Autism: The Heart of the Disorder? Sensory Processing and Social Engagement-Illustrations from Autobiographical Accounts and Selected Research Findings
Keane, Elaine, Australian Journal of Early Childhood
Autism was first identified as a separate condition in the 1940s by Leo Kanner, who published an account describing a disorder he termed 'Autistic disturbances of affective contact' (Kanner, 1943, in Donnellan, 1985). The feature found across Kanner's II cases was a 'profound autistic withdrawal'. Although it has been established that autism results from a variety of aetiologies affecting the developing brain (Gillberg, 1990), and that there is often a genetic component (Dawson et al., 2002), there have been no consistent findings concerning the neuropathology or possible core deficits. Cases continue to be identified by a set of diagnostic criteria, which are based on observable behaviour. This denotes a pattern of impairments in:
* reciprocal social interaction;
* verbal and non-verbal communication; and
* restricted, repetitive and stereotyped patterns of behaviour, interests and activities (World Health Organization, 1992; American Psychiatric Association, 1994).
The term 'autism spectrum disorders' (Wing, 1996) is frequently used as an umbrella term to cover autism, Asperger Syndrome and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) (Jordan, 2000; Gillberg, 2002). Adhering strictly to the criteria from the major diagnostic systems (World Health Organization, 1992; American Psychiatric Association, 1994), those children who had delayed early language development would fit the criteria for autism, while those with no apparent delays would fit the criteria for Asperger Syndrome. Individuals who fail to meet the criteria for autism or Asperger Syndrome, but present with one or more of the triad of impairments or a sub-threshold pattern of impairments, may be diagnosed as PDD-NOS (American Psychiatric Association, 1994). There is consensus that impairment of the development of reciprocal social interaction is a common feature across the autism spectrum (Wing & Gould, 1979; Gillberg, 1990; American Psychiatric Association, 1994; Sicotte & Semberger, 1999). A recent review of 32 surveys published between 1966 and 2002 suggests a prevalence rate for all forms of autism spectrum disorders of six per 1000 (Fombonne, 2003). Autism is four to five times as common in boys as in girls, and in high-functioning and Asperger cases it has been estimated that 10 times as many cases are boys (Cumine, Leach & Stevenson, 1998; Siegel, 1999).
The aim of this report is threefold:
* to highlight the contribution of first-hand accounts to the literature on autism;
* to provide evidence from these accounts and selected literature, that indicates early-arising and pervasive impairments in sensory processing and socio-emotional perception; and
* to provide a view of autism for practitioners that goes beyond a traditional viewing of autism 'outside-in', presenting an 'insider perspective', that may assist in developing approaches to intervention.
During the past decade, autism has been increasingly conceptualised as a different way of processing and understanding information and social cues, rather than a simple deficit account (Happe, 1999; Baron-Cohen, 2000a). Descriptions found in first-hand accounts highlight strengths and learning styles and underlying processing (Grandin, 1988, Jolliffe et al., 1992; Lawson, 1998). Accounts frequently report problems with sensory modulation and difficulties with social perception. Findings from infancy studies, seeking early indicators of autism complement themes highlighted in first-hand accounts. Cross-study comparison reveals the strongest indicators of autism in infants who later receive a diagnosis of autism, are in the areas of sensory processing and socio-emotional relating. In conjunction with other research evidence, findings indicate that sensory and socio-affective responses may be basic impairments in autism spectrum disorders, underpinning difficulties in social interaction, communication, and idiosyncratic approaches to learning. …