The autistic spectrum: From theory to practice
The autistic spectrum: From theory to practice

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The autistic spectrum: From theory to practice

7 Conclusion

This course has introduced an extremely rich and complex area in which new approaches and findings are constantly appearing. The diverse activities of psychologists and others in this area have been illuminated.

Discussion throughout the chapter has maintained several different but interwoven threads. Think first of the original twin goals of work on ASDs: establishing theoretical understanding and providing support and therapy. It should now be clear why these goals, and the means to pursuing them are inextricably connected. For instance, diagnostic practice has underlined characteristic groupings of symptoms but has simultaneously drawn attention to the variations among these groupings. This has fostered research into the ways in which different sub-groups across the spectrum operate in ToM or global processing tasks, which has in turn suggested new ways of diagnosing ASDs, and highlighted the need for therapies ‘tuned’ to different groups. Research studies highlighting socio-cognitive deficits have also informed therapeutic practices, but these have in turn questioned theories about which types of social understanding are most relevant to an individual's adjustment in the real world.

The pursuit of the twin goals has a further theoretical ‘spin-off’. Investigations of why people with ASD behave or experience the world as they do tell us much about the foundations of more typical behaviour and experience. For instance, a crucial feature of Baron-Cohen's developmental mind-reading model is how skills such as gaze monitoring pre-figure the development of ‘mind-reading’ within typical development. This ‘information processing approach’ to social engagement with others has been countered, and latterly modified, in the light of Hobson's radically different idea that people's interpersonal relations have an ‘empathic’ quality.

Here we have gained insights by contrasting typical and atypical development. Yet paradoxically, research on ASDs has also taught us to be wary of assuming clear-cut boundaries between what is typical and atypical. The notion that mild forms of autism are essentially variations on the ‘norm’ and are represented in the general population as a cognitive style or phenotype has surfaced at several points in the discussion. Indeed the characteristic ‘cognitive style’ associated with ASDs has been shown to have advantages and in some cases to go with exceptional talent.

All this poses a significant conundrum: that developments in autism research and practice are advancing simultaneously on two seemingly contradictory fronts. On the one hand there is a move to define, explain and support ‘difference’ – whether between people with ASDs and others, or among spectrum sub-groups themselves. On the other hand there is growing emphasis on continuity – on shared features of behaviour and experience across and beyond the spectrum, and on our common needs as human beings. There is no easy way to reconcile these contrasting strands, but an analogy from another field may help. Think of the spectrum of visible light: for some purposes it is useful to consider it as a series of quantitatively different wavelengths that are on a continuum – not only with each other, but with other forms of energy such as X-rays and ultra-violet, which we don't see at all. At other times, it is more appropriate to think of this spectrum more as we actually perceive colour: as relatively discreet perceptual categories (red, blue, green, etc.) that are experienced as qualitatively distinct from one another and from energies that we don't see. Both approaches have their place in our conceptual and practical scheme of things. This duality occurs in many fields of human experience and it is a particular attribute of human cognition to be able to operate and flourish in both.

A second major thread has been the variety of perspectives that inform work on autism and the ways they interrelate. We have noted a valuable role for diverse research and practice within and across at least three different levels – symptomatic/behavioural, socio-cognitive and biological. We have also considered ways in which these different perspectives complement each other, and areas in which they conflict. Does that mean that all approaches on offer should be given equal weight? Not really. There is a clear argument for favouring models that offer a coherent theoretical framework, that are compatible with a range of empirical findings, and that guide further work along appropriate paths. If there are choices between such models, then it makes sense to favour those that offer the clearer, more cogent explanations. As we saw, very similar principles apply to practice.

Thus it would be misguided to deny that biological influences and socio-cognitive influences play key roles in the development of ASDs: there is much careful research providing evidence that cannot be explained in other ways. Explaining just how these influences interact with each other and with other levels of explanation is, as we saw, more difficult. While there are persuasive links between the functioning of some brain areas and ToM type skills, this leaves other identified brain areas (such as the cerebellum) and other socio-cognitive skills (such as global processing skills) out of the frame. Models such as Baron-Cohen's, which seek to make these wider links, are at best provisional and leave the therapeutic implications unclear. A yet harder challenge is to build into such models a development trajectory in which biology, cognition and behaviour both influence and are influenced by the multi-faceted environment that surrounds the human organism. The course hinted at difficult tensions between this and known biological and cognitive constraints: in what ways can the child influence and be influenced by the immediate environment of his/her family? How might environmental privation influence biological mechanisms? How should the notion of such ‘transactions’ influence the design of interventions?

The course has also illustrated the important role of ‘insider’ accounts in modifying, extending, and even challenging conclusions based on outsider evidence. In particular, insider accounts have echoed growing theoretical reservations about the idea that people with ASDs necessarily lack forms of social or self insight. The self insights featured in this unit may be unusual, but they are striking and poignantly clear. They have done much to transform accepted stereotypes of what it is like to have an ASD, and practical approaches, such as Golding's, that seek to develop reflexivity and empathy are to be welcomed.

Finally, work on ASDs has come far since Kanner and Asperger, yet both contributed prescient insights: Kanner's notion of an ‘innate inability to form the usual, biologically provided, affective contact with people’ and both Kanner's and Asperger's emphasis on special or exceptional skills, informed their clinical practice and remain as central themes in current work.

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