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Journal of Psychology and Behavior Studies
ISSN: 2753-2364
DOI: 10.32996/jpbs
Journal Homepage: www.al-kindipublisher.com/index.php/jpbs
JPBS
AL-KINDI CENTER FOR RESEARCH
AND DEVELOPMENT
Copyright: � 2022 the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons
Attribution (CC-BY) 4.0 license (https://creativecommons.org/licenses/by/4.0/). Published by Al-Kindi Centre for Research and Development,
London, United Kingdom.
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| RESEARCH ARTICLE
Autism Spectrum Disorder: The State of Play
Fadoua Kadiri
Doctoral student, Faculty of Letters, Languages and Arts, Ibn Tofail University, Morocco
Corresponding Author: Fadoua Kadiri, E-mail: fadoua.kadiri@uit.ac.ma
| ABSTRACT
This review paper traces the evolution of autism since its simultaneous discovery back in the forties, by Leo Kanner and Hans
Asperger, until the present day. Many disciplines, ranging from psychoanalysis to behaviorism, struggled to understand autism
and provide a map to navigate it but ended up with only fragments of this multifaceted disorder. Even the Diagnostic and
Statistical Manual of Mental Disorders (DSM) kept changing autism’s categorization from infantile psychosis to behavioral
disorder and, recently, to neuro-developmental disorder. Today, autism’s rapid strides toward the realm of neuroscience are
blurring all the frontiers between the aforementioned disciplines, transcending the black-white dichotomy and establishing a
new grey area.
| KEYWORDS
Autism, ASD, disability, neurodiversity
| ARTICLE INFORMATION
ACCEPTED: 01 July 2022
PUBLISHED: 13 July 2021
DOI: 10.32996/jpbs.2022.2.2
1. Introduction
What is autism? Is it a lifelong disability, a different form of cognition, or both and more?1 In reality, all these questions carry some
sort of truth about the condition, and future progress is expected to throw more light on it.
The United Nations started recently referring to autism, or what is known now as an autism spectrum disorder (ASD), as a condition
“mainly characterized by its unique social interactions, non-standard ways of learning, keen interests in specific subjects, inclination
to routines, challenges in typical communications and particular ways of processing sensory information.”2
However, many experts and even writers define autism as a constellation of anomalies affecting a myriad of areas such as “motor
functioning, balance, the physical sense of where your own body is and inner consciousness.”3 While other authorities in the field
of psychiatry still believe that autism is an impairment affecting notably social behavior and communication and characterized by
repetitive, invariant activities. This set of deficiencies is usually used as a benchmark against which the severity of the condition is
measured, and autism red flags are identified.
This situation might be explained by the fact that autism spectrum disorder has been, since its discovery in the forties, and still,
very elusive amid the lack of conclusive evidence about what causes it.
1 Silberman, S. (2015). Neurotribes: The legacy of autism and the future of neurodiversity. Penguin.
2 World Autism Awareness Day 2 April, retrieved on September 09, 2021, from the United Nations website:
https://www.un.org/en/observances/autism-
day/background#:~:text=The%20United%20Nations%20General%20Assembly,an%20integral%20part%20of%20society.
3 Solomon, A. (2012). Far from the tree: Parents, children and the search for identity. Simon and Schuster.P. 222
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Autism Spectrum Disorder: The State of Play
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2. The psychoanalytical cradle of autism
2.1. Leo Kanner
The early definition of autism as a cluster of deficits draws mainly on the findings of Kanner (1943), who asserted that children
brought to him were displaying an acute form of “autistic aloneness” and decided to call the condition “early infantile autism”.
Leo Kanner, a child psychiatrist who is believed to be the discoverer of autism, maintained that autistic children have the tendency
to shun any kind of social interaction, favoring the perpetuation of “sameness instead” in many aspects of their lives and
“literalness” in their verbal communication. Kanner, who affirmed that these kids presented conspicuous limitations in numerous
aspects, did not fail to mention that his subjects boasted good cognitive intelligence and exceptional memory and even excelled
when tested with the Seguin form board4.
While trying to understand the newly-discovered condition, Kanner relied mainly on clinical observations, classical testing, and
parents’ testimonies. He refused to diagnose adults, believing that autism was exclusive to children, “so keen was he to establish
the new field of child psychiatry” (Baron-Cohen, 2015, p. 1330).
In his attempt to explain the emotional quotient of his autistic subjects, the scientist came up with a controversial theory in which
he openly laid the blame of the autistic children’s solitariness on toxic parenting, professing that the domestic climate in which
they were living lacked affection and was as cold as a refrigerator5 (Kanner, 1949). In some instances, these speculations led to
removing these children from their family environment and placing them in specialized institutions as a form of cure.
2.2. Hans Asperger
Roughly around the same time, Austrian pediatrician Hans Asperger was making a breakthrough in the discovery of the same
condition. Two things that explain why Asperger’s work was overshadowed for years and surfaced only posthumously are the war
that wrought havoc on Germany6 and the lack of translation from the German language into English7. Some even speculate that
Asperger’s living in the Nazi era, which was characterized by the spread of eugenics8, was the reason why he kept his experiments
secret in an attempt to shield his “little professors” from any harm perpetrated by the government.
Asperger (1991)9 believed that he came upon a unique syndrome that sets itself apart from current mental disorders and named
it “autistic psychopathy”. Though Asperger contradicted Kanner in thinking that the condition was endogenous and not caused by
outside factors, he stated, in the same vein, that these kids displayed “peculiarities” cuing to the presence of different intelligence.
However, Asperger argued that the shortcomings of autistic intelligence become more pronounced when weighted against
normative ways of thinking, especially during school assessment tests, a fact that made many autistic children drop out of school
and be called academic failures.
In a retrospective study of records of children examined by Asperger, Hippler and Klicpera (2003) affirmed that, even if autistic kids
possessed above-average cognition, most of them had some kind of learning disabilities and did not benefit from classical
pedagogical methods, on the contrary, they made them worst, especially when it came to issues of behavior management.
Both pioneers, Kanner and Asperger, advanced that autistic children were untestable using conventional IQ tests because their
special gifts and their autism-related limitations were intricately intermingled.
Asperger will later focus on the high functioning autism sub-category10 to the extent that this sub-group will be named after him
in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) before merging all categories in the
DSM V under the same heading: “autism spectrum disorder” or ASD.
3. Autism shift to behaviorism
3.1. O. Ivar Lovaas
Psychoanalysis dominated much of the autism narrative until the advent of O. Ivar Lovaas, who claimed that autism should be
tackled using a pure behaviorist approach. The psychologist deemed that the use of “operant conditioning” by radical behaviorist
B.F. Skinner was the only feasible way to teach autistic kids. He focused only on observable and measurable behavior and
4 A ten-piece board to place the most common shapes: square, circle, cross, triangle, rectangle…
5 The refrigerator mother theory was endorsed by many psychiatrists such as Bruni Bettelheim.
6 Most Asperger’s documents dating 1944-1960 were missing.
7 Lorna Wing introduced Asperger to the international scientific community in 1981, but it was not until 1991 that Asperger’s 'Autistic
psychopathy' in childhood was translated into English by Utah Frith.
8 A belief that a race should be kept pure by eliminating non-conforming groups such as people with disabilities.
9 The paper was published in 1944 and translated in 1991.
10 This term is pejorative for advocates of neurodiversity.
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experimented with forms of punishment to modify and decrease “undesirable” demeanor. He even administered electric shocks
to his subjects, claiming that this increased socially-acceptable comportment, such as eye contact (Lovaas and Simmons, 1969).
In subsequent research, the researcher pushed for Skinner’s linguistic behaviorism by exposing his preverbal subjects to an
intensive speech program. He even made food and meals dependent on verbal requests and succeeded in scoring some points
with some minimally-speaking autistic kids but not all of them, resulting in a noticeable heterogeneity regarding the degree of
improvement (Lovaas et al., 1973).
Even if Lovaas failed in randomizing assignments to control and experimental groups and used inconsistent measures to document
progress, most scholars concurred that behaviors could be altered by manipulating the physical environment of the person and
approved of the new behaviorism-based therapy (Sallows & Graupner, 1999).
3.1.1. Applied Behavior Analysis or ABA
Lovaas’ therapy, using Discrete Trial Training (DTT)11 and known more generally as Applied Behavior Analysis (ABA), shaped many
behavioral interventions based on the same premise: autistic children should be taught from scratch, in a repetitive incremental
way and via reinforcement, to hit the same developmental milestones as their neuro-typical peers.
ABA is the primary therapy pushed by the American Speech-Language-Hearing Association (ASHA), one of the oldest bodies
bringing together speech pathologists and therapists in the United States. A robust body of peer-reviewed articles backing the
behaviorism-inspired method is posted on the organization’s website. However, ASHA admits that there is not enough evidence
to say that therapies based on applied behavioral analysis are more effective than alternative interventions.
3.1.2. Picture Exchange Communication System or PECS
The PECS is a mode of alternative and augmentative communication using pictures to express a person’s needs and wants. The 6-
stage system is also inspired by Skinner’s verbal behavior and is used to teach a child how to initiate a request, how to respond to
questions, and how to make social comments (Charlop-Christy et al., 2002).
The method, which focuses on the pre-requisites of eye contact, joint attention, and collaborative play, is sometimes turned down
by parents who fear that the dependence on pictures would block or inhibit their kids’ functional communication.
3.1.3. Treatment and Education of Autistic and Related Communication Handicapped Children or TEACCH
TEACCH, which is an educational and training program devised specifically for children with autism and similar disorders, also
draws on behaviorism, though it slightly differs in some aspects from ABA in the sense that it does comprise some cognitive
elements.
The program builds on the strengths of the child to help with the emergence of new skills in a somehow individualized manner.
Like any behavioral method which believes that the kid’s environment should be under control 24/7, the method places the bulk
of the work on parents to whom the implementation of the program is delegated under the supervision of the therapist.
3.1.4. Sonrise
The Sonrise is a bit controversial method as it was developed by the parents of an autistic kid. Its tenets run counter to everything
the ABA stands for, as it calls for imitating behaviors to motivate reciprocity instead of interrupting them. Its inventors describe it
as a relational approach that helps build bridges between the autistic kid and the surrounding world. However, the method has
some similarities with ABA as isolating the child to control his environment and manipulating his responses and behaviors in a
ludic way.
3.1.5. Makaton
The Makaton is a system inspired by sign language and adopts the same principle wherein each hand gesture or movement
becomes semantically meaningful. Though it is a smart, alternative way of communication that worked miracles for the deaf, it still
has many shortcomings when applied to autistics, mainly because it presupposes that the subjects are visual and have good control
of their gross and fine motor skills.
3.1.6. GemIIni
The GemIIni program is a video modelling intervention developed by two parents to engage autistic kids, teach them word
identification, and eventually enhance their speech output. The program, which spans many levels ranging from letter
pronunciation to initiating requests, uses video clips that should be screened discreetly multiple times a day.
The GemIIni videos always zoom on the speaker to clearly show how the tongue and the lips move to articulate any specific letter.
Though the intervention is criticized for encouraging parents to let their autistic children spend prolonged periods of time glued
11 DTT breaks down tasks into components that are taught to kids repeatedly in short, one-on-one sessions until they master them.
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Autism Spectrum Disorder: The State of Play
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in front of TVs and electronic devices such as tablets, some researchers do, in fact, argue in favor of the novel program that replaces
regular speech therapy (Gilmour, 2015).
4. Autism and cognitive psychology
One of the authorities in the field of autism and its relation to cognitive psychology and cognitive neuro-psychology is French
researcher Laurent Mottron.
Mottron (2017) believed that the behaviorist viewpoint lacks depth and does, in fact, overlook the existence of a completely
different mode of learning which is “implicit learning” accompanied by a “non-communicative” language. He maintained that
autistic kids could remain unresponsive to classical methods of imparting knowledge because they follow a different
developmental curve.
Mottron theorized that even if expressive language is delayed in autism, receptive linguistic competence is present and intact
among autistic children. He categorically dismissed outdated psychoanalytical and behavioral methods and proposed what he
called “lateral tutorship”, which consists of satisfying the information-seeking behavior by exposing the child to an array of
cognition-stimulation material as well as to holistic, finalized action instead of bits of information as in DTT sessions.
In the same vein, other researchers corroborated Mottron’s theories by stating that eye contact is by no means evidence of joint
attention and that the repetitive movements, known as stims, do not affect the learning process (Chen et al., 2012), a finding that
slams Lovaas’ assumptions that eye contact is a pre-requisite for learning and that kids engaging in self-stimulatory behavior are
unteachable.
5. The neuroscientific approach to autism
Of late, neuroscientific research has made a quantum leap in deciphering the autistic mind.
In a study using event-related potentials (ERP), a biomarker that gauges the cerebral response to a specific stimulus, a cognitive
one, in this case, Distefano et al. (2019) tested 20 minimally speaking and verbal autistic kids, along with their neurotypical
counterparts, and proved the existence of robust semantic processing in both sub-categories of autism.
In addition to event-related potentials (ERP), other scholars used eye-movement monitoring and pupillary dilation as implicit
measures to test the cognition of autistic individuals who are unable to make overt behavioral responses and found out that these
measures, if tailored to each individual, could indicate the vocabulary knowledge of autistic subjects (Coderre et al., 2019).
In another research, Petit et al. (2020) used EEG and fMRI to examine language processing in the brain, circumventing the need
for overt physical or verbal responses. The researchers found solid proof of “intact semantic processing”, paving the way for
devising a “neural test of language comprehension”.
The neuro-imaging techniques, which used the neural component N400 as a neurolinguistic marker to detect cognition and
language processing when hearing semantically or grammatically correct and incorrect sentences, are currently being tested on
non-speaking autistics, and the forthcoming findings might help shed light on this neuro-developmental disorder.
Scientists like Laurent Mottron, Alexandra Woolgar, and Elizabeth Torres are venturing into unchartered territory and providing
cutting-edge data and a fertile ground for autism advocacy groups to grow stronger.
6. The neurodiversity movement
Neurodiversity is an emerging movement akin to the disability rights movement, which was spearheaded by Judith Heumann and
drew on the experiences and views of autistic self-advocates. Leadbitter et al. (2021) traced back the neurodiversity movement to
the nineties, with autistic groups coming to light and promoting autism as a valid way of being, arguing that the autism phenotype
adds value and enriches the human experience.
The neurodiversity movement, led by ASAN12, does not consider autism as a pathology but as a disability and calls for equal rights
and access to all autistics, regardless of the condition’s severity. The movement, driven mainly by autistic adults, clashes directly
with organizations led by parents of autistic children, like Autism Speaks13 , which believes that this enthusiastic mindset does not
reflect the experiences of those with the most challenging and debilitating forms of autism.
The movement opposes early intervention methods aimed at molding autistic toddlers into the desired neurotypical role model
and rejects any curative or behavior standardization techniques. According to the advocacy group, effective therapy should build
self-esteem and self-awareness and encourage society and peers to interact with autistic individuals in a supportive and respectful
12 The Autistic Self Advocacy Network (ASAN) is a non-profit organization created in 2006 and run by autistic members.
13 The largest autism organization in the United States, known for funding research into the genes causing autism.
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manner, not only through scaffolding and accommodating their needs but also by depathologizing some autistic traits such as
stimming, monotone voice, eye contact, and solitude.
Like any new movement that does not embrace the mainstream, the neurodiversity movement had proponents but also opponents
who disagree either with the totality of its ideology or with some of its problematic manifestations. Hughes (2020) castigated the
movement’s claim that autism is not a disorder that needs a cure but is simply a different way of being, arguing that this represents
a narrow conception of neurodiversity given that some autism traits are inherently harmful and pathological. He explained that
adopting an overzealous view on autism does, in fact, divert attention and services from the severely affected group in the autism
community.
On a different note, Hughes also highlighted the lexicon used by the said movement, which is trying to forge an autistic identity
by using an identity-first language instead of a person-first language (ex: an autistic child instead of a child with autism),
underlining, again, that the heterogeneity of the autism community makes it that some of the autistic people do not identify with
the neurodiversity movement and might want to be cured.
Other scholars affirmed that there is an ongoing shift in autism conceptualization, operated mainly by autistic advocates and
insiders who published their personal accounts and autobiographies, in addition to efforts made by some parent-led organizations
that urged non-autistic experts to collaborate with autistic adults. Such collaboration should be the basis of a participatory research
mode and should be used in designing methods and interpreting results (Happ� and Frith, 2020).
7. Conclusion
In this review paper, I tried to encompass and survey all salient aspects of autism since its discovery in the forties. Various theories
and approaches were applied to this condition in an attempt to comprehend it and measure its variables such as IQ, behaviors,
psyche, and even parenting style.
These theories ranged from psychoanalysis, which conceptualized autism as a mental condition and advocated the medical model
of disability to manage it, to behaviorism which believed that controlling the environment and offering rewards and punishments
could mold autistic behaviors into more typical ones, based on the principle that behaviors are contingent on their consequences.
The very recent strides that were made in the neuroscientific field prove that the human brain is yet to unfold all its secrets.
Groundbreaking technology measuring brain waves and other hidden metrics hint at the existence of an internal, invisible
intelligence in speaking and non-speaking autistics. The existing preliminary findings expand the notions of humanity and
intelligence, which can sometimes be multi-layered, complex, and resistant to cursory observations done in a clinic.
This review paper sheds light on the neuroscientific findings made recently or underway and their contribution to reconceptualizing
autism and moving it away from the prevailing reductive and simplistic psychoanalytical and behavioral approaches. It also laid
emphasis on the emergence of the neurodiversity movement, which advocates that an autism phenotype is a valid form of being.
However, the surveyed research papers have some limitations, such as the small cohorts of autistics, a fact that makes the
replication of the findings difficult. Future research should focus on increasing the number of autistic participants and recruiting
them from across the spectrum.
Funding: This research received no external funding.
Conflicts of interest: The author declares no conflict of interest to disclose.
Publisher’s Note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of
their affiliated organizations, or those of the publisher, the editors and the reviewers.
References
[1] Asperger, H. (1991). 'Autistic psychopathy' in childhood (U. Frith, Trans.). In U. Frith (Ed.), Autism and Asperger syndrome (37–92).
[2] Baron-Cohen, S. (2015). Leo Kanner, Hans Asperger, and the discovery of autism. The Lancet, 386(10001), 1329-1330.
[3] Charlop‐Christy, M. H., Carpenter, M., Le, L., LeBlanc, L. A., & Kellet, K. (2002). Using the picture exchange communication system (PECS) with
children with autism: Assessment of PECS acquisition, speech, social‐communicative behavior, and problem behavior. Journal of applied
behavior analysis, 35(3), 213-231.
[4] Chen, G. M., Yoder, K. J., Ganzel, B. L., Goodwin, M. S., & Belmonte, M. K. (2012). Harnessing repetitive behaviours to engage attention and
learning in a novel therapy for autism: an exploratory analysis. Frontiers in psychology, 3, 12.
[5] Coderre, E. L., Chernenok, M., O’Grady, J., Bosley, L., Gordon, B., & Ledoux, K. (2019). Implicit measures of receptive vocabulary knowledge in
individuals with level 3 autism. Cognitive and Behavioral Neurology, 32(2), 95.
[6] DiStefano, C., Senturk, D., & Jeste, S. S. (2019). ERP evidence of semantic processing in children with ASD. Developmental cognitive
neuroscience, 36, 100640.
Page 6
Autism Spectrum Disorder: The State of Play
Page | 10
[7] Gilmour, M. F. (2015). Comparing the teaching efficacy of two video modeling programs delivered in a group format in special education
classrooms to improve expressive language. Journal of Special Education Technology, 30(2), 112-121.
[8] Happ�, F., & Frith, U. (2020). Annual Research Review: Looking back to look forward–changes in the concept of autism and implications for
future research. Journal of Child Psychology and Psychiatry, 61(3), 218-232.
[9] Hippler, K., & Klicpera, C. (2003). A retrospective analysis of the clinical case records of ‘autistic psychopaths’ diagnosed by Hans Asperger
and his team at the University Children's Hospital, Vienna. Philosophical Transactions of the Royal Society of London. Series B: Biological
Sciences, 358(1430), 291-301.
[10] Hughes, J. A. (2021). Does the heterogeneity of autism undermine the neurodiversity paradigm?. Bioethics, 35(1), 47-60.
[11] Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2(3), 217-250.
[12] Kanner, L. (1949). Problems of nosology and psychodynamics of early infantile autism. American Journal of Orthopsychiatry, 19(3), 416.
[13] Leadbitter, K., Buckle, K. L., Ellis, C., & Dekker, M. (2021). Autistic self-advocacy and the neurodiversity movement: Implications for autism
early intervention research and practice. Frontiers in Psychology, 782.
[14] Lovaas, O. I., & Simmons, J. Q. (1969). Manipulation of Self‐Destruction in Three Retarded Children 1. Journal of applied behavior
analysis, 2(3), 143-157.
[15] Lovaas, O. I., Koegel, R., Simmons, J. Q., & Long, J. S. (1973). Some generalization and follow‐up measures on autistic children in behavior
therapy 1. Journal of applied behavior analysis, 6(1), 131-165.
[16] Mottron, L. (2017). Should we change targets and methods of early intervention in autism in favor of a strengths-based
education?. European child & adolescent psychiatry, 26(7), 815-825.
[17] Petit, S., Badcock, N. A., Grootswagers, T., & Woolgar, A. (2020). Unconstrained multivariate EEG decoding can help detect lexical-semantic
processing in individual children. Scientific reports, 10(1), 1-15.
[18] Sallows, G. O., & Graupner, T. D. (1999, June). Replicating Lovaas’ treatment and findings: Preliminary results. In PEACH: Putting research into
Practice Conference, London.