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Fashion Diagnosis Asperger

Vera Bernard-Opitz

Prof. Dr. Mathias Dose recently wrote an impressive article on the topic of "Desired diagnosis or fashionable diagnosis of autism in adults", in which he pointed out that in recent years the diagnosis "Asperger's Autism" has become a fashionable "in" diagnosis.  Frequently completely different psychological problems are hidden behind this diagnosis (Dose, 2021). It certainly is a positive development that the public discussion of the upper end of the autism spectrum has made the general diagnosis “Autism” better known. On the other hand, however, the lower end of the autism spectrum has been neglected. What severe autism can look like is made clear by the movie and comments of parents and colleagues at the end of this blog. Another link provided reflects the situation of families of affected individuals with various support needs in Singapore.

Adults with depression, anxiety, or obsessive-compulsive behaviors are increasingly seeking out practices of psychiatrists and psychologists with the request to confirm the diagnosis "Asperger's". As this diagnosis is consistently associated with a positive image of "high functioning" intelligence and special skills, it is apparently conceived as a desired benefit to belong to the group of those who should receive acceptance for their unusual behaviors and respect for their special abilities.

 

Also, the popular perception of high functioning autism as "geniuses with isolated special skills" has certainly made the diagnosis popular. Who wouldn't want to be named in the same breath as Albert Einstein, Wolfgang Amadeus Mozart, Elon Musk, Bill Gates or Greta Thunberg? However, their diagnosis is not necessarily based on the strict diagnostic criteria of the DSM/ICD, but mainly refers to individual characteristics shared with an Autism Spectrum Disorder. Concerned individuals search and find various autism scales on the Internet that provide a quick but superficial self-diagnosis (Dose, 2021). This diagnosis may bring protection from social pressures in the professional environment, new career prospects, or support for the aim of early retirement. It may even lead to a new career with public appearance as speaker, consultant, or author. 

 

In reality, the diagnosis of “Asperger's” in adults is difficult and should only be made by experienced psychiatrists or psychologists. In this process, the developmental history and early behavior at home and school must be considered, and alternative diagnoses such as giftedness, ADHD, depression, anxiety, or mutism are a possibility. 

 

Asperger syndrome is by no means a kind of "autism light". It is already stated in the ICD-10 that, as with early childhood autism, a disorder of social interaction and a restricted, stereotyped repertoire of interests and activities are necessary for a diagnosis in Asperger syndrome. The only difference between the two diagnoses is the absence of a general, language, or cognitive developmental delay at the higher end of the spectrum. Accordingly, DSM-V (and ICD-11 will follow suit) emphasizes that the distinction between the various forms of autism is based predominantly on language and cognitive development (Dose, 2021). The extent of the need for support in these areas is central to therapy and prognosis. 

 

A wishful diagnosis of "Asperger's" is understandable from the perspective of those affected, but it has led to a distortion of the public image of autism. For example, social media emphasize that autism is not a disorder, but must be seen as a "special way of being" in the context of the general discussion about neurodiversity.  Instead of help, treatment and therapy, acceptance and tolerance of those concerned are now demanded. Unfortunately this often goes along with polemics against helpful behavioral therapies, ABA/ ABT (see my blog on “Fact and Fiction in ABA/ABT). Yet the desire for a symptom-free life is perpetual even for many with the real diagnosis.  Many want to be able to cope with the feeling of being different while others focus on their high anxiety level or their depression. This can be accomplished through cognitive behavior therapy or social skill training. Often the development of new behavioral patterns through behavior therapy is also helpful. Unfortunately, however, the distorted picture of the spectrum of autistic impairments has made it increasingly difficult for those with a confirmed diagnosis and their families to get help. 

 

This is especially true for children, adolescents, and adults who are at the non-verbal and lower end of the spectrum and have significant limitations in their social behavior and independence. Since the first description of Autism by Kanner in 1943, this group has increasingly been pushed into the background and unfortunately plays a subordinate or no role in the current public discussion. 

 

In the meantime, colleagues and parents are increasingly campaigning to ensure that those affected with severe autism also receive appropriate therapies, schooling, work and accommodation. In an impressive film with numerous comments from parents, teachers and therapists, they draw attention to their concern. Even though the following film is challenging to watch, it should be disseminated, not only to show the wide spectrum of autism, but also to enable effective help for this group. This should of course include an understanding of the problems as well as an acceptance of the person, while not excluding effective therapies. As the second link impressively shows the situation of affected families, it should be considered for young as well as older family members on the autism spectrum.