Asperger Syndrome (Autism Without Language Delay)

Asperger syndrome and autism today

Asperger syndrome was named after Austrian pediatrician Hans Asperger and became a separate diagnosis in 1994. Research then showed no clear boundary between Asperger syndrome and other forms of autism, so the diagnoses were combined into autism spectrum disorder. Someone who would once have been diagnosed with Asperger syndrome today usually receives a diagnosis of ASD without intellectual or language impairment, often at level 1.

People diagnosed before the change keep their diagnosis, and many prefer the term Asperger's or "autistic." Use the language the person prefers.

Signs and characteristics

Social communication

• difficulty reading facial expressions, tone of voice and body language
• taking language literally, and finding sarcasm, idioms or hints confusing
• difficulty with the back-and-forth of conversation, such as talking at length about a topic of interest
• finding small talk hard or pointless
• unusual eye contact, either little or intense
• wanting friends but finding it hard to make or keep them
• speech that may sound formal or unusual in rhythm

Focused interests and routines

• intense, deep interest in specific subjects, often with exceptional knowledge
• strong preference for routines and sameness, with distress at unexpected changes
• repetitive movements (stimming) such as rocking, hand-flapping or fidgeting
• a preference for rules, order and logic

Sensory differences

• over- or under-sensitivity to sound, light, touch, taste or smell
• difficulty with crowded or noisy environments
• strong food preferences linked to texture

Other common features

• clumsiness or coordination difficulties
• strengths in memory, pattern recognition, attention to detail and honesty

Signs in children

Language develops on time, so signs may not be noticed until school age, when social demands increase. Parents and teachers may see a child who prefers adults or younger children, plays alone or by strict rules, talks at length about a favorite topic, becomes very upset at changes, or struggles with group work. Some children mask their difficulties at school and release stress at home.

Asperger's in adults and women

Many adults, especially women, are diagnosed only in adulthood. Women and girls often camouflage social difficulties by copying others, and their interests, such as animals, books or people, may seem less unusual. Adults may come to diagnosis after years of anxiety, burnout, depression or relationship difficulties, or after a child is diagnosed. Autistic burnout is exhaustion and loss of skills from prolonged effort to cope and mask.

Co-occurring conditions

• anxiety, including social anxiety, which affects a large share of autistic people
• depression
• ADHD
• obsessive-compulsive disorder
• sleep difficulties
• eating difficulties
• epilepsy, less often than in autism with intellectual disability

Diagnosis

There is no blood test or brain scan. Diagnosis is made by a specialist team, psychologist, psychiatrist or developmental pediatrician, using:

• a detailed developmental history, ideally including information from parents or someone who knew the person as a child
• observation and structured assessments such as the ADOS-2 and ADI-R
• questionnaires for adults, such as the Autism Spectrum Quotient as a screening tool
• assessment for co-occurring conditions such as ADHD, anxiety and learning difficulties
• hearing tests in children

The American Academy of Pediatrics recommends autism screening at 18 and 24 month checkups, though children without language delay are often identified later.

Support and treatment

Autism is not an illness to be cured. Support aims to reduce distress, build skills and adapt environments:

• Social communication support: social skills groups and coaching
• Cognitive behavioral therapy, adapted for autistic people, for anxiety and depression
• Occupational therapy for sensory needs and daily living skills
• Speech and language therapy for pragmatic language
• School accommodations: an IEP or 504 plan, quiet spaces, clear instructions, extra time
• Workplace adjustments: written instructions, flexible hours, reduced noise, remote work
• Medicines for co-occurring anxiety, depression, ADHD or sleep problems, not for autism itself
• Peer support from autistic-led organizations and communities

Outlook

Many autistic people with no intellectual disability go on to university, careers, relationships and families. Outcomes are better with early understanding, appropriate support and accepting environments. Untreated anxiety and depression are the main threats to wellbeing, so mental health support matters.

Frequently asked questions

Is Asperger syndrome still a diagnosis?

Not officially. Since 2013 in the US and 2022 in the international ICD-11, Asperger syndrome has been included in autism spectrum disorder. People previously diagnosed keep that diagnosis, and many still use the term to describe themselves.

What is the difference between Asperger's and autism?

Asperger's described autistic people without intellectual disability or early language delay. Research found no clear dividing line, so it is now part of autism spectrum disorder. The core features, social communication differences and focused interests, are the same.

What are the signs of Asperger's in adults?

Adults may find social interaction tiring and confusing, take language literally, prefer routines, have deep focused interests, be sensitive to noise, light or textures, and feel different from peers. Many have a history of anxiety, depression or burnout before diagnosis.

Can Asperger syndrome be treated?

Autism is a lifelong difference rather than a disease to cure. Support helps with communication, sensory needs, daily living and workplace or school challenges. Therapy and medicine treat co-occurring conditions such as anxiety, depression, ADHD and sleep problems.

How is Asperger's diagnosed in adults?

An adult autism assessment by a psychologist or psychiatrist includes a detailed life history, structured interviews and observation, and often input from a family member. Screening questionnaires can suggest whether a full assessment is worthwhile. Your primary care doctor can refer you.