Friday, December 28, 2007

- Part I -
Autism has drawn the attention of many medical scientists throughout the course of history. Fascinated by the various levels of impairment determined by this complex neurological disorder - behavioral, emotional, communicational and cognitive, scientists have tried to clarify the notion of autism and its revealing signs. The most exhaustive research conducted upon this type of disorder belongs to Leo Kanner, an Austrian psychiatrist that focused on the study of autism and other related disorders. Kanner was the first scientist to establish an elaborate description of the disorder which he referred to as a syndrome.
In the 40's, Kanner came up with a clear model of diagnosis for autism, based on various experiments and elaborate research. Although Kanner's model of diagnosis is relevant and complete, nowadays it can also be confusing in the process of diagnosing autism. Therefore, various contemporary medical scientists had focused their careers on improving the model of diagnosis introduced by Leo Kanner, clarifying certain obscure aspects that he presented in the past.
It is very important to understand that people with autism don't follow the same pattern of impairment, and in fact, the development of the syndrome can greatly vary from a person to another. The severity of autism can alternate from mild to very pronounced and the syndrome can affect people on multiple levels. It is very difficult to correctly diagnose people with autism, as the syndrome can generate a multitude of abnormalities that might point to other neurological disorders. For instance, while some people with autism may present a pronounced impairment of their social skills, they may have an average emotional IQ and a high performance IQ. Other people with the syndrome may have a low performance IQ, but they may present higher levels of emotional intelligence and better social skills.
When Kanner first established his model of diagnosis, he stated that the disorder is very complex and its margins are very difficult to identify. Hence, he invoked that autism can affect some levels more than others. Kanner's model of diagnosis presented these following features:
- Impairment of social skills, from early childhood to maturity;
- Impairment of communication skills, which can vary anywhere from complete inability to develop speech to poor ability of initiating and maintaining a conversation. Kanner also noted echolalia and excessive questioning as autistic features;
- Very low responsiveness to external stimuli, exaggerated preoccupation with repetitive activities, stereotype behaviors;
- Good cognitive skills and memory;
- Good physical skills and muscle coordination.
Considering the fact that Kanner didn't clarify many aspects of the syndrome, contemporary medical scientists have focused upon simplifying his model of diagnosis. Although the features and the patterns of autism described by Kanner have been preserved, modern science attempted to establish clear criteria of diagnosis. Furthermore, in the late 70's, Rutter developed new controversial theories, claiming that autism shouldn't be separated by performance intelligence in the process of diagnosing the disorder.

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The Complexity of Autism and Issues in Diagnosing the Syndrome(part two)
- Part II -
Although some medical scientists agreed upon the new features discovered and explained by Kanner, others didn't accept his ideas, claiming that autism couldn't be separated from other neurological disorders. Many medical scientists disagreed with Kanner and completely refused to see autism as a distinctive syndrome. This was due to the fact that Kanner failed to clarify various aspects of autism, leaving serious gaps in his research.
By contrast, scientists who accepted Kanner's ideas quickly began to apply his model of diagnosis in their psychiatric practice. However, considering the fact that Kanner's concept of autism was confusing, most medical scientists who adopted his theories applied the model of diagnosis too widely. Due to misinterpretation of Kanner's ideas, more and more people who suffered from neurological disorders were inappropriately diagnosed with autism.
The concept of autism was finally clarified by Rutter in the late 70's. Rutter introduced new terminologies and developed new theories that would adjust the overall interpretation of autism. In an attempt to eliminate the confusion that surrounded the concept of autism, Rutter focused his work on improving Kanner's model of diagnosis. Some of the new criteria introduced by Rutter in the process of diagnosing autism were:
- Onset of the syndrome in early childhood, by the age of 30 months;
- Abnormal social development (regarded separately from intellectual development);
- Slow and impaired development of speech (regarded separately from intellectual development);
- Poor adaptation skills, stereotype behaviors and insistence on routine.
While Kanner claimed that autism and intellectual retardation should be regarded as two separate, distinctive units, Rutter revealed that the concept of autism included some degree of intellectual retardation. Rutter refused to accept that autism should be diagnosed without measuring the levels of performance intelligence and proved that Kanner's syndrome and impaired cognitive functions went hand in hand. While this fact may seem controversial and contradictory to Kanner's findings, the truth is that the Austrian scientist failed to correctly measure the IQ levels of the subjects he studied. In fact, Kanner only discovered good memory and logical skills in his subjects, not accounting for other aspects of performance intelligence. Rutter explained that in spite of their good memory and good logical skills, most autistics present some degree of impaired mental judgment.
Rutter's work had clarified many aspects of autism, enabling medical scientists to diagnose the syndrome in a more precise and approachable manner. Rutter's improved model of diagnosis was a huge step forward in the practice of psychiatry, clarifying certain aspects omitted by his predecessors. Although there are still many uncertain aspects regarding the syndrome identified by Kanner, nowadays medical scientists are able to correctly diagnose children with autism.



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Understanding the Notion of Borderline Autism
The concept of autism can sometimes be very confusing. The syndrome first explained by Austrian psychiatrist Leo Kanner in the 40's has generated many controversial opinions throughout the course of history. Autism is a very complex neurological disorder that can lead to different forms of behavioral, communicational, social and cognitive impairment. People with autism rarely fit the standard symptomatic profile introduced by medical scientists in the past. In fact, the syndrome generates a very wide spectrum of symptoms that can be experienced on multiple levels and at various intensities.
In most cases, the criteria of diagnosis introduced by Rutter and other scientists may be enough to identify some categories of autistic children. However, some children may only present some characteristics of autism, showing no other signs of the disorder. Contemporary medical scientists have argued many times whether it is appropriate to consider this category of children autistic or not. Patients who partially fit the autistic profile could be referred to as "borderline". The concept of borderline autism is very common these days and it generally includes patients who show clear signs of abnormality but they only reveal some symptoms of Kanner's syndrome. In the past, many children with borderline autism were inappropriately diagnosed with psychosis or schizophrenia.
Patients who don't fit the exact profile of autism but present certain signs of the syndrome might nowadays be diagnosed with Asperger's Syndrome. Due to their common features, Asperger's Syndrome and Kanner's Syndrome were considered to be the same concept. Many scientists believed that Asperger's Syndrome described a milder form of autism, while others completely failed to distinguish between them. In fact, the syndrome discovered by Asperger described patients who didn't fit the exact pattern of autism and hence, it could be referred to as a form of "borderline autism". Asperger's Syndrome revealed how difficult it was to draw the line between autistic and normal children, proving that it was possible for patients to have only certain characteristics of autism.
As Asperger's theories became popular, many children that have been previously diagnosed with "mild" autism were now considered to suffer from Asperger's Syndrome. Children with Asperger's Syndrome seemed more responsive to external stimuli and presented less preoccupation to sameness. Children with Asperger's Syndrome also seemed to have higher levels of performance intelligence and better communicational skills. Unlike autistic children, who hardly made any progress as they reached more advanced stages of development, some children diagnosed with Asperger's Syndrome could be partially recovered in early childhood. With the help of specific medical treatments and with the means of appropriate educational programs, most children with Asperger's Syndrome showed signs of improvement on both behavioral and communicational levels.
Nowadays, most patients diagnosed with Asperger's Syndrome can be successfully integrated into the society and they can even live their lives independently. As adults, many patients with Asperger's Syndrome have proved to be very responsible and socially aware, showing few signs of neurological impairment.

So, if you want to find out more about Autism, and especially about autism causes or signs of autism, please click one of the following link.