978-1572305441

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Bleuler, a Swiss psychiatrist who had published a very influential book
on schizophrenia some years earlier. Bleuler argued that “autism,” defined
as a persistent withdrawal from reality, was one of the cardinal
symptoms of schizophrenia. Kanner and Asperger believed that the impairments
in social interaction seen in the children they were describing
were similar to the “autism” seen in schizophrenia. But Asperger used
the term “psychopathy” to argue that this was a feature of the child’s
personality, not an illness like schizophrenia. He did not acknowledge
Kanner in his article, suggesting that the two had arrived independently
at a similar description. The group identified by Asperger were all verbal,
whereas of the eleven children Kanner wrote about, only five were
fluent. These fluent children closely resembled the children described
in Asperger’s paper. This marked the beginning of much overlap and
confusion between the terms, a confusion that still exists today.
There has, in fact, been much controversy in academic circles as to
whether AS and autism are different disorders. To some extent, this is
not a helpful debate. The more important issue is whether it is useful to
differentiate these two types of ASD. Or should all such children be
given the label “high-functioning autism” or “autism spectrum disorder”?
Whether or not autism and AS are “really” different requires an
understanding of the underlying causes that is well beyond our current
knowledge base.
According to DSM-IV, the key differentiating feature between autism
and AS is that children with AS “lack clinically significant cognitive
and language delays.” Children with AS develop speech at roughly
the appropriate time; single words are used spontaneously and usefully
by around one year, and spontaneous phrase speech with a verb appears
by three years of age. The emphasis here is on spontaneous and useful
speech as opposed to echolalic speech, which is simple parroting of
what another person has said or what the child may have heard on TV.
Children with autism may speak early, but the speech is usually echolalic
and not spontaneous. One way of thinking about these disorders is
to think of autism as AS with an added impairment in language. The
differences between autism and AS with respect to their clinical presentation
and their outcome perhaps stem from this fundamental difference
in language ability. There is also some evidence that children with AS
have fewer autistic symptoms and are able to function better in the
community than children with autism. However, a subgroup of children
with autism can also develop fluent speech, though by definition they
do so at a later age than children with AS, between four and six to seven