Abstract
A number of parents I know of children with autism joke that everyone is on the spectrum somewhere. In this issue of Autism, White and colleagues examined the mediating role of social anxiety in the association between autism characteristics and hostility in a sample of more than 600 college students. Of most interest may be their dimensional approach to measuring autism using the Autism Spectrum Quotient. While only 13 participants obtained a score indicative of autism, the distribution was relatively normal, suggesting that these parents may be correct, and quantitative approaches to measuring autism may have similar utility to that found for measuring other psychiatric disorders such as anxiety and depression.
In their review entitled “Confusion and inconsistency in diagnosis of Asperger syndrome,” Sharma and colleagues tackle the challenges of a categorical (as opposed to dimensional) approach to diagnosis, finding that the criteria for Asperger disorder listed in the Diagnostic and Statistical Manual of Mental Disorders do not reliably distinguish between individuals with Asperger and those with other autism spectrum disorders. While they leave the door open for more granular distinctions that are not listed in the DSM, their findings generally show a lack of support for this categorical distinction.
Another manuscript in the current issue also addresses the issue of diagnostic reliability. Maljaars and colleagues examine the validity of the “Diagnostic Interview for Social and Communication Disorders in young and low-functioning children,” finding good sensitivity and specificity among children with mild intellectual disability, but poorer specificity among those with more profound cognitive impairments. The authors suggest that the utility of the DISCO as a quantitative measure is an important avenue for exploration as a measure of severity, again suggesting the potential dimensional quality of autism traits.
Two studies in this issue address issues related to treatment. Patterson and colleagues review the contributions of single subject tests of training programs for parents. They find that this corpus of research is generally of moderate quality, and does not support the generalization or maintenance of effects, with one exception. These studies do not differ that much from group tests of parent-mediated interventions, which do not show the same effects as clinician-led interventions conducted in university-based research settings. These frustrating results suggest at least two possibilities: first, our field has a general challenge in moving proven-efficacious interventions from the lab to the community, regardless of who is leading the intervention. Second, while we have grown increasingly sophisticated in our methods to change behavior among children with autism, we do not have the same strength as a field in changing parent behavior. Ultimately, we may need to marry our intervention techniques to the well-developed field of adult behavior change.
A second study with intervention implications was conducted by Kissine and colleagues, and examines the impact of sentence type on compliance requests by children with autism. The results suggest that sentence type is not an important predictor of compliance, and should not inform interventions to change children’s behavior.
The final study in this issue was conducted by Griffith and colleagues, and examines the support experiences and needs of adults with Asperger syndrome. This qualitative study found that, as many families and individuals with autism can attest to, the service system for adults in generally not suited to their needs, and they struggle with employment and participation in main stream society. Perhaps as a result, anxiety and depression are common. Clearly much work is left to do to create a society in which individuals with autism (and other disabilities) have maximum potential to live independent, self-determined and meaningful lives.