By Matt Harrington, BCBA · Behaviorist Book Club · Research-backed answers for behavior analysts
The removal of Asperger's disorder as a separate diagnosis in the DSM-5 was driven primarily by scientific evidence that the distinction between Asperger's disorder and autistic disorder was not reliably supported by research. Studies showed that clinicians could not consistently differentiate between the two conditions and that the boundary between them was arbitrary rather than reflecting a true qualitative difference. The DSM-5 replaced both with a single autism spectrum disorder diagnosis with severity levels. While the change was scientifically motivated, subsequent revelations about Hans Asperger's involvement with the Nazi regime have added ethical weight to moving away from his name as a diagnostic label.
Lorna Wing's 1981 paper brought Hans Asperger's work to international attention and, more importantly, proposed the concept of an autism spectrum. Wing recognized that autistic presentations varied continuously along multiple dimensions rather than falling into discrete categories. Her spectrum concept challenged the prevailing view that autism was a single, narrowly defined condition and opened the door to recognizing a much broader range of individuals as autistic. This insight fundamentally changed diagnostic practice and eventually led to the unified autism spectrum disorder diagnosis in the DSM-5. Wing was also the mother of an autistic child, bringing both professional and personal perspective to her work.
Historical research has revealed that Hans Asperger referred children to the Am Spiegelgrund clinic in Vienna, which was part of the Nazi child euthanasia program. Evidence suggests that Asperger was aware that children sent to this clinic were at risk of being killed and that he nonetheless made referrals for children he deemed uneducable or severely impaired. This involvement with the Nazi regime complicates his legacy as a pioneer in autism research and raises questions about how professions should acknowledge the ethical failings of their foundational figures while still learning from their scientific contributions.
The refrigerator mother theory proposed that autism was caused by cold, emotionally unresponsive parenting, particularly by mothers. While Leo Kanner described the parents of autistic children in somewhat unflattering terms in his original papers, the theory was most prominently promoted by Bruno Bettelheim, who compared the experience of autistic children to that of concentration camp prisoners. This theory caused enormous psychological harm to parents of autistic children, who were blamed for their children's condition and often subjected to psychoanalytic treatment aimed at correcting their supposed parenting failures. The theory has been thoroughly discredited by genetic and neurobiological research demonstrating that autism has strong biological foundations.
The DSM-III in 1980 introduced infantile autism as a narrowly defined category focused on early onset and severe social and communication impairments. The DSM-III-R expanded the criteria and renamed it autistic disorder. The DSM-IV in 1994 introduced a pervasive developmental disorders category that included autistic disorder, Asperger's disorder, and PDD-NOS as separate diagnoses. The DSM-5 in 2013 collapsed all of these into a single autism spectrum disorder diagnosis with two core domains, social communication deficits and restricted/repetitive behaviors, along with three severity levels. Each revision reflected evolving scientific understanding and had real consequences for service eligibility and treatment.
The neurodiversity perspective views neurological differences such as autism as natural variations in human neurology rather than deficits to be corrected. For ABA practice, this perspective challenges behavior analysts to critically examine whether treatment goals aim to build genuinely useful skills and reduce barriers to participation, or whether they primarily seek to make autistic individuals appear more neurotypical. Ethical behavior-analytic practice can align with neurodiversity principles by prioritizing client autonomy in goal selection, focusing on functional skills that enhance quality of life, respecting autistic individuals' perspectives on their own experiences, and avoiding interventions that target harmless behaviors solely because they differ from neurotypical norms.
Behavior analysts should provide accurate, balanced information when families ask about diagnostic history. Explain that autism was first described in the 1940s and that our understanding has evolved significantly since then. Acknowledge that earlier theories about the causes of autism, such as the refrigerator mother theory, were wrong and caused harm. Describe the current spectrum model as reflecting our best understanding that autism encompasses a wide range of presentations. Be honest about the limitations of diagnostic categories as imperfect tools for describing a complex condition. Avoid oversimplifying the history or presenting current diagnostic categories as definitive when they continue to evolve.
Understanding socio-cultural context helps behavior analysts recognize that scientific and clinical practices are always influenced by the cultural, political, and economic environments in which they occur. Asperger's research was conducted under Nazi ideology, Kanner's work was influenced by mid-twentieth century psychoanalytic culture, and current ABA practice is shaped by insurance mandates and commercial incentives. Recognizing these influences helps behavior analysts maintain ethical awareness about how their own socio-cultural context may be shaping their clinical practices in ways that could be harmful or inappropriate. This historical perspective supports more reflective and ethically grounded practice.
Autism diagnosis serves as the primary gateway to ABA services because most insurance mandates and funding sources require a formal diagnosis of autism spectrum disorder for service authorization. This creates a direct relationship between diagnostic criteria and service access. When diagnostic criteria were narrow, fewer individuals qualified for services. The expansion of the autism spectrum has increased the number of individuals eligible for ABA services but has also raised questions about appropriate treatment intensity and duration across the range of presentations now included under the autism spectrum disorder umbrella. Behavior analysts should understand that diagnostic changes affect the populations they serve and should advocate for service access decisions based on individual need rather than rigid diagnostic criteria.
Reconciliation begins with recognizing that the medical model and neurodiversity perspectives are not entirely incompatible. The medical model identifies genuine challenges that autistic individuals face and provides a framework for accessing services and supports. The neurodiversity perspective adds important dimensions by centering autistic individuals' perspectives, challenging deficit-focused language, and advocating for societal accommodation alongside individual intervention. Behavior analysts can work within both frameworks by selecting treatment goals collaboratively with clients and families, focusing on skill building that enhances autonomy and quality of life, respecting clients' self-identification and preferences, and advocating for environmental modifications alongside individual behavioral interventions.
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All behavior-analytic intervention is individualized. The information on this page is for educational purposes and does not constitute clinical advice. Treatment decisions should be informed by the best available published research, individualized assessment, and obtained with the informed consent of the client or their legal guardian. Behavior analysts are responsible for practicing within the boundaries of their competence and adhering to the BACB Ethics Code for Behavior Analysts.