"Catherine Lord 박사와 미국 전역의 임상 연구자 그룹이 2012년에 실시한 한 연구는 센터마다 자폐장애와 아스퍼거 장애, 상세 불명의 전박전 발달장애(PDD-NOS)라는 진단을 어떻게 내리는지 보여주었습니다. 어떤 클리닉에서는 거의 모든 어린이에게 자폐장애라는 진단을 내렸고, 다른 두 진단은 거의 사용하지 않았습니다. 어떤 클리닉에서 상세 불명의 전반적 발달장애(PDD-NOS)가 가장 흔했고, 어떤 센터에서는 아스퍼거 장애가 표본의 절반을 차지했습니다. 같은 나라에서 지역이 다르다고 세 가지 상태의 비율이 실제로 그렇게 다를까요? 이 연구는 장소가 달라도 어린이들은 비슷하다는 것을 분명히 보여주었습니다. 언어와 지능, 자폐증 행동의 심각도가 비슷한 수준이었습니다. 지역마다 아이들의 자폐 장애와 아스퍼거 장애, 상세 불명의 전반적 발달장애(PDD-NOS) 비율이 다르다는 것은 사실이 아닙니다. 한 센터와 다른 센터의 차이는 주로 임상의가 라벨을 어떻게 적용했는지, 센터마다 선호하는 진단이 있는지에 달려있었습니다. DSM-IV를 사용한 20년 동안 세계 곳곳에서 이런 현상이 일어났을 것입니다.

이러한 일은 가족에게 혼동을 줄 뿐 아니라, 자녀를 보살피는 데 부정적 결과를 가져왔습니다. 미국 일부나 다른 국가에서 아스퍼거 증후군 진단을 받은 사람은 자폐증 환자보다 제도적으로 훨씬 적은 서비스를 받아야 했습니다. 두 질환이 같은 상태이고, 같은 장애를 공유하는데, 어떤 사람에게는 모든 범위의 개입을 제공하고 다른 사람에게는 서비스를 허락하지 않는 것을 불공평합니다. 전문가들은 DSM-5가 이러한 불평등을 해결하기를 희망합니다. 

…DSM-5에서 당신 자녀 같은 사람은 자폐 스펙트럼 장애(ASD) 진단에 속합니다.DSM-IV에는 전반적 발달장애(PDD)와 다섯 가지 특정 진단의 범주가 있었지만, DSM-5는 단일 진단인 ASD를 사용합니다. DSM-IV는 12가지 증상 목록이 있으며, 다섯가지 PDD 진단에 서로 다른 패턴이 필요했습니다. 따라서 2,688가지의 다른 방식이 있게 됩니다! 이것은 사람마다 엄청난 다양성이 있고, 진단명이 같은 두 사람이 단 하나의 증상도 공유하지 않을 수 있다는 뜻입니다. DSM-5에서는 증상 목록이 일곱 개로 간소화되었습니다. ADS 진단을 받으려면 이 가운데 적어도 다섯 개 증상을 나타내야 합니다. 즉, DSM-IV와는 달리 어린이가 보여줄 수 있는 패턴은 여섯 가지 뿐입니다. 이러한 임상의에게 진단 과정이 훨씬 수월할 것이고, 신뢰도도 높아질 것입니다. 이제는 진단명이 하나뿐이라 DSM-IV를 적용할 떄보다 두 명의 의사에게 같은 진단을 받을 확률이 훨씬 커졌습니다. 가족들은 Seth의 부모가 한 질문(한 의사는 자폐증이라고 하고, 다른 의사는 아스퍼거 증후군이라고 하는 까닭)에 직면할 필요가 없습니다.

…이것이 DSM-5의 새로운 혁신입니다. 저자들은 걸음마기에서 성인까지, 언어가 유창한 경우에서 비언어적인 것까지, 가벼운 상태에서 심한 상태까지 모든 사람에게 증상을 적용할 수 있게 했습니다. DSM-IV와는 달리 DSM-5에서는 증상을 특정 행동이 "그 기능 능력이 결핍(lack of)"된 것으로 보다는 "그 양이나 질이 부족(deficit in)"한 것으로 봅니다. 따라서 고기능 어린이에 쉽게 적용할 수 있게 되었습니다. 임상의들은 DSM-IV에서 DSM-5로 바뀌며 그들의 예상과 반대로 많은 경우에서 어린이의 진단이 쉬워진 것에 놀랐습니다." 각주8

또한 드라마 『우영우』는 한국의 일상언어에서 말하는 '장애인'의 '장애'와 영어 "disorder"를 구분하지 않습니다. 이것은 매우 심각한 오류입니다. 만약 "disorder"에 해당하는 것을 한국의 일상언어에서 말하는 '장애인'으로 해석한다면 이들을 모두 장애인으로 분류해야 됩니다: 망상 장애(Delusional disorder), 조울증=양극성 장애(Bipolar or related disorders), 우울증=우울 장애(Depressive disorders), 범불안장애(Generalised anxiety disorder), 공황장애(Panic disorder), 사회불안장애 (Social anxiety disorder), 분리불안장애(Separation anxiety disorder), 알코올 유발 불안 장애( Alcohol-induced anxiety disorder), 카페인 유발 불안 장애(Caffeine-induced anxiety disorder), 강박장애(Obsessive-compulsive disorder), 외상후 스트레스 장애 = PTSD (Post traumatic stress disorder), 장기간 슬픔 장애 (Prolonged grief disorder), 불면증=불명장애(Insomnia disorders),  충동조절장애(Impulse control disorders)에 포함되는 도벽(Kleptomania)과 방화광(Pyromania), 성도착증장애(Paraphilic disorders): 지속적이고 집중적인 노출증을 가르키는 진단명 Exhibitionistic disorder, 관음증을 가르키는 진단명 Voyeuristic disorder, 페도필리아를 가르키는 진단명Pedophilic disorder, 상대에게 동의도 받지 않고 지속적이고 집중적으로 신체적 또는 정신적 강압적인 성적인 행위로 고통을 가하는 것=성폭행 을 가르키는 것 Coercive sexual sadism disorder, 공공장소에서  성추행을 하는 성추행범을 가르키는 진단명 Frotteuristic disorder  등등. 공식적인 진단명에 대해서는 다음을 참고하십시오. https://icd.who.int/browse11/l-m/en

이것은 우영우의 작중 설정과도 맞지 않습니다. 우영우는 서울대 로스쿨 수석 졸업이며 영어, 법의학, 법심리학에 상당한 지식이 없을 수가 없으며 실제로 1와 5화에는 상당한 지식이 있는 것으로 묘사됩니다. 그러나 정작 이러한 영어 개념에 대해서는 어떠한 강박적인 구분을 하지 않으며 한국의 일상어에서 사용하는 '장애인' 개념과 혼동하고 있습니다. 

1)"The practice of medicine involves a great heterogeneity of clinical presen tations, and the clinicians’ art rests on the ability to see core manifestations of a given disorder beyond these varied presentations. The prototypes described in textbooks are actually rare, and the modal presentation is aty picality. In this sense, the atypical is the norm. Physicians in most specialties usually have laboratory tests to validate diagnostic decisions, and when a diagnosis remains in doubt, it is common to begin a therapeutic trial in the hope of validating diagnosis by response to treatment." "We have invited eminent clinical scientists to present their views on autism, mood, social anxiety, panic, obsessive-compulsive disorder, post traumatic stress, and schizophrenia, all from a spectrum perspective. Be cause a previous issue of the Psychiatric Clinics of North America was devoted entirely to the bipolar spectrum [5], we have included only two articles in this issue to cover newer developments in the soft bipolar and mood spectrum. The lead article of this issue addresses symptom fluctua tion, psychosocial impact, and public health significance of subthreshold depressions, and the final article attempts to provide an overall perspective to the current status and future of the spectrum concept. Much of psychiatry and clinical psychology can be described as practice on the borders of the major mental disorders. We trust that clinicians—and the makers of DSM-V—will find this collection of articles to be useful for clinical art and science. " Maser, Jack D., and Hagop S. Akiskal. "Spectrum concepts in major mental disorders." Psychiatric Clinics 25.4 (2002) https://doi.org/10.1016/S0193-953X(02)00034-5

2) "Clinical confusion:

Second, the criteria for Asperger syndrome in the DSM-IV are flawed and hard to implement in practice, as highlighted by a number of researchers10,11,12. At least two problems exist: It is often difficult to establish whether single words were spoken before age 2 and phrases by age 3, as required for the Asperger diagnosis. Individuals receiving this diagnosis typically come into the clinic in middle childhood or later, and parental memory may be understandably vague. For the increasing number of people diagnosed in adulthood, the issue is even more problematic.

The other major problem with applying the current DSM Asperger criteria comes from the precedence rule: diagnose Asperger disorder only if the individual doesn’t meet criteria for autistic disorder.

The Asperger diagnosis is distinguished from autism by a lack of language and cognitive delay. However, language and cognitive delay are not diagnostic criteria for autism. So, to fail to meet criteria for autism, a person with Asperger syndrome must not show the communication impairments specified for autism. Since these include “marked impairment in the ability to initiate or sustain a conversation,” most — if not all — people with Asperger syndrome do meet diagnostic criteria for autism.

As a result of these problems, the Asperger diagnosis is often given when, according to DSM-IV criteria, the diagnosis should be autism. A study that examined more than 300 pervasive developmental diagnoses from a survey of more than 400 clinicians shows that almost half the young people receiving Asperger or PDD-NOS labels in fact met DSM-IV criteria for autistic disorder13.

Because the current criteria are hard to apply, different places use the term Asperger disorder differently, and inconsistently. A forthcoming study shows that the best predictor of whether someone receives the diagnosis of Asperger syndrome, PDD-NOS or autism, is which clinic they go to — rather than any characteristics of the individuals themselves14.

Although Asperger syndrome, PDD-NOS and autism are not well distinguished in clinical practice, the same study suggests that the broader distinction between autism spectrum versus not is made with good agreement and reliability.

This is an important factor in the workgroup’s proposal to subsume Asperger syndrome and PDD-NOS into the new category of autism spectrum disorder. The plan is to stop trying to ‘carve meatloaf at the joints’ and instead attempt to individualize diagnosis, while also recognizing the essential shared features of the autism spectrum."

Francesca Happé (Francesca Happé is professor of cognitive neuroscience at the MRC Social, Genetic and Developmental Psychiatry Centre, King’s College London and a member of the American Psychiatric Association’s Neurodevelopmental Disorders Work Group.), Why fold Asperger syndrome into autism spectrum disorder in the DSM-5?, spectrumnews, 29 MARCH 2011,  https://www.spectrumnews.org/opinion/viewpoint/why-fold-asperger-syndrome-into-autism-spectrum-disorder-in-the-dsm-5/

"One of the most important changes in the fifth edition of the Diagnostic and Statistical Manual of Men tal Disorders (DSM-5) is to autism spectrum disorder (ASD). The revised diagnosis represents a new,  more accurate, and medically and scientifically useful way of diagnosing individuals with autism-related  disorders.  

Using DSM-IV, patients could be diagnosed with four separate disorders: autistic disorder, Asperger’s  disorder, childhood disintegrative disorder, or the catch-all diagnosis of pervasive developmental dis order not otherwise specified. Researchers found that these separate diagnoses were not consistently  applied across different clinics and treatment centers. Anyone diagnosed with one of the four pervasive  developmental disorders (PDD) from DSM-IV should still meet the criteria for ASD in DSM-5 or another,  more accurate DSM-5 diagnosis. While DSM does not outline recommended treatment and services for  mental disorders, determining an accurate diagnosis is a first step for a clinician in defining a treatment  plan for a patient. "

American Psychiatric Association, DSM-5-Autism-Spectrum-Disorder, 2013 https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Autism-Spectrum-Disorder.pdf

3)"Among the individual patients there are great variations in the degree of the degree of the disturbance, in the manifestation of specific features, and in the step by step development in the course of time. Yet in spite of this seeming divergence they all present essential common characteristics to such an extent that they cannot but be considered as fundamentally alike from the point of view of psychopathology (Kanner, Citation1944, p. 211)."

James Harris (2018) Leo Kanner and autism: a 75-year perspective, International Review of Psychiatry, 30:1, DOI: https://doi.org/10.1080/09540261.2018.1455646

4)

"Robert F. (described in the earlier paper by Kanner and Eisenberg1956). Worked as a meteorologist in the navy, and was married with a young son. He studied musical composition and had works performed by chamber orchestras."

Howlin, Patricia. Autism and Asperger syndrome: Preparing for adulthood. Routledge, 2004, p.24.

5)

"Since  receiving his A.B. degree in 1958, he has worked in the local bank as a teller. He  is satisfied to remain a teller, having no real desire for promotion. He meets the  public there real well. His chief hobby is golf, playing four or rive rimes a week  at the local country club. While he is no pro, he has six trophies won in local  competition .... Other interests are Kiwanis Club (served as president one term),  Jaycees, Investment Club, Secretary of Presbyterian Sunday School. He is  dependable, accurate, shows ofiginality in editing the Jaycee program informa  tion, is even-tempered but has a mind of Iris own .... He owns lais second car,  likes his independencœ His room includes lais own TV, record player, and many  books. In College his major was French and he showed a particular aptitude for  languages. Don is a fair bridge player but never initiates a game. Lack of  initiative seems to be lais most serious drawback. He takes very little part in  social conversation and shows no interest in the opposite sex. "

"Donald T. (Case 1) and Frederick W. (Case 2) represent the two real success  stories. Donald, because of the intuitive wisdom of a tenant fariner couple, who  knew how to make him utilize his futile preoccupations for practical purposes and at the saine time helped him to maintain contact with his family, is a  regularly employed bank teller; while living at home, he takes part in a variety of  community activities and has the respect of lais fellow townspeople. Frederick  had the benefit of a similarly oriented arrangement in the framework of the  Devereux Schools, where he slowly was introduced to socialized pursuits via lais  aptitude for music and photography. In 1966, his parents took over. He was  enrolled in a sheltered workshop and received vocational training, learning to run  duplicating machines. He has now a regular job and is reported by his chief as  "outstandingly dependable, reliable, thorough, and thoughtful toward fellow  workers." "

Kanner, Leo. "Follow-up study of eleven autistic children originally reported in 1943." Journal of autism and childhood schizophrenia 1.2 (1971):122, 143-144. https://doi.org/10.1007/BF01537953

6)

"First, the idea that Asperger tried to protect autistic children from Nazi race hygiene cannot be easily reconciled with the fact that he dedicated a section of his 1944 paper to the hereditary basis of the condition, insisting that “any explanation based on exogenous factors is absurd”. While this position anticipated later advances in autism research, the question arises whether under the circumstances it was prudent to put such an emphasis on heredity. Had protecting his autistic patients been his primary goal, he could have taken a more flexible position, one less likely to draw the attention of race hygienists to his patients ([2]: 128–32).

Second, his prognoses for the “autistic psychopaths” were far from universally optimistic. In his 1938 paper “The Mentally Abnormal Child,” he presented two boys. One boy was “intelligent far beyond his age” but suffered from mental and physical “oversensitivities” (no link to autism). The other represented the first case of an “autistic psychopath” in medical literature. Like the first boy, he exhibited “a contrast between pathological and in some ways valuable traits,” but as Asperger insisted, he suffered from a “profound disorder of the personality.” In this article, Asperger did not highlight the potential of “autistic psychopaths” but rather contrasted them unfavorably with other, less impaired patients. Even if the boy Asperger chose as an example of “autistic psychopathy” clearly belonged to the “high-functioning” group, Asperger emphasized that the condition varied greatly in terms of “social prognosis” and “worthiness.” While he deemed some of the “autistic psychopaths” capable of “great intellectual achievements,” in other cases, “autistic originality” was deemed “bizarre, eccentric, and useless”, with “fluid transitions towards schizophrenia” whose “main characteristic is also autism, the loss of any contact with the surroundings” [1]. The four boys featuring in his better known 1944 paper also varied considerably regarding the degree of their impairments, belying the notion that he focused on the most promising cases in order to present “autistic psychopathy” in a mostly favorable light. Fritz had (for his age) outstanding abilities in mathematics, but was incapable of attending regular school, having passed the first three school years by homeschooling. Harro’s autistic symptoms were less severe, but despite his good intellectual potential, he also had great difficulties concentrating and learning in the traditional school setting. The best hope for “autistic psychopaths,” according to Asperger, was to find a way to compensate for the lack of “instinctive social adaptation” via the intellect. The problem was, however, that the “autistic character” also occurred in the “intellectually lesser able, and even in the severely feeble-minded” ([2]: 85–103). In the case of Ernst, Asperger expressed “doubt whether he was particularly smart or feeble-minded” (he struggled to keep up even in special school). But, as Asperger insisted, there were “numerous clearly feeble-minded children who also exhibited the unmistakable features of the autistic psychopath” ([2]: 108). These latter cases, according to Asperger, were often very similar to conditions caused by organic brain damage such as birth trauma. He illustrated this with the fourth case in his study, Hellmuth, whom he described not as an “autistic psychopath” but as an “autistic automaton” ([2]: 110–1)."

Czech, Herwig. "Hans Asperger, national socialism, and “race hygiene” in Nazi-era Vienna." Molecular autism 9.1 (2018) https://doi.org/10.1186/s13229-018-0208-6

"It was a great pleasure to me that I was able to meet Dr Asperger when he visited London, even though we disagreed because he thought his syndrome was separate from Kanner's autism and I thought it was part of the spectrum."

Wing, Lorna. "The history of ideas on autism: legends, myths and reality." Autism 1.1 (1997) p.19. https://doi.org/10.1177/1362361397011004

"Asperger clearly distinguished his subjects from Kanner’s early infantile autism, whom he viewed as a form of infantile psychosis. In discussion with Lorna Wing, Asperger did not accept the term autism spectrum disorder she proposed, but always maintained that his personality spectrum disorder was distinct (Donvan & Zucker, Citation2016)."

James Harris (2018) Leo Kanner and autism: a 75-year perspective, International Review of Psychiatry, 30:1, DOI: https://doi.org/10.1080/09540261.2018.1455646

7) 자세한 건 다음 논문을 정독할 것 Czech, Herwig. "Hans Asperger, national socialism, and “race hygiene” in Nazi-era Vienna." Molecular autism 9.1 (2018) https://doi.org/10.1186/s13229-018-0208-6

Czech, Herwig. "Response to ‘Non-complicit: revisiting Hans Asperger’s career in Nazi-era Vienna’." Journal of autism and developmental disorders 49.9 (2019) https://doi.org/10.1007/s10803-019-04106-w

Czech, Herwig. "Response to Tatzer et al: Their paper on what Asperger knew about Nazi ‘child euthanasia’does not provide a rigorous assessment of the available evidence." Acta Paediatrica 112.5 (2023) https://doi.org/10.1111/apa.16730

8) 샐리 오조노프, 제랄딘 도슨, 제임스 C. 맥파트랜드 지음 ; 조성연 옮김, 『고기능 자폐 스펙트럼 장애 부모 가이드 : 자녀가 어려움을 극복하고 성공적인 삶을 살도록 돕는 방법』, 서울 : 삶과지식, 2019, 40-43.