Asperger's Disorder vs. Psychopathy

When Dr. Amy Saborsky and I undertook research on the alleged link between violence and Asperger’s disorder (ASD), we found notions expressed in some media reports that people who suffered from this condition bore an emotional kinship with psychopaths.

These reports implied (or stated) that, like psychopaths, people with ASD have no empathy and thus no emotional incentive to be prosocial. Hence, they’re prone to becoming violent.

In a gradual, almost sinister way, it seemed that people were explaining violence associated with a few rampagers who had ASD as the inevitable manifestation of psychopathic tendencies. This raised red flags for parents, therapists and teachers.

However, research and experience tell a different story.

First, let’s deal with the violence issue. Woodbury-Smith (2006) and colleagues compared the rates of offending in 25 people with ASD matched to a sample from the general population. They did not find an increased risk for violence. Neither did Stål (2006), who looked at 11 studies involving 22 patients and 29 violent incidents. He found that the type of violence committed by people with ASD was far less calculated and destructive than psychopathic violence.

Murphy (2007) cites two studies in high security psychiatric care in which Asperger’s accounted for 3% of the total population. He describes their apparent similarity to patients with psychopathy. Yet, since the ASD subjects were not diagnosable as psychopaths on the Psychopathy Checklist-Revised (PCL-R), he cautioned evaluators not to confuse their difficulty reading social cues with a lack of empathy.

We found that most of these studies included too few cases to support either a positive or negative link between ASD and damaging or fatal violence. In fact, the most prevalent type of aggression seems to be mild forms of sexual offending and fire setting. Very few had elements of sadism.

The most glaring issue with ASD research in the context of violence is that many such people also have comorbid psychiatric conditions that could be implicated. Of the 37 cases that Newman & Ghaziuddin (2008) examined in the literature, 29.7 % had a definite psychiatric disorder comorbid with ASD and 54% had a probable psychiatric condition. Only 16% (6 cases) implicated ASD alone in an aggressive incident. The authors also point out that despite the apparent correlation with psychopathy, as defined by the PCL-R, “the superficiality that characterized psychopathy was different from the social disability of autism.”

So to reassure those with lingering fears about the supposed psychopathic indifference of ASD, I asked Dr. Saborksy to add her own observations. She is a licensed clinical psychologist at the Center for Integrated Behavioral Health in Bethlehem, PA, specializing in children and adolescents. In the past, she has worked in multiple programs that included children and adolescents with Asperger's, including Woods Services, where she did both assessment and treatment with kids/adolescents with varying severities of ASD. Her residency was at a specialized school for kids with ASD, the May Institute in Randolph, MA.

Her comments on this issue are below:

“Over the course of my experience, I've met and worked with several children, adolescents and adults who have diagnoses of either Asperger's, Pervasive Developmental Disorder-Not Otherwise Specified, and Autism. All of these disorders would now fit under the DSM-V diagnosis of Autism Spectrum Disorder.

“While with some cases, I've seen minor aggression, usually involved with a temper tantrum, I have never known an individual with ASD who was truly violent. At least not in a way that was as horrific as what Adam Lanza did at Sandy Hook Elementary. Most of the time, the aggression I witnessed was related to avoidance of a task or attention seeking behavior. Usually it involved hitting, and most of the hitting was superficial.

“I'm sure there is a possibility that another individual with ASD could perform such a heinous crime as Lanza, but in my experience, the risk is relatively low.

“Additionally, there is the idea that people with ASD are completely lacking emotion and remorse; this is simply not true. One of my former clients, a 14-year-old boy with ASD offers an excellent example of how loving a child or adolescent with ASD can be.

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“This individual—we'll call him Ted—had an older brother who was injured horribly in an accident during the course of our treatment. Ted was so concerned about his brother that he tended to perseverate on the topic. He'd talk about how much he loved and cared for his older brother, how he was worried he wouldn't recover fully, and how he wished he could help him get better.

“I worked with another individual who came for depression and social anxiety because he realized he was ‘different and quirky.’ It was because of this that he couldn't form friendships or a romantic relationship.

“Still another would apologize to his mother and was incredibly remorseful every time he made even a minor mistake. I could go on, but I believe that these three cases alone illustrate that individuals with ASD do possess emotion, and can be deeply remorseful when they accidentally upset or harm another.

“Of course, all three of these individuals were on the high functioning end of ASD and one could say that those on the lower end are not capable of emotion. But I have also worked with individuals who possessed severe ASD who exhibited love, sadness, and happiness.

“One little girl with whom I worked would get highly excited during our sessions. She was mostly nonverbal, but she would say the word ‘happy,’ whenever she was about to complete a task that she enjoyed. She also thrived on hugs and kisses from her loved ones, and one of her major rewards in a reinforcement plan we had for her was to get hugs from her favorite staff members.”

While blunted affect may be present in some individuals with ASD, this manifestation is still remarkably different than in those with psychopathy. The most significant difference is the lack of remorse in psychopaths, along with their propensity to manipulate, blame others, and exploit situations and people.

We hope this helps to clear up the confusion.