Journal of Human Behavior in the Social Environment, 19:298–313, 2009

Copyright © Taylor & Francis Group, LLC

ISSN: 1091-1359 print/1540-3556 online
DOI: 10.1080/10911350902790720

An Exploratory Study of the Stigma Associated

With a Diagnosis of Asperger’s Syndrome:
The Mental Health Impact on the Adolescents
and Young Adults Diagnosed With a
Disability With a Social Nature

OREN SHTAYERMMAN
New York Institute of Technology, School of Health Professions,
Behavioral and Life Sciences, Old Westbury, New York

The purpose of this exploratory study was to examine how ado-

lescents and young adults diagnosed with Asperger’s syndrome
(AS) perceived their diagnosis and whether they feel stigmatized.
The study also examined how stigma is related to mental health
diagnoses (major depressive disorder, generalized anxiety disor-
der). A cross-sectional study using a self-administrated mail ques-
tionnaire and a Web-based questionnaire were used to collect
data. The two samples selected for this study included a snowball
sampling, starting with parents of adolescents and young adults
diagnosed with AS who participated in a qualitative study con-
ducted in 2002. A second sample consisted of a volunteer sample
of parents who visited Web sites for parents and individuals diag-
nosed with autism spectrum disorder. The total sample included 10
adolescents and young adults diagnosed with AS. Level of stigma
was significantly and negatively correlated with severity of AS
symptomatology. Of the sample, 20% met criteria for a diagnosis
of major depressive disorder and 30% met criteria for generalized
anxiety disorder.

KEYWORDS Stigma, Asperger’s syndrome, autism, mental health,

social work

Address correspondence to Dr. Oren Shtayermman, New York Institute of Technology,

School of Health Professions, Behavioral and Life Sciences, Kenneth Riland, Room 348, Old
Westbury, NY 11568-8000. E-mail: oshtayer@nyit.edu

298
 Stigma Associated With Diagnosis of Asperger’s Syndrome 299

INTRODUCTION

According to the Diagnostic and Statistical Manual of Mental Disorders (4th

ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000), a diagno-
sis of Asperger’s syndrome (AS) is characterized by poor verbal and nonver-
bal communication, lack of social or emotional reciprocity, and a failure to
develop friendships. AS, also known in the literature as Asperger’s disorder,
is a neurocognitive disorder and is the mildest form of autism spectrum
disorders (Bauer, 1996). Persons diagnosed with AS are considered in a social
context as odd, innocent, emotionally detached from others, and having re-
duced nonverbal communication skills (Wing, 1998). Asperger (1944) stated
that no two people with AS are alike. In addition, individuals diagnosed
with AS had unusual ways of perceiving and conceptualizing the internal
and external environment. Adolescents and young adults diagnosed with AS
may find the social demands and transitions of adolescence more challenging
because of their lack of social reciprocity in addition to their awareness that
their peers thrive from the new social opportunities (Tantam, 2000).

LITERATURE REVIEW

Concepts of Stigma Theory

According to Goffman (1963), the term stigma was used in the past to refer
to physical marks that indicated the moral status of the signifier. Such signs
were burned or cut into one’s body, publicizing that a person was a slave, a
criminal or a conspirator. Goffman suggested that the term could also be used
to refer to an attribute that makes a person different from others. Goffman
distinguished between experiencing a stigma owing to a visible disability or
a hidden disability (Riddick, 2000). When discussing stigma, Goffman noted
that there are three types of stigma. First, there are the abominations of the
body. Second, there are blemishes of individual character perceived as weak
that are inferred from known record, such as a mental disorder, addiction, or
homosexuality. Finally, there are the tribal stigmas of race, nationality, and
religion.
Stigmatization of individuals diagnosed with developmental disabilities.
Stigmatized persons can be defined as persons who possess a quality that
others perceive as negative, unfavorable, or in some way unacceptable. Ex-
amples of such individuals include individuals diagnosed with mental retar-
dation, mental illness, or physical disabilities. The more visible, troublesome,
and visually disturbing the mark or qualities, the more powerful is the stigma
associated with having it (Westbrook, Bauman, & Shinnar, 1992). When indi-
viduals are diagnosed with a disability or chronic illness, they may experience
stigmatization as a result of their diagnosis or condition (Martz, 2004).
300 O. Shtayermman

Mor and Berkson (2003) noted that people develop impressions of

others who are influenced by the physical characteristics and nonverbal
behaviors of others around them. Moreover, people often use movement
cues of others when forming impressions of others, and an individual’s
responses and perceptions to physical cues may also serve as a basis for the
construction of stereotypes and for social interactions (Mor & Berkson). Body
rocking is one of the more common repetitive behaviors of an individual with
Autism Spectrum Disorders. Mor and Berkson found that people make more
negative trait inferences about people who engage in body rocking than they
do about those who do not.
An abnormally high rate of stenotypes or a repetition of an invariant se-
quence of behavior can be found in a number of populations diagnosed with
mental retardation, hearing impairment, and autism (Willemsen-Swinkels,
Buitelaar, Dekker, & van Engeland, 1998). There are several signs that indi-
cate that stereotypical behavior impact the child’s development. Stereotype is
a prevalent behavior of individuals with autism spectrum disorders (Militerni,
Bravaccio, Falco, Fico, & Palermo, 2002). It is defined as the cycle of repet-
itive movements that have no apparent consequences for the individual
who is emitting them (Nuzzolo, Leonard, Ortiz, Rivera, & Greer, 2002). The
repetitive behavior is part of the criteria for the diagnosis of autism spectrum
disorders (DSM-IV-TR, 2000). The current diagnostic systems for autism spec-
trum disorders are generally including categorization of repetitive behaviors
into four subgroups: (1) stereotyped motor mannerisms, (2) preoccupation
with nonfunctional objects or parts of objects, (3) patterns of interest that are
unusual in the narrowness and/or intensity of their pursuits, and (4) extreme
rigidity and insistence on sameness. All of these categories share the qualities
of being unusual, persistent, and stereotyped (South, Ozonoff, & McMahon,
2005).
Stigma and mental health. Currently, only two empirical studies have
examined the role of perceived stigma in psychological disturbance (Arnston,
Dorge, Norton, & Murray, 1986; Hermann, Whitman, Wyler, Anton, & Van-
derzwagg, 1990). Both studies found that perceived stigma was correlated
with mood disorders and low self-esteem. These studies, however, did not
use a theoretical framework to guide their research. Feldman and Crandall
(2007) noted that the more the individuals diagnosed with mental illness feel
stigmatized, the lower their self-esteem.
Stigma theory also focuses on the behaviors, perceptions, beliefs, and
development of the social and psychological self of stigmatized persons
(Westbrook et al., 1992). Because stigma arises when an individual differs
from the dominant social norms in relation to a particular domain, the
person’s whole identity is defined by that domain, and the individual is
being dehumanized by those who hold such views (Jahoda & Markova,
2004). According to Mead (1934), the key mechanism in the development of
self is through the process of reflecting upon how one is treated by others,
also known as ‘‘self looking glass’’ (Scheff, 2005). During the process of
 Stigma Associated With Diagnosis of Asperger’s Syndrome 301

socialization, one becomes aware of self through the evaluative behavior

of others. Self-consciousness involves continually monitoring self from the
point of view of others. Becoming aware that one is stigmatized will threaten
the individual’s sense of well-being.
Stigmatization of disabilities could have a powerful impact on the in-
dividual diagnosed with developmental disability. Both private and pub-
lic views of individuals with mental illness and disabilities remain largely
negative (Addison & Thorpe, 2004; Dagnan & Waring, 2004). Abraham,
Gregory, Wolf, and Pemberton (2002) indicated that self-esteem is nega-
tively correlated with stigma. In an investigation of the relationship between
stigma and the self-esteem of adolescents with epilepsy, Westbrook et al.
(1992) found that stigma and self-esteem are related to the seizure type and
length. Moreover, it was suggested by Martz (2004) that individuals with a
disability might internalize other people’s stigmatizing opinions of them. As
a consequence, the disability and the stigmatization will create difficulty for
the individual to accept himself or herself. In addition, the devaluation of
an individual’s character can also lead to feelings of isolation and separation
from one’s community. Such an individual may even experience social death,
which corresponds to the ending of one’s social identity (Martz). Stigma is
often mentioned as a risk factor for poor psychological health (Westbrook
et al., 1992). Children begin to classify those with a disability and those
without a disability at age 5 years (Cunningham & Glenn, 2004). At the age
of 8 years, children will make a shift from the physical to the social and
psychological aspects of the disability and will attach value judgments to an
individual diagnosed with developmental disability based on their experi-
ence and the attitudes of others (Cunningham & Glenn, 2004). Gray (1993)
indicated that there are unusual aspects of autism that make normal social
interaction difficult and that are significant in terms of stigma, particularly the
large discrepancy between the normal appearance of a child diagnosed with
autism and the severity of the child’s disability. This fact has special relevance
for individuals diagnosed with AS, as most social interactions begin at the
age of 6 when children enter the education system and are interacting with
their peers on a daily basis. Individuals diagnosed with AS may become
more aware of their social differences as they enter their adolescence; some
may notice their differences even earlier and because of stigmatization from
their peers they may be at risk for poor psychological health. (Please refer
to the conceptual model, Figure 1.)

METHODS

Study Design
This was an exploratory study with a descriptive and an associational pur-
pose. A cross-sectional design was used to study adolescents and young
302 O. Shtayermman

FIGURE 1 Conceptual Model

adults ages 15 to 24 years old who have been diagnosed with AS. Self-
administrated questionnaires were completed by the adolescents and one
parent either via a mail survey or completed as a Web-based survey. The
design had backward directionality and retrospective timing. The strengths of
this design were that both the child and parent were respondents, resulting
in more accurate data from the person who can best report on each measure.
 Stigma Associated With Diagnosis of Asperger’s Syndrome 303

The age and cognitive abilities of this population and the measures selected,
were appropriate for this method of data collection. The design allowed for
collecting data from a much larger sample than would have been possible
if interviews were conducted at a lower cost and in a briefer time period.
The weakness of the design was that it did not include a control group of
adolescents and young adults without AS to compare the differences in the
levels of suicidal ideation with study subjects.

Sampling Plan
The target population is adolescents and young adults in the United States
ages 15 to 24 years old who were diagnosed with AS by a mental health
professional. The unit of analysis was the individual adolescent with AS.
Two different samples were selected and combined into a single sample for
the purposes of analysis: (1) a snowball sample based on participants in a
focus group for parents of children with AS and (2) parents of children who
accessed Web sites for parents of children with AS.
Inclusion criteria for adolescents and young adults were age 15 to
24 years and having a diagnosis of AS as determined by a mental health pro-
fessional. The researcher determined whether the adolescent met eligibility
criteria by verifying the information with the parent by phone or E-mail. The
inclusion criterion for parents was sufficient familiarity with the adolescent to
complete the questionnaire. The researcher determined whether the parent
met the eligibility criterion during the first phone contact or by email.

Measures
Level of stigma related to having AS was measured by asking the five ques-
tions following, each of which had response categories of yes and no:

1. Do you think that having Asperger’s syndrome sometimes affects whether

people want to be friends with you?
2. Do you think that having Asperger’s syndrome sometimes affects whether
people like you or do not like you?
3. Do you think that having Asperger’s syndrome sometimes affects whether
or not you are asked to go out on dates?
4. Do you think that having Asperger’s syndrome sometimes affects whether
or not you are asked to or come to a party?
5. Do you think your family treats you differently because you have As-
perger’s syndrome?

Two comorbid disorders in this study were major depressive disorder

and generalized anxiety disorder. These comorbid disorders were measured
304 O. Shtayermman

using the Patient Health Questionnaire for Adolescents (PHQ-A). The PHQ-A
is a self-report measure that assesses mood, anxiety disorder, and other disor-
ders in adolescent primary care patients (Johnson, Harris, Spitzer, & Williams,
2002). The PHQ-A was designed to quickly obtain data to determine whether
it is or is not probable that an adolescent respondent currently has an anxiety
or depression disorder.
Severity of AS symptomatology was measured by using the Krug As-
perger’s Disorder Index (KADI; Krug & Arick, 2003), which indicated the
severity of AS symptomatology. The KADI is a 32-item index that has been
standardized for use with individuals 6 through 21 years of age (Krug &
Arick). The KADI includes 32 items presented in two groups. Several sam-
ples were used to obtain data for the normative values, including (1) 130
individuals diagnosed with AS from 32 states in the United States and 10
countries around the world; (2) 162 individuals diagnosed with high func-
tioning autism from 32 U.S. states and 10 countries around the world; and (3)
194 individuals from Oregon and Washington States as the ‘‘normal’’ sample
(Krug & Arick). The Cronbach’s alpha for the KADI was .93 in a sample of
130 individuals diagnosed with AS (Krug & Arick). Additional psychometric
properties for the KADI in a sample of 103 individuals diagnosed with AS
were sensitivity D 78%; specificity D 94%; and positive predictive power D
83% (Krug & Arick). According to Campbell (2005), the KADI represents the
best measure of AS based on its psychometric properties when compared
to four other measures of AS, including the Asperger’s Syndrome Diagnostic
Scale, the Gilliam Asperger’s Disorder Scale, the Autism Spectrum Screening
Questionnaire, and the Childhood Asperger’s Screening Test.
Peer victimization was measured using the Social Experience Ques-
tionnaire (Crick & Grotpeter, 1996). This measure is a summated rating
scale and had three subscales that measured overt victimization, relational
victimization, and recipient of prosocial behaviors. Each of the subscales
had 5 items, and the total scale has 15 items. Examples of items in the
overt victimization subscale are ‘‘How often do you get hit by another kid
at school?’’ and ‘‘How often does another kid yell at you and call you mean
names?’’ Examples of items in the relational victimization subscale are ‘‘How
often do other kids leave you out on purpose when it is time to play or do
an activity?’’ and ‘‘How often does a kid who is mad at you try to get back
at you by not letting you be in their group anymore?’’ Examples of items in
the recipient and prosocial behavior subscale are ‘‘How often does another
kid try to cheer you up when you feel sad or upset?’’ and ‘‘How often
does another kid give you help when you need it?’’ Response categories
ranged from 1 (never) to 5 (all of the time). The theoretical range for the
peer victimization scale was 15 to 75. Higher scores indicated more severe
victimization. Test-retest reliability over a 4-week interval was .90 in a sample
of 474 third- through sixth-grade children from four public schools in a
moderately sized midwestern town. Cronbach’s alpha for the subscales was
 Stigma Associated With Diagnosis of Asperger’s Syndrome 305

.76 for the overt victimization subscale, .86 for the relational victimization
subscale, and .76 for the recipient of prosocial behaviors subscale (Crick &
Grotpeter).

RESULTS

Clinical Characteristics of the Adolescents and

Young Adults
The clinical characteristics of the adolescents and young adults diagnosed
with AS are shown in Table 1. Twenty percent met the diagnostic criteria for
major depressive disorder and thirty percent met the diagnostic criteria for
generalized anxiety disorder. Scores on the overt victimization and relational
victimization scales were relatively high with respect to the cutoff points for
the overt and relational victimization subscales of 3.9 and 4.3, respectively
(Crick & Bigbee, 1998).
The mean age at first diagnosis was 11.8 (standard deviation [SD] D 5.0).
Of the sample, 44.4% (n D 4) were given a diagnosis by a child psychiatrist.
The adolescents and young adults in the sample had a mean score of 52.6
(SD D 11.3) on the Krug Asperger’s Disorder Index. Two-thirds of the sample
had additional psychiatric diagnoses including anxiety disorder, depression,
bipolar disorder, nonverbal learning disability, and obsessive-compulsive
disorder (n D 6), and a majority of the sample (55.6%; n D 5) were given AS
as the first psychiatric diagnosis. The majority of the sample were consuming
prescription or over-the-counter medications (88.9%; n D 8) and had an
average of 2.4 (SD D 2.0) number of total services received.

Sociodemographic Characteristics of the Adolescents and

Young Adults with AS
The sociodemographic characteristics of the adolescents and young adults
diagnosed with AS are shown in Table 1. Ninety percent of the sample were
males (n D 9), and the mean current age was 19.7 years (SD D 3.0). All
participants identified themselves as white. The majority of the sample were
living with both biological parents in the same household. The 40% who
were employed worked, on average, 21 hours a week, and all earned less
than $20,000 a year. Only 22.2% did volunteer work, and they did this, on
average, for 1.33 hours a week. The mean number of close friends reported
by the adolescents and young adults was 3.1 (SD D 2.3), and those reported
by the parents was 1.4 (SD D 1.5). There were 30% who had a bachelor’s
degree. Owing to the small sample size, it is not possible to compare the
similarities and differences of these snowball and volunteer samples with
respect to study variables.
306 O. Shtayermman

TABLE 1 Clinical and Sociodemographic Characteristics of Adolescents and Young Adults

Percent or
Characteristic No. Mean (SD)

Major depressive disorder 10 20.0%

Depressive symptomatology (theoretical range D 0 to 11, cutoff point 3 21.4%
for clinically significant symptomatology D 5)
Generalized anxiety disorder 10 30.0%
Anxiety symptomatology (theoretical range D 0 to 9, cutoff point for 3 21.4%
clinically significant symptomatology D 6)
Degree of peer victimization
Recipient of prosocial behavior 10 14.1 (4.7)
Relational victimization 10 13.2 (5.7)
Overt victimization 10 11.1 (3.9)
Total victimization 10 38.4 (5.3)
Level of stigma 10 3.0 (2.0)
Current age 10 19.7 years old (3.0)
Age at first diagnosis 9 11.8 years old (5.0)
Severity of AS symptomatology (theoretical range D 0 to 92, cutoff 8 52.6 (11.3)
point for clinically significant symptomatology D 18)
AS diagnosis 8 100%
Professional who gave AS diagnosis
Child psychiatrist 4 44.4%
Other 3 33.3%
Psychologist 1 11.1%
Has additional psychiatric diagnoses
Yes 6 66.7%
No 3 33.3%
AS was first psychiatric diagnosis given
Yes 5 55.6%
No 4 44.4%
Takes prescription or over-the-counter medication
Yes 8 88.9%
No 1 11.1%
Number of services received 9 2.4 (2.0)
Educational setting
Special education school 2 22.2%
Inclusive class 1 11.1%
Other 6 66.7%
Highest level of education
Less than high school diploma 3 30.0%
High school diploma or GED 1 10.0%
Some college 3 30.0%
Bachelor degree 3 30.0%
Living situation
With both biological parents in the same house 7 77.8%
With both biological parents in joint custody 1 11.1%
Other 1 11.1%
Employment status
Employed 4 40.0%
Not employed 6 60.0%
Number of hours a week works at a paying job in the past month 4 21.0 hours (1.1)
Does volunteer work
Yes 2 22.2%
No 8 77.8%
Number of hours a week of volunteer activity in the past month, among 2 1.3 hours (2.6)
those who do volunteer work

Note. AS, Asperger’s syndrome.

 Stigma Associated With Diagnosis of Asperger’s Syndrome 307

Sociodemographic Characteristics of the Parent

The sociodemographic characteristics of the parents are shown in Table 2.
Most of the parents reported that their household income was between
$50,000 and $100,000 a year. Almost half of parents who participated in
the study were not employed, and the majority had a bachelor’s degree. In
this sample, 44.4% of the second parent had a master’s degree. All of the
parent respondents were living with the adolescent or young adult with AS
full-time. In this sample, 11.1% of the families had two children ages 12 and
younger at home, 22.2% of the families had two children ages 13 to 17 years
old, and 22.2% of the families had two young adults ages 18 to 20 living at
home.

TABLE 2 Sociodemographic Characteristics of Parents

Characteristic No. Percent

Household income
$50,001–$100,000 7 77.8
More than $100,000 2 22.2
Employment status of parent completing survey
Not employed or homemaker 4 44.4
Employed part time 2 22.2
Employed full time 2 22.2
Retired 1 11.1
Level of education of parent completing survey
High school diploma or GED 1 11.1
Bachelor’s degree 7 77.8
Other 1 11.1
Level of education of other parent
High school diploma or GED 1 11.1
Some college 1 11.1
Bachelor’s degree 2 22.2
Master’s degree 4 44.4
Doctorate or J.D. degree 1 11.1
Number of persons in the household
Children age 12 and younger (at least 2 children) 1 11.1
Children age 13–17 (at least 2 children) 2 22.2
Young adults age 18–20 (at least 2 young adults) 2 22.2
Adults age 21 and older (at least 2 adults) 4 44.4
Number of children in household age 17 or younger with 1 11.1
an autism spectrum disorder (at least 2 children)
Number of persons in household age 18 or older with 4 44.4
autism spectrum disorder (at least 1 person)
Amount of time child with AS lives with parent
Full time 9 100.0

Note. AS, Asperger’s syndrome.

308 O. Shtayermman

Bivariate Analysis Between Level of Suicidal Ideation and

the Independent Variables
Table 3 presents the bivariate correlation between pairs of the interval level
variables. There was a strong negative correlation between level of suicidal
ideation and severity of AS symptomatology. Although none of the other
correlations between level of suicidal ideation and other variables was statis-
tically significant, there were moderate to strong correlations between level
of suicidal ideation and current age, age at diagnosis, level of depressive
symptoms, degree of total peer victimization, and level of stigma.
Owing to the small sample size and low statistical power, associations
between variables that appeared to be meaningful were not statistically
significant, with the exception of the association between level of depressive
symptoms and level of anxiety symptoms. Consequently, the focus will
be on patterns in the data that might be useful as pilot data for future
studies. Although not statistically significant, those who met criteria for major
depressive disorder had a lower level of suicidal ideation than those who
did not meet criteria for this disorder.
Participants who did not meet criteria for major depressive disorder
had a mean suicidal ideation score that was well above the cutoff point for
clinically significant suicidal ideation. The mean level of suicidal ideation
was only 6.33 points higher for those who met diagnostic criteria for gener-
alized anxiety disorder as compared with those who did not meet criteria,
and both groups were well above the cutoff point for clinically significant
suicidal ideation. There was a strong positive correlation between number
of depressive symptoms and number of anxiety symptoms (r D .790; p D
.007). There was also a strong correlation between age and age at diagnosis,
although this was not significant (r D .852).

Bivariate Analysis of Relationships Between the

Independent Variables
As indicated by Table 3, there was a strong negative correlation between
the severity of AS symptomatology and current age (r D .97; p D .001).
There was also a strong positive correlation between current age and (1)
degree of total peer victimization (r D .71; p D .02); (2) overt victimization
(r D .90; p D .001); and (3) relational victimization. Prosocial behavior was
strongly and negatively correlated with age (r D .76;, p D .001). Severity of
AS symptomatology was strongly negatively correlated with degree of total
degree of peer victimization (r D .88; p D .001), relational victimization (r D
.99; p D .001), and overt victimization (r D .99; p D .001) and strongly
and positively correlated with prosocial behavior (r D .96; p D .001). AS
symptomatology was strongly and negatively correlated with level of stigma
(r D .99; p D.001).
 TABLE 3 Correlation Between Level of Stigma With Clinical Characteristics, Comorbid Disorders, and Psychosocial Factors

1 n 2 n 3 n 4 n 5 n 6 n 7 n 8 n 9 n 10 n

1. Level of suicidal ideation 1.0

10
2. Current age .25 1.0
10 10
3. Age at diagnosis .67 .85 1.0
5 5 9
4. Severity of AS symptoms .88* .97** .03 1.0
5 5 8 8
5. Level of depressive symptoms .40 .01 .56 .48 1.0
10 10 5 5 10
309

6. Level of anxiety symptoms .20 .06 .25 .03 .79** 1.0

10 10 9 8 10 10
7. Degree of total peer victimization .30 .71* .30 .88* .17 .25 1.0
10 10 5 5 10 10 10
8. Degree of overt victimization .20 .90** .64 .99** .25 .23 .91** 1.0
10 10 5 5 10 10 10 10
9. Degree of relational victimization .11 .67* .35 .88* .48 .56 .92** .89* 1.0
10 10 5 5 10 10 10 10 10
10. Degree of prosocial behavior .03 .76** .74 .96** .60 .59 .76* .89* .91* 1.0
10 10 5 5 10 10 10 10 10 10
11. Level of stigma .56 .10 .77 .99** .23 .12 .12 .13 .15 .16
10 10 5 5 10 10 10 10 10 10

Note. AS, Asperger’s syndrome.

*p  .01; **p  .001
310 O. Shtayermman

TABLE 4 Association Between Employment Status and Clinical Characteristics, Comorbid

Disorders, Victimization, Stigma, Current Age, and Age at Diagnosis

Employment status

Employed Not employed

% or % or p
Characteristic No. Mean (SD) No. Mean (SD) Value

Level of suicidal ideation 4 81.2 (54.8) 6 34.0 (34.9) .13

Severity of AS symptoms 2 38.0 (0.0) 3 61.0 (6.9) .02*
Major depressive disorder .46
Yes 0 0.0% 2 20.0%
No 4 40.0% 4 40.0%
Level of depressive symptoms 4 1.5 (3.0) 6 3.5 (2.6) .30
Generalized anxiety disorder .20
Yes 0 0.0% 3 30.0%
No 4 40.0% 3 30.0%
Level of anxiety symptoms 4 2.0 (.8) 6 5.1 (2.9) .07
Degree of overt victimization 4 12.2 (2.0) 6 10.3 (4.9) .48
Degree of relational victimization 4 12.2 (3.7) 6 13.8 (7.0) .69
Degree of prosocial behavior 4 14.2 (1.8) 6 14.0 (6.1) .94
Degree of total peer victimization 4 38.7 (3.9) 6 38.1 (6.4) .87
Level of stigma 4 3.7 (2.5) 6 2.5 (1.6) .36
Current age 4 21.2 (2.3) 6 18.6 (3.2) .21
Age at diagnosis 2 15.0 (0) 3 8.3 (2.5) .03*

Bivariate Analysis of Relationships Between Employment

Status and Other Variables
Current age and employment status were not associated (Table 4). The
mean age of working adolescents and young adults with AS was 15 years
at diagnosis (SD D 0). The mean age for those who were not working was
8.3 years at diagnosis (SD D 2.5); however, this difference was not significant.
As shown in Table 4, adolescents and young adults diagnosed with AS who
were employed had a mean AS symptomatology score of 38.0 (SD D 0) and
those who were not employed had a score of 61.0 (SD D 6.9); this difference
was significant. There was no association between employment status and
any of the other independent variables.

DISCUSSION

Peer Victimization and Stigma

Owing to the small sample size, the correlation between degree of peer vic-
timization and suicidal ideation could not be tested. Many of the adolescents
and young adults in this study reported a high level of peer victimization.
Young adults had a higher mean level of victimization compared with the
 Stigma Associated With Diagnosis of Asperger’s Syndrome 311

adolescents in the study. This could be due to the higher level of attention
received from parents and teachers during adolescence as compared with
the young adults and by the lower level of victimization. The finding that AS
symptomatology had a very strong negative correlation with the victimization
measures may be because the adolescents and young adults with fewer AS
symptoms receive less attention from teachers because they are considered
high-functioning and therefore are at greater risk for victimization. The posi-
tive correlation between severity of AS and prosocial behavior could be due
to more awareness regarding autism in the general population.
The high proportion of respondents with scores above the cutoff point
on the overt victimization and relational victimization scales suggests that
these adolescents and young adults experienced high levels of victimization.
As peer victimization is considered a proximal risk factor for suicidal ideation,
there is a possibility that the adolescents and the young adults diagnosed
with AS who participated in this study did not have distal risk factors that
would increase their vulnerability to present with elevated levels of suicidal
ideation.
The correlation between level of stigma and level of suicidal ideation
was not tested in this study owing to small sample size. Stigma theory
(Goffman, 1963) suggests that the more visible or troublesome the mark
or quality of the individual, the more stigmatized the individual may feel
(Westbrook et al., 1992). The adolescents and young adults in this study may
not have been the targets of high levels of stigmatization owing to their low
AS symptomatology. The questions regarding level of stigma were all related
to having a diagnosis of AS and not the symptoms related to the diagnosis of
AS. Goffman has suggested that stigma due to a diagnosis or a label is related
to the concept of hidden disability (Riddick, 2000). If the adolescents and
young adults who participated in this study were high-functioning owing
to the very low severity of their AS symptomatology, the levels of stigma
experienced could be due to the label of having the diagnosis and not as a
result of symptoms.

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