Autism and Asperger's Syndrome and Creativity

An historical overview suggests an initial case of autism was identified in 1747, marked by the symptoms similar to what is diagnosed as autism spectrum disorder today, abnormality or language and cognition, obsessive behavior and mannerism, poor social skills (Wolff 2004). It was over the last 100 years that autistic mannerism was identified and not until the 1900’s was the distinct diagnosis for autism made. Interesting “Victor the wild boy of Aveyron” was viewed as having autistic behavior. However, in the 1900’s autistic behaviors were classified with mental retardation and psychosis. Kanner became aware of the divergence of symptoms of autistic children from children diagnosed with psychosis. However, during this period in history children were often treated with psychoanalysis and parents were deemed the root of etiology. In 1981 Wing developed the diagnosis of Asperger’s and autistic spectrum disorders (ASD). Throughout the years the conviction of what causes autism has changed. It is not longer believed that poor parenting leads to autism or that autism is among the group of schizophrenias, or that genetics or the MMR vaccine may be the cause. Because the number of children being diagnosed with autism has jumped 10 times over the last 20 years, public awareness has increased; consequently treatments, however controversial, have been on the rise (Ulick 2005). One in 166 children are diagnosed with autism and boys are diagnosed 4 times more than girls.


Macintosh & Dissanayake (2004) explored the distinction between high functioning autism and Asperger’s syndrome by an exhaustive literature review. This review was complied to help in the diagnosis and differentiation of the two disorders. It is interesting to note that despite the prevalent usage of the term Asperger’s Syndrome, the DSM has only recently included Asperger’s as a discrete category in its classification. The similarities between the two disorders include impairment of socialization, imagination and communication. The authors attempt to find differentiations of the two diagnoses to aid in assessment and individualized treatment. Despite the extensive research review, the authors’ find little quantifiable differences that would separate Asperger’s from the autistic spectrum disorder. A noteworthy theory proposes that language development of children with Asperger’s allows for more functional development of secondary gains, such as social skills development, where as autism may limit language development and consequently impact social and perceived cognitive development.

Ulick (2005) offers definitions and treatment recommendations for ASD. Individuals with autism present more severe language problems, limited interest in others, repetitive behaviors, resistance to change, and irrational routines. Individuals with Asperger's are stated to have stronger verbal skills, but experience difficulty with reading social situations, and sharing enjoyment, and tend to have obsessive interests. Ulick (2005) describes PDD-NOS: Known as 'atypical autism,’ whereby individuals have less severe social impairments. In addition, Childhood Disintegrative Disorder (CDD) occurs after 2 to 4 years of normal growth, then autism like symptoms develop. Rett Syndrome: is akin to CDD, but symptoms occur earlier and it if mostly seen in girls.

Ulick (2005) discusses options for children and families who are impacted by ASD. Multiple therapies can be use in treatment, including speech and occupational therapy, ABA, Applied Behavioral Analysis offers positive reinforcement for the acquisition of language and social skills, Floor Time model consists of a child-directed approach that stresses personal interactions, while introducing variables within the relationship, TEACCH taps into the child’s interests to motivate them to learn in a structured environment, Social Stories incorporates stories to teach social skills and insight into others’ perspectives, PECS uses pictures to build communication skills, and RDI, which encourages experience sharing, relationship building and parental involvement. In addition, prescriptive medications do not treat the core of the symptoms, however there are used to help in modifying behavioral issues. Medications include
Risperidone an anti-pyschotic used to decrease aggression and hyperactivity, SSRIs which may reduce repetitive behaviors, anticonvulsants like Depakote are being used to treat aggression, and stimulants such as Ritalin may lessen hyperactivity.


My work involves using RDI / Floor Time to develop a master-apprentice relationship. Within this relationship and within the consistency of the setting new variables are introduced to help the client self-regulate and modify their behaviors. Often this is with the content that the client has created, i.e. I see several children who have our sessions be TV shows (per their request). They structure the TV show format, so there is a sense of consistency, and the shows are the same each week (one teen is the star of his own art show and paints pictures, another younger client has a show with clay characters he has made). Within these shows I introduce new “plots” i.e. new picture ideas to paint, a new problem for the clay characters to solve. The latest thinking on ASD has changed from ABA, teaching children scripts for eye contact and cueing them to say hello, to a more genuine relationship based model (Gutstein 2000). The latest models contradict ABA, suggesting that these children adapt too well to consistent patterns, which they try to replicate often via self-stimulation behaviors. Instead of teaching more “rote” learning (ABA), teaching them to be flexible, to manage frustrations in an ever changing environment, to help them develop self-regulation by developing episodic memory of their successes will be much more meaningful for these individuals. Needless to say ABA professionals are at odds with these new findings and it will be interesting to see how professionals adapt in the upcoming years to meet the needs of this vastly emerging population.



References

Gutstein, S.E. (2000). Solving the relationship puzzle. Arlington, Texas: Future Horizons.

Macintosh, K. E. & Dissanayake, C. (2004). Annotation: the similarities and the differences between autistic disorder and Asperger’'s disorder: a review of empirical evidence. Journal of Child Psychology and Psychiatry, 45(3), 421-434.

Ulick, J. (2005). What to watch for. Newsweek, 145(9), 48-49.

Wolff, S. (2004). The history of autism. European Child & Adolescent Psychiatry, 13(4), 201-208.