The DSM is published in the United States by the American Psychiatric Association. As of this writing, its fourth edition, published in 1994, is still in effect but a new revision is scheduled for 2013 publication.

The 1994 version was the first edition of the DSM to formally recognize Asperger's Syndrome, which was categorized under the general heading of pervasive developmental disorders (PDD). In addition to Asperger's, there are several other diagnoses that fall under the PDD heading. These are:

• Autistic disorder (known as autism)

• Rett disorder (or Rett Syndrome)

• Childhood disintegrative disorder

• Asperger's disorder (known as Asperger's Syndrome)

• Pervasive developmental disorder not otherwise specified (or PDD-NOS)

These are all subcategories of the PDD diagnosis. At present, these experiences are collectively grouped under the PDD heading because of the similarities of symptoms related to challenges in communication, social interaction, and so-called stereotyped behaviors, interests, and activities.

Autism is the most prevalent of these experiences, more common than Down syndrome or childhood cancer. Rett disorder is usually found in girls before the age of four. Childhood disintegrative disorder affects children before the age of ten. In both circumstances, and for unknown reasons, children experience a loss of previously acquired social skills, language, motor skills, play, and self-care.

The category pervasive developmental disorder not otherwise specified (PDD-NOS) is used when a child demonstrates autistic-like symptoms but misses meeting the criteria for the other diagnoses.

Some clinicians consider the term “high-functioning autism” (HFA) synonymous with Asperger's Syndrome, but the generally accepted distinction is the presence of a speech delay in the former experience, which is absent in classic Asperger's. The DSM does not presently define HFA, so it may or may not apply to a child with Asperger's. It may also be used to describe the child who demonstrates many skills yet still falls within the PDD-NOS range of diagnosis.

PDD-NOS may be used by a physician unaccustomed to diagnosing Asperger's, or it may be used if a doctor wishes to be cautious, to “wait and see” as a child grows and develops. Sometimes, when the PDD-NOS diagnosis is revisited, a child has matured into an official Asperger's diagnosis. However, the DSM is a dynamic document, and as the psychiatric field grows and becomes more knowledgeable, reorganization of Asperger's and autistic experiences is inevitable in future, revised editions.

Clinical Criteria

Asperger's Syndrome is currently grouped under the diagnostic “umbrella” heading pervasive developmental disorders, along with other disorders with similar symptoms. As currently defined by the DSM, a child with Asperger's differs from the child with autism because of the following traits:

• No clinically significant delays in language

• No clinically significant delays in cognitive development

• No clinically significant delays in development of age-appropriate self-help skills

• No clinically significant delays in adaptive behavior (other than social interaction)

• No clinically significant delays in curiosity about the environment in childhood

To qualify for an Asperger's Syndrome diagnosis, a child must demonstrate impairment in social interaction, shown by at least two of the following:

• Impairment in the use of nonverbal behaviors (such as eye contact, facial expressions, and gestures) during social interaction

• Lack of development of relationships with peers

• Failure to seek to share enjoyment, interests, or achievements with other people (for instance, by not showing objects of interest to others)

• Failure to reciprocate emotions or social gestures

The child should also demonstrate “restrictive repetitive and stereotyped patterns of behaviors, interests, and activities,” shown by at least one of the following:

• Unusually intense preoccupation with one or more stereotyped interests

• Obsessively following specific, nonfunctional routines or rituals

• Repeated motions, such as hand or finger flapping or twisting

• Unusual preoccupation with parts of objects

To qualify as characteristics of Asperger's, these traits must be significant enough to cause great challenges for the child in social, occupational, and other important areas of daily living. Although, increasingly, some children with Asperger's have been diagnosed as young as three, the diagnosis is most often made from age six and up.

These areas and others will be gently and respectfully demystified in the contents of this book. The word “disorder” may not seem like a family-friendly way to describe your child's personal Asperger's Syndrome experience, but it is currently clinical “short-hand” to summarize it. Please do not be hurt, confused, or upset by this technical jargon. Outside of a doctor's office, you may wish to use the word “difference” or the phrase “different way of being” when you feel the need to describe your child's experience, if at all. Your child's physician, educators, or school psychologist may be able to recommend literature in addition to the DSM.