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Chronicles : The Age of Autism: New in name only?
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Posted by sylvia on Tuesday, November 08, 2005 (17:03:19)
Science Daily August 2005
By Dan Olmsted
This week's column about the first autism diagnoses brought a quick response from longtime autism researcher Dr. Darold A. Treffert. Treffert is past president of the Wisconsin Medical Society and a psychiatrist at St. Agnes Hospital in Fond du Lac. He wrote the book "Extraordinary People: Understanding the Savant Syndrome."
Our view is that the first autism diagnoses in the 1930s appear to represent something new -- because Leo Kanner, the psychiatrist who identified the early cases, called them "markedly and uniquely different" from anything seen before. Kanner was the leading child psychiatrist of his day.
Treffert, who met and was inspired by Kanner, says autism in fact has existed throughout history.
Here is his letter.
While Leo Kanner named autistic disorder, it did not begin there any more than many medical conditions recognized and named by doctors (including Asperger's, Down's Syndrome, Turner's Syndrome, Crohn's Disease, Grave's disease, Cushing's syndrome (etc. etc.) began when recognized and named.
You are right to go back in time a bit to look at autism pre-immunization-debates, but you are not going back far enough. You need to go back at least another 53-plus years to the very astute and before-their-time observations of Dr. J. Langdon Down in 1887 regarding disorders he called "developmental" way back then.
Most astoundingly, Dr. Down differentiated, in these "developmental" disorders (a term we use today) between early onset and late onset (regressive) autism! I refer you to my posting "Dr. J. Langdon Down and Developmental Disorders" on the savant syndrome Web site at www.savantsyndrome.com. Formal publication of those findings is under way and in press.
The point is, while Kanner named the condition, it did not begin with him. I had the opportunity to meet with Dr. Kanner when he was a visiting professor at University Hospitals in Madison during part of my training there. He was a very graceful, gentle and kindly man, with much to say about autistic disorder, and I valued his observations. He in fact tapped some interest in me in that unusual condition, an interest I have followed up on now, all of my professional life.
I had the opportunity to develop a Children's Unit as my first "job" as a psychiatrist, and it was there I met my first savants among the autistic patients we had on the unit. It was there also I carried out the statewide study on the epidemiology of infantile autism and confirmed, at that time, the figure of 4.8 per 10,000 cases which, like Rutter's in England, is often quoted.
I also confirmed that in that group -- at that time generally referred to as Childhood Schizophrenia -- only about 25 percent were cases of Kanner's classic autism.
Germane to the present debate was the circumstance that among the cases of autism on our unit (1962) were cases of late onset, regressive autism.
These were patients, like Down's in 1887, and like Kanner's 50 years later, who began to regress after a period of normal development.
These constituted roughly 25 percent of our cases, I would say. In each and every case, the mothers identified some event as the trigger for the regression. I remember distinctly one mother tying the regression to the child falling off the pier and nearly drowning; another tied it to when the child was hospitalized for tonsils-and-adenoids surgery; another to the time the child got trapped in the silo.
Down tied it to the "second dentition," temporally at least. And there seems to be a relationship, again temporally at least, to immunizations (whether there is more than a temporal relationship to immunizations remains to be fully explored). The point is, each parent always ascribed the abrupt and sudden regression, naturally and understandably, to some event.
So I think it worthwhile to go back in time to compare autism today with autism at an earlier time. But you need to go back farther than Dr. Kanner, observant as he was. And if I had the time, I would go back further than Down, also looking under different labels, just as I had to look under the different label of "childhood schizophrenia" in the 1970s to find a group of cases that clearly were what we now call autistic disorder.
As I said in my 1970 article, the beginning of wisdom is to call things by their right name. And we do a very poor job of that in autistic disorder. Also, in medicine and elsewhere we keep "rediscovering" the obvious and pronouncing it "news." Hence my perpetual look backwards (older people often develop an interest history).
I was somewhat amused to see news reports this week reporting the "new" discovery based on Dawson's work, that some forms of autism are "regressive" in children who reached developmental milestones and then "regress." Really! There is nothing "new" about that.
They also reported the astounding revelation that there may be more than one cause of autism. Really! That's not news either, but it is typical superficial medical reporting where someone did not do their homework.
Dr. Down reported regressive autism 125 years ago (based on his 30 years of observations) and, without doubt, autism, like mental retardation, has been around as long as man has been around. Now we need to sort out this condition by its right names, sort it out into its several causations, and gently have "mainstream" medicine and "alternative" medicine come together, work together, respect each other and gradually forge out effective treatment tailored to specific etiologies.
Three axioms have guided my career: 1) The first step in treatment is to make a diagnosis. 2) Listen to the patient (or the parent) for he or she is giving you the diagnosis. 3) The beginning of wisdom is to call things by their right names.
In the research on autism we have not a very good job with any of those axioms. That's what keeps propelling me along in this elusive search.
E-mail: dolmsted@upi.com
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Chronicles : The Age of Autism: 'Absolutely different'
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Posted by sylvia on Friday, May 27, 2005 (19:48:00)
The Washington Times 29/04/05
By Dan Olmsted
Her name was Virginia.
"Virginia S., born Sept. 13, 1931, has resided at a state training school for the feebleminded since 1936, with the exception of one month in 1938, when she was paroled to a school for the deaf for 'educational opportunity.'"
So wrote Leo Kanner, world-renowned child psychiatrist at The Johns Hopkins University in Baltimore. He went on to point out Virginia was neither feebleminded nor deaf. She was autistic.
Virginia was, in fact, the oldest of the 11 children in Kanner's 1943 paper, "Autistic Disturbances of Affective Contact," which first named "autism" as a distinct and devastating disorder. Kanner said autistic children differed "markedly and uniquely" from anyone ever described. They were "something new."
Virginia -- no last name or home state was given -- was referred to Kanner after Dr. Esther Richards saw her several times at the training school.
"Virginia stands out from other children," Richards wrote Kanner, "because she is absolutely different from any of the others." She did not talk. She did not play with other children. She did picture puzzles by the hour. "All findings seem to be in the nature of a congenital abnormality which looks as if it were more of a personality abnormality than an organic defect."
In 1955 Kanner revisited his first 42 cases. The oldest autistic person at that point was 24 -- born in 1931 and presumably Virginia S.
Across the Atlantic, something remarkably similar was happening almost simultaneously.
A Viennese pediatrician named Hans Asperger also was identifying children he called autistic, though in a slightly milder form that came to be known as Asperger's Disorder. Of his four case studies, only one, Fritz V., is given a birth year: 1933. Two of the other children also appear to have been born in the 1930s, given their age when Asperger met them.
The fourth, Hellmuth L., was first seen "six years ago, at age 11," Asperger wrote in his 1944 paper. That means he was born around 1927, but Hellmuth is interesting for another reason: His case study appears to be the only one described by Kanner or Asperger whose autism clearly was due to organic causes.
"He had severe asphyxia (lack of oxygen) at birth and was resuscitated at length. Soon after birth he had convulsions. ... In Hellmuth's case there were clear indications that his autism was due to brain injury at birth."
Many autistic children are characterized as looking angelic. Hellmuth was "grotesque," Asperger said, perhaps because of his brain damage.
Asperger drew a "preliminary conclusion" that some organic problems create symptoms "closely similar to the picture presented by 'autistic personality disorder' of constitutional origin." That has been proven correct.
So, the only case study, by either Kanner or Asperger, of an autistic child clearly born before 1931, had a different cause: brain damage.
Here is the question: How many people born before 1931 fit the profile, not of Hellmuth but Virginia -- nothing apparently wrong with them except this bizarre and baffling set of behaviors?
That might sound arcane, but it is crucial: When and where classic "Kanner autism" began is key to tracking its roots and rise. That is the focus of this series.
Some experts on autism say many such people have been documented before the 1930s. One of the most-cited instances of apparent autism -- some say the first -- was Victor, the Wild Boy of Aveyron, who was discovered living in the woods in France in the late 1700s -- and who is profiled at feralchildren.com.
"There can be no doubt that Victor was autistic and fitted into Kanner's syndrome," wrote British psychiatrist Lorna Wing.
Other early possibilities were outlined in an intriguing e-mail message I received after the last article, from longtime autism researcher, Dr. Darold A. Treffert.
"You raise the question whether Kanner and Asperger were seeing a 'new disorder,' or were they simply very keen observers who, for the first time, provided a classic description of an until-then-unrecognized but existing disorder? I think the latter," Treffert wrote.
"In fact I think autistic disorder was part of Dr. J. Langdon Down's original 10 cases of what he called (regrettably) 'idiot savant,' now known as savant syndrome. The movie 'Rain Man' made autistic savants household terms."
Treffert is past president of the Wisconsin Medical Society and a psychiatrist at St. Agnes Hospital in Fond du Lac. He wrote the book "Extraordinary People: Understanding the Savant Syndrome." He directed me to a Web site about the phenomenon: savantsyndrome.com. There, his discussion of Down's cases reveals striking similarities to modern autism.
Down, best-known for having described Down syndrome, gave a lecture in 1887 to the London Medical Society, in which he described 10 patients as having remarkable gifts -- far too remarkable to consider them retarded -- but also "living in a world of their own." One boy "(referred) to himself in the third person," "lost speech," "self-contained and self-absorbed, caring not to be entertained other than (in) his own dream-land, and automatic and rhythmical movements."
"Those descriptions are so applicable to what we now call Autistic Disorder. ... Autism is not a new disorder," the summary concluded.
Nor is it increasing, according to what might be called the "steady state" theory of the autism universe. It was always thus, just not diagnosed. Those who believe instead in the "big bang" -- an initial explosion of autism in the 1930s that has been expanding ever since -- argue that scattered cases before then actually make their point.
The pre-1930s cases were few and far between, goes this argument, and might have resulted from organic triggers such as Hellmuth L.'s brain damage or congenital defects such as Fragile X Syndrome, which causes a small percentage of today's autism cases.
Or, even measles might be responsible. There is an early account of a child who, after getting measles, changed markedly and developed repetitive speech and other autistic behaviors. Measles is a known culprit in other cases. Some women who contract German measles while pregnant give birth to children with Congenital Rubella Syndrome and a significant percentage of those children are autistic.
When Wing said, "the history of autistic disorders stretches far back into the mists of time, long before Kanner's and Asperger's insights," it is unclear how well we can see through those mists. More pertinent, perhaps, would be knowing the number of Americans with autism who were alive on Sept. 12, 1931, the day before Virginia S. was born.
Today's autism rate is 30 to 40 out of every 10,000 children, according to several studies, including one in 2003 by the Centers for Disease Control and Prevention. Applying that rate to the U.S. population of 123 million in 1931 would mean at least 369,000 people were autistic.
That is an awful lot of people, but it is the number resulting from the steady state theory of autism. Cut that number by one or two orders of magnitude, just for the sake of argument, and you face the same issue.
Of course, in 1931 none of those people would have been diagnosed with "autistic disorder," but would not some percentage of those 369,000 -- the infants, children, teens and adults of 1931 -- ultimately have been called autistic instead of deaf, or feebleminded, or schizophrenic, or whatever they were originally labeled?
Like Virginia, they already stood out because they were "absolutely different from any of the others," and by 1943 Leo Kanner had defined their disorder and given it a name.
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Chronicles : The Age of Autism: Backward
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Posted by Sylvia on Monday, May 02, 2005 (17:11:23)
New Kerala 10/03/05
By Dan Olmsted
When Leo Kanner first identified autism as a unique developmental disorder in 1943, he was certain it was present from birth.
"This is not, as in schizophrenic children or adults, a departure from an initially present relationship," Kanner wrote."It is not a 'withdrawal' from formerly existing participation.There is from the start an extreme autistic aloneness."
Almost 30 years later, in a 1972 speech, Kanner was of the same mind."I didn't find that withdrawal was a proper term because you withdrew from something where you were before.These children had never been there."
Not emphatic enough for you? Kanner declared these children were "pure-culture examples" -- as in a closely observed petri dish -- "of inborn autistic disturbances."
But certain is not a synonym for correct, and there are signs Kanner was wrong -- or at least not totally convincing -- about that.
Re-evaluating his 11 case studies of children born from 1931 to 1938, there is ample reason to wonder whether some of them developed autism after a period of normal development.
Take Richard M.,, born in November 1937. "I can't be sure just when he stopped the imitation of word sounds," his mother wrote when he was almost 3. "It seems that he has gone backward mentally gradually for the last two years."
Or Elaine C.,, who was born in February 1932. "She took feedings well, stood up at 7 months and walked at less than a year.She could say four words at the end of her first year, but made no progress in linguistic development for the following four years."(Four words at the end of the first year is about right for normally developing babies.No words for the next four years, obviously, is not.)) Both Elaine and Richard were "there" before age 1, it seems.Then they went backward -- they withdrew, to use the word Kanner wouldn't.
The term for that is regression, and today children who at first develop normally but become autistic by 36 months are diagnosed with regressive autism.Yet few associate that sequence with any of Kanner's original cases because he was so definite that their autism was present from birth.
What difference would it make if Kanner used too broad a brush in painting every single case as innate? It would make a lot of difference, by raising the possibility that some factor triggered autism in these children after they were born, not before.
In earlier articles in this series tracking the natural history of autism, we looked at whether autism has always existed at a steady prevalence or, instead, began decisively among children born in the 1930s.
We found the "steady state" theory hard to reconcile with the relatively few cases of autistic-style behavior reported before then; we calculated that at today's rate there should have been 369,000 hard-to-miss full-syndrome autistics alive in the United States in 1930. Where were they? We also pointed to a striking link among the first 10 parents -- they had college educations and many had advanced degrees.But we concluded this link weakened when the first 100 parents were analyzed.
Implication: It's plausible some new factor triggered autism in those college-educated families in the 1930s, and by the 1940s it was spreading to a broader range of families.
If some of Kanner's original cases were not autistic-from-birth but regressive -- acquired autism syndrome, in effect -- that would fit with a "new trigger" theory.
Kanner was brilliantly right in identifying autism -- which, by the way, he described as "a behavior pattern not known to me or anyone else theretofore."And Kanner wrote the book on child psychiatry -- "Child Psychiatry," published in 1934.
But like anyone studying a puzzling new phenomenon -- consider some of the misbegotten theories about AIDS -- not all of Kanner's observations or inferences have proven absolutely correct.
For instance, Kanner wrote that in the whole group of parents, "there are very few really warmhearted fathers and mothers.For the most part, the parents, grandparents, and collaterals are persons strongly preoccupied with abstractions of a scientific, literary, or artistic nature, and limited in genuine interest in people."
Kanner wondered whether "this fact" caused their children's autism, but his belief that it was present from birth gave him pause."The question arises whether or to what extent this fact has contributed to the condition of the children.The children's aloneness from the beginning of life makes it difficult to attribute the whole picture exclusively to the type of early parental relations with our patients."
Hey -- so does this fact: Quite a few of those parents didn't fit that cold unfeeling stereotype.Kanner individually described several: "a patient, even-tempered man ...a well-educated, kindly woman ...energetic and outgoing, fond of people and children."Another mother told him, "The thing that upsets me most is that I can't reach my baby."How unfeeling is that? Kanner's gift for observation undercut his generalization, which has since been proved to have nothing to do with the risk of having an autistic child.
Trying to make sense of those first cases, we did the modern thing -- we got a second opinion.We asked a pediatrician who has worked with dozens of autistic children and their families to read Kanner's original study.These were her main points: -- "I don't think he makes the case that they all were totally autistic from birth," she said.By the same token, given the limitations of the data reported in the case histories, we can't be absolutely certain that any were instances of regressive autism.
-- Ironically, some of the children seem to have the milder Asperger's Disorder rather than classic "Kanner autism," which has come to signify the most severe cases.
-- A number of these children had physical problems that shouldn't be overlooked as possible clues to their developmental disorder.Those problems centered on food, digestion and illnesses that could suggest allergic reactions or a weakened immune system, the pediatrician pointed out.
-- Donald T.,, the first patient Kanner saw in 1938, never had a normal appetite."Eating has always been a problem with him," the father wrote."Seeing children eating candy and ice cream has never been a temptation to him."
-- "Following smallpox vaccination at 12 months," Richard M."had an attack of diarrhea and fever from which he recovered in somewhat less than a week."This is the child whose mother recalled him going "backward" about that age.
-- Barbara K."nursed very poorly and was put on bottle after about a week.She quit taking any kind of nourishment at 3 months.She was tube-fed five times daily up to 1 year of age."Her eating eventually became normal.
-- Herbert B."vomited all food from birth through the third month," after which feeding progressed satisfactorily.
-- John F.''s father said, "The main thing that worries me is the difficulty feeding.That is the essential thing, and second is the slowness in development.During the first days of life he did not take the breast satisfactorily. ...There is a long story of trying to get food down.We have tried everything under the sun."
Kanner noted that John had "frequent hospitalizations because of the feeding problem.No physical disorder was ever found, except that the anterior fontanelle did not close until he was two-and-a-half.He suffered from repeated colds and otitis media (ear infections)."What could these symptoms mean? Perhaps nothing, as babies tend to have all sorts of upsets.But the pediatrician said such illnesses and digestive ailments might increase a child's vulnerability to toxins by making them harder to eliminate.
Conversely, they could signal that if something was causing the child's autism, it was disrupting their entire system.Obviously it's impossible to tell.But consider this: Today, the children diagnosed with the regressive kind of autism are usually the ones with the food allergies, digestive problems and long-running infections that suggest an immune system under siege and out of whack.And that is the kind of autism that now predominates.Initially, autism at birth was much more frequent, but now regressive cases are several times more common, according to Bernard Rimland, a pioneer autism researcher.
Perhaps something did happen to some of Kanner's children after they were born in the 1930s.And perhaps whatever that was is still happening.
copyright 2005 by United Press International
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Chronicles : The Age of Autism: Donald T. and Fritz V.
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Posted by sylvia on Monday, March 07, 2005 (11:52:48)
UPI.com 09/02/2005
By Dan Olmsted
They were born within four months of each other, Fritz V. in June of 1933 and Donald T. that September. Fritz was born in Austria, Donald in Mississippi, but they had a surprising amount in common.
Unfortunately.
When Donald was taken by his beleaguered parents to Johns Hopkins University in 1938, he acted like no 5-year-old that famed child psychiatrist Leo Kanner had ever seen.
"He learned my name," Kanner recounted decades later, "but he would never see me if he met me because he would never look up enough and had enough eye contact to recognize faces. ... Also, while he spoke, it was not for communication, and if in order to satisfy his needs some communication was needed, he would not be able to distinguish between I and you, rather echoing religiously some of the things that he was interested in.
"For instance, if he wanted his milk, he remembered constantly that his mother always asked him, 'Donnie, do you want your milk?' And his way of asking for milk was 'Donnie, do you want your milk?' Well, this was only a part of some of his peculiar behavior."
Yet strangely, by age 2 1/2 he could name the presidents and vice presidents of the Unites States backwards and forwards and recite the 25 questions of the Presbyterian catechism.
Fritz made an equally vivid impression on Hans Asperger, the pediatrician who first saw him in 1939 at age 6 in Vienna. Asperger described him as "a highly unusual boy who shows a very severe impairment in social integration. ... His gaze was strikingly odd. It was generally directed into the void."
In school, "He quickly became aggressive and lashed out with anything he could get hold of (once with a hammer). ... Because of his totally uninhibited behavior, his schooling failed on the first day. ... Another strange phenomenon in this boy was the occurrence of certain stereotypic movements and habits."
As with Donald, "The content of his speech was completely different from what one would expect of a normal child," Asperger said of Fritz. "Only rarely was what he said in answer to a question."
Yet weirdly, he started speaking at 10 months and soon "talked like an adult."
Donald T. and Fritz V. -- last names were never given -- have endured in medical literature because they are firsts. Donald was the first to confront Kanner with the behaviors that he later named "autism." Fritz was the first case study of what came to be known as Asperger's Disorder. Both conditions are now classed in the official U.S. guide to mental problems as Pervasive Developmental Disorders, and are also called Autism Spectrum Disorders. (Autism derives from the Greek word for self, "autos," as in autobiography.)
Most experts think the disorders are related, with autism the severe manifestation; Asperger's is sometimes referred to as "autism lite" or "a dash of autism" and is differentiated by a lack of delay in language development.
Kanner's study of Donald and 10 other children was titled "Autistic Disturbances of Affective Contact" and was published in the journal "Nervous Child" in 1943. Asperger called his study of Fritz and three other children "'Autistic Psychopathy' in Childhood"; it was published in "Archiv fur Psychiatrie und Nervenkrankheiten" in 1944.
Kanner described autism's defining features as "extreme aloneness and a desire for the preservation of sameness."
"The children seemed to live in a static world in which they could not seem to tolerate any kind of change introduced by anybody but themselves," Kanner said in a 1972 speech, "and even that didn't occur very often."
"The autist is only himself," Asperger wrote, "and is not an active member of a greater organism which he is influenced by and which he influences constantly."
Kanner and Asperger did not collaborate on their studies. Nor did either predict the deluge that would follow: In the United States, a reasonable estimate is that 30 or 40 children out of every 10,000 are diagnosed with autism, and another 30 or 40 are diagnosed with other Pervasive Developmental Disorders, including Asperger's.
This leads to a simple but significant question: Was it coincidence that the first few cases of these strikingly similar disorders were identified at the same time, by the same term, in children born the same decade, by doctors thousands of miles apart?
Or is it a clue to when and where autism started - and why?
The question reflects a huge, and hugely important, debate. If autistic children always existed in the same percentages but just weren't formally classified until the 1940s, that would suggest better diagnosis, not a troubling increase in the number of autistic children.
But if autism had a clear beginning in the fairly recent past (a past so recent that Fritz and Donald could both be alive today at age 71), then the issue is very different. That would suggest something new caused those first autism and Asperger's cases in the early 1930s; something caused them to increase; and something is still causing them today.
This ongoing series will look for answers by tracking the natural history of autism around the world -- a road less traveled than one might think. For example, Asperger's study was not translated into English until 1994 -- a half-century later -- and still is not easily available; actually reading Asperger's account of Fritz V. makes you realize the severity of his disorder and its similarity to classical autism.
"The reader of Asperger's first paper cannot fail to be impressed by the close similarities to Kanner's case descriptions and the relatively few differences," wrote British psychiatrist Lorna Wing in the 1994 anthology "Autism and Asperger Syndrome," which includes the first English translation. The translator, Uta Frith, noted, "By a remarkable coincidence, Asperger and Kanner independently described exactly the same type of disturbed child to whom nobody had paid much attention before and both used the label autistic."
Both said that autistic children were impossible to miss.
"Once one has properly diagnosed an autistic individual one can spot such children instantly," said Asperger. "It is a unique syndrome," said Kanner, "and almost photographically not identical, but similar."
Yet Kanner was clear that he never saw an autistic child until he met Donald T. in 1938 -- 17 years after he got his medical degree in Berlin on his way to becoming one of the world's leading psychiatrists, to whom the toughest cases were often referred "all the way to the great Hopkins," as he jokingly put it.
In fact, his landmark 1943 paper begins, "Since 1938, there have come to our attention a number of children whose condition differs so markedly and uniquely from anything reported so far, that each case merits -- and, I hope, will eventually receive -- a detailed consideration of its fascinating peculiarities."
Markedly, uniquely different: The great psychiatrist at the great Hopkins believed he was seeing something new.
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Chronicles : Revenge of the Nerds
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Posted by sylvia on Thursday, January 20, 2005 (20:03:13)
Better Humans 03/01/2005
By George Dvorsky
It was hard to believe that that the words were coming from a seven-year-old boy.
"Another characteristic of mammals is that they give placental births," he said, "Oh, except marsupials like kangaroos and koala bears." Changing gears slightly he continued, "And then there are animals with endoskeletons and exoskeletons. Humans, because they have bones on the inside of their bodies have endoskeletons, but insects have exoskeletons on the outside." With a vocabulary more closely resembling that of someone in grade nine, he chimed off the bits of scientific triviata as if he were directly linked to Wikipedia.
Clearly, this was no ordinary second grader, whom I chatted with recently at a Toronto specialist's office. Compared to other kids with Asperger's syndrome, however, his abilities are considered quite typical. His younger brother, who also has Asperger's, is already doing multiplication tables in his head while most of his kindergarten classmates are still trying to count to 10. The boy also has social interaction and behavioral problems typical of those with Asperger's.
He tends to construe all advances from his classmates as bothersome, for example, compulsively chews on his sleeves and frequently stands up to spin in class. This is pretty textbook stuff for "Aspies"—an affectionate moniker that's increasingly coming to be used to refer to those with Asperger's syndrome, a high-functioning form of autism.
Yet despite the problems, and considering his cognitive gifts, there's a good chance that this boy will integrate successfully into society and lead a fulfilling and meaningful life. That's what a growing segment of the autistic community wants the rest of society to acknowledge. Organizing around the idea that their condition is not so much a disability as a valid mode of psychological being, a growing number of autistics say that the problem is not with their condition but with the general unwillingness to accept and integrate them into society.
Moreover, because of their enhanced cognitive skills, many autistics consider themselves to be the way of the future. In a world where science, programming and math skills are increasingly desirable, where pending neurosciences promise diverse modes of consciousness and psychology, and where interpersonal shortcomings can be made up with communications technologies and social training, monotone neurotypicality may indeed be on the way out.
Good company
Historically, autism and Asperger's have always been with us. It's only now that we've got fancy names to describe them.
While never officially diagnosed as having autism, a number of historical figures are highly suspected of having it. Newton, Nietzsche, Einstein, Turing and Wittgenstein are seminal thinkers who all exhibited autistic-like traits. In the arts, Jane Austen, Beethoven, Mozart and van Gogh also likely had autism. And today, prominent figures such as Bob Dylan, Woody Allen, Keanu Reeves, Al Gore and, of course, the poster-boy for high-functioning autistics, Bill Gates, are all suspected of having autism.
Clearly, autism does not necessarily adhere to its reputation as debilitating affliction. The 1988 film Rain Man, in which Dustin Hoffman portrays a highly disturbed autistic man, has unfortunately colored much of the popular conception surrounding the disorder, offering most people the sense that autism is in all cases quite severe.
The engineer's disorder
Once thought to be a psychiatric disorder, autism is now known to be neurological despite its psychological characteristics. It is a neural condition that falls within the spectrum of pervasive developmental disorders, having considerable variability in terms of its effects on those who have it.
Occurring more frequently in boys, common traits include difficulties with emotional communication and social relationships. Autistics tend to have problems with hypersensitivity to incoming stimuli (such as sound and light), and tend to exhibit patterns of behavior and interests that are uncommon for "neurotypicals" (i.e. non-autistics).
With the high-functioning Asperger's—a kind of autism-lite—those who have it tend to have higher than usual intelligence often accompanied by cognitive gifts. Children are likely to develop sophisticated and precocious language skills at an early age. They have excellent spatial and geometric awareness, excellent rote memory skills and become intensely interested in one or two subjects.
But true to their autism, Aspies tend to have difficulties understanding nonverbal communication. They tend to comprehend everything literally and have social interaction problems. Additionally, they tend to engage in repetitive activities, have difficultly maintaining eye contact, and have poor motor coordination.
In other words, they're nerds.
There is considerable debate as to the causes of autism, but a strong case can be made for there being a genetic component. Ongoing research is focusing on finding the markers that determine autistic phenotypes, but such markers may never be found. Most autistic children, for example, tend to have neurotypical parents, throwing a wrench into the whole genetics angle.
On the rise
One fascinating possibility was expounded in a 2001 Wired article, "The Geek Syndrome," which noted the disproportionately high number of autistic children living in Silicon Valley. The author, Steve Silberman, suggested that its residents, many of whom work in the computer industry, tend to have above average intelligence and gravitate toward tech jobs. Consequently, there is a greater chance that nerdy parents will pair off and have children in Silicon Valley—a phenomenon that Silberman argues may be a facilitating factor in the rise of Asperger's.
As with the cause of autism, there is uncertainty and controversy about whether the incidence of autism is increasing, or if there's simply an increase in the number of reported cases. If the actual incidence is rising, then environmental factors may be playing a part. Or, it could be that parents who produce autistic children are pairing off more frequently, with, as Silberman suggests, some kind of strange selectional effect coming into play.
Still, critics argue that it's the increased tendency to diagnose autism that's on the rise, which explains the increase in reported cases. More teachers, clinicians, parents and doctors are aware of the condition, they argue, so diagnoses are more likely.
But in North America, studies are showing that the incidence may in fact be rising, growing from one in 5,000 to one in 150 to 400 in the last few years. Other investigations show an increase in autism of 173% in the past decade.
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