Autism

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Editorial
Dermot Bowler
Autism 2010 14: 555
DOI: 10.1177/1362361310390570
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autism 2010
SAGE Publications
and The National
Autistic Society
Vol 14(6) 555557; 390570
1362-3613(2010)

Editorial

In keeping with the aims and scope of the journal, the papers in this issue
cover a wide range of facets of the science of autism spectrum disorder
(ASD), from characterisation of its behavioural features, through to interventions. The first contribution, by Whitehouse and colleagues, reports a
study of communication difficulties in parents of individuals with ASD
with or without signs of the broader autism phenotype. The authors use
the Communication Checklist Adult Version to assess structural language, pragmatic and social engagement difficulties in individuals with ASD, their
parents and a non-autism comparison group. The most striking aspect of
the findings of this study is that the parents who show the broader phenotype tend to manifest pragmatic and social engagement difficulties but not
difficulties with structural language, suggesting that these two capacities
may develop independently of each other in ASD. This dissociation resonates
with some of the findings reported in later papers and prompts some
interesting theoretical speculation about the relation between language and
thinking in ASD.
A matter of continuing concern for clinicians is the delay between the
time parents first become anxious about their childs behaviour and eventual
definitive diagnosis. Timely diagnosis is important because it marks the
gateway to the provision of appropriate intervention and care strategies.
The paper by Noterdaeme and Hutzelmeyer-Nickels shows that in southern
Germany, this delay is considerable albeit comparable to delays reported
across a range of countries. When considering different manifestations of
ASD, these authors found that parents first anxieties occur much earlier on
for children with autism than for children with Aspergers syndrome, with
an average subsequent time to diagnosis of about 6 and 8 years for the two,
respectively. The authors also report differences between subtypes of ASD
in the behavioural features that first caused parents concern. Parents of
children with autism most often noticed problems with language and
communication, whereas for children with Aspergers syndrome, social
difficulties and more general behavioural problems caused most parental
concern. Quite how to reduce the delay between initial concern and definitive diagnosis continues to pose a major challenge for clinicians and
service providers. An encouraging development in this respect is provided
by the paper by McClure and colleagues. These authors nicely demonstrate
how delays in diagnosis can be reduced by training local teams in diagnostic assessment and providing follow-up mentoring in the use of the
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DOI: 10.1177/1362361310390570
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555

14(6)
assessment procedures. They report a high level of inter-rater agreement
between the local teams and more specialist services, agreement that continued to increase over the period of mentoring. Finally, and perhaps most
importantly, there was a significant reduction in time spent on waiting lists
(from 36 to 13 weeks) following the introduction of local teams.
The next three papers address specific aspects of behaviour and psychological functioning in individuals with ASD. Ramachandran and colleagues
report rather surprising evidence that these individuals are as accurate and
as fast at attributing physical and psychological characteristics to photographs of people based on descriptions from which these characteristics
have to be inferred. For example, they can infer that Victor is a determined
person because he ignored his injuries and completed the race. Although
qualified by sample size and diagnostic considerations, these findings raise
the question of whether individuals with ASD reach typical levels of competence through the same routes used by typical individuals or whether they
employ compensatory strategies. One answer to this question is given by
the paper by Ben Shalom, Faran and Boucher, which presents an intriguing
case report of the way JS, an able adult with Aspergers syndrome, copes
with the memory demands posed by everyday life. In particular, despite
showing diminished performance on some verbal and nonverbal sub-tests
of a standardised memory measure, JS appears to rely on verbal encoding
to help his memory functioning. This pattern of test performance is
mirrored in his own reports of how he uses his memory. Case studies such
as this, especially when accompanied by self-report, provide invaluable
insights into the inner world of people on the autism spectrum, and are a
fruitful source of hypotheses for those of us who study memory in this
population.
The theme of compensatory work-around for core difficulties is also
echoed in the brief report by Begeer and colleagues. They found that the
emotional responses of children with autism and PDD-NOS are modulated
by prior emotional experience in ways that are different from those seen
in typical children. Whereas typical children tended to over-weight prior
sad information when rating a subsequent happy target, but not the other
way round, the ratings of children with autism were appropriately affected
by prior happy or sad information to an equal extent. Children with PDDNOS, by contrast, tended to be unaffected by prior emotional exposure.
The findings of both these studies should prompt carers and educators to
play closer attention to the patterning of emotional responses in these
groups of children and not to assume that similar behavioural outcomes
are driven by similar underlying psychological processes.
The last two papers in this issue deal with the important topic of the
effectiveness of interventions. As can be seen from the paper by Karkhaneh
AU T I S M

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EDITORIAL

and colleagues, evaluations of interventions are often characterised by

serious methodological flaws, making it almost impossible to draw conclusions about whether or not a particular intervention works. The authors
review six controlled studies of the effectiveness of the Social Stories
programme and conclude that five of the six studies showed statistically
significant changes in childrens behaviour on a variety of dimensions.
They are at pains to point out the problems inherent in the execution of
good evaluation studies as well as the need to be alert to the difference
between statistical significance and clinical impact of changes in behaviour.
A mixed but encouraging picture is presented by the last paper in this
issue. Darrou and colleagues report a large-scale, longitudinal study of
higher- and lower-functioning children with ASD in France. The authors
report heartening improvements for some children, and confirm previous
findings that degree of initial severity of autistic features coupled with level
of language and communication skills are the best predictors of outcome.
They also found an encouragingly low incidence of regression from high
to low functioning in their sample. These authors failure to observe any
association between improvement and amount of intervention may, as they
note, result from the rather diverse intervention programmes currently
available to children in France.
Darrou and colleagues observation that speech and language levels are
strong predictors of good outcome, taken together with Ben Shalom, Faran
and Bouchers observation of how their participant reported using speech
to compensate for memory difficulties and the disconnection between
structural language competence and pragmatic and social abilities reported
by Whitehouse and colleagues, highlight the need for more investigation
of the relation between language, speech and thinking in ASD. It is clear
that increased understanding of autism-specific aspects of this relation is
the key to more effective intervention.
Editor
D E R M O T B OW L E R

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