What is autism? Expanding the current definition of autism

Article By: Noel Chia
Article Date: 01/29/2007

The term “autism” comes from the Greek word “autos” that means self. There have been some earliest published descriptions of autistic behaviors dating back to the 18th century. However, it was not until 1911 that Dr Eugen Bleuler, a Swiss psychiatrist, coined the term “autism” in his work while working with schizophrenic patients, whom he observed to be socio-emotionally isolated and extremely self-absorbed.

Our knowledge and understanding of autism come from the writings of Dr Leo Kanner and Dr Hans Asperger, who have been regarded as the pioneers in the field. Dr Kanner published his paper on autism in 1943; Dr Asperger, in 1944. Dr Kanner’s definition of autism was known as early infantile/childhood autism, which displays symptoms Dr Lorna Wing (1996) described as triad of impairments: impaired social interaction, lack of imaginative play, and verbal communication problems. On the other hand, Dr Asperger’s description of children with similar traits except that his subjects were of higher IQs and precocious language skills. Both described symptoms of two different sub-groups among a wide range of disorders affecting social interaction and communication. In between them, we will be able to find various subtypes of autism and related anomalies.

In 1996, Dr Bryna Siegel used the term “autism spectrum disorders” to encompass autistic disorder (i.e., the classical autism as described by Kanner) and non-autistic pervasive developmental disorders (PDDs), which include Asperger’s Syndrome, Fragile-X Syndrome, Rett’s Syndrome, Childhood Disintegrative Disorder, and PDD-Not Otherwise Specified, and correspond exactly to what the DSM-IV-TR refers to collectively as PDD.

The twelve diagnostic criteria for DSM-IV-TR Autistic Disorder have been categorized under three areas: social development, communication, and activities and interests. Within each area are four specific criteria, each representing a different area of symptoms. Generally, the first criterion in each of the three areas is the one that can be observed at the earliest age, and the latter ones in each area are those that become apparent in later development. Each criterion is to be evaluated according to the child’s level of mental development to avoid confusion between developmental delay and autistic symptoms. The need to evaluate possible autistic signs according to the child’s level of mental development is one reason why it is essential to have both IQ and adaptive behavior assessments administered.

The current definition of autism emphasizes on problems in empathizing, which involves two main steps: the ability to attribute mental states to other people as a natural way of understanding them, and having an automatic appropriate emotional reaction to other people’s mental states. Empathizing concerns what is known as the theory of mind or mind-reading. Empathizing deficits, therefore, refer to one’s failure to make connection to another individual’s experience and to respond appropriately to that person.

However, recent studies (especially those carried out by Dr Baron-Cohen and his team at the University of Cambridge) suggest that though individuals with autism display empathizing deficits, they have intact or even superior systemizing ability. Systemizing refers to that ability to analyze and build systems in order to understand and predict the behavior of impersonal events or inanimate or abstract entities. Dr Baron-Cohen and Dr Sally Wheelwright (2004) have listed six systems: mechanical, natural, abstract, motoric, organizable, and social systems. The way an individual with autism makes sense of any of these systems is not in terms of mental states, but in terms of underlying rules and regularities. Such superior systemizing ability can be seen in those termed as autistic savants, who may have two or more savant abilities (Blake, 1989). However, there is also another lesser known sub-group of autistic crypto-savants, who, because of their inability to communicate, have savant skills that are hidden, or secret, and unknown to those around them (Rimland, 1990). This aspect is often ignored in the current definition of autism.

In sum, based on the past and current research studies, autism spectrum disorder (ASD for short) can be defined as a neuro-developmental syndrome of constitutional origin, whose onset is usually around first three years of birth, with empathizing deficits that result in a triad of impairments in communication, social interaction, and imagination, but may display (especially by autistic savants) or hide (especially by autistic crypto-savants) a strong systemizing drive that accounts for a distinct triad of strengths in good attention to detail, deep narrow interests, and islets of ability.