Current research issues have included the nature of the spectrum,
gene studies, the core impairments, anxiety and emotional regulation and
supporting children with ASDs in school.
The Spectrum
Asperger's Syndrome (AS) was included in the latest edition of
the diagnostic system for the first time in 1994. It is distinguished
from ‘autistic disorder’ in two areas: 'normal early
language development’ and normal or above average intelligence;
thus only early language development differentiates it from
high-functioning autism (HFA). Individuals who fail to meet the
criteria for autistic disorder or Asperger's Syndrome, but present
with one or more of the triad of impairments, may be diagnosed as
Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS.)
This little researched category also includes 'atypical autism'
indicating the presence of two of the impairments, a sub-threshold
pattern of characteristics or later onset/identification. The term
'autistic spectrum disorders' (Wing, 1996) is often used as an umbrella
term to cover autism, Asperger's syndrome and PDDNOS.
Whilst a few writers believe that ‘autistic disorder’ is separate
to ‘Asperger's syndrome,’ others propose
that the broader definition of autism based on the triad of impairments
in social understanding, social communication and a tendency for
inflexible patterns of thinking and behaviour is more appropriate.
This is because it is now recognised that autism is a spectrum disorder
in which classic ‘Kanner autism’ and Asperger's syndrome
may be two of a range of manifestations. Studies have revealed
that who diagnoses and when can affect the diagnosis amongst higher
functioning children. Children who were originally diagnosed
with autistic disorder may “jump” to the Asperger’s
trajectory as they acquire language (Reitzel & Szatmari, 2003). Adaptive-functioning
is in adulthood is similar for individuals who were previously identified
with HFA or AS in childhood. Studies also show similar patterns
of cognition, sensory processing and socio-emotional relating
amongst children with HFA and AS. There is consensus that
problems with socio-emotional relating are cardinal, occurring across
the spectrum.
Gene and Family Studies
A study of the genes that may cause a disorder is the study of
the genotype, with a phenotype referring to how the genotype is
expressed. The replicated evidence from both twin and family studies
undertaken in the 1970s and 1980s indicated both strong genetic
influences and the likelihood that they applied to a phenotype that
was much broader than the traditional category of autism. Current
genetic studies have found a number of genes that are associated
with ASDs. Evidence would indicate that the distinct variants are
associated with different gene combinations that arise from the
phenotype, thus triggering various neurological responses at differing
times of development. With up to twenty possible genes
for autism, a combination of five may lead to an autism spectrum
disorder. Genetic characteristics may be inherited or one-off and
there are cases with no apparent genetic link, but other associated
pre-birth traumas that could also trigger an atypical developmental
pathway (Keane, 2007). Whilst sharing some common characteristics,
'subtypes' would thus vary across a broad spectrum of disorders.
Several major research studies are tracking down the genes and their
combinations.
The contribution of autobiographical perspectives
Temple Grandin (1996) reports that she 'thinks in pictures' using
visual imagery to develop category knowledge. Professor Grandin
is a world expert in her field, the design of livestock equipment;
she also has autism. Her comment encapsulates the essence of what
it is like to have autism, providing an insider’s view of
an atypical learning style. During the last decade ASDs have been
increasingly conceptualised as a different way of processing and
understanding, rather than a simple deficit account, with individuals
having learning strengths as well as difficulties. A contribution
to this shift has been the descriptions found in autobiographical
accounts that highlight strengths, challenges and underlying
processing (Grandin, 1996; Sainsbury, 2000; Lawson, 2001; Shore,
2001). The contribution of these perspectives is being recognised
as both prompting and complementing the traditional literature.
Sensory-cognitive processing
Although early clinical criteria for autism specified disturbances
in sensory modulation, a line of research did not develop until
autobiographical accounts began to appear in which sensory processing
was highlighted. Childhood recollections describe visual distortions,
tactile defensiveness and sound sensitivity. Reports have been complemented
by retrospective parental accounts and home movie studies that found
characteristics including reduced eye contact, unusual motor movements
and abnormal response to sound in infants who were later diagnosed
with an ASD. Confirming the evidence from first hand accounts
and infancy studies, recent survey investigations have found a
significantly higher incidence of sensory sensitivities among the
children with ASDs than age-peers (Keane, 2004).
A considerable body of research has demonstrated that individuals
with ASDs have uneven patterns of development, with strengths in
rote memory and/or visual processing and in some cases, savant skills.
Studies have also found ‘executive dysfunctions’ in
ASDs (Ozonoff, South & Provencal, 2005). Executive-functioning
embraces processes underlying goal-directed behaviour and higher
order thinking including attention shift, response inhibition, planning,
working memory, flexibility, generating novel ideas and problem-solving.
Impaired development of executive functioning is associated with
an atypical learning style characterised by problems in the generation
of novel ideas, organising information, generalisation (transfer
of knowledge across situations) and a tendency for inflexible learning
patterns.
Social interaction
Research conducted over the past twenty years demonstrates that
children with ASDs have delayed development of Theory of Mind
(TOM). This is the process associated with perspective-taking ability,
and encompasses being able to infer mental states (beliefs,
desires, intentions, imagination, emotions etc) that cause action
(Baron-Cohen, 2000). Until recently it was theorised that TOM
may be a core deficit if ASDs, however it is now evident that
the delay is one aspect of underlying difficulties in socio-emotional
relating. Later research revealed that whilst some individuals
with ASDs pass advanced tests of theory of mind, even the most
able experience difficulties where verbal and cognitive mediation
are not possible. The search for diagnostic indicators during
the 1990s reveals the early presence of impairments in socio-emotional
relations prior to the emergence of language and theory of mind
(Chawraska & Volkmar, 2005).
The emotionally expressive transactions and adjustments between
infant and parent are limited or absent in ASDs and babies may not
be as well socially ‘attuned’ as other babies (Hobson,
2002). Early impairments in social orienting deprive the infant
of social information, further affecting development of social competence.
The ‘enactive mind’ theory (Klin et al., 2005) proposes
that very early derailment of social salience systems is followed
by a path seeking physical entities rather than people, thus missing
out on social experiences during a period of brain plasticity. Atypical
socio-affective relating (understanding expression of emotions and
expressing emotions) result in a different learning trajectory,
with social skills learnt cognitively rather than intuitively.
Autobiographical recollections describe lack of meaning attached
to, and sometimes fear of, social contact during early childhood,
Accounts report dealing with social interactions as stressful, but
being quietly involved in their own interests and activities as
calm and soothing. As they become older more able individuals with
ASDs may become aware that they are different and desire some social
contact, but with a lack of ability to do so. There is a desire
to comply and conform, and they may become upset and not understand
why they are rejected or teased. Individuals with ASDs sometimes
describe themselves as feeling like aliens when trying to understand
social interactions. Temple Grandin has described how she uses logic
to understand social situations, and stores information to
recall when similar situations arise.
Anxiety and emotional regulation
Although one of the defining diagnostic criteria, repetitive and
restricted behaviours have received much less research interest
than communication and social development. Evidence suggests a developmental
course characterised by simple repetitive routines in younger or
less able children and the development of special interests in higher-functioning
older children and adults. Repetitive questioning and obsessive
involvement in special interests becomes more pronounced when a
person is anxious. Thus it could be that it is not change per se
that is problematic for individuals with ASDs, but problems with
organisation, sensory overload and/ or unpredictability. Studies
have found elevated levels of anxiety in children with ASDs compared
to typically developing peers (Chalfant, Rapee & Carroll, 2006).
The core impairments of ASDs are also associated with challenges
in developing emotional regulatory capacity. Emotional regulation
refers to an individual’s ability to experience, recognise,
express and regulate emotions effectively. Self-regulation
encompasses tolerating social and sensory experiences, regulating
arousal levels, using language to guide behaviour and problem-solving
ability. The foundations of self-regulation emerge in the first
few months of life when the infant begins to take an interest in
the world, and capacity develops as the result of interaction between
the infant’s maturing executive functions and their interactions
with the environment. A recent study of 65 infants later diagnosed
with ASDs found high levels of disordered self-regulatory indicators
(Gomez & Baird, 2005). Findings support previous anecdotal
evidence and theoretical speculation of impaired development of
emotional regulation (Laurent & Rubin, 2004). As children mature,
their emotional regulation capacities become increasingly sophisticated.
Equally, if not more daunting for children with ASDs, is the capacity
for mutual regulation, as it takes place in the social context and
involves expressing emotions, discerning what is helpful or threatening
and communicating requests for assistance. Clinical evidence suggests
that even when individuals with ASDs are able to communicate in
appropriate ways when in a well-regulated state, extreme dysregulation
such as fear or panic may result in the use of inappropriate behavioural responses.
Children with ASDs in school: A new line of research
Biographical recollections have described challenges faced by
even the most able individuals with ASDs in school. First hand accounts
describe difficulties in filtering out irrelevant stimuli and being
distracted from activities, with sensory stimuli at
times becoming overwhelming, causing confusion, overload and
fear. It is only very recently, however, that research has
been conducted in situ. Ashburner & Ziviani’s (2007) study
of 28 high-functioning children with ASDs enrolled in regular schools
is the first to examine the possible impact sensory processing in
the classroom. Results of the study showed that the properties of
regular school classrooms, such has background noise, visual clutter
and unpredictable tactile input were found to be related to challenges
in attending and subsequent performance of children with ASDs to
a greater extent than the child’s IQ. This accords with the
need to conduct sensory audits in classrooms found in
recommendations from service providers and persons with ASDs.
Observations conducted in schools demonstrate that peer interaction
in children with ASDs is of lower frequency and poorer quality than
peer counterparts. Whilst play is often determined by the proclivity
of the children with ASDs, ecological factors including the setting
and role of peers and adults may influence frequency, duration and
quality of interactions. Disclosure and peer education have been
shown to foster understanding and acceptance by peers. Training
of specific functional social skills and opportunities to practice
skills with peers are also beneficial. Findings of better
social response following paired or group academic work and
using special interests to foster playground interaction indicates social
interaction should not be taught in isolation. To date there has
been no published material that has examined the role of adults
in supporting social development actually conducted in schools (Keane,
2007). Writers with ASDs have commented positively on teachers who
provide scholastic and social support, and negatively on the effects
of teachers who try to ‘cure’ their autism, suggesting
that support involves working with rather than against their autism.
Some accounts also note the very significant role of teachers who
took a special interest in them, providing a turning point in developing
their assets whilst also recognising their remedial support needs.
