By CLAUDIA WALLIS
It is one of the most intriguing labels in psychiatry. Children with Asperger’s syndrome, a mild form of autism, are socially awkward and often physically clumsy, but many are verbal prodigies, speaking in complex sentences at early ages, reading newspapers fluently by age 5 or 6 and acquiring expertise in some preferred topic — stegosaurs, clipper ships, Interstate highways — that will astonish adults and bore their playmates to tears.

In recent years, this once obscure diagnosis, given to more than four times as many boys as girls, has become increasingly common.

Much of the growing prevalence of autism, which now affects about 1 percent of American children, according to federal data, can be attributed to Asperger’s and other mild forms of the disorder. And Asperger’s has exploded into popular culture through books and films depicting it as the realm of brilliant nerds and savantlike geniuses.

But no sooner has Asperger consciousness awakened than the disorder seems headed for psychiatric obsolescence. Though it became an official part of the medical lexicon only in 1994, the experts who are revising psychiatry’s diagnostic manual have proposed to eliminate it from the new edition, due out in 2012.

If these experts have their way, Asperger’s syndrome and another mild form of autism, pervasive developmental disorder not otherwise specified (P.D.D.-N.O.S. for short), will be folded into a single broad diagnosis, autism spectrum disorder — a category that encompasses autism’s entire range, or spectrum, from high-functioning to profoundly disabling.

“Nobody has been able to show consistent differences between what clinicians diagnose as Asperger’s syndrome and what they diagnose as mild autistic disorder,” said Catherine Lord, director of the Autism and Communication Disorders Centers at the University of Michigan, one of 13 members of a group evaluating autism and other neurodevelopmental disorders for the manual.

“Asperger’s means a lot of different things to different people,” Dr. Lord said. “It’s confusing and not terribly useful.”

Taking Asperger’s out of the manual, known as D.S.M.-V for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, does not mean the term will disappear. “We don’t want to say that no one can ever use this word,” Dr. Lord said, adding: “It’s not an evidence-based term. It may be something people would like to use to describe how they see themselves fitting into the spectrum.”

But the change, if approved by the manual’s editors and consultants, is likely to be controversial. The Asperger’s diagnosis is used by health insurers, researchers, state agencies and schools — not to mention people with the disorder, many of whom proudly call themselves Aspies.

Some experts worry that the loss of the label will inhibit mildly affected people from being assessed for autism. “The general public has either a neutral or fairly positive view of the term Asperger’s syndrome,” said Tony Attwood, a psychologist based in Australia who wrote “The Complete Guide to Asperger’s Syndrome” (Jessica Kingsley Publishers, 2006). But if people are told they should be evaluated for autism, he went on, “they will say: ‘No, no, no. I can talk. I have a friend. What a ridiculous suggestion!’ So we will miss the opportunity to assess people.”

The proposed changes to the autism category are part of a bigger overhaul that will largely replace the old “you have it or you don’t” model of mental illness with a more modern view — that psychiatric disorders should be seen as a continuum, with many degrees of severity. The goal is to develop “severity measures within each diagnosis,” said Dr. Darrel A. Regier, research director at the American Psychiatric Association and vice chairman of the diagnostic manual’s task force.

Another broad change is to better recognize that psychiatric patients often have many health problems affecting mind and body and that clinicians need to evaluate and treat the whole patient.

Historically, Dr. Regier said, the diagnostic manual was used to sort hospital patients based on what was judged to be their most serious problem. A patient with a primary diagnosis of major depression would not be evaluated for anxiety, for example, even though the two disorders often go hand in hand.

Similarly, a child with the autism label could not also have a diagnosis of attention deficit hyperactivity disorder, because attention problems are considered secondary to the autism. Thus, they might go untreated, or the treatment would not be covered by insurance.

The new edition, by contrast, will list not only the core issues that characterize a given diagnosis but also an array of other health problems that commonly accompany the disorder. For autism, this would most likely include anxiety, attention disorders, gastrointestinal problems, seizures and sensory differences like extreme sensitivity to noise.

Parents and advocates have been clamoring for an approach that addresses the multiple health problems that plague many children with autism. “Our kids will do much better if medical conditions like gut issues or allergies are treated,” said Lee Grossman, president of the Autism Society of America, a leading advocacy group.

The new diagnostic approach addresses another source of confusion: the current labels may change over time. “A child can look like they have P.D.D.-N.O.S., then Asperger’s, then back to autism,” Dr. Lord said. The inconsistent use of these labels has been a problem for researchers recruiting subjects for studies of autism spectrum disorder.

And it can be a problem for people seeking help. In some states, California and Texas, for example, people with traditional autistic disorder qualify for state services, while those with Asperger’s and pervasive developmental disorder do not.

A big challenge for the diagnostic manual team working on autism is how to measure severity in a condition that often causes a very uneven profile of abilities and disabilities. Mr. Grossman gives the example of a woman who serves on an advisory panel to his organization. She is nonverbal and depends on an electronic device to communicate, is prone to self-injury and relies on a personal aide. And yet “she’s absolutely brilliant, she runs a newsletter, and she’s up on all the science,” he said, adding, “Where would somebody like that come out on the rating scale?”

Recent books by people with Asperger’s give insights into the workings of some oddly beautiful minds. In “Embracing the Wide Sky” (Free Press, 2009), Daniel Tammet, a shy British math and linguistic savant, tells how he was able to learn enough Icelandic in a week to manage a television interview and how he could recite the value of pi to 22,514 decimal places by envisioning the digits “as a rolling numerical panorama” of colors, shapes and textures.

In “Look Me in the Eye” (Crown, 2007), John Elder Robison describes a painfully lonely childhood and an ability to look at a circuit design and imagine how it will transform sound — a talent he used to invent audio effects and exploding guitars for the rock band Kiss.

Not all people with Asperger’s have such extraordinary abilities, and some who do are so crippled by anxiety and social limitations that they cannot hold down a job or live on their own.

Dr. Susan E. Swedo, a senior investigator at the National Institute of Mental Health who heads the diagnostic manual group working on autism, acknowledges the difficulty of describing such a variable disorder. Dr. Swedo said the plan was to define autism by two core elements — impaired social communication and repetitive behaviors or fixated interests — and to score each of those elements for severity.

The trick is to “walk the tightrope of truth,” Dr. Swedo said, between providing clear, easily used diagnostic guidance to clinicians and capturing the individual variation that is relevant to treatment. “People say that in autism, everybody is a snowflake,” she said. “It’s the perfect analogy.”

The proposed elimination of autism subtypes comes at the very moment when research suggests that the disorder may have scores of varieties. Investigators have already identified more than a dozen gene patterns associated with autism, but Dr. Lord, of Michigan, said the genetic markers “don’t seem to map at all into what people currently call Asperger’s or P.D.D.”

Nor have many of these genes been linked to distinct sets of symptoms. Until research can identify reliable biological markers for autism subtypes, Dr. Lord and other experts say, it is better to have no subtypes than the wrong ones.

In interviews, people with Asperger’s and mild autism were divided on the prospect of losing the label. Temple Grandin, a Colorado State University animal scientist who is perhaps the best-known autistic American, said Asperger’s was too well established to be thrown overboard. “The Asperger community is a big vocal community,” Dr. Grandin said, “a reason in itself” to leave the diagnosis in place.

“P.D.D.-N.O.S., I’d throw in the garbage can,” she added. “But I’d keep Asperger’s.”

But some younger people involved in the growing autism self-advocacy movement see things differently.

“My identity is attached to being on the autism spectrum, not some superior Asperger’s identity,” said Ari Ne’eman, 21, an activist who founded the Autistic Self-Advocacy Network, a 15-chapter organization he has built while in college, adding, “I think the consolidation to one category of autism spectrum diagnosis will lead to better services.”

All interested parties will have an opportunity to weigh in on the proposed changes. The American Psychiatric Association is expected to post the working group’s final proposal on autism diagnostic criteria on the diagnostic manual’s Web site in January and invite comment from the public. Dr. Swedo and company are bracing for an earful.

This article has been revised to reflect the following correction:

Correction: November 5, 2009
An article on Tuesday about a proposal to remove Asperger’s syndrome from the next edition of psychiatry’s diagnostic manual misstated the educational affiliation for Temple Grandin, a well-known American with autism. She is a professor of animal science at Colorado State University, not the University of Colorado.

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“Thanks!” said the boy.

“Just kidding,” said the girl with another smile. “You’re only slightly dorky, but other than that, you’re pretty normal — sometimes.”

They both laughed.

“See you tomorrow,” said the boy.

“O.K., see you,” said the girl.

It was a pretty typical pre-teen exchange, one familiar through the generations. Except this one had a distinctly 2010 twist. It was conducted on Facebook. The smiles were colons with brackets. The laughs were typed ha ha’s. “O.K.” was just “K” and “See you” was rendered as “c ya.”

Children used to actually talk to their friends. Those hours spent on the family princess phone or hanging out with pals in the neighborhood after school vanished long ago. But now, even chatting on cellphones or via e-mail (through which you can at least converse in paragraphs) is passé. For today’s teenagers and preteens, the give and take of friendship seems to be conducted increasingly in the abbreviated snatches of cellphone texts and instant messages, or through the very public forum of Facebook walls and MySpace bulletins. (Andy Wilson, the 11-year-old boy involved in the banter above, has 418 Facebook friends.)

Last week, the Pew Research Center found that half of American teenagers — defined in the study as ages 12 through 17 — send 50 or more text messages a day and that one third send more than 100 a day. Two thirds of the texters surveyed by the center’s Internet and American Life Project said they were more likely to use their cellphones to text friends than to call them. Fifty-four percent said they text their friends once a day, but only 33 percent said they talk to their friends face-to-face on a daily basis. The findings came just a few months after the Kaiser Family Foundation reported that Americans between the ages of 8 and 18 spend on average 7 1/2 hours a day using some sort of electronic device, from smart phones to MP3 players to computers — a number that startled many adults, even those who keep their BlackBerrys within arm’s reach during most waking hours.

To date, much of the concern over all this use of technology has been focused on the implications for kids’ intellectual development. Worry about the social repercussions has centered on the darker side of online interactions, like cyber-bullying or texting sexually explicit messages. But psychologists and other experts are starting to take a look at a less-sensational but potentially more profound phenomenon: whether technology may be changing the very nature of kids’ friendships.

“In general, the worries over cyber-bullying and sexting have overshadowed a look into the really nuanced things about the way technology is affecting the closeness properties of friendship,” said Jeffrey G. Parker, an associate professor of psychology at the University of Alabama, who has been studying children’s friendships since the 1980s. “We’re only beginning to look at those subtle changes.”

The question on researchers’ minds is whether all that texting, instant messaging and online social networking allows children to become more connected and supportive of their friends — or whether the quality of their interactions is being diminished without the intimacy and emotional give and take of regular, extended face-to-face time.

It is far too soon to know the answer. Writing in The Future of Children, a journal produced through a collaboration between the Brookings Institution and the Woodrow Wilson Center at Princeton University, Kaveri Subrahmanyam and Patricia M. Greenfield, psychologists at California State University, Los Angeles, and U.C.L.A. respectively, noted: “Initial qualitative evidence is that the ease of electronic communication may be making teens less interested in face-to-face communication with their friends. More research is needed to see how widespread this phenomenon is and what it does to the emotional quality of a relationship.”

But the question is important, people who study relationships believe, because close childhood friendships help kids build trust in people outside their families and consequently help lay the groundwork for healthy adult relationships. “These good, close relationships — we can’t allow them to wilt away. They are essential to allowing kids to develop poise and allowing kids to play with their emotions, express emotions, all the functions of support that go with adult relationships,” Professor Parker said.

“These are things that we talk about all the time,” said Lori Evans, a psychologist at the New York University Child Study Center. “We don’t yet have a huge body of research to confirm what we clinically think is going on.”

What she and many others who work with children see are exchanges that are more superficial and more public than in the past. “When we were younger we would be on the phone for hours at a time with one person,” said Ms. Evans. Today instant messages are often group chats. And, she said, “Facebook is not a conversation.”

One of the concerns is that, unlike their parents — many of whom recall having intense childhood relationships with a bosom buddy with whom they would spend all their time and tell all their secrets — today’s youths may be missing out on experiences that help them develop empathy, understand emotional nuances and read social cues like facial expressions and body language. With children’s technical obsessions starting at ever-younger ages — even kindergartners will play side by side on laptops during play dates — their brains may eventually be rewired and those skills will fade further, some researchers believe.

Gary Small, a neuroscientist and professor of psychiatry at U.C.L.A. and an author of “iBrain: Surviving the Technological Alteration of the Modern Mind,” believes that so-called “digital natives,” a term for the generation that has grown up using computers, are already having a harder time reading social cues. “Even though young digital natives are very good with the tech skills, they are weak with the face-to-face human contact skills,” he said.

Others who study friendships argue that technology is bringing children closer than ever. Elizabeth Hartley-Brewer, author of a book published last year called “Making Friends: A Guide to Understanding and Nurturing Your Child’s Friendships,” believes that technology allows them to be connected to their friends around the clock. “I think it’s possible to say that the electronic media is helping kids to be in touch much more and for longer.”

And some parents agree. Beth Cafferty, a high school Spanish teacher in Hasbrouck Heights, N.J., estimates that her 15-year-old daughter sends hundreds of texts each day. “I actually think they’re closer because they’re more in contact with each other — anything that comes to my mind, I’m going to text you right away,” she said.

But Laura Shumaker, a mother of three sons in the Bay Area suburbs, noticed recently that her 17-year-old son, John, “was keeping up with friends so much on Facebook that he has become more withdrawn and skittish about face-to-face interactions.”

Recently when he mentioned that it was a friend’s birthday, she recalled, “I said ‘Great, are you going to give him a call and wish him Happy Birthday?’ He said, ‘No, I’m going to put it on his wall’ ” — the bulletin board on Facebook where friends can post messages that others can see. Ms. Shumaker said she has since begun encouraging her son to get involved in more group activities after school and was pleased that he joined a singing group recently.

To some children, technology is merely a facilitator for an active social life. On a recent Friday, Hannah Kliot, a 15-year-old ninth grader in Manhattan, who had at last count 1,150 Facebook friends, sent a bunch of texts after school to make plans to meet some friends later at a party. The next day she played in two softball games, texting between innings and games about plans to go to a concert the next weekend.

Hannah says she relies on texting to make plans and to pass along things that she thinks are funny or interesting. But she also uses it to check up on friends who may be upset about something — and in those cases she will follow up with a real conversation. “I definitely have conversations but I think the new form of actually talking to someone is video chat because you’re actually seeing them,” she said. “I’ve definitely done phone calls at one time or another but it is considered, maybe, old school.”

Hannah’s mother, Joana Vicente, who has been known to text her children from her bed after 11 p.m. telling them to get offline, is sometimes amazed by the way Hannah and her 14-year-old brother, Anton, communicate. “Sometime they’ll have five conversations going at once” through instant messaging, texts or video chats, she said. “My daughter, with the speed of lightning, just goes from one to the other. I think ‘My God, that is a conversation?’ ”

Some researchers believe that the impersonal nature of texting and online communication may make it easier for shy kids to connect with others. Robert Wilson is the father of Andy Wilson, the 11-year-old sixth grader from Atlanta who was good-naturedly teased over Facebook. (Mr. Wilson quoted from the exchange to illustrate the general “goofy” and innocuous nature of most of his son’s Facebook interactions.) Andy is very athletic and social, but his brother, Evan, who is 14, is more shy and introverted. After watching Andy connect with so many different people on Facebook, Mr. Wilson suggested that Evan sign up and give it a try. The other day he was pleased to find Evan chatting through Facebook with a girl from his former school.

“I’m thinking Facebook has for the most part been beneficial to my sons,” Mr. Wilson said. “For Evan, the No. 1 reason is it’s helping him come out of his shell and develop social skills that he wasn’t learning because he’s so shy. I couldn’t just push him out of the house and say ‘Find someone.’”

By JANE E. BRODY
My grandson Chasen was on a first-grade bus trip when a classmate got carsick. The other children quickly moved away, mumbling words of disgust. Chasen went over, put his arm on the boy’s shoulder and asked, “Are you O.K.?”

Chasen’s teacher later commended him for showing concern for a child in distress — and rightly so, if you’ll indulge a proud grandma. Empathy, the ability to put yourself in someone else’s shoes and recognize and respond to what that person is feeling, is an essential ingredient of a civilized society.

Lacking empathy, people act only out of self-interest, without regard for the well-being or feelings of others. The absence of empathy fosters antisocial behavior, cold-blooded murder, genocide.

The capacity for empathy seems to be innate, and is evident even in other species — the adult elephant who tried to rescue a baby rhino stuck in the mud despite being charged by its mother, as recounted by Jeffrey Moussaieff Masson and Susan McCarthy in “When Elephants Weep” (Delacorte Press, 1995).

Manifestations of empathy often show up early in life, as when a toddler brings a favorite toy or blanket to another child who is injured or in distress. Some experts maintain that infants display empathy when they whimper or cry upon hearing another baby cry.

Children may enter the world with different capacities for empathy, a result of neural connections in the brain. The capacity for empathy may be partly or wholly lacking in disorders like autism and schizophrenia, in which the mind is focused inward.

But in otherwise normal children, the environment in which they are reared can make a big difference in whether empathy is fostered or suppressed. Healthy self-esteem is essential to empathy, so anything that helps children feel good about themselves will also help them recognize and respond effectively to the feelings of others.

Start Early

If children are to relate positively to others, they must feel secure themselves and “have a secure attachment to another person,” said Carolyn Zahn-Waxler, a psychologist at the University of Wisconsin. Infants and young children whose own distress is ignored, scorned or, worse yet, punished can quickly become distrustful of their environment and feel unsafe.

Nancy Eisenberg, a psychologist at Arizona State University, agreed. “Children need a positive, caring relationship with their parents or caretakers,” she said in an interview, “if they are to be able to go beyond themselves to care about others.”

“Empathy comes from being empathized with,” Dr. Stanley I. Greenspan, a clinical professor of psychiatry and pediatrics at George Washington University School of Medicine, wrote in his book “Great Kids” (Da Capo, 2007).

Children should also be helped to recognize their own feelings and express them, he wrote. By learning to identify and label their feelings, children are better able to recognize the feelings of others. For example, when a child becomes frustrated with a toy car and throws it across the room, his caretaker could say something like: “You’re feeling upset because the car isn’t working the way it should. You don’t like it when toys don’t work.”

Dr. Zahn-Waxler says the kind of discipline a child receives should “help the child regulate emotion, to calm down rather than become more agitated.” She advises parents to stay calm: “The more emotionally aroused you are, the more aroused the child is likely to become. Hitting or screaming at a child results in anger and fear and interferes with the child’s ability to care for others.”

Dr. Eisenberg emphasized that in addition to avoiding physical punishment, “children should never be threatened with a loss of love” for misbehavior.

Caretakers can help young children understand how other people feel, say, when a child cries because a toy breaks or is snatched by another child. When a child acts kindly toward someone, Marjorie Taylor, a psychologist at the University of Oregon, suggests that saying something like “You’re very kind for doing this” or “You’re the kind of person who does nice things like that” can help make empathy a part of a young child’s identity.

Even very young children need to know how their behavior affects others, experts say. They need to have it explained why certain behaviors are hurtful or helpful, and how to make up for bad behavior.

“Be really explicit, because children can’t draw conclusions as easily as an older person,” Dr. Taylor said.

Also helpful, she said, is reading books and talking about how people (or animals) in a story feel and why they feel that way.

One such book, “P. J. the Spoiled Bunny,” by Marilyn Sadler (Random House, 1986), can help children appreciate the effects of being selfish and stubborn and always demanding one’s way. The story helps children see how someone’s actions affect the attitudes and responses of others. P. J. learns in the story that by behaving differently he could have more fun with his friends.

For older children, Dr. Greenspan suggested books like “To Kill a Mockingbird” and “The Diary of Anne Frank.” Even televised events of natural disasters can help, by encouraging a child to imagine what it must be like for people whose lives are devastated by an earthquake or tsunami.

Although an early start is ideal, experts say it is possible to instill empathy later — even, for example, in children whose emotional security was neglected in an orphanage. Undoing the damage may require extra effort on the part of adoptive parents, as well as unconditional love.

Modeling Empathy

Parents and teachers can set a good example of empathetic behavior by how they behave themselves. The old saying “Do as I do” has particular relevance for fostering empathy in children.

“Parents need to be models of altruism, compassion and caring,” Dr. Zahn-Waxler said. “It’s not enough to talk the talk. You need to be seen doing it and you need to show caring behavior toward your child.”

Parents who are sympathetic to the feelings of others and rise to a need for help, especially when it is not in their own best interest, can teach children how to identify feelings, think beyond themselves and respond empathetically to others.

In school, teachers who inspire empathy are those who recognize and address the feelings behind a child’s behavior. The most effective teachers are warm and affectionate — and when trying to correct bad behavior they remain calm, not punitive.

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