BRAIN TRAINING ASSOCIATES, INC.
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AUTISTIC SPECTRUM DISORDERS

The term "autism" was first used by the Swiss psychiatrist, Dr. Eugen Bleuler (1857-1959) in 1908 to describe the defining feature of schizophrenia ("autismos" comes from the Greek word "autos," which refers to the self). It was later borrowed by two Austrian psychiatrists, Dr. Leo Kanner (1894-1981) and Dr. Hans Asperger (1906-1980) in the early 1940's to describe the unusual behaviors of some of their patients. 

 

Kanner used the term "autism" in 1943 to describe 11 young patients who had previously been diagnosed as "feeble minded" or "schizophrenic."  (Kanner, L. "Autistic Disturbances of Affective Contact," Nervous Child, 2:217-50 (1943).

 

Kanner described the childrens' gaze aversion, repetitive motor mannerisms, language delays, delayed play skills and social isolation as "autistic" behaviors that were probably the result of an "inborn" abnormality that made it impossible for the children to form normal emotional bonds with others. Kanner noted that the children tended to have "highly intelligent parents and grandparents" who were "preoccupied with their own interests" and who also seemed to lack an " interest in others."  In Kanner's opinion, the parents' self-absorption was evidence that the children had inherited their inability to form emotional bonds.    

 

The following year, Asperger used the term "autistic psychopathy" to describe 4 boys who were being treated in his psychiatric facility (Asperger, H. , "Die 'aunstisehen Psychopathen' im Kindesalter. Archiv fur psychiatrie und Nervenkrankheiten117,76-136, (1944); English translation in "Autistic Psychopathy" in Uta Frith, ed. Autism and Asperger Syndrome,  Cambridge, UK: Cambridge U Press, 1991, p. 37-92.) (Click here to read a summary in English of these 4 cases).

 

Asperger described his patients as "clumsy" with "rigid and narrow interests," and "social problems" as well as difficulty learning.  These boys feared change (e.g. novelty or the unfamiliar) and had speech patterns that were so "unnatural" that they were frequently ridiculed by their peers.  Asperger famously wrote in his summary, "the autistic personality is an extreme variant of male intelligence" (p. 84).

 

Kanner and Asperger did not know what we know today about how brains learn and develop or how sensory experiences drive the development of neural networks that produce cognitive development and control behavior. Strangely, Kanner and Asperger's idea that autism is a "psychiatric" condition has persisted for over 60 years in spite of these advances in the neurosciences. (for more information see  Incidence of Autism, or the Criteria for Diagnosis of Autism  pages.

 

While many professionals realized that some typically developing children also exhibited some of the same behaviors as autistic children, they were apparently unaware of the neuroscience of sensory processing.  As a result, professionals frequently confuse sensory processing problems with autism, complicating the question of whether the incidence of autism is increasing. (for more information click here) 

 

The term Pervasive Developmental Disorders is an example of this type of confusion.  The term is a fairly recent one, first appearing in the 1980s. Although it technically refers to a class of developmental disorders that includes autism, it is frequently used in clinical practice to describe a child who does not meet enough criteria for a diagnosis of autism but who is developmentally delayed and has many "autistic" symptoms. 

 

Perhaps the most common disorder misdiagnosed as "autism" is pragmatic-semantic language disorder. Semantics refer to the meaning of words and pragmatics refer to the social use of language and communication, including tone of voice, facial expressions, words, social context, body language, gestures and eye gaze.  The "unnatural" characteristics that Kanner and Asperger described in their patients are today recognized as symptoms of a semantic-pragmatic language disorder. 

 

Children with pragmatic language disorders exhibit abnormal auditory processing as well as cognitive problems with attention, learning, social skills, and social behavior.  While all children with autism have pragmatic language disorder, not all children with pragmatic language disorder are autistic. While children can and do recover from autism, their pragmatic language difficulties may take years or even decades to overcome (see Kelley E, Paul JJ, Fein D, Naigles LR. "Residual language deficits in optimal outcome children with a history of autism,"J Autism Dev Disord. 2006 Aug;36(6):807-28.)

 

Another odd idea of Kanner's that continues to persist is that autism is an "inborn" (e.g. "genetic") condition. While researchers have searched widely for a genetic abnormality to link to autism, individuals with autism do not appear to share any specific genetic error. Instead, it seems that a wide variety of genetic errors associated with some type of sensory processing problem appear more frequently in some families who have multiple autistic members.  These errors include:1q24, 2q, 3q25, 6p21, 7q11, 7q22, 7q31, 7q36, 13q14, 15q11, Xq13, Xq28 and Xp22.  For more information on these genetic disorders you can click here to search the OMIM database (choose OMIM from the drop down menu on the left.) 

 

Unfortunately, the misconception that autism was a psychological or emotional disorder distracted scientists and clinicians from pursuing successful treatments. The historical tradition of autism came from medical doctors who imposed a "medical" model on the disorder.  This model resulted in what one researcher called "an unfortunate history of treatment failures" which led researchers to conclude that autism was an "incurable" or "lifelong" condition. Clinicians who disputed this claim based on clinical experiences were typically ignored, much as neuroscientists who disputed the idea that brains could not repair themselves were ignored in the 1980's.      

 
The increasing number of reports worldwide that some children were indeed recovering from autism in programs outside the traditional treatment approaches led to increasing controversy.  Unwilling to abandon the medical model completely, a group of  psychologists, psychiatrists and physicians began to promote the idea that autism was a psychiatric condition caused by some dietary or immunological problem. 

This new "biomedical " model became widely accepted in the popular culture during the 1980s and 1990s and a wide variety of "miracle treatments" for autism were promoted including Vitamin B therapy, gluten-free diets, secretin (a digestive peptide), chelation, and trans-cranial magnetic stimulation, to name but a few.  Although the scientific community consistently found that these treatments did not alter the symptoms or course of autism, the popularity of the biomedical approach did not wane, due in no small part to its intensive promotion by various advocacy groups.    

In the mean time, neuroscientists were rapidly unraveling the mysteries of how brains learn, develop, and repair themselves after injury and how early sensory problems alter the brain's ability to pay attention, acquire language, and develop cognitive and social skills. they discovered that abnormal auditory processing during infancy could disrupt developing language networks and that abnormal sensory processing could affect the development of the frontal lobe, an area of the brain that controls attention, learning from context, understanding rules of behavior, initiative, flexible thinking, pragmatic language, perseveration and other skills. (for more information see the Frontal Lobe, Auditory Processing, Vestibular, or Visual Processing pages.

Effective treatments for any autistic spectrum disorder must include both activities that address the sensory processing problems in the child as well as the cognitive consequences of sensory processing problems (e.g. delayed or absent play skills, delayed language, perseveration and problems initiating, rigidity).  As sensory processing problems improve, self-stimulation behaviors fade.  With cognitive and pragmatic language therapy children will develop natural language, play skills, flexibility, eye gaze and social relationships.  As the frontal lobes develop, symptoms like rigidity, perseveration, attention problems, impulsivity, pragmatic disorders, difficulty initiating or making decisions, aversion to novelty, difficulty learning from context and immature behaviors will resolve.  More information about cognitive rehabilitation and sensory therapy can be found in the Sensory Processing Disorders and Brain Training books.
 
At Brain Training we provide activities designed to restore or improve sensory functions at the same time that we are promoting cognitive development and frontal lobe functions through free play, problem solving and the discovery of concepts and rules. Click on the underlined links if you are interested in learning more about our therapy or having your child assessed.                    HOME