Autism and Personality - Case Study Example

Autism: Definition Autism is commonly regarded as a developmental disorder consisting of a triad of impairments (Alvarez, A. and Reid, S., 1999, p. 16). This triad consists of an impairment in communication, in the ability to make social contact and in rigidity and inflexibility of behaviour linked to the impairment for symbolic thinking and the capacity to play (Alvarez, A. and Reid, S., 1999, p. 16). These happen due to the autistic individual’s deficient awareness of the world of personal relationships. This is one of the core features of autism (Alvarez, A. and Reid, S., 1999, p. 16). The autistic individuals lack the awareness of the members of the family as people who have feelings and ideas, and as such incidence of autism in a family has a devastating effect on family life (Glasson, E.J. et al., 2004). Clinicians and researchers have achieved consensus on the validity of autism as a diagnostic category and many features central to its definition. It is somewhat surprising and very encouraging to note that, as greater consensus has been achieved on the definition of strictly defined autism, an interesting and helpful discussion on issues of broader phenotype or potential variants of autism has begun. Today, there is a broad agreement that autism is a developmental disorder, and autism and associated disorders in the spectrum represent the behavioural manifestations of underlying dysfunction in the functioning of the central nervous system (Minshew, N.J. and Williams, D.L., 2007). Within this, it can also be included that sustained educational and behavioural interventions are useful and constitute the core treatment of such condition (Klin, A., Jones, W., Schultz, R., Volkmar, F., and Cohen, D., 2002). In 1943, Kanner’s seminal clinical description of 11 children with “autistic disturbances of affective contact” has endured till date. His description of autism was grounded in data and theory of child development. Children those are normal exhibit marked interest in social interaction from early in life (Kanner, L., 1946). Kanner suggested that early infantile autism is an inborn, constitutional disorder in which children are born lacking the typical motivation for social interaction and affective comments. He used the model of inborn errors of metabolism to explain that individuals with autism are born without the biological preconditions for psychologically metabolizing the social world. The term autism was borrowed from Bleuler who first used autism to describe idiosyncratic, self-centered thinking (Bleuler, M., 1979). Kanner used this term to suggest that autistic children too live in their own world. It represents a failure of development and fantasy is impoverished if present at all (Kanner, L., 1951). In addition to the remarkable social failure, the one of the other features that may be present in such individuals is profound disturbance of communication to the extent that some of them may be mute (Nacewicz, B.M. et al., 2006). The language disturbance in others may be marked by echolalia and literalness as well as a fascinating difficulty with acquiring the use of the first person, personal pronoun, “I.” These children, therefore, refer to themselves in the third person, “he” or by first name. Another intriguing feature is the children’s unusual responses to intimate environment. This can be exemplified by unresponsiveness to parents, yet over-sensitiveness to the small changes in daily routine or simply environmental sounds. The three prime criteria enumerated by Kanner still hold good, and they are to date used to define autism. These are unusual social isolation, resistance to change, and dysfunction in communication (Landa, R.J., Holman, K.C., and Garrett-Mayer, E., 2007). It has now been recognised that parental behaviour as such plays no role in pathogenesis of autism. It is now known that children with autism are found in families of all social classes, and more recent data and rigorous research have failed to demonstrate association with social classes (Stone, W.L., McMahon, C.R., Yoder, P.J., and Walden, T.A., (2007). Decades of research has now shown that when developmentally appropriate tests are given in their entirety, full-scale intelligence and developmental quotients are in the mentally retarded range for the majority of individuals with autism, and these data maintain stability over time (Petropoulos, H. et al., 2006). Children with autism often have unusually scattered abilities with nonverbal skills frequently advanced over more verbally mediated ones (Anckarsäter, H. et al. 2006). Strictly defined autism does not shade off into normalcy in the usual sense and thus represents one of the more robust disorders for purposes of categorical diagnosis of autism (Courchesne, E., Carper, R., and Akshoomoff, N., 2003). At the same time, it is important to incorporate the body of genetic research that has raised the important issue of broader phenotype, that is, of a continuum of social and related vulnerabilities. Even for the strictly defined autism, development of an explicit definition is not that easy. The reasons are tremendous range of syndrome expression and change in symptoms over the course of development. Since the person with autism may not always be able to provide a direct and verbal report, the reports of parents or caregivers must be relied upon, and this raises other potential problems including reliability and validity of historical information. As a result, methods have been proposed for diagnosis that focus on very early development. These methods, which sometimes rely on use of dimensional rating scale may prove problematic in relation to providing a categorical diagnosis for an adolescent or adult with autism (Friedman, S.D. et al., 2006). In the absence of an accepted measure of diagnostic pathophysiology, the scientists would wish to consider a better definition of autism in a multidimensional or multiaxial way. Rutter in 1978 synthesised Kanner’s original report and subsequent research in a highly influential definition of autism as having four essential features (Boddaert, N. et al., 2004). These are early onset by age 22 months, impaired social development, impaired communication, and unusual behaviour consistent with Kanner’s concept of “insistence on sameness.” The behavioural pattern consists of resistance to change, idiosyncratic responses to the environment, motor mannerisms, and stereotypes. Rutter specified that the social and communication impairments are distinctive and not just a function of associated mental retardation (Friedman, S.D. et al., 2003). In contrast, the National Society for Autistic Children in USA proposed a definition in 1978 for autism that included disturbances in rates and sequences of development; responses to sensory stimuli; disturbances in speech, language-cognition, and nonverbal communication; and problems in the capacity to relate appropriately to people, events, and objects (Bernard-Opitz, V., Ing, S., and Kong, T. Y., 2004). As can be seen, this definition also emphasized the neurobiological basis of autism. It should be noted that despite being more accurate and providing more detail clinically, this definition proved rather less influential than the Rutter synthesis. This is probably because the latter seemed conceptually clearer and closer to Kanner’s original description (Lord, C. et al., 2006). The Diagnostic and Statistical Manual of Mental Disorders is an American Handbook for mental health professionals that lists different categories of mental disorders and the criteria for diagnosing them. The DSM-III is the third revision of this handbook since its publication. The DSM-III included autism along with several other disorders in a newly designated class of childhood-onset disorders, pervasive developmental disorders. The class name was meant to convey that individuals with these conditions suffered from impairment in the development and unfolding of multiple areas of functioning (Yeargin-Allsopp, M. et al., 2003). This also avoids a theoretical presupposition about etiology. This quickly achieved broad acceptance. The DSM-III system that extended official recognition to autism provided a useful definition of autism. Later it was found that modification of DSM-III happened to modify the definition into DSM-IV, and after rigorous field trials, the latest definition is provided by ICD-10. It is to be mentioned that DSM-IV is the fourth revision of DSM and ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990 and came into use in WHO Member States as from 1994. The classification is the latest in a series which has its origins in the 1850s (WHO, 2007). This has wide acceptability, and according to this, the autism is defined as an impaired or abnormal development that is evident before the age of three years in at least one of the three following areas (Murray, D., Lesser, M., and Lawson, W., 2005). These areas are dysfunction in receptive or expressive language as used in social communication, disturbances in development of selective social attachments or of reciprocal social interaction, and problems in functional or symbolic play. The other group consists of symptoms, and they are classified into three categories. By definition, then, autism could be perceived to be present when any individual would have at least six symptoms from all categories taken together, with at least two from the first category and at least one each from the other two categories (Warreyn, P., Roeyers, H., and de Groote, I., 2005). The first category is qualitative impairment in social interaction that may be manifested by failure adequately to use eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction. The other group consists of failure to develop in a manner appropriate for mental age and despite ample opportunities peer relationship that involves a mutual sharing of interests, activities, and emotions. These children demonstrate a lack of socio-emotional reciprocity as shown by an impaired or deviant response to the other people’s emotion. They cannot modulate their behaviours according to social context or they can just weakly integrate social, emotional, or communicative behaviours. Unlike the normal children, these individuals lack spontaneous seeking to share enjoyment, interests, or achievements with other people (Stiegler, L.N., 2007). There are qualitative abnormalities of communication as manifested by delay in or total lack of development of spoken language that is not accompanied by an attempt to compensate through gestures or mime as an alternative mode of communication often preceded by lack of communicative babbling (Barrett, S., Prior, M., and Manjiviona, J.,2004). In this category, there is relative deficit or failure to initiate or sustain conversational interchange at whatever level of language skill is present. This happens even if there is presence of reciprocal responsiveness to the communication of the other person. These children often communicate with stereotyped or repetitive use of language or idiosyncratic use of words or phrases, and they often demonstrate lack of varied spontaneous make-believe play or when young, lack of social imitative play (Wang, A.T., Lee, S.S., Sigman, M., and Dapretto, M., 2007). Behaviourally by definition, they demonstrate restricted, repetitive, and stereotyped pattern, interests, or activities. They are often preoccupied with such behaviours, and the pattern of interest is restricted with abnormal content or focus. They have abnormally compulsive adherence to specific, nonfunctional routines or rituals. They demonstrate stereotyped and repetitive motor mannerisms that involve either hand or finger flapping or twisting or even complex whole body movements. These children may be preoccupied with part objects or non-functional elements of play materials, such as, odour, feel, noise, or vibration they generate (Buschbacher, P.W. and Fox, L., 2003). Thus this presently accepted definition of autism encompasses the evolution of the information and synthesis of different schools into one. References Alvarez, A. and Reid, S., (1999). Autism and Personality: Findings from the Tavistock Autism Workshop, London, Routledge, p. 16. Alvarez, A. and Reid, S., (1999). Autism and Personality: Findings from the Tavistock Autism Workshop, London, Routledge, p. 16. Alvarez, A. and Reid, S., (1999). Autism and Personality: Findings from the Tavistock Autism Workshop, London, Routledge, p. 16. Bleuler, M., (1979). On Schizophrenic Psychoses. American Journal of Psychiatry; 136: pp. 1403 - 1409. Bibliography Tustin, F. (1990). The Protective Shell in Children and Adults, London: Karnac Books. Alvarez, A. and Reid, S., (1999). Autism and Personality: Findings from the Tavistock Autism Workshop, London, Routledge. Read More