essays on autism

Autism - List of Essay Samples And Topic Ideas

Autism, or Autism Spectrum Disorder (ASD), refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech, and nonverbal communication. Essays could explore the causes, symptoms, and treatment of autism, the experiences of individuals with autism, and societal understanding and acceptance of autism. We’ve gathered an extensive assortment of free essay samples on the topic of Autism you can find at Papersowl. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

Rain Man and Autism

The film Rain man was released into theaters in 1988 and was awarded many awards along with an Academy Award. The movie starts off by showing Charlie who works as a car salesman, attempting to close on a deal involving four Lamborghinis. Charlie decides to drive with his girlfriend Susanna to ensure that this deal goes through. On the drive over Charlie receives a call telling him that his father has just passed away. Charlie and his girlfriend go his […]

Applied Behavior Analysis and its Effects on Autism

Abstract During my research i have found several studies that have been done to support the fact that Applied Behavioral Analysis (ABA) does in fact make a positive impact on children with Autism through discrete trials. It is based on the thought that when a child is rewarded for a positive behavior or correct social interaction the process will want to be repeated. Eventually one would phase out the reward. Dr Lovaas, who invented this method, has spent his career […]

The Unique Parenting Challenges are Faced by the Parents of Special Children

Introduction For typical children, parenting experiences are shared by other parents whereas the unique parenting challenges are faced by the parents of special children. Mobility and Inclusion of the parents as well as children are affected many a times. Even though careful analysis often reveals abilities, habitual tendency to perceive the disabilities from society’s part often hinders effective normalization and proper rehabilitation. All impose severe identity crisis and role restrictions even in knowledgeable parents.. In some conditions, as in the […]

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Autism in Japanese Manga and its Significance on Current Progression in J-pop Culture

Abstract In this paper I will explore and examine Autism in Manga, the social and cultural context of Autism in Manga, its movement, and importance of Tobe Keiko’s, “With the Light.” Manga is a huge part of Japanese culture and can be appreciated by so many different people. There are different types of Manga that have been specifically produced for that type of audience. In this paper, I will address the less talked about, women’s Manga or also known as […]

Speech Therapist for Autism

Abstract Autism Spectrum Disorder is a condition that consists of various challenges to an individual such as social skills, nonverbal communication, repetitive behaviors and difficulties with speech. So far doctors have not been able to find out what causes autism although it is believed that it involves both environmental and genetic factors. Autism can usually be detected at an early age, therefore giving the patient and therapist an early start to improve their verbal skills. Speech language pathologists also known […]

Virtual Reality in Regards to Health and how it Can be Life-Changing

Exploring Virtual Reality in Health Diego Leon Professor Ron Frazier October 29, 2018, Introduction When most individuals think of technology involving computers, they think it can solely involve two of the five senses we humans have – vision (sight) and hearing (audition). But what if we could interact with more than two sensorial channels? Virtual reality deals with just that. Virtual reality is defined as a “high-end user interface that involves real-time simulation and interaction through […]

Growing up with Autism

Autism is a profound spectrum disorder; symptoms, as well as severity, range. It is one of the fastest-growing developmental disorders in America. For every 68 children born in the United States, 1 is diagnosed with a neurological development disorder that impairs their ability to interact and communicate on what we constitute as normal levels. Autism is multifaceted; it affects the brain development of millions worldwide. Not only are those diagnosed on the Autism Spectrum facing difficulties, but the family members […]

Kids with Autism

In this earth we have many different lifeforms. Animals, plants, insects, and people. Humans have populated the earth all throughout it. Some people are born healthy and some are born will disorders and illnesses and diseases. One of the disorders is Autism. Autism is constantly affecting the people who have it and the people around them all over the world. So what is Autism? Autism is a disorder that impairs the ability for social interaction and communication. It is very […]

My Personal Experience of Getting to Know Asperger’s Syndrome

The beginning of this paper covers the history of Asperger’s Syndrome, followed by an explanation of what Asperger’s is. The history provides detailed insights into Hans Asperger and Leo Kanner, and their relationship to each other. Their work has significantly enriched our understanding of the research surrounding Autism and Asperger’s Syndrome. The paper also discusses the process leading to Asperger’s becoming a recognized diagnosis, including the contributions of Lorna Wing and Ulta Frita. Furthermore, it traces Asperger’s entry into the […]

Cultural Stereotypes and Autism Disorder

“It’s the fastest growing developmental disability, autism” (Murray, 2008, p.2). “It is a complex neurological disorder that impedes or prevents effective verbal communication, effective social interaction, and appropriate behavior” (Ennis-Cole, Durodoye, & Harris, 2013). “Autism spectrum disorder (ASD) is a lifelong disorder that may have comorbid conditions like attention deficit disorder (ADD)/attention deficit/hyperactivity disorder (ADHD), anxiety disorder, stereotypical and self-stimulatory behaviors, insomnia, intellectual disabilities, obsessive compulsive disorder, seizure disorder/epilepsy, Tourette syndrome, Tic disorders, gastrointestinal problems, and other conditions. Another certainty, […]

Understanding Autism Spectrum Disorder (ASD)

Autism Spectrum Disorder (ASD) is a cognitive disability that affects a person’s “communication, social, verbal, and motor skills” . The umbrella term of ASD created in 2013 by the American Psychiatric Association that covered 5 separate autism diagnosis and combined them into one umbrella term, the previous terms being Autistic Disorder, Rett syndrome, Asperger’s Disorder, Childhood disintegrative Disorder, and Pervasive Developmental Disorders. The word spectrum in the diagnosis refers to the fact that the disability does not manifest itself in […]

Defining Altruism Issue

In current society, it can be justified that the level of autonomy directly influences the amount of altruism an autistic adolescent implements. Defining Altruism: When it comes to the comprehension of socialization within the development of behaviors in adolescents, altruism is vital. Although there is no true altruism, more or less altruism can be determined based upon the involuntary actions and behaviors of an individual. In the absence of motivation, altruism cannot transpire. An altruist must have the inherent belief […]

911 Telecommunicators Response to Autism

Autism is becoming more prevalent every day. The Center for Disease Control and Prevention released new statistics in 2018. Nationally, 1 in 59 children have autism spectrum disorder (ASD) and boys are 4 (four) times more likely to have autism than girls. 1 in 37 boys and 1 in 151 girls were found to have autism. These are incredibly high statistics that will affect our communities across the United States We, as Telecommunicators, need to know how to understand and […]

Representation of Autism in the Netflix TV Show “Atypical”

In the first season of the TV show “Atypical”, the viewer meets the Gardner family, a seemingly normal family with an autistic teenage son, Sam, as the focus. This show failed initially to deviate from typical portrayals of autistic people on screens, as a white male, intellectually gifted, and seemingly unrelatable, although it seemed to try. Sam acts in ways that seem almost unbelievable for even someone with autism to, such as when he declares his love for someone else […]

Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a group of developmental disorders that challenges a child’s skills in social interaction, communication, and behavior. ASD’s collective signs and symptoms may include: making little eye contact, repetitive behaviors, parallel play, unexplainable temper tantrums, misunderstanding of nonverbal cues, focused interests, and/or sensory overload. Positive symptoms of ASD may reflect above-average intelligence, excellence in math, science, or art, and the ability to learn things in detail. A question that many parent has is whAlthough an individual […]

The Complexity of Autism

Autism spectrum disorder is a complex disease that affects the developmental and speech capabilities of adolescents that carries with them to adulthood. It is distinctly apparent when the child is still very young and able to be diagnosed from about a year and a half old onwards. Although the disease cannot be pinpointed to one specific area of the brain, it is believed to stem from a glitchy gene that makes the child more susceptible to developing autism, oxygen deprivation […]

An Overview of the Five Deadly Diseases that Affect the Human Brain

There are hundreds of diseases that affect the brain. Every day, we fight these diseases just as vehemently as they afflict their carriers. Parkinson's disease, Alzheimer's, depression, autism, and strokes are just five of the most lethal and debilitating diseases that afflict human brains. Parkinson's disease alone claims up to 18,000 lives a year (Hagerman 1). But what is it? Parkinson's disease occurs when a brain chemical called dopamine begins to die in a region that facilitates muscle movement. Consequently, […]

Autism Genes: Unveiling the Complexities

“Autism is a brain disorder that typically affects a person’s ability to communicate, form relationships with others and respond appropriately to the environment (www.childdevelopmentinfo.com).” There are different levels of autism. “There is the autistic disorder, Asperger's syndrome and pervasive developmental syndrome (www.asws.org).” According to (www.everydayhealth.com/autism/types), “Each situation is unique as there are many levels and severities of it. Many cases also include sensory difficulties. These can range from imaginary sights and sounds to other sensations.” There are many different characteristics […]

Autism and Assistive Technology for Autistic Children

Autism is a complex neurobehavioral condition that is found in a person from early childhood days where the person faces difficulty in communicating with another person. It is also known as ASD or Autism Spectrum Disorder. It is a spectrum disorder because its effect varies from person to person. This is caused due to some changes that happen during early brain development. It is suggested that it may arise from abnormalities in parts of the brain that interpret sensory input […]

The Evolution of Autism Diagnosis: from Misunderstanding to Scientific Approach

Autism has come a long way from the early 1980s when it was rarely diagnosed to today where 100 out 10,000 kids are diagnosed. Autism is defined as a developmental disorder that affects communication and behavior (NIMH 2018). There are many aspects surrounding Autism and the underlying effects that play a role in Autism. According to the Diagnostic and Statistical Manual of Mental Disorders, people with Autism have “Difficulty with communication and interaction with other people Restricted interests and repetitive […]

Do Vaccines Cause Autism

In a world of medicines and “mommy bloggers”, there is a controversy between pro-vaxxers and anti-vaxxers. The vaccination controversy cause an uproar for many people, understandably, it’s very polarized- you strongly believe in them or you strongly do not. For me, at the age of 15, I strongly believe in the Pro-Vaccine movement and I have data that can back me up. For starters, you may wonder ‘what is a vaccine’ or ‘how to do they work’. For a general […]

Autism: Characteristics, Diagnosis, and Understanding

The prevalence of Autism Spectrum Disorder has nearly doubled in recent years, and the numbers are staggering: nearly 1 in every 59 children are diagnosed with autism in the United States alone. Yet, there are so many questions surrounding the complexity and increase in diagnoses of this condition that affects so many in such diverse ways. (Autism Speaks) How autism originates in the first place and its impact on communication, both verbal and nonverbal, are questions that need to be […]

Autism Spectrum Disorder and its Positive Effects

What would it feel like if you were constantly ignored or treated as though you have little usefulness? Many people experience this kind of treatment their entire lives. Long has it been assumed that people with mental disabilities such as Autism, were meant to be cared for but to never expect any value from them. Evil men such as Hitler even went so far as to kill them because he thought they had no use to society. However, there is […]

Adolescents with Autism Spectrum Disorders and ADHD

Autism spectrum disorder (ASD) is a complex lifelong neurodevelopmental disorder that affects communication and behavior, generally diagnosed within the early stages of life. No two individuals living with Autism experience the same symptoms, as the type and severity varies with each case (Holland, 2018.). Autism has been around for hundreds of years, but the definition has evolved immensely. In 1943, scientists Leo Kanner and Hans Asperger conducted research on individuals with social and emotional deficits to better refine the definition […]

Raising a Child with Autism

All impose severe identity crisis and role restrictions even in knowledgeable parents.. In some conditions, as in the case of physical challenges, the child needs physical reassurance and support from the parents against those conditions of cognitive deficits in which the demands are always parent’s constant attention and feedback. As far as autism is concerned, the child’s deficits are many namely social, emotional, communicational, sensual, as well as behavioral. Symptoms are usually identified between one and two years of age. […]

Is Autism a Kind of Brain Damage

Many people have different views about autism. Autism may be only one simple word, but with this one word comes many forms in the way it could affect people with this disability. Autism should not be looked down on as much as this disability is from others in society. It may seem as if it has more “cons” than “pros” as some call them, but if looked at from a better perspective, there could be more pros than cons and […]

Trouble with Social Aspects and People on the Autism Spectrum

Autism in childhood starts as early as age two, and symptoms will become more severe as children continue into elementary school. When a child goes to a psychiatrist, they will work on social development. Adolescence with autism struggle when attempting to project others pain. For example, my brother has Asperger's and when I have a bone graph done on my hand, he could not stop touching my hand. He needed constant reminders to not touch and remind him of when […]

Effects of Autism

When he was eight years old, the parents of Joshua Dushack learned that their son was different. He had been diagnosed with Autism. According to the doctors, Joshua would never be able to read, write, talk, or go to school on his own. This might have been the case, had his parents accepted it. But his mother saw her son as a normal boy, and treated him as such. He did need some extra help in school, but because of […]

How Different Types of Assistive Technology Can Help Children with Autism

I. Introduction An anonymous speaker once said, “some people with Autism may not be able to speak or answer to their name, but they can still hear your words and feel your kindness.” Approximately thirty percent of people diagnosed with Autism Spectrum Disorder never learn to speak more than a few words (Forman & Rudy, 2018). Fortunately in today’s society, new technologies have made it possible for these individuals to communicate and socialize with others. Purpose The primary focus of […]

Searching Employment Autism

Over the last 20 years, there has been an alarming increase for children who have been diagnosed with Autism Spectrum Disorder (ASD) in the United States. According to the Centers for Disease Control, in the year 2000 1 in 159 children would be diagnosed with ASD. In the latest version of the study, the number has been reduced to 1 in 59 children will be diagnosed with ASD (Centers for Disease Control and Prevention, 2018). This is a subject that […]

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Exp Neurobiol
v.25(1); 2016 Feb

A Short Review on the Current Understanding of Autism Spectrum Disorders

Hye ran park.

1 Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea.

Jae Meen Lee

Hyo eun moon, dong soo lee.

2 Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.

Bung-Nyun Kim

3 Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul 03080, Korea.

Jinhyun Kim

4 Center for Functional Connectomics, Korea Institute of Science and Technology (KIST), Seoul 02792, Korea.

Dong Gyu Kim

Sun ha paek.

Autism spectrum disorder (ASD) is a set of neurodevelopmental disorders characterized by a deficit in social behaviors and nonverbal interactions such as reduced eye contact, facial expression, and body gestures in the first 3 years of life. It is not a single disorder, and it is broadly considered to be a multi-factorial disorder resulting from genetic and non-genetic risk factors and their interaction. Genetic studies of ASD have identified mutations that interfere with typical neurodevelopment in utero through childhood. These complexes of genes have been involved in synaptogenesis and axon motility. Recent developments in neuroimaging studies have provided many important insights into the pathological changes that occur in the brain of patients with ASD in vivo. Especially, the role of amygdala, a major component of the limbic system and the affective loop of the cortico-striatothalamo-cortical circuit, in cognition and ASD has been proved in numerous neuropathological and neuroimaging studies. Besides the amygdala, the nucleus accumbens is also considered as the key structure which is related with the social reward response in ASD. Although educational and behavioral treatments have been the mainstay of the management of ASD, pharmacological and interventional treatments have also shown some benefit in subjects with ASD. Also, there have been reports about few patients who experienced improvement after deep brain stimulation, one of the interventional treatments. The key architecture of ASD development which could be a target for treatment is still an uncharted territory. Further work is needed to broaden the horizons on the understanding of ASD.

INTRODUCTION

Autism spectrum disorder (ASD) is a set of neurodevelopmental disorders characterized by a lack of social interaction, verbal and nonverbal communication in the first 3 years of life. The distinctive social behaviors include an avoidance of eye contact, problems with emotional control or understanding the emotions of others, and a markedly restricted range of activities and interests [ 1 ]. The current prevalence of ASD in the latest large-scale surveys is about 1%~2% [ 2 , 3 ]. The prevalence of ASD has increased in the past two decades [ 4 ]. Although the increase in prevalence is partially the result of changes in DSM diagnostic criteria and younger age of diagnosis, an increase in risk factors cannot be ruled out [ 5 , 6 ]. Studies have shown a male predominance; ASD affects 2~3 times more males than females [ 2 , 3 , 7 ]. This diagnostic bias towards males might result from under-recognition of females with ASD [ 8 ]. Also, some researchers have suggested the possibility that the female-specific protective effects against ASD might exist [ 9 ].

A Swiss psychiatrist, Paul Eugen Bleuler used the term "autism" to define the symptoms of schizophrenia for the first time in 1912 [ 10 ]. He derived it from the Greek word αὐτὀς (autos), which means self. Hans Asperger adopted Bleuler's terminology "autistic" in its modern sense to describe child psychology in 1938. Afterwards, he reported about four boys who did not mix with their peer group and did not understand the meaning of the terms 'respect' and 'polite', and regard for the authority of an adult. The boys also showed specific unnatural stereotypic movement and habits. Asperger describe this pattern of behaviors as "autistic psychopathy", which is now called as Asperger's Syndrome [ 11 ]. The person who first used autism in its modern sense is Leo Kanner. In 1943, he reported about 8 boys and 3 girls who had "an innate inability to form the usual, biologically provided affective contact with people", and introduced the label early infantile autism [ 12 ]. Hans Asperger and Leo Kanner have been considered as those who designed the basis of the modern study of autism.

Most recently, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) adopted the term ASD with a dyadic definition of core symptoms: early-onset of difficulties in social interaction and communication, and repetitive, restricted behaviors, interests, or activities [ 13 ]. Atypical language development, which had been included into the triad of ASD, is now regarded as a co-occurring condition.

As stated earlier, the development of the brain in individuals with ASD is complex and is mediated by many genetic and environmental factors, and their interactions. Genetic studies of ASD have identified mutations that interfere with typical neurodevelopment in utero through childhood. These complexes of genes have been involved in synaptogenesis and axon motility. Also, the resultant microstructural, macrostructural, and functional abnormalities that emerge during brain development create a pattern of dysfunctional neural networks involved in socioemotional processing. Microstructurally, an altered ratio of short- to long-diameter axons and disorganization of cortical layers are observed. Macrostructurally, MRI studies assessing brain volume in individuals with ASD have consistently shown cortical and subcortical gray matter overgrowth in early brain development. Functionally, resting-state fMRI studies show a narrative of widespread global underconnectivity in socioemotional networks, and task-based fMRI studies show decreased activation of networks involved in socioemotional processing. Moreover, electrophysiological studies demonstrate alterations in both resting-state and stimulus-induced oscillatory activities in patients with ASD [ 14 ].

The well-conserved sets of genes and genetic pathways were implicated in ASD, many of which contribute toward the formation, stabilization, and maintenance of functional synapses. Therefore, these genetic aspects coupled with an in-depth phenotypic analysis of the cellular and behavioral characteristics are essential to unraveling the pathogenesis of ASD. The number of genes already discovered in ASD holds the promise to translate the knowledge into designing new therapeutic interventions. Also, the fundamental research using animal models is providing key insights into the various facets of human ASD. However, a better understanding of the genetic, molecular, and circuit level aberrations in ASD is still needed [ 15 ].

Neuroimaging studies have provided many important insights into the pathological changes that occur in the brain of patients with ASD in vivo. Importantly, ASD is accompanied by an atypical path of brain maturation, which gives rise to differences in neuroanatomy, functioning, and connectivity. Although considerable progress has been made in the development of animal models and cellular assays, neuroimaging approaches allow us to directly examine the brain in vivo, and to probably facilitate the development of a more personalized approach to the treatment of ASD [ 16 ].

ASD is not a single disorder. It is now broadly considered to be a multi-factorial disorder resulting from genetic and non-genetic risk factors and their interaction.

Genetic causes including gene defects and chromosomal anomalies have been found in 10%~20% of individuals with ASD [ 17 , 18 ]. Siblings born in families with an ASD subject have a 50 times greater risk of ASD, with a recurrence rate of 5%~8% [ 19 ]. The concordance rate reaches up to 82%~92% in monozygotic twins, compared with 1%~10% in dizygotic twins. Genetic studies suggested that single gene mutations alter developmental pathways of neuronal and axonal structures involved in synaptogenesis [ 20 , 21 , 22 ]. In the cases of related with fragile X syndrome and tuberous sclerosis, hyperexcitability of neocortical circuits caused by alterations in the neocortical excitatory/inhibitory balance and abnormal neural synchronization is thought to be the most probable mechanisms [ 23 , 24 ]. Genome-wide linkage studies suggested linkages on chromosomes 2q, 7q, 15q, and 16p as the location of susceptibility genes, although it has not been fully elucidated [ 25 , 26 ]. These chromosomal abnormalities have been implicated in the disruption of neural connections, brain growth, and synaptic/dendritic morphology [ 27 , 28 , 29 ]. Metabolic errors including phenylketonuria, creatine deficiency syndromes, adenylosuccinate lyase deficiency, and metabolic purine disorders are also account for less than 5% of individuals with ASD [ 30 ]. Recently, the correlation between cerebellar developmental patterning gene ENGRAILED 2 and autism was reported [ 31 ]. It is the first genetic allele that contributes to ASD susceptibility in as many as 40% of ASD cases. Other genes such as UBE3A locus, GABA system genes, and serotonin transporter genes have also been considered as the genetic factors for ASD [ 18 ].

Diverse environmental causative elements including pre-natal, peri-natal, and post-natal factors also contribute to ASD [ 32 ]. Prenatal factors related with ASD include exposure to teratogens such as thalidomide, certain viral infections (congenital rubella syndrome), and maternal anticonvulsants such as valproic acid [ 33 , 34 ]. Low birth weight, abnormally short gestation length, and birth asphyxia are the peri-natal factors [ 34 ]. Reported post-natal factors associated with ASD include autoimmune disease, viral infection, hypoxia, mercury toxicity, and others [ 33 , 35 , 36 ]. Table 1 summarizes the known and putative ASD-related genes and environmental factors contributing to the ASD.

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In recent years, some researchers suggest that ASD is the result of complex interactions between genetic and environmental risk factors [ 37 ]. Understanding the interaction between genetic and environmental factors in the pathogenesis of ASD will lead to optimal treatment strategy.

Clinical features and Diagnosis

ASD is typically noticed in the first 3 years of life, with deficits in social behaviors and nonverbal interactions such as reduced eye contact, facial expression, and body gestures [ 1 ]. Children also manifest with non-specific symptoms such as unusual sensory perception skills and experiences, motor clumsiness, and insomnia. Associated phenomena include mental retardation, emotional indifference, hyperactivity, aggression, self-injury, and repetitive behaviors such as body rocking or hand flapping. Repetitive, stereotyped behaviors are often accompanied by cognitive impairment, seizures or epilepsy, gastrointestinal complaints, disturbedd sleep, and other problems. Differential diagnosis includes childhood schizophrenia, learning disability, and deafness [ 38 , 39 ].

ASD is diagnosed clinically based on the presence of core symptoms. However, caution is required when diagnosing ASD because of non-specific manifestations in different age groups and individual abilities in intelligence and verbal domains. The earliest nonspecific signs recognized in infancy or toddlers include irritability, passivity, and difficulties with sleeping and eating, followed by delays in language and social engagement. In the first year of age, infants later diagnosed with ASD cannot be easily distinguished from control infants. However, some authors report that about 50% of infants show behavioral abnormalities including extremes of temperament, poor eye contact, and lack of response to parental voices or interaction. At 12 months of age, individuals with ASD show atypical behaviors, across the domains of visual attention, imitation, social responses, motor control, and reactivity [ 40 ]. There is also report about atypical language trajectories, with mild delays at 12 months progressing to more severe delays by 24 months [ 40 ]. By 3 years of age, the typical core symptoms such as lack of social communication and restricted/repetitive behaviors and interests are manifested. ASD can be easily differentiated from other psychosocial disorders in late preschool and early school years.

Amygdala and ASD

The frontal and temporal lobes are the markedly affected brain areas in the individuals with ASD. In particular, the role of amygdala in cognition and ASD has been proved in numerous neuropathological and neuroimaging studies. The amygdala located the medial temporal lobe anterior to the hippocampal formation has been thought to have a strong association with social and aggressive behaviors in patients with ASD [ 41 , 42 ]. The amygdala is a major component of the limbic system and affective loop of the cortico-striato-thalamo-cortical circuit [ 43 ].

The amygdala has 2 specific functions including eye gaze and face processing [ 44 ]. The lesion of the amygdala results in fear-processing, modulation of memory with emotional content, and eye gaze when looking at human face [ 45 , 46 , 47 ]. The findings in individuals with amygdala lesion are similar to the phenomena in ASD. The amygdala receives highly processed somatosensory, visual, auditory, and all types of visceral inputs. It sends efferents through two major pathways, the stria terminalis and the ventral amygdalofugal pathway.

The amygdala comprises a collection of 13 nuclei. Based on histochemical analyses, these 13 nuclei are divided into three primary subgroups: the basolateral (BL), centromedial (CM), and superficial groups [ 42 ]. The BL group attributes amygdala to have a role as a node connecting sensory stimuli to higher social cognition level. It links the CM and superficial groups, and it has reciprocal connection with the orbitofrontal cortex, anterior cingulate cortex (ACC), and the medial prefrontal cortex (mPFC) [ 48 ]. The BL group contains neurons responsive to faces and actions of others, which is not found in the other two groups of amygdala [ 49 , 50 ]. The CM group consists of the central, medial, cortical nuclei, and the periamygdaloid complex. It innervates many of the visceral and autonomic effector regions of the brain stem, and provides a major output to the hypothalamus, thalamus, ventral tegmental area, and reticular formation [ 51 ]. The superficial group includes the nucleus of the lateral olfactory tract [ 42 ].

Neurochemistrial studies revealed high density of benzodiazepine/GABAa receptors and a substantial set of opiate receptors in the amygdala. It also includes serotonergic, dopaminergic, cholinergic, and noradrenergic cell bodies and pathways [ 52 ]. Since some patients with temporal epilepsy and aggressive behavior experienced improvement in aggressiveness after bilateral stereotactic ablation of basal and corticomedial amygdaloid nuclei, the role of amygdala in emotional processing, especially rage processing has been investigated [ 53 , 54 , 55 , 56 ]. Some evidences for the amygdala deficit in patients with ASD have been suggested. Post-mortem studies found the pathology in the amygdala of individuals with ASD compared to age- and sex-matched controls [ 57 , 58 , 59 ]. Small neuronal size and increased cell density in the cortical, medial, and central nuclei of the amygdala were detected in ASD patients.

Several studies proposed the use of an animal model to confirm the evidence for the association between amygdala and ASD [ 60 , 61 ]. Despite the limitation which stems from the need to prove higher order cognitive disorder, the studies suggested that disease-associated alterations in the temporal lobes during experimental manipulations of the amygdala in animals have produced some symptoms of ASD [ 62 ]. Especially, the Kluver-Bucy syndrome, which is caused by bilateral damage to the anterior temporal lobes in monkeys, has characteristic manifestations similar to ASD [ 63 , 64 ]. Monkeys with the Kluver-Bucy syndrome shows absence of social chattering, lack of facial expression, absence of emotional reactions, repetitive abnormal movement patterns, and increased aggression. Sajdyk et al. performed experiments on rats and discovered that physiological activation of the BL nucleus of the amygdala by blocking tonic GABAergic inhibition or enhancing glutamate or the stress-associated peptide corticotropin-releasing factor (CRF)-mediated excitation caused reduction in social behaviors [ 65 ]. On the contrary, lesioning of the amygdala or blocking amygdala excitability with glutamate antagonist increased dyadic social interactions [ 60 ]. Besides animals, humans who underwent lesioning of the amygdala showed impairments in social judgment. This phenomenon is called acquired ASD [ 66 , 67 , 68 ]. The pattern of social deficits was similar in idiopathic and acquired ASD [ 69 ]. Felix-Ortiz and Tye sought to understand the role of projections from the BL amygdala to the ventral hippocampus in relation to behavior. Their study using mice showed that the BLS-ventral hippocampus pathway involved in anxiety plays a role in the mediation of social behavior as well [ 70 ].

The individuals with temporal lobe tumors involving the amygdala and hippocampus provide another evidence of the correlation between the amygdala and ASD. Some authors reported that patients experienced autistic symptoms after temporal lobe was damaged by a tumor [ 71 , 72 ]. Also, individuals with tuberous sclerosis experienced similar symptoms including facial expression due to a temporal lobe hamartoma [ 73 ].

Although other researchers failed to find structural abnormalities in the mesial temporal lobe of autistic subjects by performing magnetic resonance imaging (MRI) studies [ 74 , 75 , 76 ], recent development in neuroimaging has facilitated the investigation of amygdala pathology in ASD. Studies using structural MRI estimated volumes of the amygdala and related structures in individuals with ASD and age-, gender, and verbal IQ-matched healthy controls [ 77 ]. Increase in bilateral amygdala volume and reduction in hippocampal and parahippocampal gyrus volumes were noted in individuals with ASD. Also, the lateral ventricles and intracranial volumes were significantly increased in the autistic subjects; however, overall temporal lobe volumes were similar between the ASD and control groups.

There was a significant difference in the whole brain voxel-based scans of individuals with ASD and control groups [ 78 ]. Individuals with ASD showed decreased gray matter volume in the right paracingulate sulcus, the left occipito-temporal cortex, and the left inferior frontal sulcus. On the contrary, the gray matter volume in the bilateral cerebellum was increased. Otherwise, they showed increased volume in the left amygdala/periamygdaloid cortex, the right inferior temporal gyrus, and the middle temporal gyrus.

Recently, the development of functional neuroimaging also provided some evidence for the correlation between amygdala deficit and ASD. A study using Technetium-99m (Tc-99m) single-photon emission computed tomography (SPECT) found that regional cerebral blood flow (rCBF) was decreased in the bilateral insula, superior temporal gyri, and left prefrontal cortices in individuals with ASD compared to age- and gender-matched controls with mental retardation [ 79 ]. Also, the authors found that rCBF in both the right hippocampus and amygdala was correlated with a behavioral rating subscale.

On proton magnetic resonance spectroscopy (MRS) in the right hippocampal-amygdala region and the left cerebellar hemisphere, autistic subjects showed decreased level of N-acetyl aspartate (NAA) in both areas [ 80 ]. There was no difference in the level of the other metabolites, such as creatine and choline. This study implies that a decreased level of NAA might be associated with neuronal hypofunction or immature neurons.

These findings support the claim that amygdala might be a key structure in the development of ASD and a target for the management of the disease.

Prefrontal cortex and ASD

Frontal lobe has been considered as playing an important role in higher-level control and a key structure associated with autism. Individuals with frontal lobe deficit demonstrate higher-order cognitive, language, social, and emotion dysfunction, which is deficient in autism [ 81 ]. Recently, neuroimaging and neuropsychological studies have attempted to delineate distinct regions of prefrontal cortex supporting different aspects of executive function. Some authors have reported that the excessive rates of brain growth in infants with ASD, which is mainly contributed by the increase of frontal cortex volume [ 82 , 83 ]. Especially, the PFC including Brodmann areas 8, 9, 10, 11, 44, 45, 46, and 47 has been noted for the structure related with ASD [ 84 ]. The PFC is cytoarchitectonically defined as the presence of a cortical granular layer IV [ 85 ], and anatomically refers to the regions of the cerebral cortex that are anterior to premotor cortex and the supplementary motor area [ 86 ]. The PFC has extensive connections with other cortical, subcortical and brain stem sites [ 87 ]. It receives inputs from the brainstem arousal systems, and its function is particularly dependent on its neurochemical environment [ 88 ].

The PFC is broadly divided into the medial PFC (mPFC) and the lateral PFC (lPFC). The mPFC is further divided into four distinct regions: medial precentral cortex, anterior cingulate cortex, prelimbic and infralimbic prefrontal cortex [ 89 ]. While the lPFC is thought to support cognitive control process [ 90 ], the mPFC has reciprocal connections with brain regions involved in emotional processing (amygdala), memory (hippocampus) and higher-order sensory regions (within temporal cortex) [ 91 ]. This involvement of mPFC in social cognition and interaction implies that mPFC might be a key region in understanding self and others [ 92 ].

The mPFC involves in fear learning and extinction by reciprocal synaptic connections with the basolateral amygdala [ 93 , 94 ]. It is believed that the mPFC regulates and controls amygdala output and the accompanying behavioral phenomena [ 95 , 96 ]. Previous authors investigated how memory processing is regulated by interactions between BLA and mPFC by means of functional disconnection [ 97 , 98 ]. Disturbed communication within amygdala-mPFC circuitry caused deficits in memory processing. These informations provide support for a role of the mPFC in the development of ASD.

Nucleus Accumbens and ASD

Besides amygdala, nucleus accumbens (NAc) is also considered as the key structure which is related with the social reward response in ASD. NAc borders ventrally on the anterior limb of the internal capsule, and the lateral subventricular fundus of the NAc is permeated in rostral sections by internal capsule fiber bundles. The rationale for NAc to be considered as the potential target of DBS for ASD is its predominant role in modulating the processing of reward and pleasure [ 99 ]. Anticipation of rewarding stimuli recruits the NAc as well as other limbic structures, and the experience of pleasure activates the NAc as well as the caudate, putamen, amygdala, and VMPFC [ 100 , 101 , 102 ]. It is well known that dysfunction of NAc regarding rewarding stimuli in subjects with depression. Bewernick et al. demonstrated antidepressant effects of NAc-DBS in 5 of the 10 patients suffering from severe treatment-resistant depression [ 103 ].

Two groups reported about the neural basis of social reward processing in ASD. Schmitz et al. examined responses to a task that involved monetary reward. They investigated the neural substrates of reward feedback in the context of a sustained attention task, and found increased activation in the left anterior cingulate gyrus and left mid-frontal gyrus on rewarded trials in ASD [ 104 ]. Scott-Van Zeeland et al. investigated the neural correlates of rewarded implicit learning in children with ASD using both social and monetary rewards. They found diminished ventral striatal response during social, but not monetary, rewarded learning [ 105 ]. According to them, activity within the ventral striatum predicted social reciprocity within the control group, but not within the ASD group.

Anticipation of pleasurable stimuli recruits the NAc, whereas the experience of pleasure activates VMPFC [ 106 ]. NAc is activated by incentive motivation to reach salient goals [ 106 ]. Increased activation in the left anterior cingulate gyrus and left mid-frontal gyrus was noted during both the anticipatory and consummatory phase of the reward response [ 104 , 107 , 108 ]. However, the activity within the ventral striatum was decreased in autistic subjects, which caused impairment in social reciprocity [ 105 ].

These findings indicate that reward network function in ASD is contingent on both the temporal phase of the response and the type of reward processed, suggesting that it is critical to assess the temporal chronometry of responses in a study of reward processing in ASD. NAc might be one of the candidates as a target of DBS which is introduced as below.

Various educational and behavioral treatments have been the mainstay of the management of ASD. Most experts agree that the treatment for ASD should be individualized. Treatment of disabling symptoms such as aggression, agitation, hyperactivity, inattention, irritability, repetitive and self-injurious behavior may allow educational and behavioral interventions to proceed more effectively [ 109 ].

Increasing interest is being shown in the role of various pharmacological treatments. Medical management includes typical antipsychotics, atypical antipsychotics, antidepressants, selective serotonin reuptake inhibitors, α2-adrenergic agonists, β-adrenergic antagonist, mood stabilizers, and anticonvulsants [ 110 , 111 ]. So far, there has been no agent which has been proved effective in social communication [ 112 ]. A major factor in the choice of pharmacologic treatment is awareness of specific individual physical, behavioral or psychiatric conditions comorbid with ASD, such as obsessive-compulsive disorder, schizophrenia, mood disorder, and intellectual disability [ 113 ]. Antidepressants were the most commonly used agents followed by stimulants and antipsychotics. The high prevalence of comorbidities is reflected in the rates of psychotropic medication use in people with ASD. Antipsychotics were effective in treating the repetitive behaviors in children with ASD; however, there was not sufficient evidence on the efficacy and safety in adolescents and adults [ 114 ]. There are also alternative options including opiate antagonist, immunotherapy, hormonal agents, megavitamins and other dietary supplements [ 109 , 113 ].

However, the autistic symptoms remain refractory to medication therapy in some patients [ 115 ]. These individuals have severely progressed disease and multiple comorbidities causing decreased quality of life [ 44 , 110 ]. Interventional therapy such as deep brain stimulation (DBS) may be an alternative therapeutic option for these patients.

Two kinds of interventions have been used for treating ASD; focused intervention practices and comprehensive treatments [ 116 ]. The focused intervention practices include prompting, reinforcement, discrete trial teaching, social stories, or peer-mediated interventions. These are designed to produce specific behavioral or developmental outcomes for individual children with ASD, and used for a limited time period with the intent of demonstrating a change in the targeted behaviors. The comprehensive treatment models are a set of practices performed over an extended period of time and are intense in their application, and usually have multiple components [ 116 ].

Since it was approved by the FDA in 1997, DBS has been used to send electrical impulses to specific parts of the brain [ 117 , 118 ]. In recent years, the spectrum for which therapeutic benefit is provided by DBS has widely been expanded from movement disorders such as Parkinson's disease, essential tremor, and dystonia to psychiatric disorders. Some authors have demonstrated the efficacy of DBS for psychiatric disorders including refractory obsessive-compulsive disorder, depression, Tourette syndrome, and others for the past few years [ 119 , 120 , 121 ].

To the best of our knowledge, there have been 2 published articles of 3 patients who underwent DBS for ASD accompanied by life-threatening self-injurious behaviors not alleviated by antipsychotic medication [ 122 , 123 ]. The targets were anterior limb of the internal capsule and globus pallidus internus, only globus pallidus, and BL nucleus of the amygdala, respectively. All patients obtained some benefit from DBS. Although the first patient showed gradual re-deterioration after temporary improvement, the patient who underwent DBS of the BL nucleus experienced substantial improvement in self-injurious behavior and social communication. These experiences suggested the possibility of DBS for the treatment of ASD. For patients who did not obtain benefit from other treatments, DBS may be a viable therapeutic option. Understanding the structures which contribute to the occurrence of ASD might open a new horizon for management of ASD, particularly DBS. Accompanying development of neuroimaging technique enables more accurate targeting and heightens the efficacy of DBS. However, the optimal DBS target and stimulation parameters are still unknown, and prospective controlled trials of DBS for various possible targets are required to determine optimal target and stimulation parameters for the safety and efficacy of DBS.

ASD should be considered as a complex disorder. It has many etiologies involving genetic and environmental factors, and further evidence for the role of amygdala and NA in the pathophysiology of ASD has been obtained from numerous studies. However, the key architecture of ASD development which could be a target for treatment is still an uncharted territory. Further work is needed to broaden the horizons on the understanding of ASD.

Acknowledgements

This study was partly supported by the Korea Institute of Planning & Evaluation for Technology in Food, Agriculture, Forestry, and Fisheries, Republic of Korea (311011-05-3-SB020), by the Korea Healthcare Technology R&D Project (HI11C21100200) funded by Ministry of Health & Welfare, Republic of Korea, by the Technology Innovation Program (10050154, Business Model Development for Personalized Medicine Based on Integrated Genome and Clinical Information) funded by the Ministry of Trade, Industry & Energy (MI, Korea), and by the Bio & Medical Technology Development Program of the NRF funded by the Korean government, MSIP (2015M3C7A1028926).

CONCEPTUAL ANALYSIS article

Research, clinical, and sociological aspects of autism.

$\nPaul Whiteley$

ESPA Research, Unit 133i Business Innovation Centre, The Robert Luff Laboratory, Education & Services for People With Autism Research, Sunderland, United Kingdom

The concept of autism continues to evolve. Not only have the central diagnostic criteria that define autism evolved but understanding of the label and how autism is viewed in research, clinical and sociological terms has also changed. Several key issues have emerged in relation to research, clinical and sociological aspects of autism. Shifts in research focus to encompass the massive heterogeneity covered under the label and appreciation that autism rarely exists in a diagnostic vacuum have brought about new questions and challenges. Diagnostic changes, increasing moves towards early diagnosis and intervention, and a greater appreciation of autism in girls and women and into adulthood and old age have similarly impacted on autism in the clinic. Discussions about autism in socio-political terms have also increased, as exemplified by the rise of ideas such as neurodiversity and an increasingly vocal dialogue with those diagnosed on the autism spectrum. Such changes are to be welcomed, but at the same time bring with them new challenges. Those changes also offer an insight into what might be further to come for the label of autism.

Introduction

Although there is still debate in some quarters about who first formally defined autism ( 1 ), most people accept that Kanner ( 2 ) should be credited as offering the first recognised description of the condition in the peer-reviewed scientific literature. The core diagnostic features covering issues in areas of social and communicative interaction alongside the presence of restricted and/or repetitive patterns of behaviour ( 3 ) described in his small caseload still remain central parts of the diagnosis today. The core issue of alterations in social cognition affecting emotion recognition and social attention ( 4 ) remain integral to the diagnosis of autism. The additional requirement for such behaviours to significantly impact on various areas of day-to-day functioning completes the diagnostic criteria.

From defining a relatively small group of people, the evolution of the diagnostic criteria for autism has gone hand-in-hand with a corresponding increase in the numbers of people being diagnosed. Prevalence figures that referred to 4.5 per 10,000 ( 5 ) in the 1960s have been replaced by newer estimates suggesting that 1 in 59 children (16 per 1,000) present with an autism spectrum disorder (ASD) in 2014 ( 6 ). The widening of the definition of autism has undoubtedly contributed to the significant increase in the numbers of people being diagnosed. It would be unacceptably speculative however, to define diagnostic changes as being the sole cause of the perceived prevalence increases.

Alongside the growth in numbers of people being diagnosed with autism so there have been changes in other areas related to autism; specifically those related to the research, clinical practice and sociological aspects of autism. Many of the changes have centred on key issues around the acceptance that autism is an extremely heterogeneous condition both in terms of presentation and also in relation to the genetic and biological complexity underlying its existence. That autism rarely exists in some sort of diagnostic vacuum is another part of the changes witnessed over the decades following the description of autism.

In this paper we highlight some of the more widely discussed changes in areas of research, clinical practice and sociological terms in relation to autism. We speculate on how such changes might also further develop the concept of autism in years to come.

Autism Research

As the definition of autism has subtly changed over the years, so ideas and trends in autism research have waxed and waned. The focus on psychology and behaviour as core descriptive features of autism has, in many respects, guided research and clinical views and opinions about the condition. Social cognition, including areas as diverse as social motivation, emotion recognition, social attention and social learning ( 4 ), remains a mainstay of research in this area. The rise of psychoanalysis and related ideas such as attachment theory in the early 20th century for example, played a huge role in the now discredited ideas that maternal bonding or cold parenting were a cause of autism. The seemingly implicit need for psychology to formulate theories has also no doubt played a role in perpetuating all-manner of different grand and unifying reasons on why autism comes about and the core nature of the condition.

As time moved on and science witnessed the rise of psychiatric genetics, where subtle changes to the genetic code were correlated with specific behavioural and psychiatric labels, so autism science also moved in the same direction. Scientific progress allowing the genetic code to be more easily and more cost-effectively read opened up a whole new scientific world in relation to autism and various other labels. It was within this area of genetic science that some particularly important discoveries were made: (a) for the vast majority of people, autism is not a single gene “disorder,” and (b) genetic polymorphisms whilst important, are not the only mechanism that can affect gene expression. Mirroring the role of genetics in other behavioural and psychiatric conditions ( 7 ), the picture that is emerging suggests that yes, there are genetic underpinnings to autism, but identifying such label-specific genetic issues is complicated and indeed, wide-ranging.

What such genetic studies also served to prove is that autism is heterogeneous. They complemented the wide-ranging behavioural profiles that are included under the diagnostic heading of autism. Profiles that ranged from those who are profoundly autistic and who require almost constant attention to meet their daily needs, to those who have jobs, families and are able to navigate the world [seemingly] with little or minimal support for much of the time.

It is this heterogeneity that is perhaps at the core of where autism is now from several different perspectives. A heterogeneity that not only relates to the presentation of the core traits of autism but also to how autism rarely manifests in a diagnostic vacuum ( 8 ). Several authors have talked about autism as part of a wider clinical picture ( 9 , 10 ) and how various behavioural/psychiatric/somatic issues seem to follow the diagnosis. Again, such a shift mirrors what is happening in other areas of science, such as the establishment of the Research Domain Criteria (RDoC) project ( 11 ). RDoC recognised that defining behavioural and psychiatric conditions on the basis of presented signs and symptoms does not necessarily “reflect” the relevant underlying processes and systems that might be important. It recognised that in order to deliver important clinical information about how and why a condition manifests, or the best strategies to intervene, research cannot just singularly start with the label. Science and clinical practice need more information rather than just a blanket descriptive label such as autism.

To talk about autism as a condition that also manifests various over-represented comorbid labels also asks a fundamental question: is the word “comorbidity” entirely accurate when referring to such labels? ( 12 ). Does such comorbidity instead represent something more fundamental to at least some presentations of autism or is it something that should be seen more transiently? Numerous conditions have been detailed to co-occur alongside autism. These include various behavioural and psychiatric diagnoses such as depression, anxiety and attention-deficit hyperactivity disorder (ADHD) ( 13 ). Other more somatic based conditions such as epilepsy ( 14 ), sleep ( 15 ) and various facets of gastrointestinal (GI) functioning ( 16 ) have also been discussed in the peer-reviewed science literature. Some of these co-occurring conditions have been described in the context of specific genetic conditions manifesting autism. Issues with the BCKDK (Branched Chain Ketoacid Dehydrogenase Kinase) gene for example, have been discussed in the context of autism, intellectual (learning) disability and epilepsy appearing together ( 17 ). Such a diagnostic combination is not unusual; autism often being described as the primary diagnosis with epilepsy and learning disability seen as “add-ons.” But should this be the case? Other evidence pointing to the possibility that epilepsy might under some circumstances beget autism ( 18 ) suggests that under some circumstances, such co-occurring conditions are so much more than just co-occurring or comorbid.

Other evidence for questioning the label “comorbid” comes from various animal models of autism. Accepting that one has to be particularly careful about extrapolating from animal models of autism to the more complex presentation of autism in humans ( 19 ), various models have suggested that autism may for some, fundamentally coexist with GI or bowel issues ( 20 , 21 ). Such observations have been noted across different animal models and cover important issues such as gut motility for example, that have been talked about in the context of autism ( 22 ).

Similarly, when one talks about the behavioural and psychiatric comorbidity in the context of autism, an analogous question arises about whether comorbidity is the right term. Anxiety and depression represent important research topics in the context of autism. Both issues have long been talked about in the context of autism ( 1 , 13 , 23 ) but only in recent years have their respective “links” to autism been more closely scrutinised.

Depression covers various different types of clinical presentations. Some research has suggested that in the context of autism, depressive illnesses such as bipolar disorder can present atypically ( 24 ). Combined with other study ( 25 ) suggesting that interventions targeting depressive symptoms might also impact on core autistic features, the possibility that autism and depression or depressive symptoms might be more closely linked than hitherto appreciated arises. Likewise with anxiety in mind, similar conclusions could be drawn from the existing research literature that anxiety may be a more central feature of autism. This on the basis of connections observed between traits of the two conditions ( 26 ) alongside shared features such as an intolerance of uncertainty ( 27 ) exerting an important effect.

A greater appreciation of the heterogeneity of autism and consideration of the myriad of other conditions that seem to be over-represented alongside autism pose serious problems to autism research. The use of “autism pure” where research participants are only included into studies on the basis of not having epilepsy or not possessing a diagnosis of ADHD or related condition pose a serious problem when it comes to the generalisation of research results to the wider population. Indeed, with the vast heterogeneity that encompasses autism, one has to question how, in the context of the current blanket diagnosis of autism or ASD, one could ever provide any universal answers about autism.

Autism in the Clinic

As mentioned previously, various subtle shifts in the criteria governing the diagnosis of autism have been witnessed down the years. Such changes have led to increased challenges for clinicians diagnosing autism from several different perspectives. One of the key challenges has come about as a function of the various expansions and contractions of what constitutes autism from a diagnostic point of view. This includes the adoption of autism as a spectrum disorder in more recent diagnostic texts.

The inclusion of Asperger syndrome in the DSM-IV and ICD-10 diagnostic schedules represented an expansion of the diagnostic criteria covering autism. Asperger syndrome defined by Hans Asperger ( 28 ) as autistic features without significant language impairment and with intelligence in the typical range, was included in the text for various different reasons. Allen Frances, one of the architects of the DSM-IV schedule, mentioned the importance of having a “ specific category to cover the substantial group of patients who failed to meet the stringent criteria for autistic disorder, but nonetheless had substantial distress or impairment from their stereotyped interests, eccentric behaviors, and interpersonal problems ” ( 29 ). It is now widely accepted that the inclusion of Asperger syndrome in diagnostic texts led to an increase in the number of autism diagnoses being given.

More recent revisions to the DSM criteria covering autism—DSM-5—included the removal of Asperger syndrome as a discrete diagnosis on the autism spectrum ( 30 ). Instead, a broader categorisation of autism spectrum disorder (ASD) was adopted. The reasons for the removal of Asperger syndrome from DSM-5 are complex. The removal has however generally been positively greeted as a function of on-going debates about whether there are/were important differences between autism and Asperger syndrome to require a distinction ( 31 ) alongside more recent revelations about the actions of Asperger during World War II ( 32 ). Studies comparing DSM-IV (and its smaller revisions) with DSM-5 have also hinted that the diagnostic differences between the schedules may well-impact on the numbers of people in receipt of a diagnosis ( 33 ).

Shifts in the diagnostic text covering autism represent only one challenge to autism in the clinical sense. Other important factors continue to complicate the practice of diagnosing autism. Another important issue is a greater realisation that although the presence of observable autistic features are a necessary requirement for a diagnosis of autism, such features are also apparent in various other clinical labels. Autistic features have been noted in a range of other conditions including schizophrenia ( 34 ), personality disorders ( 35 ) and eating disorders ( 36 ) for examples. Coupled with the increasingly important observation that autism rarely exists in a diagnostic vacuum, the clinical challenges to accurately diagnosing autism multiply as a result.

The additional suggestion of “behavioural profiles” within the autism spectrum adds to the complexity. Terms such as pathological demand avoidance (PDA) coined by Newson and colleagues ( 37 ) have started to enter some diagnostic processes, despite not yet being formally recognised in diagnostic texts. Including various autistic traits alongside features such as “resisting and avoiding the ordinary demands of life” and the “active use of various strategies to resist demands via social manipulation,” debate continues about the nature of PDA and its diagnostic value ( 38 ).

Early diagnosis and intervention for autism have also witnessed some important clinical changes over the years. Driven by an acceptance of the idea that earlier diagnosis means that early intervention can be put in place to “ameliorate” some of the more life-changing effects of autism, there has been a sharp focus on the ways and means of identifying autism early and/or highlighting those most at risk of a diagnosis. It's long been known that there is a heritable aspect to autism, whether in terms of traits or diagnosis ( 39 ). In this respect, preferential screening for autism in younger siblings when an older child has been diagnosed is not an uncommon clinical sentiment ( 40 ). Other work looking at possible “red flags” for autism, whether in behaviour ( 41 ) or in more physiological terms still continue to find popularity in both research and clinical terms.

But still however, autism continues to confound. As of yet, there are only limited reliable red flags to determine or preclude the future presence of autism ( 42 ). Early behavioural interventions for autism have not yet fulfilled the promise they are said to hold ( 43 ) and autism is not seemingly present in the earliest days of development for all ( 44 , 45 ). There is still a way to go.

Autism in a modern clinical sense is also witnessing change in several other quarters. The traditional focus of autism on children, particularly boys, is being replaced by a wider acceptance that (a) autism can and does manifest in girls and women, and (b) children with autism age and mature to become adults with autism. Even the psychological mainstay of autism—issues with social cognition—is undergoing discussion and revision.

On the issue of autism presentation in females, several important themes are becoming more evident. Discussions about whether there may be subtle differences in the presentation of autism in females compared to males are being voiced, pertinent to the idea that there may be one or more specific female phenotypes of autism ( 46 ). Further characterisation has hinted that sex differences in the core domain of repetitive stereotyped behaviours ( 47 ) for example, may be something important when it comes to assessing autism in females.

Allied to the idea of sex differences in autism presentation, is an increasing emphasis on the notion of camouflaging or masking ( 48 ). This masking assumes that there may active or adaptive processes on-going that allow females to hide some of their core autistic features and which potentially contributes to the under-identification of autism. Although some authors have talked about the potentially negative aspects of masking in terms of the use of cognitive resources to “maintain the mask,” one could also view such as adaptation in a more positive light relating to the learning of such a strategy as a coping mechanism. Both the themes of possible sex differences in presentation and masking add to the clinical complexity of reliably assessing for autism.

Insofar as the growing interest in the presentation of autism in adulthood, there are various other clinical considerations. Alongside the idea that the presentation of autism in childhood might not be the same as autism in adulthood ( 49 ), the increasing number of people receiving a diagnosis in adulthood is a worthy reminder that autism is very much a lifelong condition for many, but not necessarily all ( 50 ). The available research literature also highlights how autism in older adults carries some unique issues ( 51 ) some of which will require clinical attention.

Insofar as the issue of social cognition and autism, previous sweeping generalisations about a deficit in empathy for example, embodying all autism are also being questioned. Discussions are beginning debating issues such as how empathy is measured and whether such measurements in the context of autism are as accurate as once believed ( 52 ). Whether too, the concept of social cognition and all the aspects it encompasses is too generalised in its portrayal of autism, including the notion of the “double empathy problem” ( 53 ) where reciprocity and mutual understanding during interaction are not solely down to the person with autism. Rather, they come about because experiences and understanding differ from an autistic and non-autistic point of view. Such discussions are beginning to have a real impact on the way that autism is perceived.

Autism in Sociological Terms

To talk about autism purely through a research or clinical practice lens does not do justice to the existing peer-reviewed literature in its entirety. Where once autism was the sole domain of medical or academic professionals, so now there is a growing appreciation of autism in socio-political terms too, with numerous voices from the autism spectrum being heard in the scientific literature and beyond.

There are various factors that have contributed to the increased visibility of those diagnosed with autism contributing to the narrative about autism. As mentioned, the fact that children with autism become autistic adults is starting to become more widely appreciated in various circles. The expansion of the diagnostic criteria has also played a strong role too, as the diagnostic boundaries of the autism spectrum were widened to include those with sometimes good vocal communicative abilities. The growth in social media and related communication forms likewise provided a platform for many people to voice their own opinions about what autism means to them and further influence discussions about autism. The idea that autistic people are experts on autism continues to grow ( 54 ).

For some people with autism, the existing narrative about autism based on a deficit model (deficits in socio-communicative abilities for example) is seemingly over-emphasised. The existing medical model of autism focusing such deficits as being centred on the person does not offer a completely satisfying explanation for autism and how its features can disable a person. Autism does not solely exist in a sociological as well as diagnostic vacuum. In this context, the rise and rise of the concept of neurodiversity offered an important alternative to the existing viewpoint.

Although still the topic of some discussion, neurodiversity applied to autism is based on several key tenets: (a) all minds are different, and (b) “ neurodiversity is the idea that neurological differences like autism and ADHD are the result of normal, natural variation in the human genome ” ( 55 ). The adoption of the social model of disability by neurodiversity proponents moves the emphasis on the person as the epicentre of disability to that where societal structures and functions tend to be “ physically, socially and emotionally inhospitable towards autistic people ” ( 56 ). The message is that subtle changes to the social environment could make quite a lot of difference to the disabling features of autism.

Although a popular idea in many quarters, the concept of neurodiversity is not without its critics both from a scientific and sociological point of view ( 57 ). Certain key terms often mentioned alongside neurodiversity (e.g., neurotypical) are not well-defined or are incompatible with the existing research literature ( 58 ). The idea that societal organisation is a primary cause of the disability experienced by those with the most profound types of autism is also problematic in the context of current scientific knowledge and understanding. Other issues such as the increasing use of self-diagnosis ( 59 ) and the seeming under-representation of those with the most profound forms of autism in relation to neurodiversity further complicate the movement and its aims.

The challenges that face the evolving concept of neurodiversity when applied to autism should not however detract from the important effects that it has had and continues to have. Moving away from the idea that autistic people are broken or somehow incomplete as a function of their disability is an important part of the evolution of autism. The idea that autism is something to be researched as stand-alone issue separate from the person is something else that is being slowly being eroded by such a theory.

The concept of autism continues to evolve in relation to research, clinical practice and sociological domains. Such changes offer clues as to the future directions that autism may take and the challenges that lie ahead.

The continuing focus on the huge heterogeneity and comorbidity clusters that define autism are ripe for the introduction of a new taxonomy for describing the condition. A more plural definition—the autisms—could represent one starting position ( 60 ) encompassing a greater appreciation that (a) there is variety in the presentation of the core features of autism, (b) there are seemingly several different genetic and biological pathways that bring someone to a diagnosis of autism, (c) different developmental trajectories are an important facet of the autism spectrum, and (d) the various “comorbidities” that variably present alongside autism may offer important clues about the classification of autism. Some authors have stressed that a multi-dimensional conceptualisation may be more appropriate than a categorical concept ( 61 ) but further investigations are required.

In relation to the proposed pluralisation of the label, several long held “beliefs” about autism are also ripe for further investigation. The idea that autism is innate and presents in the earliest days in all does not universally hold ( 45 ). The finding that some children experience a period of typical development and then regress into autism ( 62 ) is becoming more readily discussed in research and clinical circles, albeit not universally so. Similarly, the belief that autism is a lifelong condition for all is also not borne out by the peer-reviewed literature ( 63 ). Terms such as optimal outcome ( 64 ) might not be wholly appropriate, but do nonetheless, shed light on an important phenomenon noted in at least some cases of autism where diagnostic cut-off points are reached at one point but not another. These and other important areas provide initial support for the adoption of the idea of the plural autisms.

Allied to the notion of “the autisms” is the requirement to overhaul the terminology around the use of the “level of functioning” phrase ( 65 ). “High functioning” is typically used to describe those people on the spectrum who present with some degree of communicative language, possess typical or above-average intelligence and who can seemingly traverse the world with only minimal levels of support. “Low functioning”, conversely, is used to describe those with significant support needs who may also be non-communicative. Aside from the societal implications of labelling someone “low functioning” and the possible connotations stemming from such a label, such functioning categorisation do not seemingly offer as accurate a representation as many people might think. The high-functioning autistic child who for example, has been excluded from school on the basis of their behaviour, cannot be readily labelled “high-functioning” if the presentation of their autistic behaviours has led to such a serious outcome. This on the basis that part of the diagnostic decision to diagnose autism is taken by appreciation of whether or not presented behaviours significantly interfere with day-to-day living ( 3 ). What might replace functioning labels is still a matter for debate. The use of “levels of support requirement” utilised in current diagnostic criteria offer a template for further discussions. Such discussions may also need to recognise that the traits of autism are not static over a lifetime ( 51 ) and support levels may vary as a result.

Whatever terminology is put forward to replace functioning labels, there is a need to address some very apparent differences in the way that parts of the autism spectrum are viewed, represented and included in research. Described as the “understudied populations” by some authors ( 66 ) those with limited verbal communicative language and learning disability have long been disadvantaged in research terms and also in more general depictions of autism. In more recent times, there has been a subtle shift to acknowledge the bias that exists against those with a more profound presentation of autism ( 67 ). Further developments are however required to ensure that such groups are not excluded; not least also to guarantee the generalisability of autism research to the entire spectrum and not just one portion of it.

On the topic of generalisability to the entire autism spectrum, the moves to further involve those diagnosed with autism in research, clinical and sociological discussions presents opportunities and obstacles in equal measure. The application of the International Classification of Functioning, Disability and Health (ICF) to autism ( 68 ) to measure “health-related functioning” represented a key moment in autism participatory research. Taking on board various views and opinions about autism, the development of the ICF core autism sets has allowed those with autism and their significant others to voice their opinions about autism ( 69 ).

Such joint initiatives are to be welcomed on the basis of the multiple perspectives they offer including lived experience of autism. But with such participation, so questions are also raised about how representative such opinions are to the entire autism spectrum ( 70 ). Questions on whether those who are able to participate in such initiatives “can ever truly speak for the entire autism spectrum?” are bound to follow. Questions also about whether such first-hand reports are more important than parental or caregiver input when it comes to individuals on the autism spectrum are likewise important to ask. This bearing in mind that those with autism participating in such initiatives bring with them the same potential biases as researchers and clinicians carry with them about the nature of autism, albeit not necessarily in total agreement.

The translation of research findings into clinical practice represents another important issue that has yet to be suitably addressed. Although covering a sizeable area, several important stumbling blocks have prohibited the move from “bench to bedside” when it comes to autism research. The focus for example, on the overt behavioural presentation of autism, has in some senses continued to hinder the translational progress of more biological-based findings into autism practice. Nowhere is this seemingly more evident than when it comes to the over-representation of gastrointestinal (GI) issues in relation to autism and their management or treatment. Despite multiple findings of such issues being present ( 16 ), very little is seemingly offered despite autism-specific screening and management guidance being in place for nearly a decade at the time of writing ( 71 ). Other quite consistently reported research findings in relation to low functional levels of vitamin D ( 72 ) for example, have similarly not sparked massive shifts in clinical practices. Ignoring such potentially important clinical features contributes to a state of relative health inequality that is experienced by many on the autism spectrum.

Without trying to prioritise some areas over others, there are some important topics in relation to autism that are becoming important to autism research and clinical practice. Many of these topics are more “real life” focused; taking into account the impact of autism or autistic traits on daily living skills and functioning. These include issues such as the truly shocking early mortality statistics around autism ( 73 ) and the need for more detailed inquiry into the factors around such risks such as suicide ( 74 ) and self-injury ( 75 ) and wandering/elopement ( 76 ) alongside the considerable influence of conditions such as epilepsy.

Although already previously hinted at in this paper, the nature of the relationship between autism and various “comorbid” conditions observed to be over-represented alongside is starting to become more widely discussed in scientific circles. Whether for example, moves to intervene to mitigate issues such as depression in relation to autism might also have knock-on effects on the presentation of core autistic features is something being considered. Interest in other topics such as employment, ageing, parenting and the worrying issue of contact with law enforcement or criminal justice systems ( 77 ) are also in the ascendancy.

Conclusions

Autism as a diagnostic label continues to evolve in research, clinical practice and sociological terms. Although the core features described by Kanner and others have weathered such evolution, important shifts in knowledge, views and opinions have influenced many important issues around those core behaviours. As well as increasing understanding of autism, many of the changes, past and present, have brought about challenges too.

Author Contributions

All authors contributed equally to the writing and review of this manuscript.

This paper was fully funded by ESPA Research using part of a donation from the Robert Luff Foundation (charity number: 273810). The Foundation played no role in the content, formulation or conclusions reached in this manuscript.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Keywords: autism, research, clinical, sociological, knowledge, future

Citation: Whiteley P, Carr K and Shattock P (2021) Research, Clinical, and Sociological Aspects of Autism. Front. Psychiatry 12:481546. doi: 10.3389/fpsyt.2021.481546

Received: 28 June 2019; Accepted: 30 March 2021; Published: 29 April 2021.

Reviewed by:

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*Correspondence: Paul Whiteley, paul.whiteley@espa-research.org.uk

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Published: 28 May 2021

Advances in autism research, 2021: continuing to decipher the secrets of autism

Julio Licinio ORCID: orcid.org/0000-0001-6905-5884 1 &
Ma-Li Wong 1

Molecular Psychiatry volume 26 , pages 1426–1428 ( 2021 ) Cite this article

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Autism spectrum disorders
Neuroscience

We are proud to publish this Special Issue focused on autism, a topic that has been exceedingly important for Molecular Psychiatry since our inception. It is not too bold a statement to say that we were a fundamental contributor to bringing autism to the forefront of the national discourse. A Pubmed search reveals 403 articles published in Molecular Psychiatry since our founding in 1996. Our first autism article by Vincent et al., published in July 1996, examined the fragile X syndrome gene (FMR1) for mutations in autistic individuals, using single-stranded conformational polymorphism analysis; those authors identified three new FMR1 polymorphisms and identified specific and significant association findings with autism [ 1 ].

In late 2001–early 2002 we received four exciting papers with findings on the genetics of autism that were published together in our March 2002 issue, with an accompanying editorial [ 2 , 3 , 4 , 5 , 6 ]. We issued then a press release that was picked up by Time magazine and served as the basis for their unprecedented May 6, 2002 cover story on autism, featuring as that iconic magazine’s cover a young boy who was visibly autistic [ 7 ]. That was the first time that a person with autism was the cover of a national magazine. The magazine’s cover displayed in big yellow letters “Inside the world of autism” and it had a subtitle stating “More than one million Americans may have it, and the number of new cases is exploding. What scientists have discovered. What families should know.” The full story, by Nash [ 8 ], was entitled: “The Secrets of Autism,” with the following subtitle: “The number of children diagnosed with autism and Asperger’s in the U.S. is exploding. Why?” Time ’s cover article was so successful that their editors expanded that from a single issue into an entire series on autism over multiple issues. That Time series effectively made autism emerge as a mainstream topic of kitchen table conversations across America. As that effort was triggered by our press release and four articles on autism, it is reasonable to boast that Molecular Psychiatry launched the national conversation on autism.

The four papers highlighted in our March 2002 issue were within the first 20 articles that we published on this topic. Now, 383 papers later, we have a much more substantial body of work that further unravels the secrets of autism, the culmination of which is this autism Special Issue, with 26 truly superb papers on autism [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. These extraordinary articles cover essentially all aspects of this disorder, from the training of specialists, to the interface with other disorders, such as polycystic ovarian syndrome and Alzheimer’s disease, and in-depth analyses of genetics, structural and functional imaging, as well as neuroscience, including postmortem brain studies, transcriptome of induced pluripotent stem cell models, assessments of the role of vitamin D, and studies highlighting the contributions of inflammatory mediators to autism.

We have had for over three decades a particular interest on the interface of immune mediators and psychiatric disorders [ 35 ]. It is very rewarding to see the interface of immune mediators and psychiatry evolve from a hypothesis, that we and others explored decades ago, into a broad and established area within psychiatric neuroscience. As we have developed a new model of analysis of the simultaneous contributions of multiple genes and environmental factors to a psychiatric phenotype [ 36 ], were also encouraged to see studies looking at the polygenic risk for autism in the context of childhood trauma, life-time self-harm, and suicidal behavior and ideation [ 30 ], as well in comparison to several other psychiatric disorders [ 32 ].

One paper in this issue, by Frye et al., is highly usual, and particularly intriguing: it investigates the role of the mitochondrion, in the influence of prenatal air pollution exposure on neurodevelopment and behavior in 96 children with autism spectrum disorder [ 22 ]. Second and third trimester average and maximal daily exposure to fine air particulate matter of diameter ≤2.5 µm (PM 2.5 ) was obtained from the Environmental Protection Agency’s Air Quality System. Mediation analysis found that mitochondrial respiration linked to energy production accounted for 25% and 10% of the effect of average prenatal PM 2.5 exposure on neurodevelopment and behavioral symptoms, respectively. Those results suggest that prenatal exposure to PM 2.5 disrupts neurodevelopment and behavior through complex mechanisms, including long-term changes in mitochondrial respiration and that patterns of early development need to be considered when studying the influence of environmental agents on neurodevelopmental outcomes.

We are honored to have initiated the national conversation on autism twenty years ago and we believe that the 403 autism papers published to date in Molecular Psychiatry , including, but not limited to those highlighted in this Special Issue, report major advances in a key area of molecular psychiatry. It is particularly rewarding to see that these articles cover the full spectrum of research translation [ 37 ], from molecules to society.

In future issues, Molecular Psychiatry will continue to publish outstanding advances in autism research.

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Licinio J, Alvarado II. Progress in the genetics of autism. Mol Psychiatry. 2002;7:229.

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Bonora E, Bacchelli E, Levy ER, Blasi F, Marlow A, Monaco AP, et al. Mutation screening and imprinting analysis of four candidate genes for autism in the 7q32 region. Mol Psychiatry. 2002;7:289–301.

Buxbaum JD, Silverman JM, Smith CJ, Greenberg DA, Kilifarski M, Reichert J, et al. Association between a GABRB3 polymorphism and autism. Mol Psychiatry. 2002;7:311–6.

Time Magazine. Inside the world of autism. More than one million Americans may have it, and the number of new cases is exploding. What scientists have discovered. What families should know. Time. 2002. http://content.time.com/time/covers/0,16641,20020506,00.html .

Nash M. The Secrets of Autism: The number of children diagnosed with autism and Asperger’s in the U.S. is exploding. Why?” Time. 2002. http://content.time.com/time/subscriber/article/0,33009,1002364,00.html .

Pasca SP, Veenstra-VanderWeele J, McPartland JC. Research and training in autism spectrum disorder to catalyze the next genomic and neuroscience revolutions. Mol Psychiatry. 2020. https://doi.org/10.1038/s41380-020-0830-5 . [Epub ahead of print].

Lombardo MV. Ribosomal protein genes in post-mortem cortical tissue and iPSC-derived neural progenitor cells are commonly upregulated in expression in autism. Mol Psychiatry. 2020. https://doi.org/10.1038/s41380-020-0773-x . [Epub ahead of print].

Griesi-Oliveira K, Passos-Bueno MR. Reply to Lombardo, 2020: An additional route of investigation: what are the mechanisms controlling ribosomal protein genes dysregulation in autistic neuronal cells? Mol Psychiatry. 2020. https://doi.org/10.1038/s41380-020-0792-7 . [Epub ahead of print].

Menon V, Andrade C, Thennarasu K. Polycystic ovarian syndrome and autism spectrum disorder in the offspring: Should the primary outcome have been different? Mol Psychiatry. 2019. https://doi.org/10.1038/s41380-019-0571-5 . [Epub ahead of print].

Chapman R, Veit W. The essence of autism: fact or artefact? Mol Psychiatry 2020. https://doi.org/10.1038/s41380-020-00959-1 . [Epub ahead of print].

Niesler B, Rappold GA. Emerging evidence for gene mutations driving both brain and gut dysfunction in autism spectrum disorder. Mol Psychiatry. 2020. https://doi.org/10.1038/s41380-020-0778-5 . [Epub ahead of print].

Antunes C, Da Silva JD, Guerra-Gomes S, Alves ND, Ferreira F, Loureiro-Campos E, et al. Tet3 ablation in adult brain neurons increases anxiety-like behavior and regulates cognitive function in mice. Mol Psychiatry. 2020. https://doi.org/10.1038/s41380-020-0695-7 . [Epub ahead of print].

Xiong GJ, Cheng XT, Sun T, Xie Y, Huang N, Li S, et al. Defects in syntabulin-mediated synaptic cargo transport associate with autism-like synaptic dysfunction and social behavioral traits. Mol Psychiatry. 2020. https://doi.org/10.1038/s41380-020-0713-9 .

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Ben-Reuven L, Reiner O. Dynamics of cortical progenitors and production of subcerebral neurons are altered in embryos of a maternal inflammation model for autism. Mol Psychiatry. 2019 Nov 18. https://doi.org/10.1038/s41380-019-0594-y . [Epub ahead of print].

Ramirez-Celis A, Becker M, Nuno M, Schauer J, Aghaeepour N, Van de Water J. Risk assessment analysis for maternal autoantibody-related autism (MAR-ASD): a subtype of autism. Mol Psychiatry. 2021. https://doi.org/10.1038/s41380-020-00998-8 . [Epub ahead of print].

Frye RE, Cakir J, Rose S, Delhey L, Bennuri SC, Tippett M, et al. Prenatal air pollution influences neurodevelopment and behavior in autism spectrum disorder by modulating mitochondrial physiology. Mol Psychiatry. 2020. https://doi.org/10.1038/s41380-020-00885-2 . [Epub ahead of print].

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Griesi-Oliveira K, Fogo MS, Pinto BGG, Alves AY, Suzuki AM, Morales AG, et al. Transcriptome of iPSC-derived neuronal cells reveals a module of co-expressed genes consistently associated with autism spectrum disorder. Mol Psychiatry. 2020. https://doi.org/10.1038/s41380-020-0669-9 . [Epub ahead of print].

Rontani P, Perche O, Greetham L, Jullien N, Gepner B, Feron F, et al. Impaired expression of the COSMOC/MOCOS gene unit in ASD patient stem cells. Mol Psychiatry. 2020. https://doi.org/10.1038/s41380-020-0728-2 . [Epub ahead of print].

Ivashko-Pachima Y, Hadar A, Grigg I, Korenkova V, Kapitansky O, Karmon G, et al. Discovery of autism/intellectual disability somatic mutations in Alzheimer’s brains: mutated ADNP cytoskeletal impairments and repair as a case study. Mol Psychiatry. 2019. https://doi.org/10.1038/s41380-019-0563-5 . [Epub ahead of print].

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Ratanatharathorn A, Koenen KC, Chibnik LB, Weisskopf MG, Rich-Edwards JW, Roberts AL. Polygenic risk for autism, attention-deficit hyperactivity disorder, schizophrenia, major depressive disorder, and neuroticism is associated with the experience of childhood abuse. Mol Psychiatry. 2021. https://doi.org/10.1038/s41380-020-00996-w . [Epub ahead of print].

Brownstein CA, Smith RS, Rodan LH, Gorman MP, Hojlo MA, Garvey EA, et al. RCL1 copy number variants are associated with a range of neuropsychiatric phenotypes. Mol Psychiatry. 2021. https://doi.org/10.1038/s41380-021-01035-y . [Epub ahead of print].

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Licinio, J., Wong, ML. Advances in autism research, 2021: continuing to decipher the secrets of autism. Mol Psychiatry 26 , 1426–1428 (2021). https://doi.org/10.1038/s41380-021-01168-0

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Mindblindness : An Essay on Autism and Theory of Mind

Simon Baron-Cohen, Professor in Developmental Psychopathology and Director of the Autism Research Centre at the University of Cambridge, is the author of Mindblindness (MIT Press, 1997) and The Essential Difference: The Truth about the Male and Female Mind .

In Mindblindness , Simon Baron-Cohen presents a model of the evolution and development of "mindreading." He argues that we mindread all the time, effortlessly, automatically, and mostly unconsciously. It is the natural way in which we interpret, predict, and participate in social behavior and communication. We ascribe mental states to people: states such as thoughts, desires, knowledge, and intentions.

Building on many years of research, Baron-Cohen concludes that children with autism, suffer from "mindblindness" as a result of a selective impairment in mindreading. For these children, the world is essentially devoid of mental things.

Baron-Cohen develops a theory that draws on data from comparative psychology, from developmental, and from neuropsychology. He argues that specific neurocognitive mechanisms have evolved that allow us to mindread, to make sense of actions, to interpret gazes as meaningful, and to decode "the language of the eyes."

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Mindblindness : An Essay on Autism and Theory of Mind By: Simon Baron-Cohen https://doi.org/10.7551/mitpress/4635.001.0001 ISBN (electronic): 9780262267731 Publisher: The MIT Press Published: 1995

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And Straight on Till Morning: Essays on Autism Acceptance

Cover image for 'And Straight on Till Morning'

ASAN created our first e-book, And Straight on Till Morning: Essays on Autism Acceptance , as part of our celebration of Autism Acceptance Month 2013. These collected writings, originally posted to our website, build on our tagline for Autism Acceptance Month — “Acceptance is an action.” They are part of an ongoing campaign to shift April from discourse about autism awareness toward discourse about autism acceptance, centering Autistic voices and creating a more inclusive, accepting world. The authors are Autistic people and allies, who write about the need for moving beyond awareness and toward acceptance; the ways in which awareness fails our community; and what acceptance can look like in practice in the community.

★★★★★A must for every parent... When my son was diagnosed with a severe communication disorder, and labelled educationally autistic by the school over 15 years ago, I had to dig and dig to find autistic adults who had also been given the label as a child. All I knew about autistic adults was Rain Man. Once I met Amanda Baggs and Larry Arnold, my heart eased somewhat...they were really good people, and I would be proud for my son to turn out as they did. The heart is the most important thing to me. Julia Bascom came to my awareness with a wonderful essay she wrote, juststimming(dot)wordpress(dot)com/2011/10/05/quiet-hands/ (I'm not sure Amazon allows links.) Then the Loud Hands project began, I contributed a little. How wonderful to be a part of something far larger than ourselves. Autism experts today believe in abusive tactics (sometimes behaviorism is abusive. Not physically, necessarily,but it kind of discounts the humanity of an autistic individual...in essence, treats them as an animal trainer would treat his charge. Oops, maybe I shouldn't have said that. Anyhow, there is no curiosity about what is inside.) Other's belittle the way they walk and/or talk, still, very special experts call them evil, lacking basic human instincts. I'm glad my son wasn't born in this day. The "experts" would scare the @#$% out of me. Thank God for Temple Grandin, and Donna Williams, who had written the only books I read about true autism experts...the autistics themselves. I tried reading the PhD stuff...ech...dry as old bones. This is a living book, a testament to the humanity to a group of people others choose to treat inhumanely. The other books are written by the prison guards. These are the prisoners. Their crime is being born with a neurological difference that sets them apart. You will not be unchanged.

★★★★★Must have autism book It's critical the non-disabled world, parents, siblings, teachers and friends, shift perspective and understand the experience of autism first hand. This brilliant book takes you there to deconstruct all the myths and prejudice we all hold before we love someone who tells us how it really is.

★★★★★Must read to save lives! This is one of the best books I've ever read. A must for people with autism and people who love or support them. I'm a 30 year veteran in the disability world, so best is a real achievement.

★★★★★Beautifully done I absolutely loved this book. The essays are well-written and compelling, self-advocacy at its best. An excellent read, particularly for the non-autistic community at large.

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Feb 17, 2023

The Great List of Autistic Essays

I’m a late-identified autistic who loves writing about autism. How much do I love it? I’ve written over 150 essays on it in the past six months alone.

How do I think of so many autistic topics to write about? I’m an art therapist who specializes in late-identified autistic adults. That means I not only have my personal experience to draw from, but also the hundreds of hours spent listening to my clients.

I share most of my essays here on Medium, which means it has now become quite the library. In an effort to make my essays more accessible to those wanting clear, relatable information about late-identified autism in adults, I’ve sorted my essays into topics below. While I wish I could provide a link to each of them for you… I’ve got to prioritize my time and energy. So if a specific essay interests you, just pop it into the search and it’ll come up

Autism in a Neurotypical World

What Would a World Designed by Autistic People Be Like

The Harm in "They're a Little Autistic"

Autism Does Not Directly Cause Socializing Problems

Please Trust My Lived Autistic Experience

Can Someone Please Create a Neurodivergent Intentional Living Community

What if I Accept that Most Neurotypicals Won't Like Me

How Neuro-Bias Shows Up in Professional Testing

Your Autistic Experience Sounds Just LIke my Neurotypical One

Neurotypical Words that Don't Work for Autistics: Overachiever

But Neurotypicals Experience That, Too!

Neurotypical Norms That Don’t Work for Autistics: Hustle Goals

The Fear of Being a Hypocritical Autistic

Neurodiversity: Us vs Them?

How to Meet an Autistic Adult Exactly Where They're At

Autism Characteristics

The Autistic Mind Loves to Take Detours

4 Reasons Why Autism Symptoms Lists are Confusing

My Autistic Brain: Sunshine and Detours

The Joys of Being Autistic: Part 1

Stop Saying Autistic People Can't Empathize

Redefining Fun for Autistic Adults

9 Reasons Why Autism Looks So Similar to CPTSD

We Need More Depictions of the Interior Experience of Autism

Clarity is What my Autistic Mind Craves

How Trauma and Autism Can be a Confusing Mix to Decipher

Why am I like This? Understanding the Autistic Brain

My Autistic Mind Does What it Wants

The Dissociated Autistic Performance State

The Joys of Being Autistic: Increased Creativity and Innovation

My Autistic Memory Is Not the Same as Others

The Firehouse Dilemma: Autism and Infodumping

The Variability of the Autistic Sensory System

5 Reasons Autistics are Especially Hard on Themselves

The Shame That Often Accompanies Autism

Knowing You’re Different as an Autistic Adult

3 Reasons Autism is Worse After You Learn You're Autistic

Disability and Internalized Ableism

I Had to Dismantle My Fear of Autistic People

Is Autism a Disability?

I’m Ok With Saying I have a Disability, Right?

Dog Training

The Difficulties of Adjusting to a New Dog When You're Autistic

Tips for Adjusting to a New Dog When You're Autistic

5 Tips to Integrate a Dog into Your Autistic Life

Defining and Explaining Autism

What I Wish Others Knew About Autism

Let’s Drop the “Disorder” From Autism Spectrum Disorder

How Low and High Autism Labels are Misleading

We Need All the Autism Theories and Models

Autism Can Be a Murky Thing To Understand

How I Explain Autism to Someone Unfamiliar With It

What is Late Identified Autism

Autistic Statistics are Not Accurate for Late-Identified Autistics

I'm Here for the Autistic Awakening

How It Helps to Know You’re Autistic

Why It Matters to Know You're Neurodivergent

What is Neurodiversity and Why Does it Matter

How Neurodivergent Acceptance Can Improve Our Lived Experiences

How Unidentified Autistics are Taught to Socially Camouflage and Mask

Is There a World Where I can Be Unmasked?

The False Dichotomy of Masked and Unmasked Autism

6 Reasons Why UnMasking Is Harder Than it Sounds

What if You have to Mask Everywhere?

My Personal Experience as an Autistic

Hating Cooking as an Autistic Adult

I Make Giant Lists About Autism for Fun

The Challenges of Writing Publically About Autism

The Risk of Sharing my Autistic Passions with Others

I'm Reclaiming Weird for My Autistic Self

I Expand and Then I Contract

I Stopped Seeing Myself As Broken When I learned I was Autistic

Respecting my Limits as an Autistic Business Owner

I Need to Lessen the Pressure on my Autistic Self

My Autistic Brain Doesn’t Want to Watch TV Right Now

Embracing Who I am as an Autistic Adult

I Used to be a Very Judgemental When I Didn’t Know I was Autistic

A Letter from An Autistic Adult to Trust

Don’t Get So Upset: A Line that Doesn’t Work for This Autist

Why This Autistic Writer Didn't Respond to Your Comment

Relationships

Is Dating Worth it as an Autistic Adult?

Is it Possible to be Happily Partnered as an Autistic Adult?

Not Liking People as an Autistic Adult

Self-Identification

So You Think You Might Be Autistic

Dearly Newly Identified Autistic Person

Am I Actually Autistic?

Dearest Smart, Weird, and Caring Autistic

I Am Deeply Unsure About Autism

How to Self Identify Autism as an Adult

When the Past Makes Sense after a Late-Identification of Autism

Where to Start When You First Learn You’re Autistic

6 Strategies to Harness the Hyperfocus Power of an Autistic Mind

Leave the Gremlin In the Cave: Self-Isolation as a Necessary Autistic Tool

No Plans Days as an Autistic Tool

Making Accommodations for Myself as an Autistic Adult

How Many Accommodations Can We Ask for as Autistic Adults?

Using Art to Help Your Autistic Mind

Dissociation as an Autistic Tool

The Power of the Home Environment for Autistics

Is It Ok to Honor My Autistic Needs?

Recognizing When It's Not Time to Make Decisions as an Autistic

Therapy for Autistics

Dearest Autistic Client of Mine

8 Ways Therapy Can Help With Late Identified Autism

Gaslighting the Autistic Experience

Dearest Therapist Who Knows Barely Anything About Autism

I'm an Autistic Therapist: Sometimes It's Easier Than Everyday Life

Does Your Therapist Know Enough About Autism to Help You?

Questions to Ask a Potential Therapist When You're Autistic

How I Work with Newly Identified Autistic People

What to Ask When You're Seeking Therapy for Late-Identified Autism

12 Ways Therapy Can Enhance Life for Late Identified Autistic Adults

Therapy is Not for Fixing Autism

The Harm I Caused When I Didn't Know about Autism

A Newly Identified Autistic Therapist Working with Newly Identified Autistics

Common Therapy Advice That is Counterproductive for Autistics

A Therapist Told Me Treating Autism is Like Treating Depression

Who Can Diagnose Autism in Adults?

Autistic Adults Deserve Better from the Mental Health Field

Undiagnosed Autism

The Correlation Between Intelligence and Undiagnosed Autism

10 Consequences of a Life with Unidentified Autism

The Gap Between “Diagnosable Autism” and a Lifetime of Unidentified Autism

Autism Diagnosis Criteria are Limiting for Men Too

No Autistic Should Receive a Diagnosis Letter Like Mine

Identifying Autism in Undiagnosed Women Abstract

How I Identify Autism in Undiagnosed Women

Autistic Stereotypes Block People From Knowing They're Autistic

Thank you for reading. If you’d like to read more, sign up for my FUNletter . If you would like to explore your autistic identity with an autistic therapist, you can learn more about my therapy services here .

Want to read more on topics that interest you? Subscribe to my FUNletter.

Thanks for submitting!

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ASIN ‏ : ‎ B00C35BDFG
Publisher ‏ : ‎ The Autistic Press; 1st edition (March 28, 2013)
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Language ‏ : ‎ English
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Home — Essay Samples — Nursing & Health — Autism — Why Autism Awareness is Important

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To the parents of a newly-diagnosed child on World Autism Day: One day you will bake a cake

Nothing could have prepared me for that rainy April morning 11 years ago when my daughter Lily was first diagnosed with autism : not the growing prevalence among children , not the autism awareness online, not even relationships with autistic people.

No matter how incredible the education, no matter how positive the exposure – learning your child has autism can take the breath from your lungs. You lose the one thing that every parent desperately wants: certainty.

"Give me something reliably true," is what I said after learning the news. An autism diagnosis drew a red line through my plans and the future I had imagined for us.

But Lily's love changed me, and I watch every year as Lily's light changes the world. I would never go back and rewrite this story. I would choose being mom to my girl.

World Autism Day is Tuesday. The day was crafted in 2018 by the United Nations General Assembly as a day to promote, protect and ensure rights, freedoms and dignity for people with disabilities.

As we approach what some in the community call Autism Acceptance Day, my heart turns to the parents who are new here, who have just learned their child has a lifelong neurological condition, who don't yet know what the range of characteristics may be, and who probably don't yet feel like celebrating.

I want you to know that one day you will throw a party – just as I now do every year on World Autism Day with my autistic daughter. Though it could take time.

Eleven years ago, I thought we were just passing through, until I realized autism wasn't a mountain I could climb and conquer. It was a garden I had to nurture, day in and day out.

I wish I would've opened my heart and my arms a little sooner. Here's what I wish I knew 11 years ago.

Tips for a successful trip: Traveling with a child on the spectrum can be 'overwhelming'

Accept the diagnosis, reject the prognosis

I walked into the stuffy back office at our local clinic in April 2013, a single mom of two with so much unresolved pain, I thought another thing would break me.

We couldn't have been there more than 10 minutes before the doctor glanced at his college intern to say, "You see that? Textbook autism. Look at her. She has no idea we're in the room right now." I'm not sure I was even in the room. I felt myself slowly fade into the background, lost in my thoughts.

My daughter's speech stopped progressing at 2 years old. I suspected something may be up and I was terrified of what that may mean. I was getting ready to graduate college and had all of my plans together on what to pursue after school to be able to provide for my kids. A red line was drawn through those plans, too. I could not pursue the career I'd worked so hard for. Not now that our life would be one therapy appointment after another and around-the-clock care.

I didn't know anything about autism the day Lily was diagnosed. I remember curling up in a ball and crying until I was too exhausted to shed another tear.

If I could go back, I would tell her it's OK to accept the diagnosis, because rejecting it would mean rejecting my daughter, and she would feel it every day of her life.

I would also tell myself to refuse every bit of the prognosis.

Sometimes as parents, we so desperately want to have something to plan for. We'd rather cling tight to a dire outcome than plunge ourselves into the unknown. It oddly feels safer there. But deciding a child's potential before they are ever able to live it out, is felt by them. It goes deep into the soil of their life and affects how they grow.

We have to reject every limitation placed on our child, not just in our mind; it has to penetrate the heart and permeate our core. Rejecting limitations won't bring us any certainty, but it will allow our children to become everything they are meant to be.

'She felt safe': How autism-certified travel options can be life-changing for families

You cannot stop living

Another thing I wish I would've known is that life doesn't stop at a diagnosis.

Just as we reject the projected limitations of our child's autism, we also need to reject the idea that going out into the world will be a disaster.

I've noticed that this is hard for some parents of autistic kids. We resent that we have to live a different life than the other families we see. I did.

Love on the spectrum: At 17, she found out she was autistic. It's a story that's becoming more common. Here's why.

We don't venture out because we don't want the world to look at us and notice our difference. We are envious that we can't just be "normal families." I was that way for years. I told people that I loved my child and that I didn't want the world to be harsh to her.

It was actually that I didn't want the world to be harsh to me. I wasn't protecting her. I was protecting myself.

I realized when she was about 8 years old, that I was the one holding us back.

The world cannot be off limits for your disabled child.

It was the fresh air, the mountains, the trees, the water that brought my daughter to life, and subsequently, our adventures together injected life into me.

I crave adventures with my girl now. This is her world, too. So let people stare. Let them sit in their discomfort. Let them witness the freedom that comes from being loved for who you are.

What is autism? Here's how autistic advocates say you can support the community responsibly

One day, you will bake a cake

To the parent of a newly diagnosed child, I hope you know how proud of you I am. You want to learn. You want to grow. You want to have a beautiful life with your child. I know that.

Change is hard, and loss of control is scary. There may even be a burial of dreams, but I promise you, they will be so much wilder one day.

Yes, there will be challenges and tough weeks. In this early stage, find your village. Understand that your child cannot be separated from their autism, so don't attempt to take it upon yourself.

I want you to know that Lily is now 14. She is not broken. She's a teenage girl who loves the Spice Girls, who thinks boys are cute, who laughs at your jokes and whose joy fills a room. She loves baking and aquatic life and though she isn't fully verbal, she absolutely can communicate.

She told me to tell you that "today is a beautiful day."

I know that World Autism Day may not feel like one big party right now. I know the day might not yet feel beautiful. Your life has just changed. You are looking at all the things you had planned and you are learning how to let it all go.

But your day is coming when an overwhelming love will replace the fear you have right now.

Maybe like me, you'll even tell your story.

Maybe like Lily, you'll want to bake a cake.

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Opinion Readers critique The Post: This power trip is one big guilt trip

Every week, The Post runs a collection of letters of readers’ grievances — pointing out grammatical mistakes, missing coverage and inconsistencies. These letters tell us what we did wrong and, occasionally, offer praise. Here, we present this week’s Free for All letters.

Regarding Glenn Kessler’s April 7 Fact Checker column, “ Robert F. Kennedy Jr.’s running mate falsely implies vaccines cause autism ”:

On behalf of all the parents of neurodiverse children in the world, thank you for debunking the myth that vaccines cause autism. Perhaps the most insidious message from those people is that somehow the parent of a child on the autism spectrum is to blame for their child’s condition.

As the father of a 21-year old who was diagnosed as autistic 16 years ago, I spent every day wondering why, how. Was it something we parents did?

Last month, we did a genetic test and found that he has a deletion at the 16p11.2 chromosome. It explained everything. The speech delay. The developmental delay. His autism spectrum attributes. That discovery wiped away years of guilt and fear because, for the first time, we could accept that his challenges were genetic, no different than the color of his eyes. That we parents did nothing wrong.

So shame on Kennedy and his running mate, Nicole Shanahan, for continuing to push the myths. They are causing incalculable grief and guilt on top of what is already an extremely hard issue to deal with.

And kudos to Kessler and all the other journalists holding them to account. Keep it up.

John Williams , Seattle

From accidents of birth to accidents of death

Regarding the April 5 front-page article “ Arms deal greenlit on day convoy was struck ”:

This headline and article conflated two entirely unrelated topics. Accidents happen in war, and they do not necessarily dictate a change in national policies. For example, according to Brown University’s Watson Institute for International and Public Affairs, more than 432,000 civilians were killed in America’s post-9/11 wars. None of these accidental deaths deterred the United States from pursuing its military objectives.

It is in the national interest of the United States for Israel to defeat Hamas . A Hamas victory would embolden terrorists everywhere to commit the same kinds of depraved atrocities Hamas committed in Israel on Oct. 7. An Israeli victory depends in part on continued U.S. military support. And contrary to the misguided idea that fighting terrorists only produces more terrorism, it is the appeasement of those who support and inflict terrorism, such as the Iranian regime and its Hamas proxies, that encourages terrorists — and terrorism.

Daniel H. Trigoboff , Williamsville, N.Y.

Death notices at death’s door

First, Robert Thomson, a.k.a. Dr. Gridlock, left The Post. Then, John Kelly took a buyout. And now, the number of death notices in the daily paper has dwindled to a trickle. These three mainstays allowed readers to grasp the flavor of the Washington area without having to read about crime or tragedy.

Take the reminiscence of a Foreign Service officer’s wife who went with her husband to embassies around the world, with their five children in tow, or the notice for a 90-year-old woman who came to work for the federal government from a small town in the Midwest during World War II. Even tidbits about the departed, such as the observation that one man “was a voracious reader of the Washington Post, keeping issues for weeks and even months to make sure that he read every word from the front to the back page,” have lingered with me.

As an avid reader of them, I mourn the continued dwindling of these tributes to local human beings. That’s a shame, especially given the amount of money The Post charges to place these announcements.

Betty Lawson Walters , Rockville

Last rites for the last rights

I am a big fan of Ann Telnaes, a gifted editorial cartoonist with a keen ability to capture the political zeitgeist. But I must take issue with her March 29 cartoon, “ The right wing’s to-do list .”

She was all too correct about the right wing’s goal of eroding many rights that Americans have enjoyed for decades. But putting “voting rights” at the bottom of that list was incorrect. It is precisely by eroding voting rights at each and every opportunity that conservative Supreme Court justices, members of Congress and state and local officials will further eradicate our other rights. Once we lose unfettered access to the ballot, our most fundamental right, the rest of our rights will be at risk. Let’s hope Americans realize what is at stake in this year’s elections and vote.

Arina van Breda , Alexandria

Apples and oranges

In their April 3 Wednesday Opinion essay, “ The Taliban’s oppression of women is apartheid. Let’s call it that ,” Melanne Verveer, Karima Bennoune and Lina Tori Jan rightfully argued that gender apartheid should be recognized as a crime against humanity.

May I respectfully request that writers not distract us from their important points by giving us math homework? This essay presented statistics from before 2021 in absolute numbers of women and girls, and from after 2021 as “7 percent” and “2 in 10.” Comparing these statistics requires researching the populations of women and girls in Afghanistan in those years to get a sense of the scale of this crime. Apples to apples, please!

Meg Brosnan , Redwood City, Calif.

Apples and oranges and shrooms

The Post’s cartoonists need a refresher on the Book of Genesis, it seems. A “Rhymes With Orange” cartoon featured prominently in the March 30 Free for All cited Eve, of biblical renown, saying, “The trouble didn’t start after I ate the apple. It was after I ate the mushroom — that’s when the snake started talking.”

On first glance, I didn’t even get the cartoon. It was only after seeing it for the second time that I realized it was alluding to psychedelic mushrooms, not the regular kind, with which I am more familiar. But that closer glance also revealed the comic’s basic ignorance of the sacred text. As almost every beginning Sunday school pupil knows, the snake started talking to Eve before she ate the apple, not after.

Steven P. Levine , Bethesda

Our heads are out of joint

The March 30 front page featured this headline: “ ‘We train joint. We fight joint.’ ”

I thought I might learn more about this awkward headline in the first paragraph, but the phrase didn’t reappear until the third paragraph from the bottom of a very long article. I had to assume it had something to do with the Marines pictured near the headline testing antitank missiles. Readers should be informed by headlines, with no need to assume or guess the meaning.

Peggy Douglas , Rehoboth Beach, Del.

Why the cap on dunce caps?

The April 2 front-page article “ Trump ramps up his attacks ,” about Donald Trump ’s rants against the judges overseeing his various trials, included this sentence:

“And in a lengthy post on Easter Sunday, Trump wrote in all caps: ‘Happy Easter to all, including crooked and corrupt prosecutors and judges that are doing everything possible to interfere with the presidential election of 2024, and put me in prison.’”

Please, please quote Trump’s all-caps rants in all caps, just as he typed them. Why are you cleaning them up? With that stylistic choice, readers can’t get the full flavor of the former president’s social media rages.

Fred Kelemen , Philadelphia

Patron of the arts — or artist of patronage?

The April 3 front-page article “ From Calif. billionaire, a lifeline for Trump ” dove deeply into the background of Don Hankey, a wealthy California business owner who lent Donald Trump the money to satisfy his $175 million appeal bond in the New York civil case judgment. Hankey described the loan as a good business deal and also said he provided it, in the words of The Post, “because he agreed with the former president’s defense in the New York civil case.” The tone of the article was critical of Hankey’s business of offering high-interest loans to car buyers with poor credit and warned: “If Trump is elected, their relationship could come under new scrutiny if the government is involved in matters affecting Hankey’s business.” Fair enough.

But contrast this article with The Post’s coverage of Kevin Morris, also a wealthy California business owner, whom the Jan. 24 news article “ Hunter Biden’s art pieces garnered $1.5 million ” described as “one of Biden’s closest friends while also acting as an attorney and financial benefactor.” Morris purchased 11 of Biden’s paintings for $875,000. Morris’s connection to the Biden family was treated almost as an aside, though the article did quote a few parts of Morris’s House deposition in which he admitted to lending Biden approximately $5 million.

Lending millions to a client facing lengthy prison terms in tax and gun cases, and no apparent ability to repay, is an ethically questionable move for a lawyer and a financially questionable deal for a businessperson. That article noted that “ethics experts have questioned whether buying Hunter Biden’s paintings could be a dubious way for individuals to curry favor with the White House.” Why no equally deep dive into the background of Kevin Morris?

Joseph A. Capone , Oakton

The patron saint of artistic freedom

As one might expect, the March 28 obituary for Richard Serra, “ Steelworker turned sculptor left a legacy defined by massive masterworks ,” discussed the controversy surrounding the installation of his “Tilted Arc” sculpture in front of the federal building in Lower Manhattan. However, the obituary failed to mention that the removal of the sculpture in 1989 is generally credited with instigating the passage of the Visual Artists Rights Act in 1990 . The law gives the artist the right to protect his or her work of art from modifications, including wholesale removal that was the fate of “Tilted Arc,” during the creator’s lifetime and for 50 years after. The law was a watershed in establishing an artist’s control over his or her artwork after it was turned over to the patron. The removal of “Tilted Arc” didn’t merely help make Serra’s reputation, as the obituary noted. It helped protect all artists who followed him.

Daniel Feil , Fairfax

Patronizing the arts

The March 28 Style article “ In a shift, Rubell will go without local leader ,” about a management change at the Rubell Museum D.C., characterized the Washington regional “art scene” as “marked by two extremes — giant cultural treasuries on the National Mall and tiny nonprofits with shoestring budgets.” As artists, art professionals and board members of arts institutions in the area, we feel this description was both inaccurate and derogatory.

Of course our regional nonprofit visual arts centers have smaller budgets than the Smithsonian Institution. Despite their varying budgets, even the midsize and smaller regional nonprofit visual arts organizations in our area make sizable and very significant cultural contributions to a wide range of communities and audiences. Area residents are lucky to have access to a large, diverse ecosystem of nonprofit visual arts centers offering a wealth of visual arts activities that enrich the cultural life of greater Washington.

Richard L. Dana , Bethesda

Helen Frederick , Silver Spring

June Linowitz , Bethesda

Nancy Sausser , Glen Echo

It is large, it contains multitudes

After reading the March 31 front-page article “ Last hours of Baltimore’s Key Bridge: Dark, quiet, then calamity ,” I wonder whether The Post could help readers resolve what to some will seem like a disconnect between photographs and words.

The cargo ship Dali has a known capacity of just under 10,000 “twenty-foot equivalent units,” or TEUs, a shipping business measurement. The article said it was loaded with “only about 4,700” containers. But in photos, the ship does not appear to be half-full; it appears to be full. Articles might be unclear because actual containers are confused with TEUs.

A 40-foot container counts as two TEUs. I did a rough count from photos of the visible stack of mostly 40-foot containers (19 athwartships, by 9 or 10 high, by 16 rows bow to stern) and calculated more than 3,000 boxes. Add in an approximation of the containers hidden from view within the hull, and that might add up to approximately the claimed 4,700 containers, a figure that when multiplied by two is in the neighborhood of the almost 10,000 TEUs the fully loaded ship can hold.

If The Post consistently explained to readers the difference between a ship’s capacity in containers and in TEUs, and the difference between the number of containers the Dali had on board and how fully they were loaded, it would leave readers more informed about both the shipping industry in general and this disaster in particular.

Brad Thompson , McMinnville, Ore.

There’s even more under the surface

Regarding Dan Rosenzweig-Ziff and Praveena Somasundaram’s April 1 Retropolis column, “ A cleanup crane has origins in Cold War CIA ”:

The Soviet ballistic missile submarine K-129 that was partially salvaged by the heavy lift ship Hughes Glomar Explorer — as part of the secret Project Azorian — carried a crew of 99 men, including its captain, not “at least six crew members” as this piece stated.

The CIA undertook the salvage attempt in an effort to recover the one-megaton warhead of one of the three nuclear-tipped ballistic missiles carried by the K-129. The two other missiles were destroyed in the disaster that befell the submarine.

Because of damage to the Glomar Explorer’s lift claws during the attempted salvage, only 38 feet of the bow section of the K-129 were recovered. That section contained two nuclear torpedoes and the remains of six Soviet sailors. Their remains subsequently were buried at sea with military honors. A film of the burial was passed to the Russians after the fall of the Soviet regime at the end of 1991.

Project Azorian was the most ambitious maritime salvage effort ever attempted. The ballistic missile warhead that was the goal of that effort was not recovered.

Norman Polmar , Alexandria

The writer is co-author of “ Project Azorian: The CIA and the Raising of the K-129 .”

Not even a straw man could keep his cool over this

According to Mark Athitakis’s March 31 Book World review, “ Don’t worry, be stoic ,” “modern Stoicism finds itself somehow settling into Successories-style aphorisms, screw-your-feelings machismo and the ends justifying the means. This is many things, but it’s not a coherent moral philosophy.”

This claim is many things, but it’s not a coherent critique of Stoicism. The hollow “modern Stoicism” Athitakis criticizes seems more like a phantom philosophy of his own imagination than the philosophical movement as I’ve experienced it. He does not engage with meaningful contributions from the likes of William B. Irvine, whose 2008 book, “ A Guide to the Good Life: The Ancient Art of Stoic Joy ,” is arguably a linchpin in the renaissance of this philosophy as practiced today. Had he done so, Athitakis might have encountered more of the modern Stoics who continue to emphasize duty and discipline, character and joy. Marcus Aurelius’s invocation that we “dwell on the beauty of life” might be “bumper-sticker” fodder. But it also happens to be a valuable insight.

Olev Jaakson , New York

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State police begin offering blue envelope program to drivers with autism

Alison Kuznitz, State House News Service

Massachusetts State Police Detective Lieutenant Kevin Baker (left) and Deputy Superintendent John Pinkham hold up new Blue Envelopes. (Massachusetts State Police)

State police in Massachusetts have begun implementing a program to improve interactions with people on the autism spectrum, building upon legislation that won Senate approval in January and remains before a House committee.

Participating drivers can choose to place copies of their license, registration and insurance cards inside a blue envelope , which acts as a visual cue for police and other public safety officials during stressful and potentially dangerous traffic stops.

The envelope would notify police that the driver is on the spectrum and provide guidance for how to handle certain behaviors, such as stimming. Drivers can also share emergency contact information on the envelope.

Lt. Gov. Kim Driscoll touted the initiative, which state police developed with the Massachusetts Chiefs of Police Association and advocacy groups, during an event hosted by the Advocates for Autism of Massachusetts (AFAM) organization Tuesday morning.

"This is an initiative that reflects our administration's deep commitment to support programs that strengthen inclusivity and support law enforcement's ability to more effectively meet the needs of every single community member," Driscoll said.

The Senate in early January passed legislation to also create a voluntary blue envelope program, directing the envelopes to be made available at Registry of Motor Vehicle offices. The bill, filed by Sen. Jo Comerford and now in the House Ways and Means Committee, did not carve out a specific responsibility for state police to use the envelopes, Comerford aides said.

With the bill's fate in the House unclear, law enforcement and advocates have moved forward with their own program, which the Healey administration announced Tuesday as it marked Autism Acceptance Month in April. State police implemented the initiative "with the cooperation of Senator Comerford," spokesman Dave Procopio said.

Autism advocates warn that police, without training, can misinterpret the behavior of individuals on the spectrum — such as hand-flapping, body rocking or repeating certain phrases — and use force when it could have been avoided.

"It is incumbent upon us, as law enforcement officers and compassionate community caretakers, to recognize and mitigate the stressful effects that interaction with a police officer can have on a person with autism," Col. John Mawn, interim superintendent of the state police, said in a statement. "The Blue Envelope Program is an important step toward that goal."

State police are rolling out the blue envelopes to their barracks and working to share information with municipal police departments in the coming days, said Agawam Police Chief Eric Gillis, president of the police chiefs association.

Blue envelopes "will soon be available at local police departments," the Executive Office of Public Safety said.

People on the spectrum can request the envelopes at barracks or online , according to a new state webpage . The envelopes are free, and people can request multiple envelopes if they have more than one car.

"Our officers receive training in dealing with persons with autism and the different communication styles that are necessary for those interactions," Gillis told the News Service. "But to open the conduit right out of the gate with the blue envelopes lets our officers know across the commonwealth who're they dealing with, and that they need to kind of shift gears a little bit when dealing with that type of individual."

Gillis added, "This is something we've been behind for a long, long time, and it's just nice to see it come to fruition."

The blue envelopes, which contain written instructions for police officers and drivers on the autism spectrum, were available at Tuesday's event.

For police officers, the envelope states the driver "may display repetitive body movements or fidgeting and may have unusual eye contact" and "may exhibit signs of high anxiety especially due to bright lights and noises such as your radio."

Police are asked to "allow driver extra time to respond to your questions; they may have difficulty interpreting and processing your directions"; "use the most simplistic explanations possible, speak clearly, and limit unnecessary details or jargon"; "please clearly tell the driver when the stop is over and that they may leave"; and "if the driver becomes upset, ask and/or consider contacting the person listed on the reverse of this envelope."

Drivers are given instructions that tell them to keep their hands on the steering wheel until they are told otherwise by police, provide the blue envelope to the officer, and ask the officer to consider calling their emergency contact. Drivers are warned "the officer may shine a flashlight in your car, may have a loud radio, and may have flashing lights on their car."

State officials recommend attaching the envelopes to the car's sun visor or placing them in another accessible location.

The envelopes also contain QR codes, which out-of-state law enforcement can scan if they are unfamiliar with the program.

Ilyse Levine-Kanji , an AFAM executive committee member, said the wording on the envelopes may be slightly adjusted should the legislation clear the House and be signed into law. But Levine-Kanji, who offered feedback to state police on their envelopes, said she doesn't expect major changes.

"They knew of the blue envelope bill and they'd been helping push it along, but when it wasn't moving, they said, 'This idea is too good to let go. We just need to do our own blue envelope,'" she said. "This is a blue envelope that is going to be used until the bill passes."

Essay: How we can make traffic stops safer for people with autism

Robert MacNeil, Earnest News Anchor for PBS, Dies at 93

With his longtime co-host Jim Lehrer, he delivered thoughtful reports that stood in stark contrast to the commercial networks’ ever more sensational newscasts.

By Elizabeth Jensen

Robert MacNeil, the Canadian-born journalist who delivered sober evening newscasts for more than two decades on PBS as the co-anchor of “The MacNeil/Lehrer Report,” later expanded as “The MacNeil/Lehrer NewsHour,” died early Friday in Manhattan. He was 93.

His death, at NewYork–Presbyterian Hospital, was confirmed by his daughter Alison MacNeil.

Mr. MacNeil spent time at NBC News early in his career and was a reporter for the network in Dallas on the day President John F. Kennedy was assassinated. But he came to reject the flashier style of the commercial American networks, and in 1971 he joined the fledgling Public Broadcasting Service.

He brought with him a news sensibility honed at the BBC, where he had worked in the interim, and became a key figure in shaping U.S. public television’s in-depth and evenhanded approach to news coverage.

A pairing with Jim Lehrer in 1973 to cover the Senate Watergate hearings for PBS was unpopular with the operators of many local public stations, who thought the prime-time broadcasts weren’t appropriate evening fare. But the two men’s serious demeanor was a hit with viewers, and the broadcasts won an Emmy Award and eventually launched an enduring collaboration.

In October 1975, some major public stations began carrying the “The Robert MacNeil Report,” a half-hour of Mr. MacNeil’s design that examined a single issue each night and shunned showy production values. Within a year the program was renamed “The MacNeil/Lehrer Report.” It was expanded again in 1983 to become “The MacNeil/Lehrer NewsHour,” a multitopic program that was the nation’s first full hour of evening news.

The program offered a stark counterpoint to the ever-frothier newscasts on the commercial networks’ local affiliates and was honored with every major broadcast journalism award.

Intensely private in public, Mr. MacNeil was known to friends as engaging and wickedly funny. He was proud of his no-nonsense style on air, which critics called boring but which he called civilized discourse in the public interest. One memorable example was his hourlong interview in 1985 with Fidel Castro, in which Mr. Castro reluctantly defended the Soviet invasion of Afghanistan in 1979, in part because he would never “be on the side of the United States.’’

Mr. MacNeil defended his interviewing style and his program’s unsensational approach to weighty topics. “I cannot stand the theatrical, prosecutorial interview, the interview designed to draw attention to the interviewer, full of either mawkish, false sentiment or theatrically belligerent questioning,” he told The New York Times in 1995, when he retired from the daily newscast.

“Every journalist in this country has a stake in the democratic system working, and I think institutions of democracy are worth taking seriously,” he added. “It’s a very old-fashioned, corny view, but Jim and I both feel that strongly, which is one of the reasons our show is the way it is.”

Robert Breckenridge Ware MacNeil, known as Robin, was born on Jan. 19, 1931, in Montreal and raised in the port city of Halifax, Nova Scotia. His father, Robert A.S. MacNeil, served in the Royal Canadian Navy during World War II, commanding convoy escort ships, and later joined the Royal Canadian Mounted Police. His mother Margaret (Oxner) MacNeil, was left to raise her children alone for several years while her husband was at war.

While Mr. MacNeil was attending Dalhousie University in Halifax, a producer for the Canadian Broadcasting Corp. saw him in a school production of “Othello,” and he was hired to act in CBC radio productions and eventually a daily radio soap opera.

He soon dropped out of college to try his hand full time at stage acting, but decided that he was better suited to be a playwright and returned to school, this time at Carleton University in Ottawa. While still a student he worked as a national radio announcer for the CBC and then for the CBC’s new television service, where he also hosted a children’s program.

After graduating, he moved to England to write plays, but quickly turned to journalism to make money. He told The Times in 1995, “I had one of those golden careers; it just floated.”

In 1960, after five years at the Reuters news agency in London, Mr. MacNeil joined NBC News, eventually replacing John Chancellor as a wide-ranging foreign correspondent, covering wars in Africa and the Cuban missile crisis. (For about a week after that October 1962 episode, he and five other journalists were held under house arrest in a Havana hotel by the Castro government.) He was present at the construction of the Berlin Wall and later covered its dismantling in 1989.

Mr. MacNeil was assigned to cover Washington in 1963 and was on his first presidential trip on Nov. 22 when President Kennedy was assassinated in Dallas. While his work covering the killing was overshadowed by that of his NBC News colleagues, he may have had his own brush with the drama of that day.

After the shots were fired in Dealey Plaza, Mr. MacNeil made his way to the nearest building, the Texas School Book Depository — the building from which the fatal shots had been fired. There, he asked a man who was leaving and another in the lobby where the nearest telephone was. Kennedy’s accused assassin, Lee Harvey Oswald, later told the Dallas police that he had encountered a Secret Service agent at the building. The historian William Manchester concluded in his 1967 book, “The Death of a President,” that the man in the suit, crew cut and press badge was, in fact, Mr. MacNeil.

In his autobiography, “The Right Place at the Right Time” (1982), Mr. MacNeil wrote that “it was possible, but I had no way of confirming that either of the young men I had spoken to was Oswald.”

In 1965, Mr. MacNeil became the co-anchor, with Ray Scherer, of NBC’s half-hour weekend news broadcast, “The Scherer-MacNeil Report.” But two years later he returned to London, reporting for the BBC’s “Panorama” program, before joining PBS in 1971.

Mr. MacNeil, who had homes in Manhattan and Nova Scotia, became an American citizen in 1997 and was made an officer in the Order of Canada the same year. He reflected on his life as a dual citizen in a 2003 memoir, “Looking for My Country: Finding Myself in America.”

His wife, Donna MacNeil, died in 2015 . His first marriage, to Rosemarie Coopland, ended in divorce, as did his second marriage, to Jane Doherty.

He is survived by two children from his first marriage, Ian MacNeil, a theatrical set designer who won a Tony in 2009 for his work on the musical “Billy Elliott,” and Cathy MacNeil; two children from his second marriage, Alison and Will MacNeil; and five grandchildren.

After retiring from the daily newscast, Mr. MacNeil continued to work with PBS, including hosting the “America at a Crossroads” series of documentaries in 2007, which examined the nation’s challenges in the post-9/11 world. With Mr. Lehrer, his close friend, he remained a partner in MacNeil/Lehrer Productions, which produced their newscast until 2014, when WETA, the Washington, D.C., public media station where the “NewsHour” is based, assumed ownership. Mr. Lehrer died in 2020 at 85.

Mr. MacNeil found himself at the center of controversy in 2011 when, returning to “NewsHour” for a six-part series on autism, he featured the story of his grandson Nick. He was criticized for allowing his daughter Alison to question whether her son’s autism was linked to vaccines. (He did qualify her comments by noting that “public health authorities say there is no scientifically valid evidence that vaccines cause autism.”)

Mr. MacNeil chaired the board of the MacDowell Colony (now known as MacDowell), the retreat for artists, writers and musicians in Peterborough, N.H., from 1993 to 2010. After leaving the “NewsHour,” he returned to his first love, writing. He was the author of “The People Machine” (1968), about the relationship between television and politics; three memoirs; and four novels — “Burden of Desire” (1992), “The Voyage” (1995), “Breaking News” (1998) and “Portrait of Julia” (2013).

He was a co-author of “The Story of English,” a companion volume to the 1986 BBC-PBS television series that he hosted, and he wrote its 2005 sequel, “Do You Speak American?”

Mr. MacNeil remained proud of his early evening newscast. In interviews for the Archive of American Television in 2000 and 2001, he was asked how he wanted to be remembered.

“Television has changed journalism, utterly, not just for television, but for print and everybody else,” he said. “It’s changed the whole culture and ethos of journalism. And to have been able hold the line — perhaps Canute-like — against a tide that’s going to engulf us all in the end, for a few years, has been a source of gratification to me.”

Sofia Poznansky contributed reporting

One-To-One Programs: Supporting Autistic Children Essay

Introduction, literature review, challenges teachers and children with autism face, potential benefits of one-to-one programs, potential disadvantages of one-to-one programs, suggestions and recommendations.

Autism is defined as a neuro-developmental disorder which mostly affects children by impairing their neural development making it difficult for them to interact with other children and adults socially (Newschaffer et al 2007).

The impairment in their neural developmental network causes the sufferer to engage in repetitive behaviour such as repeating the same words or actions because it affects the information processing part of the brain (Caronna et al 2008).

The causes of autism are mostly genetic although some disorders have been caused by birth defects, exposure to heavy metals or vaccinations which might affect children of three years and below. This disease is mostly common in children during their first two years and it continues to progress without any form of remission (Gerber and Offit 2009).

The prevalence of autism according to the Centre for Disease Control and Prevention (CDC) has been estimated to be about 1 to 2 people per every 1,000 people around the world. The number of children that suffer from autism has been estimated to be 9 per every 1,000 children world wide.

The Centre for Disease Control and Prevention has also estimated the ratio of male to females who have autistic disorders to average 4.3:1 (CDC 2010). In the UK, the prevalence rate of children with autism was estimated to be 4.5 per 10,000 children in 1966 while in 1979, the figure rose to 20 per 10,000 children when the criteria for autistic spectrum disorders (ASD) was introduced to determine the prevalence of the disorder in the country.

Before the 1990s, the prevalence rate of autism within the country was estimated to be 4 to 5 cases per 10,000 people. However, according to previous studies conducted by medical researchers and paediatricians, the prevalence rate of autism in 2006 was estimated to be 116 per 10,000 children in the UK.

The researchers noted that the prevalence rate of the disease had increased when compared to the statistics for the previous years. The Centre for Disease Control and Prevention (CDC) released new data on the prevalence rate of autism and autistic spectrum disorders in 2007 which revealed that prevalence rates of the disorder averaged between 66 to 67 per 10,000 children (Zhang 2008).

Other studies conducted in the UK to determine the prevalence rate of the disorder revealed that 39 per 10,000 children had autism and 77 per 10,000 had autistic spectrum disorders. The total prevalence rate of the disorder in the UK based on the number of children who have been identified with the disease is 44 per 10,000.

Professor Gillian Baird who conducted the study in South London noted that the findings demonstrated children with autism and other autistic spectrum disorders constituted 1% of the child population in Britain (Lister 2006). For years the most suitable estimate for determining the prevalence rate of autism in children three years and below has always been four to five per 10,000 children in the United Kingdom as well as the rest of the world.

The recent studies have however demonstrated that the current diagnostic criteria used to determine the prevalence rate of the disease has been changed to reflect 1 in 500 children with autism and 1 in 166 children with autistic spectrum conditions. These estimates show that the disorder has grown steadily in the UK over the past decades as more and more young children develop autism spectrum conditions (Zhang 2008).

A consensus estimate conducted in 1978 revealed that the prevalence of autism was 4 in 10,000 while the current estimate has shown that autism affects approximately 1% of the population in UK (Cohen et al 2009).

The number of people that have been diagnosed with autism has increased rapidly over the years because of changes to the diagnostic procedures for detecting the disorder. This massive increase can be attributed to a variety of factors which have made it possible to detect and treat children with autism.

These factors include improved recognition and detection technology, changes in the methods used to study the disorder , increasing availability of diagnostic services in many hospitals and specialised care facilities, an increasing awareness by healthcare professionals and parents on ways of dealing with autistic children and the widening criteria that can be used to detect and diagnose the disease.

Such factors have made it easy to determine the various methods and interventions that can be used to deal with the increasing number of autistic children in the UK (Cohen et al 2009).

The purpose of conducting this essay will be to examine the educational intervention of one-to-one support programs during normal school times within a mainstream classroom and also to discuss the challenges faced by teachers and autistic children as well as the advantages and disadvantages of providing one-to-one support to autistic children.

One-to-one educational interventions in treating autism deal with how teachers or class instructors offer children suffering from autism intervention strategies that are meant to address their cognitive and behavioural problems within the classroom setting. One-to-one educational interventions attempt to increase the functional independence of autistic children within the classroom setting where they are able to learn on their own without any assistance from their teachers and peers.

This type of educational intervention is meant to promote self efficacy skills on the part of the autistic child where they are able to do learning tasks on their own. Teachers under the one-to-one support programs design learning programs that they will use to guide the learning of the autistic child.

The main focus of these programs is to reduce the associated deficits of the disease by increasing the independence of the child within the classroom environment and also improving their social interaction with peers (Caronna et al, 2008).

Various researchers such as Johnson and Myers (2007) have conceded that one-to-one programs are usually successfully when all the school resources are utilised to improve the performance of the child in their learning process.

Such resources include classroom peers where their participation in the one-to-one program occurs when they are prevailed upon by their class teachers to engage with the autistic child during class time sessions; the class teachers or instructors who play a major role in designing the learning programs and techniques that will be used to educate the autistic child and the school administration which provides the necessary learning aids, materials and equipment that will be needed to design the learning program (Johnson and Myers 2007).

Medical researchers and paediatricians have been able to note that teaching children in a highly structured one-to-one support setting is an effective technique of teaching children with autism communication skills, interpersonal skills, social interaction skills and behavioural skills. If autistic children are going to succeed in classroom environments, they need to learn how they will behave and learn within social groups.

One-to-one teaching techniques are able to foster the development of learning skills in autistic children and they have been deemed to be effective in teaching autistic children within a classroom set up of eight to ten children.

The one-to-one teaching of autistic children has also been seen as an essential teaching technique for children who have autism and other mental disorders because it offers personalised training and teaching that allows the child to learn at their own pace through the guidance of their course instructor (Cohen et al 2009).

One-to-one educational programs have been developed in educational systems to help children with autism in acquiring self care and social skills as well as behavioural skills that will enable them to associate well with their peers. These programs have also been designed to improve the functioning behaviours of autistic children and to also help them decrease the severity of symptoms related to their disorder.

Medical studies have showed that interventions that are undertaken on autistic children before the age of three are more than likely to help these children with their compulsive and restrictive behaviour. Interventions therefore need to be undertaken during the formative years of the child’s development to ensure that they are able to develop socially and intellectually (Arndt et al 2005).

The National Research Council has endorsed the use of one-to-one training in teaching autistic children with the main reason being that the needs of the child will be adequately addressed during the learning process. The council recognised that one-to-one interventions provided many autistic children with the opportunity to enter into mainstream educational programs that would be beneficial in their intellectual development.

These programs enable the child to progress from one level of education to another as the teacher equips the child with the necessary educational information for their class grade. The specialised attention that the child gets during these programs is also beneficial as it allows the child to progress at their own rate within the classroom setting (Cohen et al 2009).

Kurtz (2008) notes that one-to-one educational programs are suitable educational interventions for children suffering from autism as they allow them to develop social skills during class interactions with their teachers and peers.

This method of teaching and learning caters for the various stages of an autistic child’s development which include the developmental stage that encompasses intellectual and emotional growth, the individual based development of the child where their communication, social, thinking and learning skills begin to form and the relationship based development of the child where their social interaction skills begin to form.

One-to-one support programs cover all the stages of the autistic’s child’s growth thereby ensuring they are able to operate properly within social settings (Rapin and Tuchman 2008).

One-to-one support programs are also beneficial to autistic children as they allow them to gain receptive processing skills as well as social communication skills that will allow them to communicate and process information they acquire from their instructors.

The scheduled sessions that are developed for one-to-one programs are meant to move the autistic child from one level of the learning program to another thereby developing their intellectual, emotional, thinking, learning and social interaction skills (Kurtz 2008). One-to-one support programs also increase the ability of the child to have emotional connections with their parents, siblings and other people who are important to the child.

This method ensures that the child is able to participate in social relationships by equipping them with emotional and social information. Autistic children under one-to-one support programs are able to become more aware of their environments by being equipped with perceptive and relationship building skills.

This method ensures that children suffering from autistic disorders are able to have a better quality of life in the event their behaviour does not become disruptive or problematic (Siegel 2008).

Because the autistic child gets to learn on a one on one basis with their teachers or instructors, their verbal behaviour becomes improved especially during the reading and speaking assignments which allows them to communicate better with their peers and parents.

As outlined earlier in this discussion, autistic children suffer from an inability to effectively communicate with others as they mostly speak in a repetitive manner where their spoken words are disorderly. This method therefore enables them to verbally relay their emotions and feelings to people that are close to them thereby enhancing social understanding.

The one-to-one approach also improves the organizational and planning abilities of autistic children allowing them to adapt to changes in their daily routines which is important given that most autistic children have restricted daily routines that cannot be subjected to change (Gutstein 2007).

The major limitation or challenge of this type of approach in providing educational support to autistic children is that it proves difficult for the teacher to manage especially in a class of ten children or more. The teacher’s attention is usually divided between managing the learning objectives and outcomes of the autistic child and those of the rest of the class during learning sessions.

This might mean that whatever the teacher set out to cover with the autistic child might not be achievable especially if they are forced to pay attention to the learning needs of the rest of the class (Gutstein 2004). One-to-one learning approaches might also require the teacher to allocate a substantial amount of time from their teaching schedules so that they can be able to develop learning goals and objectives for the autistic child.

This presents a challenge for teachers especially in the event the school administrators and paediatricians concerned with the health of the child have been unable to resolve the work schedule for the affected teacher. The workload therefore becomes too much as they have to handle the needs of the autistic child as well as the needs of the other children within the class.

Heavy workloads therefore results in cases of neglect which means that the educational interventions for the child will not be met. Another limitation of one-to-one programs is that additional costs and resources will be needed to manage the teacher-student sessions that come with this type of support program.

School administrators will have to acquire teaching aids designed for autistic children as well as other materials that are needed for the instructors at an increased additional cost to ensure that the child is properly taught on reading, writing and speaking skills (Robledo and Kucharski 2005).

The availability of one-to-one support programs also presents a major challenge to many schools with autistic children especially in the public schools that are funded by the government. Such schools are unable to provide language services that are useful in the one-to-one support programs because of a shortage of language specialists who can be able to properly communicate with the autistic child.

Certain school districts in the UK and in the US have also been unable to provide the recommended intervention of one-to-one instruction for their autistic students because of the high expense incurred by this type of educational intervention (Howlin 2005).

While most autism experts and paediatricians agree that one-to-one support programs for autistic children are usually beneficial, they present a myriad of challenges to both the teachers and students who interact with the autistic child in the classroom everyday. One such challenge is that a substantial amount of time is needed for the one-to-one sessions every day of the week.

The teacher is meant to set aside about 20 to 40 hours every week to provide support for the autistic child during classroom sessions. The reason why a lot of time is needed for these programs is to ensure that the teacher is able to achieve a high level of success during the one-to-one sessions.

This might prove to be a heavy workload for the teacher who has other students to deal with in the classroom and therefore allocating such a huge amount of time to one student might seem to be a waste of their time (Turkington and Anan 2007).

One-to-one programs are also a challenge to class teachers in the event they have to undergo training to enable them to properly conduct the one-to-one learning sessions. This training might require more of their time and effort which becomes a challenge if they have a large workload to deal with in the classroom.

The teachers might at times be required to work hand in hand with autism experts and therapists to ensure that the behavioural and cognitive problems of the child have been properly addressed.

The challenge lies in trying to strike a meaningful relationship between the teacher and the experts where the teacher might feel that a certain educational strategy would be useful in helping the autistic child to learn while the experts might hold a different opinion of how the one-to-one sessions should be conducted by the teacher (Turkington and Anan 2007).

Teachers also face the challenge of overlooking the educational needs of the other children in the classroom especially if the teacher decides to concentrate on the learning efforts of the autistic child. Trying to achieve a balance between managing the learning needs of the autistic child and managing the needs of the other children in the class becomes a challenge.

Also within the classroom, teachers are faced with the challenge of protecting the autistic child from any victimization from the rest of the class. Children who do not properly understand the condition might make fun of the affected child during class sessions such as reading tasks which might further increase the child’s self esteem issues. It therefore falls on the teacher to keep the rest of the class in check when it comes to the learning needs of autistic children (Levy 2006).

The challenges that children with autism face within the school system are usually based on their behavioural problems and the severity of the disorder in the child’s cognitive capabilities. These factors impact significantly on the type of interactions that the child will have with their peers and teachers within the classroom setting.

Since autistic children suffer from emotional and behavioural problems, the kind of interaction that these children have with their teachers and peers might worsen especially for teachers who have less willingness to teach autistic children.

Various studies conducted by researchers such as Cook and Landrum, Pavri and Monda have shown that children with more advanced autistic tendencies might affect the attitudes of teachers when it comes to interacting with the child (Levy 2006).

Autistic children also face the challenge of being taught by uneducated teachers and classroom instructors who have not received any special training to cater for the educational needs of the autistic child.

Most public school systems lack the necessary funds and resources to train their teachers on how they can be able to meet the learning needs of autistic children which means that the children end up not understanding what is being taught in class.

Additionally, the lack of long-term structures in most school systems to address the needs of autistic children makes it difficult for most parents to find conducive environments for their autistic children (Levy 2006).

Children who are transitioning from intensive behavioural programs into the school based systems might find it difficult to adjust to the learning conditions where the characteristics of autistic children present a great inhibition to inclusion. The benefits of placing autistic children within normal school systems is that they can be able to learn from observing the actions of their peers in the classroom and also in the playground. Being included in peer related programs enables the autistic child to learn real-life skills within realistic contexts and settings.

The challenge however becomes determining whether the child will be socially responsive to such a setting and whether they will actively participate in classroom sessions or playtime activities. Since all autistic children are unresponsive to their environment, they might not be able to gain any valuable educational experiences from such contexts (Handleman et al 2004).

According to Siegel (2008), most parents and educators view one-to-one programs as the first step in teaching children with autism on how to communicate or engage in the socialization process before they are integrated into a classroom setting or social group. One-to-one programs offer autistic children with the opportunity to develop an awareness of their environment and surroundings by focusing on the particular needs of the autistic child.

There are an increasing number of schools that can be able to offer one-to-one teaching for autistic children where the teachers involve the use of various one-to-one teaching techniques that are meant to provide the child with basic social and communication skills.

Some of the most commonly used one-to-one treatment programs for autistic children include relationship development interaction (RDI), peer to peer tutoring, facilitated communication and the DIR/floor time model for educational intervention (Siegel 2008).

Peer-to peer tutoring as an approach of one-to-one support programs in the classroom has grown with significance because it improves the child’s social and communication skills among their peers. This method is also suitable as it develops the behaviour of the child to enable them interact with other children during playtime and study group discussions.

Peer tutoring enables the child to demonstrate their intellectual capability by leading other children in classroom activities such as singing, reading and drawing. All these one-to-one techniques are therefore important addressing the communication disabilities of autistic children as their needs are specifically addressed by tutors, peers and teachers (Gutstein 2007).

Peer to peer tutoring is defined as a one-to-one method of teaching autistic children which focuses on educating autistic children together with non-autistic children where they are able to learn faster by observing the behaviour of their peers during class sessions.

This teaching method is mostly common in inclusion schools and also special education classes where the non-autistic children within the class lead the autistic children through a number of tasks that have specific instructions.

The tutor or teacher who utilises this method in treating autistic children first identifies the behavioural issues that are presented by the autistic students in the class. The teacher then makes a list of these behaviours and categorises them to determine how they can be managed in the class (Kurtz 2008).

A peer tutoring program is then developed based on this list where children who are non autistic become the peer tutors of autistic children in the class for a day or two. The children with autism are also allowed to be tutors to their peers in the class which enables them to develop both interpersonal and leadership skills.

Another way to conduct peer-to-peer support within the classroom is when the autistic child is paired with a normal child. The purpose of doing this is to ensure that the autistic child is able to learn from the actions of the normal child during class assignments. The normal children are able to help their autistic peers with the class assignments, homework and other tasks that have been assigned by the teacher.

Peer tutoring is therefore an important one-to-one teaching method that helps to build the social and behavioural learning objectives of autistic children especially when they are given leadership roles within the classroom setting. Peer support proves beneficial in helping the autistic child to develop friendships with their peers within the classroom (Sailor et al 2009).

The relationship development interaction (RDI) is another approach used in one-to-one support programs for autistic children where dynamic sets are developed to measure intelligence in the autistic child so as to improve their quality of life. This educational intervention allows children to participate in genuine emotional relationships that they are exposed to in their current environment.

The main goal that underlies RDI is to systematically develop emotional relationships through the use of motivational tools which enable the child suffering from autism to successfully interact in various social relationships.

The main aspects that are focused on in the relationship development intervention method are the establishment of building blocks that will be used in fostering social connections that are a common feature in early childhood development (Gerber and Offit 2009).

Relationship interaction development is an important technique because it helps the child to have a stronger relationship with their peers and teachers which will eventually lead to cognitive remediation for the child. Cognitive remediation refers to the process of restoring the optimal neural connectivity of the autistic child through a series of self-discovery activities that will be important in their intellectual development process.

The relationship development method is therefore an important technique that can be used to restore the social interaction and connectivity of the child to their school environment since it focuses on specific activities in autistic children that will elicit interactive behaviours (Lam and Aman 2007).

Another one-to-one treatment program for autistic children is the floortime or DIR model which offers a comprehensive framework for understanding and treating children with autism. The acronym DIR stands for three components that make up the floor time model which include developmental, individual difference and relationship-based.

The floortime model of one-to-one treatment focuses on helping autistic children with their communication problems as well as their interpersonal skills rather than on treating them for a particular set of behaviours. The floortime or DIR model was developed by child psychiatrist, Stanley Greenspan, who was also a specialist in autism related disorders.

Greenspan developed a model that would be a comprehensive and interdisciplinary approach that would help autistic children with social-emotional functions, psychomotor skills, thinking and learning skills (Kurtz 2008).

The DIR approach basically focuses on floor-time sessions that are meant to enhance the emotional and social interactions that the autistic child has with his/her peers within the school and classroom context so as to facilitate emotional and cognitive growth. The model also focuses on providing therapeutic remedies which can be used to remediate biologically based processing capacities that are necessary in intellectual growth (Myers and Johnson 2007).

The aspect of developmental in the floor time model involves focusing on the developmental aspects of children that are needed for them to grow and mature intellectually and emotionally. This component determines which developmental milestones are important for the autistic child in their childhood so that they can be able to mature intellectually (Kurtz 2008).

The Individual difference component refers to understanding the autistic child’s sensory processing differences which are unique from those of normal children. This particular component of the DIR involves determining how these unique differences will impact on the learning and behavioural patterns of the autistic child.

The relationship-based component of the floor time model focuses on helping the autistic child to develop social interactions and relationships with their primary caregivers and peers which will enable the child to foster social development tendencies. All these components are important in the floor time model as they enable the trained consultant or teacher to design programs that will meet the specific development, relationship and individual needs of the autistic child (Kurtz 2008).

Facilitated communication is another one-to-one method that can be used to teach autistic children within classrooms settings. Facilitated communication involves the teacher physically guiding the learning and communication activities of the autistic child. The tutor or facilitator basically places a hand over the autistic child’s hand or wrist and guides them during the learning process.

The tutor guides the child by holding their hand in identifying various objects, pictures and images to express their thoughts. The purpose of facilitated communication in one-to-one educational support is to enable the child build on their perception, communication and interaction skills.

The child is able to communicate with their hands to the facilitator or tutor allowing them to express their thoughts and opinions. This method also allows autistic children to demonstrate their intelligence levels during the facilitation sessions (Kurtz 2008).

The advantages of one-to-one support programs are that they enable children to adapt to mainstream classroom and playground settings where the child is taught on social interaction and communication skills.

These programs cater for the various stages of a child’s development which include the developmental stage that encompasses intellectual and emotional growth, the individual based development of the child where their communication, social, thinking and learning skills begin to form and the relationship based development of the child where their social interaction skills begin to form.

One-to-one support programs also allow the autistic child to learn at their own pace without necessarily being influenced by the learning progress of other children in the classroom (Gutstein 2004).

One-to-one support programs are beneficial to autistic children since they allow them to develop an awareness of their school environment where they observe the actions of their peers, educators and other important elements of the school system improving their cognitive and behavioural abilities.

One-to-one programs that are peer supported are mostly beneficial for autistic children as they learn from observing the learning actions of their peers. Peer tutors provide the much needed guidance for autistic children as they can be able to interact and relate on the same intellectual level. Autistic children who engage in peer-to-peer support groups can be able to accrue the potential benefits that come with taking turns during tutoring sessions or during playtimes (Siegel 2008).

One-to-one support programs ensure that autistic children receive the best educational training from teachers who are more than likely trained to teach children with this disorder. These support programs have structured moment-to-moment activities that ensure the child is able to cover the curriculum within the allocated time for the sessions.

One-to-one support programs provide a degree of consistency and routine for autistic children allowing them to take advantage of the learning opportunities offered to their peers and also to develop intellectually. This form of educational intervention is also beneficial for the autistic child as it allows the instructor to improve their speech and language difficulties.

In the event the programs are offered in consultation with an autism expert, the instructor might be able to develop language therapy sessions that will allow the child to improve on their speech and language difficulties (Goldstein 2002).

Relative interaction development techniques have proven to be beneficial one-to-one support programs for autistic children as their social and communication skills are improved where the teacher elicits some verbal emotions from the autistic child. RDI improves the ability of the child to relay their emotions and feelings to the people who are close to the child thereby improving social interactions.

Social and emotional skills allow autistic children to be more aware of their environments as their perceptive skills become increased with every relationship building exercise they are engaged in. One-to-one support programs ensure that the child’s learning process is supported throughout every step by the teacher or facilitator so that they can be able to achieve the learning outcomes set by their teacher (Dodd 2005).

According to various studies conducted on autism and the educational interventions that can be used for autistic children (Eikeseth et al 2002: Howard et al 2005: Sallows and Graupner 2005), one-to-one support programs have proven to be efficient in providing autistic children with early intensive behavioural treatment that is important in increasing the academic performance of these children as well as increasing their IQ levels and adaptive behaviour.

When combined with other educational interventions such as applied behavioural analysis, the support programs increase the adaptive behaviour of children that suffer from autism. The studies conducted on this method of treating autism have mostly focused on the treatment of unwanted behaviours such as communication impairment and repetitive behaviour (Lovaas 2003).

A major disadvantage of this method of treating autism is that it focuses on establishing relationships rather than on academic learning and thinking. While these relationships are important to the child, they do not teach the child on how they can be able to form interactions during the learning process.

One-to-one programs in class settings that have eight children or more might fail to be successful because the teacher’s attention will be divided amongst the rest of the class. Some of the approaches used in one-to-one training mostly focus on play times rather than on academic learning which makes this method weak in educational programs (Myers and Johnson 2007).

One-to-one support programs also prove to be disadvantageous when the attention of the teacher is focused on the autistic child rather than on the whole class. Time and attention is taken away from the rest of the class who might in the end feel neglected by the teacher especially if it is a class of ten to twenty students (Lieberman et al 2004).

One-to-one support programs that are administered within the mainstream context pose a challenge to the academic education of autistic children when the teachers who conduct the sessions lack the necessary training to guide the autistic child’s learning process. Teachers who are in mainstream classes within the public school systems lack the proper training and skills that can be used to accommodate the special needs of the autistic child within the general education classes.

Research work has revealed that teachers who are not aware of the learning needs required by autistic children are more than likely to resist having these children in their classrooms. The negative impact of this is that it can lead to a form of regression in autistic children which in the end affects their classroom productivity and educational outcomes (Suomi et al 2003).

Another limitation of one-to-one support programs is that they are generally expensive to operate especially for public schools that are required by the state government to provide special education classes without any additional funds.

The cost of one-to-one support programs according to a 2005 Special Education Expenditures Program (SEEP) report developed by the United States revealed that the cost for student’s in special education programs such as one-to-one educational interventions amounts to $10, 558 when compared to the cost charged for regular education amongst normal children which averaged $6,556 (Schiller et al 2007)

While one-to-one support programs present various challenges, studies conducted on this form of educational intervention have revealed that the benefits far outweigh the challenges. One-to-one support programs need to be improved on to ensure that there are no challenges presented to the student and teacher during the learning process and that the objectives of the program have been met by both the autistic child and instructor.

There should be access to these programs especially in the public school systems to ensure that autistic children from poor income families are able to access special educational services that will meet their learning needs. More awareness needs to be created on the importance of one-to-one support programs especially in the mainstream so that both the teachers and students are able to adapt to the autistic child’s educational needs.

This will also improve peer-to-peer tutoring where normal children will be willing to provide assistance to autistic children during class assignments and tasks. A major recommendation for the study is that more research needs to be conducted on one-to-one support programs in educating autistic children as very few authors used in the study have been able to provide substantive information that can be used to explain this type of educational intervention.

The discussion has focused on one-to-one support programs in the classroom setting by focusing on the challenges, benefits and limitations of this type of programs on the education of an autistic child. The essay has been able to provide an in-depth analysis of one-to-one support programs by examining the various approaches used in teaching autistic child within the classroom.

The study has been able to determine that one-to-one programs ensure that children are able to achieve the learning objectives set by the trained instructors so that they can achieve academic excellence. Overall one-to-one support programs have been termed to be effective especially in developing the communication, behavioural and interpersonal skills of the autistic child

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