by : Uta Frith
The image often invoked to describe autism is that of a beautiful child imprisoned in a glass shell. For decades, many parents have clung to this view, hoping that one day a means might be found to break the invisible barrier. Cures have been proclaimed, but not one of them has been backed by evidence. The shell remains intact. Perhaps the time has come for the whole image to be shattered. Then at last we might be able to catch a glimpse of what the minds of autistic individuals are truly like.
Psychological and physiological research has shown that autistic people are not living in rich inner worlds but instead are victims of a biological defect that makes their minds very different from those of normal individuals. Happily, however, autistic people are not beyond the reach of emotional contact and attachment to others.
Thus, we can make the world more hospitable for autistic individuals just as we can, say, for the blind. To do so, we need to understand what autism is like—a most challenging task. We can imagine being blind, but autism seems unfathomable. For centuries, we have known that blindness is often a peripheral defect at the sensory-motor level of the nervous system, but only recently has autism been appreciated as a central defect at the highest level of cognitive processing. Autism, like blindness, persists throughout life, and it responds to special efforts in compensatory education. It can give rise to triumphant feats of coping but can also lead to disastrous secondary consequences— anxiety, panic and depression. Much can be done to prevent problems. Understanding the nature of the handicap must be the first step in any such effort.
Autism existed long before it was described and named by Leo Kanner of the Johns Hopkins Children’s Psychiatric Clinic. Kanner published his landmark paper in 1943 after he had observed 11 children who seemed to him to form a recognizable group. All had in common four traits: a preference for aloneness, an insistence on sameness, a liking for elaborate routines and some abilities that seemed remarkable compared with the deficits.
Concurrently, though quite independently, Hans Asperger of the University Pediatric Clinic in Vienna prepared his doctoral thesis on the same type of child. He also used the term “autism” to refer to the core features of the disorder. Both men borrowed the label from adult psychiatry, where it had been used to refer to the progressive loss of contact with the outside world experienced by schizophrenics. Autistic children seemed to suffer such a lack of contact with the world around them from a very early age.
Kanner’s first case, Donald, has long served as a prototype for diagnosis. It had been evident early in life that the boy was different from other children. At two years of age, he could hum and sing tunes accurately from memory. Soon he learned to count to 100 and to recite both the alphabet and the 25 questions and answers of the Presbyterian catechism. Yet he had a mania for making toys and other objects spin. Instead of playing like other toddlers, he arranged beads and other things in groups of different colors or threw them on the floor, delighting in the sounds they made. Words for him had a literal, inflexible meaning.
Donald was first seen by Kanner at age five. Kanner observed that the boy paid no attention to people around him. When someone interfered with his solitary activities, he was never angry with the interfering person but impatiently removed the hand that was in his way. His mother was the only person with whom he had any significant contact, and that seemed attributable mainly to the great effort she made to share activities with him. By the time Donald was about eight years old, his conversation consisted largely of repetitive questions. His relation to people remained limited to his immediate wants and needs, and his attempts at contact stopped as soon as he was told or given what he had asked for.
Some of the other children Kanner described were mute, and he found that even those who spoke did not really communicate but used language in a very odd way. For example, Paul, who was five, would parrot speech verbatim. He would say “You want candy” when he meant “I want candy.” He was in the habit of repeating, almost every day, “Don’t throw the dog off the balcony,” an utterance his mother traced to an earlier incident with a toy dog.
Twenty years after he had first seen them, Kanner reassessed the members of his original group of children. Some of them seemed to have adapted socially much better than others, although their failure to communicate and to form relationships remained, as did their pedantry and single-mindedness. Two prerequisites for better adjustment, though no guarantees of it, were the presence of speech before age five and relatively high intellectual ability. The brightest autistic individuals had, in their teens, become uneasily aware of their peculiarities and had made conscious efforts to conform. Nevertheless, even the best adapted were rarely able to be self-reliant or to form friendships. The one circumstance that seemed to be helpful in all the cases was an extremely structured environment.
As soon as the work of the pioneers became known, every major clinic began to identify autistic children. It was found that such children, in addition to their social impairments, have substantial intellectual handicaps. Although many of them perform relatively well on certain tests, such as copying mosaic patterns with blocks, even the most able tend to do badly on test questions that can be answered only by the application of common sense.
Next : Part 2