Disease, Disorder, or Indifferent? A study of Autism

Course Description: In this course, we will explore autism from its initial recognition as a disorder to its perception today. It is estimated that one in two hundred and fifty individuals worldwide has received an Autism Spectrum diagnosis. Just as there is a spectrum of disorders that affect both high and low functioning individuals, there are different ways of seeing Autism, and thus different ways of addressing treatment of individuals with ASD diagnoses. This course will provide an analysis of three different ways that autism has been defined: as a disorder, as a disease, and as a natural product of neurodiversity.

Week 1: What is Autism? Introduction and History

1. Shapin, Steven. “Seeing the Spectrum: A New History of Autism.” The New Yorker, January 25, 2016. Can be accessed at: http://www.newyorker.com/magazine/2016/01/25/seeing-the-spectrumhttp://www.newyorker.com/magazine/2016/01/25/seeing-the-spectrum

Shapin provides an appropriate introduction to our course. He explains what autism is, how it has developed, and how it is perceived today.

2. Kanner, Leo. “Autistic Disturbances of Affective Contact.” Nervous Child, 2, 217-250. Can be accessed at: http://simonsfoundation.s3.amazonaws.com/share/071207-leo-kanner-autistic-affective-contact.pdf

Leo Kanner was an Austrian psychiatrist who identified the disorder he called “autism” in this paper from 1943. The paper begins with case studies of children he observed for the common characteristics he attributed to the disorder, and continues with a discussion of his findings and his diagnosis of the group as having “autism.”

3. Wing, Lorna. “Asperger’s Syndrome: A Clinical Account.” Psychological Medicine, 11(1), 115-129. Can be accessed at: http://childstudycenter.yale.edu/autism/class/Asperger%E2%80%99s%20syndrome%20A%20clinical%20account._tcm339-166245_tcm339-284-32.pdf

At the same time that Dr. Kanner identified autism in Austria, Hans Asperger, a German psychiatrist, used the same term—without the two individuals ever having met—to diagnose children with “autistic disorder.” Dr. Asperger’s work was largely unknown to the psychiatric community until it was translated by Dr. Wing, who found that his analysis of symptoms closely related to what she had observed in children in her London neighborhood. Dr Wing and her colleagues advocated for Asperger’s Syndrome to be added to the DSM.

4. Compare the DSM diagnosis criteria for Autism (DSM I, II, III, IV, and 5) – all will be posted on blackboard. (example: DSM 5, p 50-59)

The DSM, shorthand for the Diagnostic and Statistical Manual of Mental Disorders, is the primary authority for the diagnosis of psychological disorders. An analysis of the official diagnostic criteria will inform us of how the scientific perspective of autism has changed over the years.

Week 2: Autism the Disorder

1. Ryan, J.J., Hughes, E., Katsiyannis, A., McDaniel, M., and Sprinkle, C. (2014). “Research-Based Educational Practices for Students With Autism Spectrum Disorders.” Teaching Exceptional Children, 47(2), 94-102.

Ryan et al provide a summary of the most commonly used, evidence based therapies for autism disorders, including ABA and Floortime. Skim the first few pages, but carefully read table and the rest of the paper.

2. Cuvo, Anthony. “Applied Behavior Analysis.” Encyclopedia of Neuropsychology. 230-235. Accessible on blackboard.

This article provides an overview of Applied Behavior Analysis, one of the longest-used therapies for children with autism. ABA uses discrete trial training to modify social behaviors and teach social, academic and daily living (ADL) skills.

3. Bonazinga, Laura. “Floor Time.” Encyclopedia of Neuropsychology. 1300-1305. Available on blackboard.

This article provides an overview of Floortime/the DIR method. Floortime, developed by Greenspan and Wieder in 1997, focuses on creating learning opportunities by fostering emotional engagement and meaningful interaction as the foundation for emotional, social and academic growth.

4. Maurice, C. and O’Hanion, M. “Autism’s Battle Within.” September 3, 2010. Accessible at https://www.brookings.edu/opinions/autisms-battle-within/

The authors reflect on the efficacy of ABA and Floortime in an obituary for Ivar Lovaas and Stanley Greenspan, pioneers in these two therapies.

5. Wallace, Claudia. “A Tale of Two Schools.” Time Magazine, May 7, 2006. Accessible at http://www.celebratethechildren.org/uploads/1/8/3/9/18392315/a_tale_of_two_schools_–_printout_–_time.pdf

Wallace visits two schools, one founded on ABA principles and another on Floortime, to compare their approaches, and compares the efficacies of both programs as well.

 

Week 3: Autism the Disease

1. McNeil, Donald. “An Outbreak of Autism, or a Statistical Fluke?” New York Times, March 16, 2009. Accessible at http://www.nytimes.com/2009/03/17/health/17auti.html?_r=0

In this article, the author explores “autism clusters” that are discovered and investigated by the CDC. In the cluster explored in Minneapolis, CDC officials chose to explore an ethnic link between the cases, looking for correlation between Somali-American families having children diagnosed with autism.

2. Silverman, Steve. “The Geek Syndrome.” Wired, December 1, 2001. Accessible at https://www.wired.com/2001/12/aspergers/

In this article, Silverman explores the autism cluster pinpointed in Silicon Valley. Silverman explores why such a cluster may have occurred, and what the parents in a community known for its financial success and mental acumen are doing to combat the high rates of diagnosis.

3. Macmillan, Leigh. “More Than One Ball in the Air: Paths to new treatments for autism.” Lens, November 2003. Accessible at http://www.mc.vanderbilt.edu/lens/article/?id=70&pg=999

The author explores the genetic research that has boomed in recent years, pinpointing genomic discoveries of correlations between abnormalities on specific chromosomes and autism diagnoses. Though genomic research was begun as a foundation for looking for a quick cure for autism, it was soon discovered that autism was not universal in the discrepancies it caused in the genomes of those affected.

4. Decoteau, C. L., & Underman, K. (2013). Science on Trial: The Omnibus Autism Proceedings and the Co-Production of Uncertainty. Conference Papers — American Sociological Association, 1-43. Available on blackboard.

Michelle Cedillo v. Secretary of Health and Human Services, also known as the Omnibus Proceedings, was a court case involving the family of a girl with autism who sued the United States government because they believed her autism was caused by the MMR vaccine she had received as an infant. The court ruled against causation between vaccination and autism. Vaccines are still being debated as possible inducers of autism though there is no scientific evidence to back their claim.

Week 4: Autism, the New Normal

1. Blume, Harvey. “Neurodiversity.” The Atlantic, September 1998. Accessible at http://www.theatlantic.com/magazine/archive/1998/09/neurodiversity/305909/

Harvey Blume was the first to write about neurodiversity as a concept in which individuals with autism consider themselves just as neurologically acceptable as “neurotypical” individuals.

2. Silberman, Steve. “Neurodiversity Rewires Conventional Thinking About Brains.” Wired, April 16, 2013. Accessible at https://www.wired.com/2013/04/neurodiversity/ “

Silverman explores neurodiversity in the classroom and the workplace. He includes takes on neurodiversity from interviews with high functioning individuals with autism. Notable quote: “Just because a PC is not running windows doesn’t mean it’s broken.” What does this quote mean to you?

3. Explore asan.com, the Autism Self Advocacy Network, and read https://www.wired.com/2010/10/exclusive-ari-neeman-qa/.

Ari Ne’eman is a high-functioning individual diagnosed with Asperger’s syndrome who was appointed to the National Council on Disability by President Barack Obama. Ne’eman is also the current president of ASAN. Ne’eman advocates strongly for the inclusion of individuals with autism, especially in matters that concern their education, employment and quality of life.

4. Sacks, Oliver. “An Anthropologist on Mars.” The New Yorker, December 27, 1993. Accessible at http://www.newyorker.com/magazine/1993/12/27/anthropologist-mars Can also be found as chapter 1 in Sacks’ book An Anthropologist on Mars.

For our last class, read this article written by Dr. Oliver Sacks, a well-known psychiatrist. It explores Sacks’ experience with autism before and after an interview with Temple Grandin, a high-functioning individual with autism.