autism editorial

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http://aut.sagepub.com/content/14/6/555.citationThe online version of this article can be found at:

DOI: 10.1177/1362361310390570

2010 14: 555AutismDermot Bowler

Editorial

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The National Autistic Society

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autism 2010SAGE Publicationsand The National

Autistic SocietyVol 14(6) 555557; 390570

1362-3613(2010)

Editorial

In keeping with the aims and scope of the journal, the papers in this issuecover a wide range of facets of the science of autism spectrum disorder(ASD), from characterisation of its behavioural features, through to inter-ventions. The first contribution, by Whitehouse and colleagues, reports astudy of communication difficulties in parents of individuals with ASDwith or without signs of the broader autism phenotype. The authors usethe Communication Checklist Adult Version to assess structural language, prag-matic and social engagement difficulties in individuals with ASD, theirparents and a non-autism comparison group. The most striking aspect ofthe findings of this study is that the parents who show the broader pheno-type tend to manifest pragmatic and social engagement difficulties but notdifficulties with structural language, suggesting that these two capacitiesmay develop independently of each other in ASD. This dissociation resonateswith some of the findings reported in later papers and prompts someinteresting theoretical speculation about the relation between language andthinking in ASD.

A matter of continuing concern for clinicians is the delay between thetime parents first become anxious about their childs behaviour and eventual

definitive diagnosis. Timely diagnosis is important because it marks thegateway to the provision of appropriate intervention and care strategies.The paper by Noterdaeme and Hutzelmeyer-Nickels shows that in southernGermany, this delay is considerable albeit comparable to delays reportedacross a range of countries. When considering different manifestations ofASD, these authors found that parents first anxieties occur much earlier onfor children with autism than for children with Aspergers syndrome, withan average subsequent time to diagnosis of about 6 and 8 years for the two,respectively. The authors also report differences between subtypes of ASD

in the behavioural features that first caused parents concern. Parents ofchildren with autism most often noticed problems with language andcommunication, whereas for children with Aspergers syndrome, socialdifficulties and more general behavioural problems caused most parentalconcern. Quite how to reduce the delay between initial concern and defin-itive diagnosis continues to pose a major challenge for clinicians andservice providers. An encouraging development in this respect is providedby the paper by McClure and colleagues. These authors nicely demonstratehow delays in diagnosis can be reduced by training local teams in diag-nostic assessment and providing follow-up mentoring in the use of the

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assessment procedures. They report a high level of inter-rater agreementbetween the local teams and more specialist services, agreement that con-tinued to increase over the period of mentoring. Finally, and perhaps mostimportantly, there was a significant reduction in time spent on waiting lists

(from 36 to 13 weeks) following the introduction of local teams.The next three papers address specific aspects of behaviour and psycho-logical functioning in individuals with ASD. Ramachandran and colleaguesreport rather surprising evidence that these individuals are as accurate andas fast at attributing physical and psychological characteristics to photo-graphs of people based on descriptions from which these characteristicshave to be inferred. For example, they can infer that Victor is a determinedperson because he ignored his injuries and completed the race. Althoughqualified by sample size and diagnostic considerations, these findings raisethe question of whether individuals with ASD reach typical levels of com-petence through the same routes used by typical individuals or whether theyemploy compensatory strategies. One answer to this question is given bythe paper by Ben Shalom, Faran and Boucher, which presents an intriguingcase report of the way JS, an able adult with Aspergers syndrome, copeswith the memory demands posed by everyday life. In particular, despiteshowing diminished performance on some verbal and nonverbal sub-testsof a standardised memory measure, JS appears to rely on verbal encodingto help his memory functioning. This pattern of test performance ismirrored in his own reports of how he uses his memory. Case studies such

as this, especially when accompanied by self-report, provide invaluableinsights into the inner world of people on the autism spectrum, and are afruitful source of hypotheses for those of us who study memory in thispopulation.

The theme of compensatory work-around for core difficulties is alsoechoed in the brief report by Begeer and colleagues. They found that theemotional responses of children with autism and PDD-NOS are modulatedby prior emotional experience in ways that are different from those seenin typical children. Whereas typical children tended to over-weight prior

sad information when rating a subsequent happy target, but not the otherway round, the ratings of children with autism were appropriately affectedby prior happy or sad information to an equal extent. Children with PDD-NOS, by contrast, tended to be unaffected by prior emotional exposure.The findings of both these studies should prompt carers and educators toplay closer attention to the patterning of emotional responses in thesegroups of children and not to assume that similar behavioural outcomesare driven by similar underlying psychological processes.

The last two papers in this issue deal with the important topic of theeffectiveness of interventions. As can be seen from the paper by Karkhaneh

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and colleagues, evaluations of interventions are often characterised byserious methodological flaws, making it almost impossible to draw conclu-sions about whether or not a particular intervention works. The authorsreview six controlled studies of the effectiveness of the Social Stories

programme and conclude that five of the six studies showed statisticallysignificant changes in childrens behaviour on a variety of dimensions.They are at pains to point out the problems inherent in the execution ofgood evaluation studies as well as the need to be alert to the differencebetween statistical significance and clinical impact of changes in behaviour.A mixed but encouraging picture is presented by the last paper in thisissue. Darrou and colleagues report a large-scale, longitudinal study ofhigher- and lower-functioning children with ASD in France. The authorsreport heartening improvements for some children, and confirm previousfindings that degree of initial severity of autistic features coupled with levelof language and communication skills are the best predictors of outcome.They also found an encouragingly low incidence of regression from highto low functioning in their sample. These authors failure to observe anyassociation between improvement and amount of intervention may, as theynote, result from the rather diverse intervention programmes currentlyavailable to children in France.

Darrou and colleagues observation that speech and language levels arestrong predictors of good outcome, taken together with Ben Shalom, Faranand Bouchers observation of how their participant reported using speech

to compensate for memory difficulties and the disconnection betweenstructural language competence and pragmatic and social abilities reportedby Whitehouse and colleagues, highlight the need for more investigationof the relation between language, speech and thinking in ASD. It is clearthat increased understanding of autism-specific aspects of this relation isthe key to more effective intervention.

Editor

D E RM OT B OW LE R

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