatively common.

Correlated characteristics

Research indicates that individuals with Aspergers have significantly higher rates of LGBT identities and feelings than the general population. They are also significantly more likely to be non-theistic.

History

Main article: History of Asperger syndrome

Asperger syndrome was named after the Austrian pediatrician Hans Asperger (1906–1980), but not coined by him. Asperger syndrome was a relatively new diagnosis in the field of autism, though a syndrome like it was described as early as 1925 by Soviet child psychiatrist Grunya Sukhareva (1891–1981). As a child, Asperger appears to have exhibited some features of the very condition named after him, such as remoteness and talent in language. In 1944, Asperger gave detailed descriptions of four representative children in his practice who had difficulty in integrating themselves socially and showing empathy towards peers. They also lacked nonverbal communication skills and were physically clumsy. Asperger described this "autistic psychopathy" as social isolation. Fifty years later, several standardizations of AS as a medical diagnosis were tentatively proposed, many of which diverge significantly from Asperger's original work.

Unlike what became known as AS, Asperger believed autistic psychopathy could be found in people of all levels of intelligence, including those with intellectual disability: as such, Asperger's understanding of autistic pathology was more akin to what is known as the autism spectrum today. Asperger defended the value of so-called "high-functioning" autistic individuals, writing: "We are convinced, then, that autistic people have their place in the organism of the social community. They fulfill their role well, perhaps better than anyone else could, and we are talking of people who as children had the greatest difficulties and caused untold worries to their care-givers." Asperger also believed some would be capable of exceptional achievement and original thought later in life.

Asperger's paper was published during World War II and in German, so it was not widely read elsewhere. Lorna Wing used the term Asperger syndrome in 1976, and popularized it to the English-speaking medical community in her February 1981 publication of case studies of children showing the symptoms described by Asperger, and Uta Frith translated Asperger's paper to English in 1991. Sets of diagnostic criteria were outlined by Gillberg and Gillberg in 1989 and by Szatmari et al. in the same year. AS became a standard diagnosis when it was included in the tenth edition of the World Health Organization's diagnostic manual, International Classification of Diseases (ICD-10), published in 1990 and coming into effect in 1993; and in the fourth edition of the American Psychiatric Association's diagnostic reference, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published in 1994.

Hundreds of books, articles, and websites later described AS and prevalence estimates increased dramatically for ASD, with AS recognized as an important subgroup. Whether AS should be seen as distinct from autism, particularly forms of autism sometimes described as "high functioning", became an issue receiving significant attention and disagreement, along with questions about the empirical validation of the DSM-IV and ICD-10 criteria.

With the publication of the next major editions of the DSM and ICD, the DSM-5 (published in 2013) and the ICD-11 (published in 2018, coming into effect in 2022), AS was eliminated as a separate diagnosis and folded into the autism spectrum. A scale of "severity" levels was included in the DSM-5, whereby most people previously diagnosed with AS would have been classified as "level 1"; but these levels are widely opposed by the autistic community and are not included in the ICD-11. The ICD-11 characterizes ASD with qualifiers describing the presence of disorders of intellectual development and the degree of functional language impairment; the former diagnosis of Asperger syndrome is characterized as autism spectrum disorder without disorder of intellectual development and with mild or no impairment of functional language.

According to polls taken by autistic activist Chris Bonnello (primarily of autistic people within the United States and the United Kingdom), self-use of the Asperger label declined from approximately 51 percent to 19 percent between 2018 and 2022. This drop followed the 2018 publication of Asperger's Children, a book by historian Edith Sheffer that revealed Asperger, himself, was complicit in the Nazis' murder of disabled children. Critics have also rejected the Asperger label for unnecessarily dividing the autistic community and reinforcing the outmoded view of the autistic spectrum as a functioning hierarchy.

Society and culture

See also: Societal and cultural aspects of autism, Neurodiversity movement, and Disability rights movement

People identifying with Asperger syndrome may refer to themselves in casual conversation as aspies (a term first used in print in the Boston Globe in 1998). Some autistic people have advocated a shift in perception of autism spectrum disorders as complex syndromes, neurodivergences, and/or neurominority cognitive styles rather than diseases that must be cured. Proponents of this neurodiversity paradigm reject the notion that there is an "ideal" brain configuration and that any deviation from the norm is pathological; they promote tolerance of neurodiversity. These views are the basis for the autistic rights and autistic pride movements, within the broader neurodiversity movement. There is a contrast between the attitude of people with AS, who typically do not want to be cured and are proud of their identity; and parents of children with AS, who more often seek a "cure" of their children's autism.

Some researchers have argued that AS and other autism can be viewed as a different cognitive style, not a disorder, and that it should be removed from psychiatric and medical manuals classifying diseases (ICD) or mental disorders (DSM), much as homosexuality was removed.

Even some people typically associated with a pathology paradigm for autism are willing to consider AS a neutral difference. For example, in 2002, Simon Baron-Cohen wrote of those with AS: "In the social world, there is no great benefit to a precise eye for detail, but in the worlds of maths, computing, cataloging, music, linguistics, engineering, and science, such an eye for detail can lead to success rather than failure." Baron-Cohen cited two reasons why it might still be useful to consider AS to be a disability: to ensure provision for legally required special support, and to recognize emotional difficulties from reduced empathy, which was commonly associated with autism during that time but has since lost support. Baron-Cohen argues that the genes for ASD's combination of abilities have operated throughout recent human evolution and have made remarkable contributions to human history.

By contrast, Pier Jaarsma and Welin wrote in 2011 that the "broad version of the neurodiversity claim, covering low-functioning as well as high-functioning autism, is problematic. Only a narrow conception of neurodiversity, referring exclusively to high-functioning autists, is reasonable." They say that "higher functioning" individuals with autism may "not [be] benefited with such a psychiatric defect-based diagnosis ... some of them are being harmed by it, because of the disrespect the diagnosis displays for their natural way of being", but "think that it is still reasonable to include other categories of autism in the psychiatric diagnostics. The narrow conception of the neurodiversity claim should be accepted but the broader claim should not."