Commentary: Refracting the various shades of the spectrum of autism

By Dr. Ron Leaf
Autism Partnership

Autism Spectrum Disorder has received tremendous attention in the media. This appears to be due to a number of factors including the increasing rates of diagnosis, outspoken celebrities and the recognition that with comprehensive and intensive intervention based upon Applied Behavior Analysis, there can be significant and long-lasting success. The majority of attention however, has been focused on young children. Unfortunately, this has resulted in tweens, teens and adults not receiving necessary and life-changing intervention.
While it may be true that the best time to start treatment is at a very young age, adolescents and adults can also benefit from intensive treatment. The difference in the treatment is the emphasis of intervention. Whereas in the early years the focus is on language development and academics, when working with tweens and teens, our focus becomes preparation for adulthood and most importantly teaching the skills necessary so our children can enjoy the highest quality of life. Teaching how to cope with everyday frustrations, independently navigate their world and develop meaningful friendships is absolutely critical. When treating young children, often the goal is recovery, that is, becoming indistinguishable from their peers. Although our expectations remain high when treating teens and adults, we need to focus on those skills that will bring ultimate happiness to themselves and their families.
Besides limited attention to tweens, teens and adults there has also been little focus on Asperger’s Disorder and High-Functioning Autism. First, there has been a misunderstanding on the differences between the two disorders. Often, someone who meets the diagnostic criteria of Autistic Disorder, but who is high functioning, is misdiagnosed as having Asperger’s Disorder. According to the Diagnostic and Statistical Manual (American Psychiatric Association, 2000) the difference is that with Asperger’s Disorder early language and cognitive skills are not significantly delayed. With Asperger’s there are also deficiencies in social behavior as well as areas of interest. Regardless of the diagnosis, there is a tremendous need for treatment. And with quality treatment, there can be amazing progress.
There is often the perception that those who are “fortunate” to have either High Functioning Autism or Asperger’s do not require treatment. And, if treatment were at all necessary, it would be very limited and quite simple. After all they are “high functioning.” However, we have found this to be categorically untrue. In fact treatment is often far more difficult because of the tremendous subtleties of the presenting problems such as behavior difficulties and social isolation. Moreover, therapy requires a high degree of sophistication and expertise. Besides focusing on how to deal with everyday frustrations, which can be overwhelming to our clients, intervention often requires teaching highly complex skills such as self monitoring and self regulation of behaviors, understanding other people’s perspectives, reading subtle non-verbal behaviors and learning how to artfully deal with conflicts.
Adolescents and adults with Asperger’s and High-Functioning Autism have amazing potential. Living and working independently is not only possible but should be probable. Even more importantly, having meaningful social relationships is absolutely achievable. With increased understanding of the need for life-changing intervention, dreams can be reality.