2012年2月13日 星期一

What is Autism?

Autism is the term given to the collection of behaviors arising from unusual neurological (brain) development. There is evidence that in some cases this neurological difference is present from birth. However the observed behaviors, from which autism is diagnosed, tend not to be detectable until around the age of 18 months.

Autism is usually thought of as a behavioral disorder, some early theorists have gone so far as to suppose it to be caused by "refrigerator mothers". Research has since thoroughly discredited this notion. For the majority of the last sixty years (since autism was first described scientifically by Kanner in 1943) the syndrome has still been thought of in terms of behavior rather than underlying brain development. As such all current diagnoses are made on the basis of observable behavior which significantly delays diagnosis in most cases. Currently steps are being made towards identifying neurological markers of autism to aid in earlier diagnosis and thus earlier intervention.

What about genetics? There is much evidence showing a strong genetic component in autism (Rutter, 2005). There are also suggestions that autism is caused by poor sensory integration (Smith-Myles & Simpson, 1998), maturational delays in primary reflexes (Teitelbaum, Benton & Shah, 2004), immune system dysfunction (Pardo, Vargas & Zimmerman, 2006), or gastro-intestinal issues (Gurney, McPheeters & Davis, 2006). At this point there is no clear consensus.

Autism is now more frequently referred to as Autism Spectrum Disorder (ASD) indicating the wide variation in symptomology. Children diagnosed with PDD or PDD-NOS or Asperger's Syndrome tend to exhibit similar behaviors to a milder degree.

The behaviors that tend to lead to a diagnoses of Autism or ASD are usually classified into three clusters - known as the "triad of impairments". These describe challenges in:

Social Interaction
Communication and Language and
Imagination (including use of repetitive, self-stimulatory behaviors)

What the diagnostic criteria fail to acknowledge is the strengths exhibited by people diagnosed with autism. There are many, many reports - scientific and otherwise - about the incredible abilities many people with autism posses. At the extreme end of this spectrum are people referred to as savants who display mind-boggling abilities often in mathematics, music or art (Happe, 1999). The thousands of people with autism who don't gain fame for their savant abilities also posses many amazing skills. People with autism have been shown to often posses greatly enhanced visuo-spatial skills (Happe, 1999). We have worked with five year old children who can put together a 500 piece jigsaw puzzle in a matter of minutes with the picture side facing down. Other people with autism are able to memorize a scene they see once and go home and draw the scene down to the tiniest detail (e.g. Steven Wiltshire).

Many people with autism, actually a higher proportion than in the non-autistic population have perfect pitch-the ability to produce a note heard (Happe, 1999). Still others, as popularized by the movie "Rainman", are able to do incredible mathematical calculations. We have worked with children as young as four capable of performing multiplication of two three-digit numbers in their head. These children have had no training in mathematics but showed this ability from an early age. The mother of one child we worked with as a teenager told us her son began teaching himself math from age two and by five was performing calculus problems for fun.

It is important to look at any child as a whole rather than focusing only on what is challenging for that child. By embracing a child's strengths and motivations you can help that child to grow in his or her areas of challenge. This is widely accepted wisdom in the education of typically developing children. However in approaches to autism this wisdom has been regrettably ignored. The trend has been to try and steer children with autism away from their interests and practiced skills as these are seen as "obsessions". These skills have been believed to be harmful to the child in some way to the extend that extreme measures have been taken (and still are in some therapies) to keep children away from their interests including electric shock and being sprayed with water. This approach has come from a core belief about autism that thankfully is beginning to change.

The old belief is that autism is a behavioral disorder. The consequence of this belief has been to focus on changing the behavior and trying to stamp out those deemed "atypical". The new belief is that autism is the developmental consequence of a brain programmed to operate differently. The consequence of this belief is that therapy focuses on providing a physical and social environment that accounts for this difference and facilitates the optimal enjoyment and learning of the individual child.

Practitioners of The Son-Rise Program have seen for the last three decades that acceptance and appreciation of these interests and activities can build a bridge to social interaction with a child with autism. Through social interaction many other skills can be learned by the child. There is now scientific research showing the value of this approach (e.g. Dawson & Galpert, 1990; Kim & Mahoney, 2004; Mahoney & Perales, 2005 and Trivette, 2003).


Dawson, G. and Galpert, L. (1990) Mothers' use of imitative play for facilitating social responsiveness and toy play in young autistic children. Development and Psychopathology; 2: 151-162.

Gurney, J. G., McPheteers, M. L. & Davis, M. M. (2006). Parental report of health conditions and health care use among children with and without autism: National survey of Children's Health. Archives of Pediatric and Adolescent Medicine, 160(8), 825-830.

Happe, F. (1999) Autism: cognitive deficit or cognitive style? Trends in Cognitive Neurosciences: 3(6): 216-222.

Kanner, L. (1943) Autistic disturbances of affective content. Nervous Child; 2: 217-225.

Mahoney, G. and Perales, F. (2003) Using relationship-focused intervention to enhance the socio-emotional functioning of young children with autism spectrum disorders, Topics in Early Childhood Special Education; 23: 74-86.

Rutter, M. (2005). Aetiology of autism: Findings and questions. Journal of Intellectual Disabilities Research, 49(4), 231-238.

Smith-Myles, B. & Simpson, R. L., (1998). Asperger Syndrome: A Guide for Educators & Parents. Austin, TX: PRO-ED.

Trivette, C.M. (2003) Influence of caregiver responsiveness on the development of young children with or at risk for developmental disabilities. Bridges; 1(3): 1-13.

Pardo, C. A., Vargas, D. L. & Zimmerman, A. W. (2006). Immunity, neuroglia and neuroinflamation in autism. International Review of Psychiatry, 17(6), 485-595.

Kat Houghton is an autism treatment consultant specializing in The Son-Rise Program, a relationship-enhancement method of approaching autism. She is the founder and director of Inspired by Autism Consulting (http://www.inspiredbyautism.com), director of research at The Autism Treatment Center of America and completing a PhD in Psychology at Lancaster University in the UK.

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