Week 1: Introducing the autism spectrum

In the following activities you will evaluate your own knowledge of autism.

This section gives an overview of key facts about autism. Read it through, and add to your notes again where necessary.

Autism is considered to be a lifelong, developmental condition that affects how a person thinks, communicates with and relates to other people, and interacts with the world around them.

Autism is much more common than was previously thought. About one per cent (or one in a hundred) of people in the UK are thought to be on the autism spectrum. You may know someone with autism, or be on the autism spectrum yourself.

The exact causes are still unknown, but there is good evidence that subtly atypical brain function may lie behind the differences in thinking and behaviour. It is also clear that autism is highly genetic. Scientific evidence suggests that multiple genes are involved, and different combinations of genes in different families or individuals.

The current framework for diagnosing autism identifies two main groups of characteristics. The first concerns social communication and interaction: autistic people find it hard to interact socially with others or to make friends. They have communication difficulties – some can’t speak at all; others develop speech later than usual; others can speak perfectly well, but have problems with the social aspects of communication. For example, they don’t understand when a listener is getting bored by their stories; they may take language very literally or find it hard to get the point of a joke.

The second group of characteristics is ‘non-social’: autistic people tend to have narrow or unusual interests, such as acquiring lots of information about just one type of dinosaur. They often repeat the same activity, ranging from constantly rocking backwards and forwards or flicking the fingers, to always eating the same foods, or repeatedly watching the same video. These traits are collectively known as Restricted and Repetitive Behaviours and Interests (RRBIs). Finally, most autistic people also have unusual sensory responses, such as being overly sensitive to particular sounds, sights or smells, or quite the opposite, for instance being insensitive to sensory inputs such as pain.

While diagnosis is based on these social and non-social difficulties, many autistic people also have enhanced skills such as good attention to and memory for detail, or natural ability with numbers or IT. A very small proportion of individuals on the spectrum have outstanding talents in fields including art and music. 

While social, language and sensory challenges may mean that an autistic person finds it hard to function in a mainstream school or workplace environment, with the right support they can flourish. Employers are beginning to realise the benefit to the workplace of attributes often associated with autism, such as mathematical and IT skills, persistence and attention to detail.

Because of the striking differences among individuals with autism, researchers and practitioners usually talk of the ‘autism spectrum’. This emphasises that autistic individuals may have very different profiles of strengths and weaknesses. Autism Spectrum Disorder (ASD) is the term used within formal autism diagnosis. ASD is also used by some researchers and practitioners; however, many prefer the more neutral term Autism Spectrum Condition (ASC).

A proportion of people on the spectrum (up to about 50%) have profound social and communication difficulties often including little or no speech, markedly restricted and repetitive behaviour and interests, and intellectual disabilities. This variant of autism has sometimes been known as classic or Kanner’s autism, after Kanner, who described autism in 1944 (there will be more on Kanner in Section 6).

Another major group are those who have no obvious language problems and are intellectually capable or even exceptionally bright, while remaining inflexible, bound by routines, struggling to interact socially and communicate effectively. This variant has until recently been diagnosed as Asperger syndrome (after the other main autism pioneer). However, sub-types such as Asperger syndrome are being phased out in contemporary approaches to diagnosis. One contemporary approach treats the spectrum essentially as a continuum on which all autistic individuals have their own specific profile of strengths and challenges. Another approach maintains the notion of a spectrum, but allocates autistic profiles of strengths and difficulties into some newly defined sub-types. You will read more about this in Week 3.

Autism spectrum conditions can occur alongside other psychological and physical conditions (sometimes known as co-morbidity). Epilepsy is fairly common, especially in those with ‘classic’ autism. Depression is also very common, as is dyslexia, although it is not clear if the incidence of these is greater than in the non-autistic population.

Note that the concept of a spectrum derives from the physics of white light which is made up of an array of colours ordered from low frequencies (red) to higher frequencies (violet) as can be seen in a rainbow. But borrowing this concept has led to the misleading idea that autism is a linear scale with profoundly affected individuals at the 'low' end and less affected individuals at the 'high' end. In practice, a person with good intellectual and language skills, often known as high-functioning, may nevertheless be profoundly disabled by repetitive behaviours and routines which challenge daily living skills. So the autism spectrum needs to be thought of in more complex terms. In this 'infinity spectrum' one individual could be in the 'high' or violet area for intellectual skills, have moderately good language and communication skills (green) but be in the 'low' or red area for daily living skills.

Figure 1 Autism spectrum infinity awareness symbol.

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An infinity symbol, coloured from left to right with rainbow colours from the visible spectrum of light.

Figure 1 Autism spectrum infinity awareness symbol.

How have your initial ideas about autism compared to what you have read so far? You may have been pleased to have your ideas confirmed, or surprised by what you didn’t know. As you will see, it is also important to think about where your initial ideas came from.

In the next section you will read about the different methods used by researchers and clinicians to derive evidence about autism. Following that there will be some personal testimonies from autistic people and from parents.

Claims about autism should be based on the careful and balanced evaluation of evidence derived from reliable sources. There are many different ways of obtaining evidence, and no one method can provide all the answers. Key methods, as discussed in this section, typically involve studying autism from an ‘outside perspective’– that is from the stance of the clinician or researcher. In the next section you will consider insights from the ‘inside perspective’ – from personal accounts by autistic people or close family members. Clinical and research methods may also involve working closely with autistic individuals and their families to gain more of an ‘inside view’. Consequently ‘outsider’ and ‘insider’ approaches are not always clearly differentiated.

The case study method, most often used by clinicians, involves careful, detailed observation of individuals (autistic children in this case) over a period of time, together with in-depth interview with the individuals, or with other family members. The clinician uses their expertise to interpret observed behaviour and other signs as carefully and objectively as possible in order to formulate detailed individual reports. But the choice of which individuals and which behaviours to observe, and the clinician’s own assumptions and expectations may nonetheless serve as sources of bias. Fully fledged observational methods, often used in research studies, may involve further steps to control or minimise such biases.

In a typical investigation, observations of a group of autistic individuals will be compared with observations of a comparable group of neurotypical people (people without autism). The neurotypical comparison group, known as a control group, is matched as closely as possible to the autistic group in terms of factors such as age, intellectual level and language ability. Thus any differences that emerge between the autistic and control groups can be attributed to autism, not some other group difference, such as age. Matching by age might seem straightforward, but is usually not sufficient to make a fair comparison, since autistic people may have language difficulties or be intellectually less able than neurotypical people of the same age. Specialised tests of language ability and/or intellectual ability (IQ), part of a systematic method known as psychometrics, are used to measure the functioning of those in each group. Psychometrics means the objective measurement of psychological abilities and traits, and includes tests of skills and knowledge, abilities, attitudes, personality traits and so on.

Other means to avoid observational bias may include an agreed observation schedule to avoid the researcher picking out just what appear to be the most significant behaviours, and ‘blinding’, a procedure in which those making and interpreting the observations are not told which participants have autism and which are neurotypical.

The experiment is a method which builds further on the systematic, controlled approach just described. Experiments are typically used to gain insights into how people deal with the world around them – for instance, how they remember information, attend to things, or recognise people’s faces. Experiments put claims such as ‘individuals with autism have very good memories’ to a critical test, so countering false or misguided opinions.

Say that a researcher sets out to explore memory ability in autistic people. Firstly a hypothesis is formulated. This might state, for instance, that memory for words or faces will differ between autistic and neurotypical people. An experimental group of autistic people and a matched neurotypical control group will take part in a memory test: for instance, seeing or hearing a list of words and recalling them after an interval. The number of words recalled by each participant would be one simple measure of their memory in this task. From this the researcher calculates the average score for each group and compares them. Statistical tests are used to evaluate the probability that any apparent difference between the groups has occurred by chance. A result that is highly unlikely to have occurred by chance is said to be statistically significant, enabling a reasonably confident conclusion that the hypothesis has been confirmed.

The same basic framework can also help determine whether or not an intervention (treatment) is useful, by comparing changes in a group of autistic children receiving the intervention with an age- and intellectually-matched group of children also with autism, but not receiving the intervention.

Much of the evidence for differences in the brain in autistic people comes from brain imaging methods. Some – for instance Magnetic Resonance Imaging (MRI) – are used to explore whether there are differences in brain structure. Others, for instance functional Magnetic Resonance Imaging (fMRI), are used to explore brain activity while a person performs experimental tasks such as recognising faces.

All the methods mentioned so far – case studies, observational studies, experiments and brain imaging – can be repeated at intervals. So, for instance, behaviours in a particular group of children may be tracked over a number of months or years. Following the progress of individuals or groups over a time period like this is called a longitudinal study.

Another important method for autism research is the twin study. This involves comparing identical twins, who originate from a single fertilised egg and have identical genes, with non-identical twins, who come from two different eggs and who, on average, share 50% of their genes – just as siblings do. This type of study regularly finds that when one member of an identical twin pair has autism, the second twin is more likely to have some form of autism than when the twins are non-identical, providing evidence of a strong genetic influence. Studies of both twins and wider family members have shown that autism is highly heritable, meaning that genetic factors play a major role in determining whether individuals within a population will develop autism. However, this heritability is very complex. For instance, while some genetic variations linked to autism are ones that offspring inherit from their parents, others may arise afresh, affecting just one individual or a pair of identical twins within a family. Some non-genetic factors may also contribute to causing autism. These complex factors are further discussed in section 5.3.

Surveys and questionnaires are ways to obtain a relatively large sample of opinions, attitudes or preferences. The methods involve standardised questions (written or verbal) exploring topics such as what parents and autistic people think about the support which is available to them. This information is then analysed statistically to obtain a representative picture of the responses.

While not everyone with autism is able to describe their experiences, an increasing number of personal accounts provide insights which both complement and differ from ‘outsider’ insights. Parents may also provide deep insights which are not available without these close bonds. Remember, though, that individual accounts of autism are just that. For instance, some autistic individuals describe their thinking style as highly visual. But this does not necessarily mean that visual thinking is a general trait in autism. Next you will consider some parental and personal accounts.

Activity 6 Learning from personal accounts

Timing: Allow about 20 minutes

Read these two passages and listen to the interview extract. Make a few notes on similarities and differences between the accounts. For instance, are the accounts given by autistic individuals or by parents? What interests and difficulties do they talk about?

Jessy’s social understanding remained, and remains, radically incomplete. Such simple lessons. ‘We can’t ask them to move because they were there first.’ The difference between irritation and hurt feelings. Making sense of people, ‘grasping the general significance of situations’. What the autistic adult, like the autistic child, finds hardest of all.

What is it like to have a mind that picks ‘remembrance’ out of the newspaper yet must struggle to comprehend the most ordinary vocabulary of social experience? What is it like to have to learn the myriad rules of human interaction by rote, one by one? By rote, because the criterion of ‘how would I feel if’ is unavailable, since so much of what pleases (or distresses) her, does not please others, so little of what pleases (or distresses) others pleases her.

Clara Claiborne Park writing about Jessy, aged 42 (Claiborne Park, 2001, pp. 16–7)

I must mention that the boy loved to watch the different calendars of different rooms and then recall the numbers. He also compared them. He thus spent a lot of time, gazing at the numbers. He wanted to know what they meant. He found a kind of pattern in them. He wondered how the figures bent and straightened up, curled and sometimes broke!

Tito Mukhopadhyay aged 8, writing about himself as an infant (Mukhopadhyay, 2000, p. 19)

Listen to the following extract from a recorded interview with Dr Wenn Lawson discussing his autism with Dr Ilona Roth (Lawson and Roth, 2011). Note that Wenn was living as a woman at the time of this interview.

Download this audio clip.Audio player: aut_1_wk01_lawson_childhood_experiences_clip.mp3

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ILONA ROTH

You have talked a little about your childhood and you’ve written about your childhood; in what ways did you feel different from others when you were growing up?

WENN LAWSON

I know that I didn’t experience life in the same way as other children simply because people kept referring to things which didn’t make sense to me, everyday things, children’s games, things that adults required of you, things that were said. When people said things like they would just be a minute, but they weren’t a minute, they were much longer, I used to feel lied to and get very angry about things which other people, other children, kinda took in their stride, so those sorts of things I think I experienced very differently

ILONA ROTH

Would you say that you felt lonely as a child?

WENN LAWSON

That’s a difficult one because I don’t think I felt lonely. I often felt alone, because of being misunderstood, the isolation of not connecting to understanding, which is actually quite different to feeling lonely, I think

ILONA ROTH

And looking back now how do you think your autism manifested itself in your behaviour as a child and adolescent?

WENN LAWSON

I was very obsessive, I had interests that just took over all of my being really, mostly interests in insects, in animals, later on in my teens very obsessed with engines; piston engines in particular not into rotaries, and I think that was very noticeable because my sisters and my brother were not interested in those sorts of things and the things they were interested in often varied so they would be interested in something for a very short time and then that would change, whereas my interests, my passions, were very passionate and stayed with me for quite a while. Other things that were quite different was I didn’t talk for quite a while and then when I did speak I tended to monologue or talk about the things that I was interested in and not so good at listening or turn-taking-those sorts of things; very noticeably different to the ways my sisters and brother interacted with their peers and with each other.

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Tito Mukhopadhyay (a young boy in 2000) and Wenn Lawson (an adult) contribute their personal reflections, while Clara Claiborne Park speaks for her adult daughter Jessy.

Tito and Wenn Lawson mention passionate engagement with particular topics (calendars, numbers, insects, machines) while Clara mentions Jessy’s attention to detail.

Clara Claiborne Park and Wenn Lawson both mention problems and frustrations of understanding the subtleties of language, the rules governing social situations, and the difficulty of taking other people’s feelings into account.

Finally, in this clip meet Alex, who will describe his experiences of autism at various points in the module.

Download this video clip.Video player: boc_aut_1_video_week1_5_alex.mp4

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ALEX:

I'm 21, and I live in Crawley, which is next to Gatwick Airport. I any currently work a part time job, but I also study. I'm doing pharmaceutical science, because that's the route I would like to go down, to do pharmacology or pharmacy.

ILONA:

So you have an autism diagnosis?

ALEX:

Yep.

ILONA:

And do you remember how old you were when this was made?

ALEX:

I was actually one of the lucky ones, very young. I was about 2 and 1/2, 3.

ILONA:

So you wouldn't be able to remember what it was like to be diagnosed. But what about your family? How do you think they reacted?

ALEX:

Well, I think my dad was all right, but my mum was quite upset about it and that. And she thought, would I be able to do things on my own independently and all that. But obviously, I am now.

ILONA:

Were your parents particularly helpful in encouraging you to do things independently?

ALEX:

Yeah, I meant now I'm pretty independent. I drive, I work, obviously. I'm studying. So I've got a busy lifestyle.

ILONA:

Do you live at home?

ALEX:

Yeah, I do at the moment. But I do one day hope to have my own place.

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We will end this introduction to autism with some historical background. Autism was first described in the early 1940s, and with developments in knowledge, the concept has been evolving ever since. To understand where we are now, it is important to know something about the key players and historical milestones of the last 8 decades.

Some of the language and concepts for describing and discussing autistic people throughout history may now seem odd or completely unacceptable. Remember, though, that ideas about autism arose within the context of psychiatric thinking and social attitudes of the time. Even if some of these ideas now seem misguided or wrong, their role in the history of autism must be understood and acknowledged.

Leo Kanner, an Austrian-born immigrant to the USA, pioneered the application of psychiatry (the branch of medicine that deals with the mind) to psychological problems in children. In 1943, he published one of the first known accounts of autism, based on his case studies of 11 children referred to his clinic (Kanner, 1943). He identified language problems; atypical use of non-verbal communication, such as eye gaze and gesture; narrowly restricted interests and a desire for sameness; and atypical reactions to sensory stimuli. The children’s apparent aloofness and isolation from the human world led him to coin the phrase ‘autistic aloneness’. ‘Autism’ comes from the Greek word ‘autos’ for self, and means being absorbed into oneself. To Kanner these shared features of behaviour suggested a syndrome, a specific disorder with a characteristic set of symptoms (observable characteristics that may indicate a clinical problem or disorder). Even today Kanner’s descriptions of autism remain remarkably fresh and up to date. However, these days the varied profile and severity of key symptoms between individuals is considered to represent a spectrum of problems rather than a single unified syndrome

Figure 2 Leo Kanner 1894-1981

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A portrait photograph of Leo Kanner.

Figure 2 Leo Kanner 1894-1981

The second autism pioneer was Hans Asperger, a paediatrician working in Vienna during the same period as Kanner was active in the USA. In a paper published in German, Asperger described a behaviour pattern very similar to Kanner’s description, which he called ‘autistic psychopathy’ (Asperger, 1944). ‘Autistic’, as for Kanner, referred to the children’s aloneness and self-absorption, while by ‘psychopathy’ Asperger meant a psychiatric disorder affecting the personality. Asperger highlighted important features in common with Kanner’s case studies, yet the children he described seemed less disabled than Kanner’s group, generally having fluent speech and vocabulary, even if they used it oddly. They tended to talk at length about their favourite topic or interest. Rather than seeming unaware of the existence of others, their reactions to others appeared strange and antisocial. Asperger’s work was for many years not widely known outside Austria. It was only in the 1980s that psychiatrist Lorna Wing highlighted the remarkable similarity between Asperger’s and Kanner’s clinical observations and ‘Asperger syndrome’ was recognised as a diagnostic sub-type of autism. Wing also introduced the term ‘autism spectrum’ to reflect the variation on the core symptom profile.

Figure 3 Hans Asperger 1906-1980

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A photograph of Hans Asperger.

Figure 3 Hans Asperger 1906-1980

Until very recently, many believed that Asperger shielded children in his clinic from Nazi programmes designed to ‘cleanse’ the Austrian and German population of individuals deemed to be weak, burdensome or ethnically non-Aryan (e.g. Jewish). However, very recently two researchers have shed new light on Asperger’s war-time activities (Czech 2018; Sheffer 2018). They provide convincing evidence that Asperger collaborated with the Nazi regime, despatching some children in his care to a ‘euthanasia clinic’ where they met their death. These revelations have caused widespread shock and revulsion, and at the time of launching this course, Asperger’s standing and contributions to the autism field are under searching review. There is no simple way forward. For instance, although Asperger syndrome is, for other reasons, ceasing to be a formal sub-diagnosis, for several decades, many people on the autism spectrum have accepted Asperger syndrome as their diagnosis, and embraced it as an identity. A range of views is beginning to emerge: some are arguing that Asperger syndrome should be renamed; others point out that history cannot be completely rewritten and terminology should be considered distinct from the individuals who may have originated it.

You can read more about the researchers’ findings and about different ideas for the way forward here:

https://www.spectrumnews.org/ news/ new-evidence-ties-hans-asperger-nazi-eugenics-program/

Kanner initially favoured a biological explanation of autism (an atypicality in brain function). However, he began to consider autism as a form of withdrawal from the emotional coldness he had perceived in some mothers. This socio-emotional explanation of autism was probably influenced by the early 20th century popularity of Freudian psychoanalysis in the USA, which saw children’s personalities as strongly influenced by their early experiences with their parents. Although Kanner later retracted this idea, it was enthusiastically promoted by the psychoanalyst Bruno Bettelheim who, in the 1960s, practised a treatment in which children with autism were separated from their parents to live in a special ‘therapeutic’ environment (Bettelheim, 1967). He described apparently dramatic improvements in the emotional adjustment, speech and behaviour of children treated in this way, but his claims were subsequently discredited.

Many parents were extremely upset by the poor parenting theory. The psychologist Bernard Rimland noted that while his wife was an affectionate mother, their son screamed constantly and inconsolably from an early age. Rimland began to collect scientific and medical evidence to challenge Bettelheim’s approach, publishing his own biological theory of causation (Rimland, 1964). He devoted his life’s work to autism, acting as an advocate for children with autism and founding the Autism Society of America in 1965.

In 1962, a group of pioneering UK parents founded the National Autistic Society (NAS) to campaign for better services and support for autistic children. Their first school, run by Sybil Elgar, was established in 1965. Elgar pioneered a teaching method using a structured environment, clear and straightforward communication and visual aids. The NAS has since become a major source of information, advice, services and resources, and notably campaigns for the needs of adults with autism to be recognised and addressed.

Some of the first experimental studies of autism were conducted in the 1970s by the psychologists Beate Hermelin and Neil O’Connor, who developed a framework for studying many aspects of sensory, perceptual and memory processing (Hermelin and O’Connor, 1970).

Later in the 70s, Susan Folstein and Michael Rutter carried out their pioneering twin study (Folstein and Rutter, 1977). Folstein and Rutter found that when one member of an identical twin pair had autism, the second twin was more likely to have some form of autism than when the twins were non-identical. The researchers interpreted this as strong evidence that autism has a genetic basis.

Figure 4 Sir Michael Rutter b.1933

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A photograph of Michael Rutter.

Figure 4 Sir Michael Rutter b.1933

An influential early development in therapeutic interventions adopted the idea that autistic people have acquired, through learning, a set of ‘maladaptive’ or inappropriate behaviours, which can be eradicated or ‘retrained’. The psychologist Ivar Lovaas pioneered behaviour modification techniques for children with autism, using rewards to encourage ‘desired’ behaviour such as language and to discourage ‘difficult’ behaviours (Lovaas, 1987). While these days some practitioners are highly critical of behaviour modification, arguing that it does not address the underlying psychological difficulties, approaches based on Lovaas’ ideas are still in use. Other approaches which aim to tackle the core problems more directly may nonetheless incorporate the basic principles of behaviour shaping.

Figure 5 Ivar Lovaas 1928-2010

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A photograph of Ivar Lovaas.

Figure 5 Ivar Lovaas 1928-2010

In 1985 three psychologists, Simon Baron-Cohen, Uta Frith and Alan Leslie, published an experimental study suggesting that children with autism have difficulty understanding what others are thinking and feeling – a ‘Theory of Mind (ToM)’ difficulty (Baron-Cohen, Leslie and Frith, 1985). This finding stimulated a huge wave of further research, throughout the 1990s and to the present day. Though by no means the only new theory proposed during this period, and much modified, it is still influential. You will come across it later in the course.

Figure 6 Simon Baron-Cohen b.1958

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A photograph of Simon Baron-Cohen.

Figure 6 Simon Baron-Cohen b.1958

Figure 7 Uta Frith b.1941

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A photograph of Uta Frith.

Figure 7 Uta Frith b.1941

Prevalence means the number of individuals affected by a condition at a given time. Measuring autism prevalence depends on estimating how many individuals in a population have a symptom profile that fits the diagnosis. When autism was first identified it seemed to be rare. In 1966, Lotter estimated that childhood autism affected 4 children in 10,000. In the late 1970s, and adopting a wider definition of autism, Lorna Wing and Judith Gould (Wing and Gould, 1979) scrutinised the medical and social services records of 35,000 children in Camberwell for likely cases of autism. Their prevalence estimate was 21 children in 10,000, of whom 5 would have ‘classic autism’, while the rest were somewhere on a ‘spectrum’ – which was becoming an increasingly relevant concept to all working on autism. Notice how prevalence estimates changed as the definition of autism (i.e. the inclusion criteria) was broadened. With further research and clinical advances leading to even broader criteria and more widespread diagnosis, it is currently estimated that at least 1 in 100 individuals in the UK may be on the autism spectrum. A recent worldwide estimate, based on prevalence studies in different countries, is somewhat lower. But where awareness of autism and diagnostic services are limited, estimates of prevalence are inevitably lower. For some parts of the world (for instance many African countries) where diagnosis is barely available, prevalence cannot be reliably estimated. You will read more about this in Weeks 3 and 8.

The dominant image of autism up to the 1980s was that of a person lacking the self-insight and communicative skills necessary to tell others what it is like to be autistic. This perception was challenged when an American professor called Temple Grandin published a book about her experience of autism (Grandin and Scariano, 1986). As a child in the 1950s, Temple’s delayed speech development and odd behaviour were attributed to brain damage. Her mother resisted attempts to have her institutionalised and hired a speech therapist. At school Temple benefitted from the encouragement of some wise mentors. When she was 18, her mother happened upon Bernard Rimland’s work and realised that her daughter was autistic. Temple nonetheless went from strength to strength, studying at university and becoming a professor and world expert on livestock handling, as well as a spokesperson on autism. Since Temple’s pioneering effort, many other personal accounts of autism have been published.

Once people like Temple Grandin had found a voice and an audience, other challenges to the image of autism as a disabling medical condition started to occur. Neurodiversity refers to the idea that a neurological condition such as autism is simply one form of variation between individuals, not a fundamentally different or pathological category (Blume, 1998). This goes hand in hand with the idea that autism does not need treatment or a cure. Not everyone agrees with this view: many families where an individual is profoundly affected by autism do see autism as disabling, seek treatment, and argue that those advocating neurodiversity do not speak for everyone on the autism spectrum.

The many developments in the autism field since the year 2000 make it hard to select the most important ‘players’ and milestones. You will learn more during the rest of this course. In research, advances in brain imaging and human genetics have shed new light on the brain systems and genetic mechanisms that may be involved. There is no ‘cure’ for autism, and some reject the very idea of a cure. But a range of helpful interventions is available, thought to be especially effective if started early. Revised diagnostic criteria for autism published by the American Psychiatric Association (American Psychiatric Association, 2013) addressed some of the inadequacies of earlier versions. Yet there is growing concern that autism in women may present in atypical ways and is going undiagnosed. Progress in autism rights includes, in the UK, the 2009 Autism Act, responding to an NAS campaign to protect the interests and address the needs of autistic adults. In 2014 the 67^th World Health Assembly of the World Health Organisation passed a resolution supported by 60 member states to coordinate their efforts in addressing autism worldwide.

Check what you’ve learned this week by taking the end-of-week quiz.

Week 1 practice quiz

Open the quiz in a new window or tab then return here once you’ve finished it.

This introductory week of the course has provided you with an overview of autism, highlighting key facts, and also just how much remains to be discovered. You have seen how the concept of autism has evolved since Kanner's and Asperger's early work, and in light of the variability which has emerged, how autism has come to be known as a spectrum. The importance of basing claims about autism on reliable sources of information has been demonstrated. Systematic methods such as experiments and surveys play a key role in furthering knowledge; insider accounts by people on the spectrum are also crucial in enhancing understanding. You will have noted that some ways of discussing, explaining and engaging with autism are highly contested, especially concerning whether it is a disorder, condition, or just a form of neurodiversity, and the related issue of whether autistic people need to be ‘cured’.

You should now be able to:

• evaluate and update your own knowledge of autism
• express a general overview of autism and why it is considered a spectrum
• understand different ways of gaining evidence and insights into autism
• appreciate some different experiences of autism
• understand key milestones in autism history.

Next week you will look at the different features of autism in more detail, giving particular attention to characteristic profiles of difficulties and strengths, to difficulties which may accompany autism, and to how things may change as children develop.

Now you can go to Week 2.