Beyond Kanner and Asperger – Part 3

Dr. Coplan continues his discussion of a new paradigm for thinking about ASD.

Last time, I listed seven basic principles upon which my way of looking at ASD rests. In this post, I’ll deal with the first two:

1. Atypicality (i.e., “autistic behavior”) exists in various degrees, from profound to minimal.

2. There is no clear boundary between atypical and “normal.” Rather, atypical traits are distributed throughout the entire population

Contrary to the DSM5, Mother Nature does not put people into two mutually exclusive cubbies: Autistic, and Non-Autistic. Rather, each of the traits or behaviors we associate with ASD can also be found in the “normal” population. It’s all a matter of degree. Did you ever get a song stuck in your head? Did you ever fail to understand a joke? Do certain sensations (e.g., fingernails across a blackboard) bother you? The fact that most of us experience things like this doesn’t necessarily mean we have “repetitive behavior,” “impaired theory of mind skills,” or “unusual responses to sensory stimuli.” Rather, these are traits / behaviors we all share. However, when these and other traits or behaviors become impediments to daily life, they turn into “symptoms of a disorder.” Exactly where that boundary lies, however, is partly a matter of context. A normal behavior at one stage of development becomes a “symptom” if it persists into later life. Conversely (as Steve Silberman points out in his book), a “symptom” in one setting may be an asset in another. The person with a hyper-acute sense of smell may be bothered by scents that other people cannot even detect. This can be a useful trait for a wine taster. Thus, there is not a bright line between “normal” and “autistic.”

Here is a table that presents a thumbnail sketch of degrees of severity in what I regard as the four principal domains that define ASD. I could have added dozens of specific items in each cell. This condensed version is just meant to give the flavor of what I’m talking about. I am well aware that DSM5 attempts to reduce ASD to two domains: “Language & Social,” and “Repetitious Behavior,” but this is an over-simplification. Language and social development are closely correlated statistically (which is why the authors of DSM5 lumped them together), but they are in fact separate domains, neurologically and developmentally. Lumping these two sets of behavior into one category (a) limits the richness of our description of what’s going on, and (b) negates what we’ve learned over the past 150 years about the functional neuroanatomy of the brain. DSM5 also relegates sensory and motor issues (exaggerated or blunted responses to sensory stimuli; clumsiness) to a sub-category of “Repetitive Behavior,” rather than elevating them to a category all their own. (Perhaps this is because psychiatrists view themselves as concerned with “things of the mind,” whereas sensory reactivity and fine motor clumsiness seem to be mere “things of the body.” As one researcher has observed, however, “altered connectivity and action model formation in autism is autism.” [1] Emphasis added). So I continue to describe autism in terms of four domains: Social, Language, Repetitive Thoughts and Behaviors, and Abnormal Sensorimotor Processing. Ultimately, however, whether we define ASD by two, three, or four domains doesn’t impact the validity of my model.

(Click to enlarge)

Table 1. Degrees of Atypicality in four domains (social, language, repetitive thoughts & behaviors, and sensory). “ToM” = “Theory of Mind.” The ability to infer the inner mental state of others. See Coplan, 2010 for details.

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Now I’m going to intentionally commit an over-simplification myself: I’m going to “blenderize” Table 1, and condense everything into one simple figure, which I’ve called “ASD in 1 Dimension” (Figure 1). The intensity of the blue shading represents the severity of the atypicality: dark blue on the left, fading as we move to the right. I’ve added a horizontal axis, labelled “Atypicality” – Severe, Moderate, and Mild. Notice the dotted arrow that continues to the right, extending beyond the boundary of the figure itself. This is to signify that atypicality doesn’t suddenly fall to zero at the right-hand boundary of our 1 dimensional image of ASD. Rather, atypicality continues on, at a milder level, into the “normal” or “neurotypical” population.

(Click to enlarge)

Figure 1. Atypical features exist on a continuum from severe (left hand edge of figure; dark blue) to minimal (right hand edge of figure, pale blue). The horizontal axis continues beyond the boundary of the figure, into the “Normal” range. The right-hand border of the figure is also shown as a dashed line, to further emphasize the porous interface between “autistic” and “normal.”

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Keep Figure 1 in mind. We’ll come back to it in a bit. But first I need to expand our frame of reference, by talking about something unrelated to ASD: General Intelligence.

More next time.

James Coplan, MD is an Internationally recognized clinician, author, and public speaker in the fields of early child development, early language development and autistic spectrum disorders. Join Dr. Coplan on Facebook and Twitter. Have a question for Dr. Coplan? Ask the doctor.