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Not only did research efforts increase, the numbers of cases increased massively too. All this went hand in hand with the increase in the awareness of autism and the widening of the boundaries of the autism spectrum. From the s Asperger syndrome became a familiar label. The prototype of Asperger syndrome is the highly intelligent individual who has social impairments as well as abstruse interests.
This new prototype was soon mixed up with older stereotypes of the mad genius. An idea that took off at amazing speed was that many of us, and men in particular, have autistic features. Namely, they lack social sensitivity and have obsessive interests. This is one of the questions that now need to be resolved. At the feet of the great pioneers To me it feels that I have experienced a large part of this history personally during my own life.
I have taken on board the changes in the concept of autism and have observed the huge increase in numbers of children and adults diagnosed autistic. From being unknown and obscure, autism has become a familiar topic. He taught me and several generations of students about fundamental issues of normal and abnormal development. His thinking shaped the concept of autism and spread awareness. Lorna Wing was another of my mentors. As a mother of an autistic daughter she had intimate knowledge of autism.
I could not hear enough about her experience and her then very revolutionary ideas about the disorder. At the same time she became aware that social impairment comes in different varieties—the aloof, the passive, and the odd. Their ultimate aim was to link behaviour to the brain, and therefore they adapted the methods of neuropsychology for the study of children. They established a method to study impairments in cognitive abilities, such as language, perception, and memory. They realized that differences are only interesting if you can relate them to expected similarities.
For example, they found that autistic children who remembered jumbled up words as well as other children did worse than other children when remembering whole sentences. This proved an important clue to unlocking the enigma of their minds.
Apart from these professional mentors, I have always learned a The changing face of autism great deal from parents of autistic children.
The earliest biographical account that I read was by Clara Claiborne Park. It was a revelation. Parents are the real heroes in the history of autism. My personal heroine is Margaret Dewey, the mother of a highly talented autistic son, with whom I have corresponded for decades.
The awareness of autism in the s and s was still very low. This school was led by a gifted teacher, Sybil Elgar. She carefully observed what each individual child was capable of learning, gave clear and simple instructions, used visual aids, and encouraged physical exercise.
I often visited this school. They resembled the cases described by Kanner and Asperger in astonishing detail. Many did not talk but had some words or phrases that were copied from the adults around them. All had rather low measured IQ, but at the same time many of them showed remarkable talents. One girl had a beautiful singing voice, one boy painted marvellous pictures, another, who was unable to speak, had an astonishing knowledge of prime numbers.
Nevertheless, it became clear that these children would need support throughout their life. Urgent practical questions: what to do about the children? At the time virtually nothing was known about what would happen when the autistic child grew up. Now we know that Autism autistic children become autistic adults. The development of appropriate education for children with autism and mental retardation—who often had quite challenging behaviour—was of the highest priority.
Simply put, desired behaviour is rewarded while undesired behaviour is ignored and the reward is withheld. If such a regime is applied systematically, the desired behaviour increases and the undesired behaviour decreases. The success of these methods in managing some appalling problems, for example self-injury through constant head banging, made them acceptable and even popular.
Ivar Lovaas founded a movement in California where his methods have been gradually developed into what is now known as ABA, or Applied Behavioural Analysis. But less intensive variants seem to be just as successful, as are variants that emphasize warm emotional contact with the child. All these variants can produce amazing changes. Behaviour can be reinforced even when it is as yet barely present. For instance, parents described to me how over the course of six weeks their little son gradually learned to speak.
Soon he was able to make some few whispered sounds. Eventually he broke through into producing a syllable, then a word. This seemed like a miracle to them, but it is an often repeated one. There are other approaches that are geared to compensation and coping strategies rather than to shaping and changing behaviour.
His approach emphasizes a highly structured timetable and uses pictures in a concrete and at the same time imaginative way. You can see the typical visual aids, depicting a series of activities laid out in a clear timetable in almost all schools for autistic children, but also in centres for autistic adults. The child or adult knows that they can always check their own timetable to know where they are in the course of the day and what to do next.
This has an enormously reassuring effect and acts as a vital scaffold to organize work and leisure. The many faces of autism Once upon a time it used to be assumed that autism almost always went together with learning disability, or mental retardation, both terms indicating brain pathology associated with low measured IQ.
Recent studies have changed this view. At present the diagnosis of autism combined with low intellectual ability is made in about 50 per cent of cases, and in 50 per cent is combined with average or even superior levels of intellectual ability. This is a general effect. Here emotional and social abilities are out of line and well below the rest of cognitive abilities.
The case of David illustrates this very well. However, if all abilities are low-ish, then it is almost impossible for one particular ability to stand out as lower still. In some cases, notably Williams syndrome, the social interests and abilities are way ahead of other abilities.
You can feel that there is reciprocal communication. These children initiate social contact and try to keep you engaged. The individual with Williams syndrome, even as a young child, will gaze at others, will spontaneously engage with another person, and try and hold and direct their interest. This is also often the case with children with Down syndrome. What are autistic children with superimposed intellectual disability like? They still are a mystery, and they present many challenges to their parents and teachers.
They tend to be very delayed in speaking and may never speak at all. They are more likely to suffer from additional neurological disease, in particular epilepsy. The ingenuity of parents and teachers is stretched to the utmost. Sadly they are often neglected when people talk about autistic conditions. Most people like to think of autism in high-functioning, not low-functioning, cases. But this is the sharp end of autism. The term high-functioning autism was coined to distinguish it from the previously more familiar cases of mute and withdrawn children.
High-functioning children have great possibilities for compensatory learning. Their intellectual resources allow them to develop alternative means to learn social skills. They may carefully The changing face of autism observe the social rules, but still not become integrated into the complex social world. They can do well in academic subjects as long as they are taught in ways that take into account their particular strengths and interests.
However, the core features of their autism are not necessarily of a milder form. A superior level of intelligence makes a big difference to the vocational achievements that can be attained, but sadly does not make a big difference to the ability to live independently.
Many able individuals struggle to cope with even simple demands of everyday life. These children are aloof. If they speak at all, they tend to use rote-learned phrases and words. They show rather more elaborate rituals. They develop complex routines and repeat them faithfully. An integral part of this classically autistic child is that it is a child—at the time Kanner described it, virtually nothing was known about their life as adults.
Such a child is an icon. It is a beautiful and remote child. The impression of high intelligence can be strong, as is the impression that a normal child is locked inside. But, alas, this is an illusion.
It fades as the autistic child grows up. The autistic child grows up Child development holds many surprises. A child can grow out of problems. A slow developer might catch up later. But more often than not children with problems become adults with problems.
Autism Slow development spotted in childhood may often turn out to be a lifelong learning disability. The main character portrayed by Dustin Hoffman is based on a combination of real individuals with autism.
Previously only professionals who specialized in children, that is, child psychiatrists, child psychologists, speech therapists, and special educators—but only a minority of all these—knew about the disorder and were able to diagnose it.
Neurologists, psychiatrists, and psychologists who worked mainly with adults remained ignorant of the condition at that time. It took a while to face the frightening thought that there were many adults in institutions for the mentally ill or mentally disabled who had not been recognized as autistic.
The autistic man he portrayed was very strange, but also lovable. He looked and acted mentally disabled, and yet had the most amazing skills. He was extremely naive and had no idea that his scheming brother, portrayed by Tom Cruise, wanted to deceive and defraud him. Yet he was able to remember all the addresses in a phone book as soon as he read them and was able to win at a card game in Las Vegas precisely through his amazing memory. He did not know how unusual his abilities were.
Rainman is an ambassador of autism. But not all individuals with ASD are lovable eccentrics with amazing gifts. Far from it. It needs to be spelled out that only 10 per cent of individuals with ASD have a truly astounding gift. The families of the other 90 per cent are rightly annoyed when strangers expect that they have a genius in their midst. However, it also needs to be pointed out that among these 90 per cent there are many who have talents that are unusual and remarkable, even if they cannot be described as astounding.
The realistic view about growing up with an autism spectrum condition is provided in a number of biographical accounts. What do they say about the autistic teenager? In many ways he or she is unaware of what it means to be a teenager.
They do not have the usual obsession with looking like everyone else in their peer group and wanting to have the same clothes and gadgets. The autistic teenager retains many features that others view as childish. Yet they have the normal sexual urges. Peek reads a whole book in an hour and remembers the text verbatim. He has been described as a walking Google awareness that they are different.
They stick out compared to their peer group. Now you notice the ungainly gait, the lack of facial expressions. Of course, in a sad way, this is helpful because it is an obvious signal to others that there is a problem. There are an ever increasing number to be found in the catalogues of specialist publishers such as Jessica Kingsley and on websites.
Compensatory learning can lead to sometimes highly successful lives, including in some cases marriage and children. This is heartening, given that the basic problems in social insight never quite go away. According to these authors they have to be worked on continuously.
Many people have commented to me that I act much less autistic now than I did ten years ago. My mind works just like an Internet search engine that has been set to access only images.
The more pictures I have stored in the Internet inside my brain the more templates I have of how to act in a new situation. Do they have the same life span as everyone else? People with intellectual disability—whether autistic or not—usually have a shorter life span, but this could be for a large number of reasons. Sadly, one of the reasons is that they may not alert others to health problems that might be treatable. Many old people see their partners and friends die before them and they have to get used to being lonely, a very hard adaptation for most of us.
Is it easier if you never had any friends? Asperger syndrome Asperger syndrome has gained such popularity that we need to give it some special attention. It can be seen as a variety of autism with similar biological causes and similar effects on the development of brain and mind, but with somewhat different behavioural manifestations.
At least this is what we assume at present. The changing face of autism Asperger syndrome is usually considered a mild form of autism. But this may be deceptive. It may be a form of relatively pure autism where massive learning and compensation are covering up the core problems.
There are good reasons for suspecting compensation and covering up. Asperger syndrome goes with high intelligence. Perhaps the strangest fact about Asperger syndrome is that it is not usually diagnosed at all until the age of 8 or even later, sometimes only in adulthood.
This is strange, because it is a developmental disorder. It does not start suddenly, but it was always there as family and sufferers almost unanimously proclaim.
Research still needs to uncover the early signs of Asperger syndrome. Further, classic autism implies aloofness, while this is not necessarily found in Asperger syndrome. Individuals with Asperger syndrome often have a strong interest in other people. Children typically seek out adults as valued listeners to monologues, as answerers of questions, and providers of useful information.
A striking difference between autism and Asperger syndrome in childhood is that the child with Asperger syndrome displays high verbal intelligence. This is rightly a source of pride and joy to parents, but might make them overlook a lack of truly reciprocal social behaviour. Again this is illustrated in the case of Edward. As the case of Gary shows, the label is sometimes also applied to individuals with distinct social impairment who also have a mild degree of intellectual impairment.
Here, Asperger syndrome is used to indicate an atypical form of autism. Autism What is the connection to Hans Asperger? Hans Asperger emphasized that autistic disorders appear in many different shades and varieties, including some milder varieties, and including those with high intelligence.
How did Asperger syndrome get its now well-established place? There are many reasons, but probably the most important was the need to widen the boundaries of the initially narrow concept of classic autism. In the s a number of clinicians began to use the label Asperger syndrome. Christopher Gillberg in Gothenburg drew up diagnostic criteria to capture this particular type of individual.
This allowed clinicians in other centres to identify similar cases. The criteria that are now generally used for Asperger syndrome are very similar to what in the past was considered a residual or atypical form of autism.
They are in almost every respect the same as those for autism. Critically, there is no language delay, and language is often a particular cognitive strength. Many clinicians took up the label Asperger syndrome with an eagerness that suggested that there was a real need for the category. These children and adults were on the whole not so severely affected and promised hope of a better prognosis. Not surprisingly, The changing face of autism many parents craved the diagnosis Asperger syndrome rather than autism.
The popularity of the label rose inexorably. Rightly or wrongly, Asperger syndrome has become a magnet that attracts cases. One of its attractions is that it has acquired the cachet of being linked to genius. But this is not correct. Nevertheless, Asperger syndrome has a special place in the popular imagination. This book has sold 2 million copies and has been translated into thirty-six languages. It has undoubtedly increased awareness of Asperger syndrome. I know all the countries of the world and their capital cities and every prime number up to 7, There are many details in the story that could have been taken from real life and therefore supply telling examples of the typical features of someone who has Asperger syndrome.
He does not understand the purpose of polite language. It is hard to know whether Asperger syndrome will eventually split off and form its own distinct category of developmental disorder. Is it indeed a form of autism and with the same genetic causes as autism? Or is it merely a personality type and not a disorder?
There are now a number of people who have diagnosed themselves as having Asperger syndrome. These individuals often call themselves Aspies, and they feel different from NTs or neurotypicals. They do not need the attention of a clinician. They are perfectly adapted in their everyday lives, occupying a niche that is just right for their special interests and skills. It is not surprising that these people argue that Asperger syndrome is not a disorder.
To them it is merely a difference, and a difference to be proud of. Instead there should only be talk of differences in brain and mental make-up, some of which represent the autistic mind. This is a strange proposition.
To someone who is familiar with classic cases and other severe cases of autism, and knows of the suffering that is associated with autism, it seems perverse. You may disagree, but then this book is not for you. The one thing that frightened Diane when she was worried about baby Mickey was that she felt bombarded with reports of a huge increase in cases of autism.
There was talk of an epidemic. The stark facts as presented on the website of the Autism Society of America state that since the s there has been an increase of per cent of cases diagnosed as autistic. Actually, it is inevitable that there is a huge increase in recorded cases. Consider that autism was recognized only seventy years ago and became widely known only about twenty years ago.
Clearly children and adults are now diagnosed with autism when they would not have been diagnosed before. Ever greater awareness of autism goes hand in hand with the discovery of more and more cases. The extent of this change was revealed in a Californian study. The decrease in mental retardation in Figure 4 corresponds very well to the increase in cases of autism. One might therefore be tempted to say that all that happened is a relabelling.
However, there are also other factors at play. The increase in cases diagnosed autistic and the decrease in cases diagnosed mentally retarded in California Croen, L.
Journal of Autism and Developmental Disorders, 32, —15 Autism One factor has to do with the widening of the diagnostic criteria to include milder cases of autism, and cases with normal and high intelligence. These cases would previously not have been diagnosed at all. If they were noticed, they would have been considered eccentrics or loners. This increase is seen in Figure 5, based on the same Californian study. These criteria were social aloofness, elaborate rituals, and insistence on sameness.
They turned out to be too restrictive. They apply only to a small subset of children with ASD, and are observed only at a particular stage of their development, mostly between 3 and 5 years. A withdrawn child on getting older often becomes socially interested, and the reverse is also found.
Cases without mental retardation increased even more than cases with retardation among those diagnosed with autism in California A huge increase in cases Croen, L. Journal of Autism and Developmental Disorders, 32, —15 Likewise, elaborate routines and insistence on sameness can wax and wane over time.
The criteria were widened towards what is now known as the autistic spectrum. This spectrum includes very typical cases but also rather atypical ones. Further, there are mild cases and severe cases. All this adds up to more cases. What are the numbers now? The most reliable information to date comes from a British study of 57, children aged 9 to 10 years.
If you only looked at autism cases, then the estimate was 0. Other forms of autistic disorder, including Asperger syndrome, make up around 0. If we take the 1 per cent estimate seriously, then in the USA, with a population of million, there are a staggering two to three million individuals who have some form of autism; in the UK, with a population of about 60 million, there are at least half a million.
Assuming that about 1 per cent of the general population have an autism spectrum disorder, you are almost certain to know someone who is affected. This makes autism as common a mental disorder as schizophrenia or bipolar disorder. But unlike schizophrenia and bipolar disorder, autism is present from early childhood and persists throughout life. These are scary numbers. Fifty years ago few people were aware of autism.
Only the most classic form of autism was diagnosed, and everyone believed this was a very rare disorder. Is this cause for alarm? Not necessarily. In fact, quite the opposite, if we think of the increase as an effect of increased awareness.
Even classic cases had been missed previously. After all, most professionals were ignorant of childhood autism, and institutions for individuals with mental retardation housed considerable numbers of cases, who are now recognized as autistic. I certainly saw such children in special hospitals in the s. All these factors play a part in the huge increase in cases.
Is this all there is to it? How would we know? The awareness of the condition increased gradually. We would also expect that there is a levelling off by now. In fact the increase has been gradual and it has been levelling off recently. Nevertheless, it would be wrong to feel complacent.
Parents want to know all the reasons for the fast and recent rise in cases of autism spectrum disorders. After all, one other reason could be a new and as yet unknown toxin or virus that is affecting brain development even before birth. It is very unlikely that autism is caused by some adverse environmental event after birth.
As we will see in the next chapter the abnormalities that can be detected in the nerve cells of autistic brains date from well before birth. Nevertheless the personal experience of many parents goes against this. Remember, that many parents reported that their children seemed perfectly Autism normal to them as babies.
They had no cause for concern until their child inexplicably changed. This was sometime in the second year of life. They lost the language they already had and completely lost interest in other people. Scare stories What sort of unusual and possibly traumatic events happen in the second year that might cause this problem?
Vaccination always has an aura of suspicion. By its very nature vaccination is an assault on the small and vulnerable body of a young child. In order to prevent disease, the vaccine provokes a mild form of the disease. These symptoms are temporary and soon shaken off by almost all healthy children. But there are rare cases where things can go wrong, and very wrong, where consequences might even result in brain damage.
Now, if vaccinations were multiplied, would the risk be even higher? Precisely such a multiplication was introduced relatively recently. Could the triple vaccination be linked to the increase in autism? And it was pursued vigorously in a number of studies worldwide. Almost unanimously these studies came up with a resoundingly negative answer.
Study after study demonstrated that the increase in autism started long before triple vaccination was introduced. The introduction of the vaccine did not go together with a steep rise in cases. In short, this vaccination is not responsible for increases in cases of autism.
Even though the negative results were reported in the press, remaining doubts and dissenting views continued to be presented.
Indeed the general concern with vaccination has still not disappeared. Are governments and big pharmaceutical corporations out to suppress the truth and deny responsibility? Does the individual ever get a hearing against a powerful corporate defence? On the other hand, do lawyers unscrupulously take advantage of suspicion to make claims for compensation? There have been precedents for both cover-ups and greed. Given previous scandals where public reassurance had been wrong, politicians feel understandably ambivalent and are torn between whether to side with scientists or parental pressure groups.
But it was not only the triple vaccination that worried people. Thimerosal, a derivative of mercury, has been used from the s as an effective preservative for vaccines and for other medicines too until very recently.
It has been phased out from It seemed possible that this could be a contributory cause of autism. This is another idea that was worth pursuing. It was taken very seriously by scientists in the USA and particularly in Japan, where in the recent past a terrible environmental disaster due to metal poisoning had occurred.
However, researchers were able to rule out mercury poisoning as a cause of autism, comparing children exposed to mercury with those who were not. Furthermore, the number of autism cases continued to increase in California after Thimerosal was removed from vaccines. Nevertheless, the idea still lingers on, and many websites are devoted to this case, including those that offer treatments to remove traces of heavy metals from the body, which are themselves hazardous.
Just as in the case of the triple vaccine, some campaigners are so convinced of their claims regarding Thimerosal that they cannot change their belief. This suggests that other as yet unknown scares could start at any time and take over the lives of campaigners. Of course there will be more ideas about which environmental factors might contribute to autism.
But these ideas need to be anchored in basic research, and basic research has not yet thrown up a credible candidate. On the other hand, blue-sky ideas about possible factors, not anchored in basic research, can waste an awful lot of time and energy. More reasons for further increases in numbers Here we take a brief look at the now often blurred boundaries of autistic spectrum disorders. Diane was not surprised when Moira announced that Ben had an autism spectrum disorder.
The diagnosis brought considerable relief to Moira. Ben was not simply a naughty child, who misbehaved all the time. Further, she now might obtain special educational resources that she could not otherwise have claimed. Quite possibly. What about the very bright children who are puzzling because, compared to their high intelligence, their social interaction and communication is relatively backward? There may now sometimes be pressure for a diagnosis of Asperger syndrome, when in A huge increase in cases previous times no one would have worried.
In past times these children would have been treasured for their high abilities, and their social awkwardness would have been excused. Perhaps today social incompetence is apparent more often because the demands on social competence are so high. Maybe our social life has become more complicated as people travel more, migrate more, and change jobs more often. If so, it would not be surprising if more children and adults fall short of high demands on social skills.
This would include individuals with no particular problems of any kind, but a propensity to be loners and unconventional in their interests. Possibly such people would now be considered for diagnosis, even though they would not have been a generation ago.
We also should consider children with mental retardation of unknown causes. Here social competence is often in line with other abilities and all abilities are very limited. However, these children too tend to be increasingly subsumed under the autism spectrum.
I have mentioned these examples because the blurring of the boundaries brings the danger of diluting the concept of autism. This would be a pity, because research has succeeded in identifying the core social features of autism, and has provided methods to differentiate different kinds of social impairment.
I have already touched on the characteristic impairment in autism as concerning truly reciprocal interaction. The widening of the criteria for autistic disorder is a commonly acknowledged reason why there are so many cases today. Is this a good thing or a bad thing? The answer will depend on your point of view. Is there a limit to widening the concept of autism and the Autism stretching of criteria?
Does the spectrum really have sharp cut-off points where we can diagnose a person who is affected by autism and a person who is not? What about the relatives of people with ASD? Sometimes quite strong and sometimes very watered down symptoms can be seen in the relatives. The observation of very mild autistic features in relatives is greater than might be expected by chance. This has given rise to the idea that there is indeed a broader phenotype of autistic disorders.
This means that the genes that are responsible for this phenotype might exist in quite a large number of people, hardly any of whom are autistic themselves. Perhaps these genes predispose them to have children with ASD. This idea is plausible, but as yet speculative. Are we all—or at least all men—a little bit autistic? Diane can easily spot people with poor social and emotional intelligence, and most of them seem to be male.
He seems to spend endless hours going through websites to identify the latest technical gizmos and accessories for his camera. Does this have anything to do with the autism spectrum? It conveys quite a lot of information about the person. But for me this has nothing to do with the true autism spectrum.
We are usually talking of a highly educated male who can focus single-mindedly on a particular goal to the detriment of his concern for other people. Sometimes he is a scholar who is not particularly creative, but has the ability to acquire and retain masses of information. He will A huge increase in cases generally dislike novelty and often rigidly hold to his own opinion. It can also be a great compliment.
It vaguely alludes to genius. Hans Asperger himself implied that a dash of autism was part and parcel of being a creative scientist. Was Asperger right in claiming that the autistic personality is an extreme variant of male intelligence? El cerebro autista. El poder de una mente distinta. Temple Grandin y Richard Paneck. Una manera diferente de ver el autismo. Barry M. Isabel Paula. La ansiedad en el. She has pioneered much of the current research into autism and dyslexia, and has written several books on the two subjects arguing for autism to be considered a mental condition rather than being caused by parenting.
Her book Autism: Explaining the Enigma introduces the cognitive neuroscience of autism. She is credited for creating the Sally-Anne test. Skip to main content. Users who liked this track. Autismo y psicosis infantiles: una alternativa para su tratamiento. Madrid: Gredos, Frith.
Hacia una explicacion del enigma' se convirtio muy pronto en un clasico porque proporcionaba el primer relato psicologico satisfactorio de lo que pasa en la mente de una persona con autismo. PDF In this paper we will try to show that the treatment of some traditional problems of the philosophy of the mind, in the case of this work, the Find, read and cite all the research you.
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