by Dr Hester Bancroft, BSc (Hons) Psych, DCPsych, CPsychol

Autism is a pervasive developmental disorder which can have a profound effect on a person's ability to communicate and interact. In addition, it can involve repetitive, obsessive behaviours and hypersensitivity. Whilst developmental psychology has contributed much to the understanding of autism it is also important to recognise that historically it has been criticised for taking an ethnocentric approach by failing to listen to insider viewpoints. Although first hand accounts should not be treated as incorrigible, they should be regarded as providing an important contribution to the scientific understanding of autism.

In 1943, Leo Kanner in America described a group of children as having a particular disorder he called Early Infantile Autism. Just one year later Hans Asperger in Austria described a group of older children with much commonality in the symptoms to the children Kanner described. It wasn't until 1979 in London that Lorna Wing and Judith Gould carried out a ground breaking study that pointed to Autism existing on a continuum. Wing and Gould introduced the term 'Autistic Spectrum Disorder' (ASD) to cover the range of pervasive developmental disorders where autistic symptoms are the common feature. They put forward the idea that the whole spectrum is united by the presence of a 'triad of impairments' in social interaction, social imagination and social communication. Asperger's syndrome is distinguished from Autism by not having structural language problems or intellectual impairment.

There is much evidence to suggest that ASD is an organic disorder, probably resulting from a variety of different causal pathways. Twin studies carried out provide strong evidence for genetic susceptibility with concordance rates of 0% in fraternal twins compared to 36% in identical twins (Frith, 1989). In addition, due to the significant advances made in brain scanning techniques, it is now known that there are differences in some areas of the brains of people with ASD. Recognising the importance of the first person experience, Frith’s research looked at both structure and functioning in ASD patients. However, the precise brain mechanisms associated with ASD have not been definitely established and it should be remembered that these differences could be the results of the disorder rather than its cause.

There has been much important research into the precursors of ASD which have been found to include a lack of pointing, gaze monitoring and showing gestures. Such research assists in early identification and there is much evidence to suggest that the most effective intervention programmes are those that begin at 2-4 years. In 1985 Simon Baron-Cohen proposed that the difficulty children with ASD have reading into the mental life of others (known as the Theory of Mind or ToM) is the distinctive core deficit of ASD. He found that 80% of participants with ASD routinely fail ToM tasks (for a fascinating clip explaining these tasks please click on the link above). However, the theory of mind deficit is not specific to children with ASD.

Chin and Bernard-Opitz (2000) found that the children they studied could be trained to improve their conversational skills (defined by the amount of shared interest and appropriate responses) but, interestingly, their performance remained the same on ToM tasks. There were limitations to this study; it involved only three high functioning children (aged 5-7), the training was over a very short nine week period and there was no control group. Chin and Bernard-Opitz also point out that the participants may have learned and applied a set of rules and therefore were not referring to mental states at all. It does, however, highlight the point that ToM tasks only look at one aspect of mentalizing in everyday life. Despite this, Chin and Bernard-Opitz acknowledge that Baron-Cohen's theory provides a much needed instrument for screening very young children with autism (from 18 months).

Some theories argue that ASD is associated with underdeveloped or disrupted executive functions and highlight difficulties with regard to the flexibility of thought and behaviour. However, like Baron-Cohen's ToM deficit, executive dysfunction is not specific to ASD. Other theorists argue that the primary deficit is a weak drive for central coherence and see autism as a distinct cognitive style. Happe (1994) argues that any theory must explain not only the deficits associated with ASD but also the strengths. There is evidence to suggest that children with ASD excel at focusing on fine detail and outperforming non-ASD controls on embedded figures tasks and block design although this ability can result in difficulties seeing the coherent whole. However, there is relatively little research in this area and the findings are conflicting.

Whilst these theories all focus on trying to identify a primary deficit, all of the theories overlap considerably with one deficit often being explainable by another (for example executive dysfunction may explain elements of ToM). There are also issues with defining ASD in terms of deficits: the way psychology approaches ASD has implications for society's attitude to and understanding of people with ASD.

Historically, much of the clinical, educational and research work has been informed by outsider accounts. However, there is much that can, and should, be learnt from insider accounts.

Whilst many of the subjective experiences are reflected in the diagnostic criteria there are some notable and important exceptions. Hypersensitivity, despite being so prevalent in first person accounts, has historically received scant attention having had a major impact on the way a child with ASD experiences their environment. In addition, without first person accounts there is room for misinterpretation of the behaviour resulting from hypersensitivity.

An enlightening piece of recent research was carried out by Davis et al. (2006). Nine high-functioning autistic children were matched with nine typically developing children and were assessed for sensory sensitivity, flooding and attentional dysregulation in the auditory, visual, tactile, gustatory and olfactory modalities. The results of the autistic children were in stark contrast with those of the typically developing children: all children with ASD reported at least one sensory anomaly and 40% reported sensory hypersensitivity across all five modalities. Whilst a limitation of this study is clearly the number of participants, the effect sizes indicated meaningful group differences.

In common with much research into the subjective experiences of children with ASD, the participants in the Davis study were high functioning. Whilst this is understandable given the communication problems experienced, it nonetheless means that the findings may not generalise to all people with ASD.

Like hypersensitivity, motor impairment is another common symptom of ASD that has largely been ignored in research. However, Ming et al. (2007) used clinical examinations of 154 children with ASD to research the prevalence of motor impairment. They found that hypotonia (increased activity and resistance in muscles) affected 63% of children aged 2-6 years while dyspraxia (a motor learning difficulty that can affect planning of movements and co-ordination) affected 41%. Despite this, they found that the children with motor deficits were no more likely than those with no motor deficits to receive occupational therapy, suggesting that proper recognition of these motor deficits is warranted. The advantage of this study was that the sample size was relatively large and the examinations were performed by a single paediatric neurologist. However, a longitudinal study would provide a better assessment of the prevalence and long term implications.

It is estimated that 80% of children with ASD have profound learning difficulties and around half of all children with ASD fail to develop functional speech. Establishing successful education facilities is therefore both challenging and crucially important.

Howlin (1998) points out in her practitioner review that it has long been recognised that early intervention and the provision of appropriately structured educational programmes are the most important aspects of successful treatment. However, several treatments for ASD are not clearly supported by evidence. Whilst a psycho-educational approach is generally recognised as the basis of most successful programmes she questions those that take a radical behaviourist stance. Howlin argues for example that the original Lovaas study made extravagant claims that have not been supported by subsequent research and analysis. According to Howlin, the best teaching arises from an empathetic understanding, a willingness to be flexible and a focus on developing existing strengths.

Jordan (2005), in her review of educational practice, also stresses that there is a lack of research into the effectiveness of existing interventions. She argues though, that autism-friendly environments can be created to reduce stress for children with ASD and enable learning and social adjustment. This involves providing repetition for initial learning, visual cueing, explicit teaching on the exceptions to rules of behaviour and appropriate aesthetic, visual and spiritual activities. Like Howlin, Jordan argues that a diagnosis of ASD should not be used to determine the educational approach but to interpret the individual needs. Individual characteristics are significant in establishing the needs and difficulties a child will face in education; language ability, general cognitive ability, sociability and sensory sensitivity all need to be taken into account.

In conclusion, major advances in understanding the neurological and psychological aspects of autism have assisted in the development of special methods of education and treatment for children with ASD. However, it is clear that much research still needs to be done. The growing recognition that insider accounts should be incorporated into scientific understanding should further improve those methods and, in addition, should lead to a better understanding of and support for children with ASD and their families.

Asperger, H. (1944) 'Die Autistischen Psychopathen Im Kindersater', Archiv für Psychiatrie und Nervenkrankheiten 117: 76-136. Trans. U. Frith in U. Frith (ed.) (1991) Autism and Asperger Syndrome, pp. 37-92. Cambridge: Cambridge University Press.

Baron-Cohen, S., Leslie, A. M., Frith, U. (1985) ‘Does the Autistic Child Have a ‘Theory of Mind’’, Cognition, 21: 37–46.

Chin, H. Y. & Opitz, V. B. (2000) ‘Teaching Conversational Skills to Children with Autism: Effect on the Development of a Theory of Mind’, Journal of Autism and Developmental Disorders, 30: 569-583.

Davis, R. A. O., Brockbrader, M. A., Murphy, R. R., Hetrick, W. P., O’Donnell, B. F. (2006) Subjective Perceptual Distortions and Visual Dysfunction in Children with Autism, Journal of Autism and Developmental Disorders, 36:199-210.

Frith, U. (1989) Autism: Explaining the Enigma, pp. 42-3. Oxford: Blackwell.

Happe, F. G. E. (1994) ‘An Advanced Test of Theory of Mind: Understanding of Story Characters’ Thoughts and Feelings by Able Autistic, Mentally Handicapped, and Normal Children and Adults’, Journal of Autism and Developmental Disorders, 22:129-154.  

Howlin, P (1998) Children with Autism and Asperger Syndrome: A Guide for Practitioners and Carers. Chichester and New York: Wiley.

Jordan, R. (2005) Managing Autism and Asperger’s Syndrome in Current Educational Provision, Developmental Neurorehabilitation, 8: 104-112.

Kanner, L. (1943) 'Autistic Disturbances of Affective Contact', Nervous Child 2: 217-50.

Ming, X, Brimacombe, M., Wagner, G. C. (2007) Prevalence of Motor Impairment in Autism Spectrum Disorders, Brain and Development, 29: 565-570.

Wing, L. & Gould, J. (1979) 'Severe Impairments of Social Interaction and Associated Abnormalities in Children: Epidemiology and Classification', Journal of Autism and Developmental Disorders, 9: 11-29.