, Marcy Willard1 and Helena Huckabee1
(1)
Emerge: Professionals in Autism, Behavior and Personal Growth, Glendale, CO, USA
Abstract
Increasing rates of autism have changed the face of child psychology, education, and family life. Clinicians and educators, in general education and special education alike, are challenged like never before to identify and treat children with autism. Autism assessment, school psychology, and forensic psychology fields are rapidly expanding to address critical issues in the ASD population. As children on the Autism Spectrum mature to adulthood, the community college and university system, as well as employment programs and adult service providers, encounter a new level of need for this expanding population. Although assessment and treatment technologies have advanced substantially over the past decade, there are a myriad of unanswered questions about the potential for people with ASD to function in school and the workplace, have families, and live fulfilling lives. Psychologists, scientists, and doctors feel a deep sense of urgency to find answers to these provoking questions that plague our time. This passion is ever increased through the continued deepening understanding of individuals with ASD who are often endearing, talented, intriguing and may see the world in a new way; offering us a window into the brain and to the breadth of human experience. In this chapter, the reader is invited to explore the meaning of the term “autism,” the history since its early foundations as “Kanner’s autism,” and the currently increasing prevalence estimates.
Keywords
What is autism?What is the autism spectrum?Autism spectrum disorderWhat happened to “autistic”?Theory of mindKanner’s autismHigh functioning autismAutism prevalence ratesIntelligence in autismWhat is Autism?
Considering that this book is dedicated primarily to providing an in-depth guide for diagnosing Autism Spectrum Disorders and associated comorbid diagnoses or differentially separate disorders, the information provided here is just a “warm up” to the big picture. The big picture, per se, is for readers to be able to understand autism diagnosis on a deep level, such that clinicians can offer clear and accurate diagnosis to families, as early as is feasible. It is also important for readers to learn what autism is so that individuals in the greater community are equipped to identify and refer loved ones for a comprehensive evaluation . Finally, this deep understanding should allow readers to see the gravity of obtaining an autism diagnosis and also the hope for a bright future, given early diagnosis and effective treatment .
The new term Autism Spectrum Disorders was regularly used even before the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) and refers to a set of common symptoms, although there is a great deal of variation in the presence and severity of those symptoms. A full description of the “Spectrum ” is provided later in this book. For now, readers should know that the terms “autism” and “Autism Spectrum Disorder” refer to a continuum of symptoms, ranging from severe and pervasive to low severity level, or High Functioning . On another continuum are language and cognitive abilities . An individual may be very intelligent but demonstrate many symptoms of autism or he or she may be lower in cognitive domains and have a low symptoms severity level. The DSM-5 diagnosis requires a clinician to specify each individual symptom including severity, language, and cognition. Throughout the book, the term “autism” and “Autism Spectrum Disorder” are used interchangeably. Readers should know that the term “autistic” has largely been abandoned at present; as most clinicians prefer person-first language, referring to an individual with these symptoms as, “a child with autism” or “adolescent with ASD”; “individual with autism” or “adult with ASD.”
Individuals with autism struggle primarily with social communication . They often show a limited range of facial expressions and their emotions are generally not well-integrated with the content of the dialogue. They often fail to share enjoyment, interests, or emotional experiences with others. Thus, conversations with individuals on the Spectrum are often flat or awkward in nature. Individuals with ASD may use repetitive or scripted language. They tend to use gestures less frequently than neurotypicals; perhaps, due in part to a limited social-communicative motivation . That is, some individuals with autism do not focus as much on engaging the listeners or “checking in” for understanding. They may speak in a robotic or a “sing-song” voice or use an overly formal style of communication with advanced vocabulary for their age and developmental level. Children with autism tend to use vocabulary that is beyond not only what is expected for their age, but also beyond what they understand themselves. That is, children with autism often show a unique pattern where expressive language skills are higher than receptive. While all of these things may be true for an individual with autism, they also may not be. Speaking with appropriate prosody and conversational fluency does not in reverse rule out the diagnosis.
Even very bright individuals on the Spectrum tend to show significant delays in comprehension, particularly comprehension within a social context . They may misread or fail to assess the intentions, perspectives, and feelings of others. Unfortunately, this deficit may render people with autism more vulnerable to bullying and victimization. They may struggle to comprehend metaphors, idioms, jokes, or sarcasm. This problem is, in part, due to limited “Theory of Mind ,” which is the understanding of another person’s perspective. These comprehension difficulties may manifest in social relationships as well as academic endeavors. Sometimes individuals with autism have poor narrative coherence (meaning difficulty telling sensible stories) and poor reading and oral comprehension.
Individuals with this disability may avoid eye-contact and display sensory sensitivities or tactile-defensiveness, being highly sensitive to sights, smells, tastes, and touch. They may show significant rigidity and resist changes to familiar routines.
Children with autism may display repetitive behaviors such as hand flapping, rocking, and odd finger movements. They may have special or circumscribed interests. Although having passion or a focus area is generally considered a valuable personality trait, these interests are either not appropriate developmentally, or they are obsessive in nature (APA, 2000). Children with autism tend to “monologue” about their interests or ideas, whether or not it fits within the context of the conversation. They often appear more restricted in their play, using less imaginative, symbolic, or pretend play than typical children (Rutherford, Young, Hepburn & Rogers, 2007).
The most significant symptom of autism is a lack of social reciprocity . Individuals with autism tend to lack the understanding of the give-and-take nature of conversation and relationships. They do not take others’ perspectives well. This difficulty can be so pervasive that they may not understand why seeking friendship is a useful endeavor. Often, even in highly intelligent children with autism, there is a failure to understand the concept of friendship. They tend to struggle to join peers in play or social exchanges ; sometimes preferring to be alone, and other times avoiding social contact because of a history of frustration and failure in establishing relationships. Thus, children with autism sometimes appear to be withdrawn and this is often the feature that raises red-flags to parents and family members. Taken together, the term autism encompasses a set of symptoms manifested primarily in disordered social communication and reciprocity.
History and Foundations of ASD
Autism was originally discovered by Dr. Leo Kanner (1943). Prior to Dr. Kanner’s discovery, children with autism symptoms were referred to as “feeble-minded, retarded, moronic, idiotic or schizoid” (Fischbach, 2007, p. 1). The term “autism” was actually borrowed from Eugene Bleuller, who used the term “infantile autism” to describe the introverted and self-absorbed aspects of patients with schizophrenia (2007).
In developing a construct for understanding autism, Dr. Kanner wrote a paper in 1943 where he drew symptom similarities between 11 case studies (Kanner, 1943). He became fascinated with one particular child named “David,” who did not socialize with other children , repeated phrases from adults, and displayed repetitive behaviors. In his article, Autistic Disorders of Affective Contact (1943), Kanner writes about David,
He seems to be self-satisfied…He does not observe the fact that anyone comes or goes, and does not seem glad to see father or mother or any playmate. He seems almost to draw within his shell and live within himself…In his second year he developed a mania for spinning blocks and pans and other round objects (218).Related posts:
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