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.” Read the rest of this entry »

Beyond Kanner and Asperger – Part 2.

Copernicus’ heliocentric model of the solar system. The sun is at the center; the earth and other planets orbit around the sun.

Beyond Kanner and Asperger – Part 2. Dr. Coplan continues his discussion of a paradigm shift in the way we frame ASD

Ever since Kanner’s 1943 paper, clinicians have been arguing about how atypical is “atypical enough” to qualify for an autism diagnosis. Diagnosing ASD in a child with moderate to severe atypicality generally is not a problem. Problems arise, however, when considering adults, and/or persons with mild atypicality. There are a couple of reasons for this. First, Leo Kanner’s ghost – with its insistence that autism is both rare and severe – continues to roam the halls of the American Psychiatric Association. Thus, DSM5 clings to a fictitious boundary between “Normal” and “Abnormal,” and emphatically rejects the concepts of “compensated” or “subclinical” ASD. In the view of DSM5, treatments merely “mask” symptoms, and in order to qualify for an autism diagnosis an individual must remain “significantly impaired.” At a deeper level, however, there is another problem: ironically, autism experts have a tendency to over-focus on atypicality in isolation, and miss the forest for the trees. Paradoxically, taking autism out of the middle of the picture will actually let us think more clearly about ASD – just as taking earth out of the center of the solar system enables us to think more clearly about astronomy.

As we discussed last time, Copernicus revolutionized astronomy by advancing a “heliocentric” model of the solar system. At one stroke, this paradigm shift solved a lot of problems in celestial mechanics. Before explaining his model in detail, Copernicus laid out a foundation of seven basic principles, such as:

• All the spheres revolve about the sun as their midpoint, and therefore the sun is the center of the universe.

• What appear to us as motions of the sun arise not from motion of the sun, but from the motion of the earth…which revolve(s) about the sun like any other planet.

These and a few additional basic principles formed the foundation for all that followed. Read the rest of this entry »