Xoxoxoxox

Journal of Child Psychology and Psychiatry 45:4 (2004), pp 672–686

Emanuel Miller lecture: Confusions and controversies
about Asperger syndrome
Uta Frith
UCL Institute of Cognitive Neuroscience, UK

Background: Hans Asperger drew attention to individuals who show the core symptoms of autism in
the presence of high verbal intelligence. Methods: A review of the literature explores currentissues
concerning the diagnosis and nature of Asperger syndrome. Results: The behavioural and neurophysiological evidence to date suggests that Asperger syndrome is a variant of autism typically occurring in high-functioning individuals, and not a separate disorder. One of the problems of diagnosis is
that the typical impairment of social communication may be difficult to identify in earlychildhood, and
can be camouflaged in adulthood by compensatory learning. The range and nature of the social
impairments in Asperger syndrome are still in need of investigation, but appear to be less severe than in
autism. Experimental evidence suggests that individuals with Asperger syndrome may lack an intuitive
theory of mind (mentalising), but may be able to acquire an explicit theory of mind.Brain imaging
studies pinpoint a network that links medial prefrontal and temporal cortex as the neural substrate of
intuitive mentalising. This network shows reduced activation and poor connectivity in Asperger syndrome. While some individuals with Asperger syndrome have written eloquently about their lives, their
ability to talk about their own emotions appears to be impaired (alexithymia). Thisimpairment may be
linked to depression and anxiety, which is common in adulthood. Little is as yet known about the often
considerable cognitive strengths in Asperger syndrome, or about the difficulties observed in higher-level
executive skills. Conclusions: Studies are needed that define the developmental course of the disorder
and the nature of the strengths and weaknesses in both social andnon-social domains. This requires
more sensitive assessment instruments than are currently available. Questions about the prevalence of
Asperger syndrome, about associated and secondary features, and about optimal education and
management, urgently call for such studies. Keywords: Autistic disorder, emotion, executive function,
mentalising impairment, social cognition, theory of mind.Emanuel Miller’s (1893–1970) biographical details
suggest some significant parallels to Hans Asperger
(1906–1980). Both men were among the first child
psychiatrists in their respective countries, Great
Britain and Austria, and founded lasting institutions
that care for children’s mental health. Both emphasised the critical importance of social work and
education. From all accounts both wereRenaissance
men who built up large libraries testifying to their
wide interests from medicine to philosophy and the
arts. Asperger’s working life, as well as Miller’s, was
deeply marked by the historical cataclysm of the first
half of the 20th century. The wars that wrecked
Europe had psychiatric consequences of a kind that
clinicians had hardly experienced before. Just as in
London, where EmanuelMiller treated shell-shocked
patients returning from the First World War, so in
Vienna, Erwin Lazar, Hans Asperger’s teacher, set
up centres for severely deprived children, and devoted
his clinical expertise to alleviating their condition.
A tradition of remedial education was started, which
Asperger continued throughout his life.
However, what Hans Asperger is chiefly remembered for is thathe was one of the two farsighted
clinicians who identified and labelled the condition
that is now known as autism. Leo Kanner, who was
working in Baltimore, published his seminal paper
on autistic disturbances of affective contact in 1943,

while Hans Asperger published his paper on autistic
psychopathy in 1944. Neither of them knew the
other, and they appear to have kept a professional...