Understanding Autism Spectrum Disorder (ASD)

• ASD is a neurological and developmental disorder that affects communication, social interaction, learning, and behavior.
• ASD is typically called a "developmental disorder" because symptoms appear in early stages of life, usually around 2 years old
• Symptoms include; difficulties with social communication, restrictive interests and repetitive behaviors, and challenges with daily functioning in school, work, etc.
• ASD is present from birth
• Earliest diagnosis age is around 18 months
• Individuals with ASD can have a wide range of talents and interests and is therefore unique to each individual diagnosed
• Early diagnosis and treatment can improve symptoms and support daily life functioning.
• ASD is referred to as a "spectrum" because of the wide variation in the type/severity of symptoms experienced.

Social Communication Difficulties (IRCSUD)

• Inconsistent eye contact and reduced response to social cues
• Challenges with reciprocal conversation and sharing interests
• Unusual facial expressions, gestures, and tone of voice
• Difficulty understanding others' perspectives/social contexts

Restrictive and Repetitive Behaviors (RRBs)

• Echolalia (repetition of words/phrases)
• Intense interests on specific topics/objects, such as numbers, details, and facts
• Resistance to changes in routine and transitions
• Variable sensory activities related to light, sound, and clothing

Historical Context

• ASD is considered a neurological condition that has likely existed throughout history
• Study of ASD is a long and complex one

Eugen Bleuler (1911-1912)

• He was a Swiss psychiatrist
• Coined the term "autism" to describe a symptom of severe schizophrenia
• Observed that many patients with schizophrenia had related systems, including withdrawal ("autos")
• Autism was initially categorized as a version of schizophrenia
• Autism and childhood schizophrenia are now recognized as distinct conditions
• Pre-Kanner references by researchers (Minkowski, Witmer) noted behaviors now recognized as autistic, but lacked a categorization framework

Key Contributors

• Melanie Klein (1882-1960)
• Developed the object relations theory
• Conducted research on symbolic play
• Contributed to psychoanalytical approaches
• Did NOT directly study ASD
• Leo Kanner (1943)
• Categorized characteristics of ASD
• Was one of the founders of ASD research
• Referred to high-functioning individuals as odd loners, who don't need intervention
• Described a syndrome of disturbances in affective contact
• Observed lack of social motivation toward communication and interaction in eleven boys
• Noted children had inability to form usual affective contact and did well on parts of IQ tests
• Described autism as an inborn, constitutional disorder
• Found a sex ratio of 4:1 male to female among subjects
• Noted enlarged head circumference in some children, with modern MRI testing revealing differences in brain volume
• Identified triad of impairments: social difficulties, communication problems, restricted activities
• Described the 3 key contributions as: defining autism as a unique condition, core characteristics and the role of early life, being present early in life
  • Autism is separate from schizophrenia and has no hallucinations
  • ASD core characteristics are: social relations, atypical communication patterns, routine

Hans Asperger (1944)

• He was a German pediatrician

• Similar to Kanner

• Described "Asperger's Syndrome"

• Observed high intelligence, verbal skills, but social awkwardness in boys

• Described boys as "little professors" and noted similar profiles in their fathers

• Asperger's report had little impact in the English-speaking world until the 1980s

• Observed distinctive behavior patterns in kids

• Trouble with social interactions, intensive/specific interests, advanced language skills, and clumsiness

• Asperger's key contributions are: identification of a unique profile, focus on strengths, and broader understanding of ASD

• Autism was first described by Asperger and Kanner

• 1952: Publication of DSM 1

• 1968: Publication of DSM 2

• 1956: Kanner-Eisenberg revision of criteria for autism (ASD is a distinct disorder from schizophrenia)

1960s Developments

• Bruno Bettelheim: the unfortunate influence
• Bernard Rimland: the great debunker
• Lorna Wing and the birth of the National Autistic Society in the UK
• First to use term “autism” to describe group of people displaying characteristic of ASD

Bruno Bettelheim (1950s)

• Blamed parents for their child's autism
• Believed that 'The precipitating factor in infantile autism is the parent's wish that his child should not exist.'
• Known for the "refrigerator mother" theory
• His 1967 was a best seller
• Mothers felt shame and guilt
• Middle class caucasian families (with educated parents) were the target
• Solution proposed was Mother: psychoanalysis/counseling and Child: play therapy

Bernard Rimland (1964)

• Landmark 1964 book, Infantile Autism: The Syndrome and Its Implications for a Neural Theory of Behavior, debunked the belief that parents' behaviour made their children autistic
• Showed that the disorder had a biological basis relating it to not poor parenting
• He refuted "Refrigerator Mother" Theory
• 1964: Book: Infantile Autism: The Syndrome and Its Implications for a Neural Theory of Behavior
• 1965: Founded the Autism Society of America (ASA)
• He advanced Biomedical and Nutritional Research on Autism
• Suggested diets to use to avoid side effects of toxins for people with ASD
• He influenced the DSM-III (1980) and Beyond
• Hypothesis: brain differences in those with ASD to typically developing kids
• Founded autism research institute (ARI), supports project Defeat autism now (DAN)

1970s Developments

• 1977: Used Folstein and Rutters twin study
• 1978: Formed Rutter's four criteria for defining ASD
• 1979: Lorna Wing and Judith Gould's Triad of Impairments

Sir Michael Rutter's twin studies

• 1977: Twin studies with Susan Folstein: genetic component

• One of the greatest strides towards making ASD both a coherentand conventional diagnosis

• Found that if One twin has ASD, there is a high likelihood that other twin also has ASD

• These studies had huge effect on psychology world; understanding of other health conditions began using genetic component

• Found four main ASD categories:

  • Impairment on social interaction
  • Impairment in communication
  • Presence of RRB (restricted and repetitive behaviors)
  • Onset during childhood

Lorna Wing: the spectrum

• Founded National Autistic Society (UK)
• Introduced concept of the Triad of Impairments w/ Judith Gould (1979)
• First to use autism to describe group of symptoms displaying characteristics of ASD
• Work highlighted that ASD varies greatly in symptoms and severity
• Gould and Wing were the first to use the term “asperger syndrome"

Educational and Therapeutic Approaches:

• Eric Schopler and TEACCH (1971)
• Saw unfairness while working with Bruno Bettelheim in Chicago
• Founded TEACCH (Teaching and Education of Autistic and other Communication-Handicapped Children) in North Carolina
• TEACCH: break tasks and use visual supports
• Assists to lead to task completion independently
• This educational program (TEACCH) is now used all over the world
• Ivar Lovaas
  • Developed ABA
  • Believed in early and intensive behavioral treatments to gain skill
  • Stated that Early trainings were not without controversy
  • Noted the Scientific research needed a data driven approach
  • Positive and negative reinforcement
  • Brings about desired behavior/goal
  • Both Lovaas and Schopler famous for groundbreaking work in INTERVENTIONS for autism
  • Creating independence through visual learning by using visual cues for example: color matching, sorting, word boxes...

Diagnostic Evolution

• Transition from multiple diagnostic categories to a unified term “Autism Spectrum Disorder"
• DSM is the main diagnostic and statistical manual of mental disorder that is
• Published by APA (american psychiatric association)
• Key classification system used in psychology and psychiatry for mental health conditions
• Significant changes in diagnostic criteria from DSM-III through DSM-IV (1980-2013)
• DSM5: adopted idea of ASD but did not include separate criteria of the disorder