Understanding Autism

We have come a long way - History of approaches to the field

From time to time it is helpful to reflect on the history of autism, and how our understanding of the condition has shaped views on the needs of people with an Autism Spectrum Disorder. When we look back thought the literature of the 19th century, we see accounts of children we now recognise as having autism. It was not until 1943, however, that Leo Kanner, an American psychiatrist, wrote a paper on eleven children he had seen over a period of 5 years. These children struck Kanner as having ‘fascinating peculiarities’ which included an apparent lack of awareness of other people’s existence or feelings; a lack of an ability to play imaginatively; echolalia (an echoing of what is heard); failure to use speech to communicate; and repetitive behaviour and routines. Kanner was puzzled by the fact that while many of these children were not functioning at an age appropriate level, they gave the impression of normal intelligence, and demonstrated good rote memory and visuo-spatial skills. Dr Kanner coined the term ‘early infantile autism’ to describe this group of children.

For over a decade after the publication of Kanner’s paper, the field was very influenced by psychoanalytic theories. Views were held that autism was the result of an environmental disorder, i.e. a failure of parental bonding with the child. This was an extremely stressful period for parents. On the one hand they were told their child was severely disabled; and on, the other they were told that in some way they were responsible for their child's condition. It was not until the 1960s/1970’s that research began to demonstrate findings which pointed to a neurobiological basis for Autism.

In the 1970’s Hermelin & O’Connor published their landmark research findings, which examined how children with autism think. They looked at how children processed information through vision, touch, hearing and how they used this information in memory and motor tasks. Hermelin & O’Connor found that children with autism had a cognitive profile different from other children, including those with an intellectual disability. They found that children with autism had difficulty in perceiving order and meaning in events.

Following this breakthrough work of Hermelin & O’Connor, a great deal of research occurred in the 1980’s examining cognition in autism.

In the 1990’s another focus of research developed, examining how children with autism understand the perspective of other people. Baron-Cohen, Frith and others undertook research which demonstrated that people with autism have difficulty understanding how people think. This is an important finding in that all competent social behaviour rests on being able to predict how people, other than ourselves, think e.g how will they react to what we do and say; and being able to determine what might influence the reaction of others, in different circumstances. Without being able to make such predictions, we have no way of knowing how to behave in a way that others will find acceptable.

As our understanding of autism developed over the decades, since Kanner’s first account of autism, so have the type of intervention strategies used in this field.

In the early 1960’s the hope for effective behavioural treatments seemed limitless. The belief at the time was that disorders such as autism were the result of a ‘faulty learning history’; that ‘abnormal’ behaviours were the result of the child somehow failing to learn the skills required for ‘normal’ behaviour. The concomitant belief that seemed so hopeful at the time was that such skills could be taught. It was believed that with the right behavioural technology, autistic children could learn all their ‘missing skills’ and become normal. However as an understanding of the cognitive profile of children with autism grew, so did the strengths and limitations of behavioural interventions. We came to realise that, while behavioural methods are extremely powerful for teaching the individual a range of skills, and for the management of difficult behaviours, they cannot change the underlying deficit. That is, they do not remove the deficits in social understanding, language and cognition that will continue to affect the persons ability to learn, and to understand their world throughout their life.

Today, approaches to supporting people with autism are based on knowledge from a range of disciplines in communication, behavioural and cognitive science. We know that:

individuals with autism have a specific style of learning, and a particular way of experiencing the world based on their cognitive profile.
routines for the person with autism bring order to an bearably chaotic world. We understand that it is not our role to eliminate those routines, as some professionals have done in the past. Rather, we need to broaden and modify the routines that the person uses as a means to cope with a complex social world. We need to make them more ordinary and functional.
the best way of eliminating self-stimulatory behaviour is not simply telling the child to stop, or preventing the child from engaging in these behaviours. We must teach the child more productive activities; a functional and enjoyable alternative needs to be provided.
many of the behavioural difficulties seen in children with autism are a result of demands being too high; of children not being given a means to communicate their wants and needs; of over-intrusion from (often well meaning) others; of over-stimulating noisy and unpredictable social environments; and of under stimulation. We know that to address the problem of difficult behaviour in autism we must go beyond training compliance. Rather we must provide children with the skills and supports, which address their needs. We must understand how the child perceives the world and the modifications which need to be made to support their learning style.
many of the social difficulties seen in autism can be modified but never completely eliminated.
to enable the person with autism to cope with the social world and its demands, we must change how we behave. We need to be consistent and predictable; we need to take into account the interests of the person with autism; we need to develop strategies which support the person to respond more flexibly to a complex changing social world; and above all else, we need to understand the difficulties the person with autism has in understanding our behaviour e.g our motives, our beliefs, our emotions.

It is now known that autism is a developmental disability with specific impact on social, communication and cognitive development. We know that children with autism need to be taught the skills, which will help them to make sense of, and fit into, our social world.

Source:

Living with Autism: Practical strategies for supporting people with Autism Spectrum Disorders