Academic journal article The Psychoanalytical Study of the Child

Autism Spectrum Disorders: In Theory and Practice

Academic journal article The Psychoanalytical Study of the Child

Autism Spectrum Disorders: In Theory and Practice

Article excerpt

INTRODUCTION

AUTISM, ASPERGER'S SYNDROME, AND RELATED DISORDERS-NOW termed the "autism spectrum disorders," or ASD (American Psychiatric Association [APA], 2013)-have been officially recognized as psychiatric disorders since 1980. The original work on these conditions began in the 1940s with Kanner's classic description of the syndrome of early infantile autism (Kanner, 1943) and the report (made independent from Kanner) by Asperger of the condition that now is commonly referred to as Asperger's syndrome (Asperger, 1944). Indeed, to some extent the early reports by Rank of atypical patterns of personality development (Rank, 1949) prefigured the concept of the broader "spectrum" of autism. With the wisdom of hindsight it is quite likely that cases had been reported prior to this work, for example, in reports of so-called "feral" children (Wolff, 2004). Beginning in the nineteenth century, other reports of "childhood insanity" and later of what now might be termed childhood schizophrenia (De Sanctis, 1906) appeared and set the stage for a period of considerable debate about the validity of autism and related conditions.

Early work on autism assumed, partly because of severity and partly because of Kanner's use of the word "autism," that there must be some strong connection between autism and schizophrenia (Bettelheim, 1967). This led to much diagnostic confusion and a focus on psychogenic factors in syndrome etiology. However, several lines of evidence began to converge and suggest that autism was a distinctive condition in its own right. For example, it became clear that many children with autism developed seizures- often in adolescence (Volkmar and Nelson, 1990) and that there was high heritability (Folstein and Rutter, 1977) as well as important differences in clinical presentation (Kolvin, 1971). Moreover, the early emphasis on psychotherapeutic interventions began to change as evidence accumulated to suggest that more structured special educational and behavior procedures were associated with greater degrees of improvement (Bartak and Rutter, 1973). The official recognition of autism in the Diagnostic and Statistical Manual, DSM-III, (American Psychiatric Association, 1980) set the stage for what has become an explosion of work on the condition, particularly over the past two decades, with thousands of scientific papers now published.

In the field of autism the early focus on psychogenic factors and the tendency to "blame" parents led many parents to feel traumatized by their work with mental health professionals trying to remediate "bad parenting" (Feinstein, 2012). As a result, in the mainstream scientific literature, publications on psychotherapy of individuals with autism and Asperger's became quite sparse and only recently have begun to increase as it has become apparent that for some individuals psychotherapy can be particularly helpful (see Volkmar, Klin, and McPartland, 2014). In another way, the study of development in persons with autism or other serious social learning disabilities has stimulated an increased awareness of the importance of appreciating others in development of early cognitive and other processes (Chawarska et al., 2014).

As the research literature has grown, our understanding of autism has substantially increased. It is clear that autism is a strongly genetic, brain-based disorder and that with earlier diagnosis and provision of effective treatments many children can be helped. Indeed some reports now suggest that individuals can be helped to "outgrow" their autistic symptomatology (Fein et al., 2013). Put in its most basic form, our current understanding is that autism is a serious social learning disability with an onset early in life, if not before birth, and that the failure to orient to people from the earliest beginning of consciousness has a profound impact on learning. This leads to idiosyncratic and rigid learning styles and, if untreated, a high risk for development of concurrent intellectual deficiency. …

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