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three-year-old child would be labeled autistic if he or she lacked both social
relatedness and speech or had abnormal speech. This diagnosis is also called
classic Kanner's syndrome, after Leo Kanner, the physician who first described
this form of autism, in 1943. These individuals usually learn to talk, but they
remain very severely handicapped because of extremely rigid thinking, poor
ability to generalize, and no common sense. Some of the Kanner people have want
skills, such as calendar calculation. The savant group comprises about 10
percent of the children and adults who are diagnosed.
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child with classic Kanner's syndrome has little or no flexibility of thinking
or behavior. Charles Hart describes this rigidity in his autistic brother,
Sumner, who had to be constantly coached by his mother. He had to be told each
step of getting undressed and going to bed. Hart goes on to describe the
behavior of his autistic son, Ted, during a birthday party when ice cream cones
were served. The other children immediately began to lick them, but Ted just
stared at his and appeared to be afraid of it. He didn't know what to do,
because in the past he had eaten ice cream with a spoon.
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serious problem for people with Kanner's syndrome is lack of common sense. They
can easily learn how to get on a bus to go to school, but have no idea what to
do if something interrupts the routine. Any disruption of routine causes a
panic attack, anxiety, or a flight response, unless the person is taught what
to do when something goes wrong. Rigid thinking makes it difficult to teach
people with Kanner-type autism the subtleties of socially appropriate behavior.
For example, at an autism meeting, a young man with Kanner's syndrome walked up
to every person and asked, "Where are your earrings?" Kanner
autistics need to be told in a clear simple way what is appropriate and.
inappropriate social behavior.
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Uta
Frith, a researcher at the MRC Cognitive Development Unit in London, has found
that some people with Kanner's syndrome are unable to imagine what another
person is thinking. She developed a "theory of mind" test to
determine the extent of the problem. For example, Joe, Dick, and a person with
autism are sitting at a table. Joe places a candy bar in a box and shuts the
lid. The telephone rings, and Dick leaves the room to answer the phone. While
Dick is gone, Joe eats the candy bar and puts a pen in the box. The autistic
person who is watching is asked, "What does Dick think is in the
box?" Many people with autism will give the wrong answer and say "a
pen." They are not able to figure out that Dick, who is now outside the
room, thinks that the box still contains a candy bar.
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People
with Asperger's syndrome, who tend to be far less handicapped than people with
Kanner-type autism, can usually pass this test and generally perform better on
tests of flexible problem-solving than Kanner's syndrome autistics. In fact,
many Asperger individuals never get formally diagnosed, and they often hold
jobs and live independently. Children with Asperger's syndrome have more normal
speech development and much better cognitive skills than those with classic
Kanner's. Another label for Asperger's syndrome is "high-functioning
autism." One noticeable difference between Kanner's and Asperger's
syndromes is that Asperger children are often clumsy The diagnosis of
Asperger's is often confused with PDD, a label that is applied to children with
mild symptoms which are not quite serious enough to call for one of the other
labels.
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Children
diagnosed as having disintegrative disorder start to develop normal speech and
social behavior and then regress and lose their speech after age two. Many of
them never regain their speech, and they have difficulty learning simple
household chores. These individuals are also referred to as having
lowfunctioning autism, and they require supervised living arrangements for
their entire lives. Some children with disintegrative disorder improve and
become high-functioning, but overall, children in this category are likely to
remain low-functioning. There is a large group of children labeled autistic who
start to develop normally and then regress and lose their speech before age
two. These early regressives sometimes have a better prognosis than late regressives.
Those who never learn to talk usually have severe neurological impairments that
show up on routine tests. They are also more likely to have epilepsy than
Kanner or Asperger children. Individuals who are low-functioning often have
very poor ability to understand spoken words. Kanner, Asperger and PDD children
and adults usually have a much better ability to understand speech.
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Children
in all of the diagnostic categories benefit from placement in a good
educational program. Prognosis is improved if intensive education is started
before age three. I finally learned to speak at three and a half, after a year
of intensive speech therapy Children who regress at eighteen to twenty-four
months of age respond to intensive educational programs when speech loss first
occurs, but as they become older they may require calmer, quieter teaching
methods to prevent sensory overload. If an educational program is successful,
many autistic symptoms become less severe.
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Temple
Grandin "Thinking in Pictures" (1996)
