BACKGROUND: Despite years of intensive research, there is much about autism that remains theoretically and practically difficult to understand. There are presently three main theories: (1) defect of theory of mind, (2) executive dysfunction, and (3) lack of central coherence, i.e. an inability to integrate sensation and behavior into complex and sensible wholes. CASE REPORT: The patient, Damian S, born 1993, was diagnosed in early childhood with profound autism. He has been closely observed longitudinally by the first author, who is his therapist. Despite the absence of noticeable improvement in standard psychometric tests, he has shown considerable clinical progress. However, he continues to have difficulty in making and maintaining contact with others: he converses spontaneously only with his father and his teacher, and interacts with other persons (including his mother) only in the presence of one of these two persons. However, he has learned to use a computer to communicate. Samples of dialogue are provided to help illuminate how he thinks. CONCLUSIONS: Despite his profound autism, Damian displays awareness of and concern for the thoughts and feelings of others. He is also able to solve problems. On the basis of this and other observations, the authors suggest that the "central coherence" theory better explains the available observations and data.
BACKGROUND: Despite years of intensive research, there is much about autism that remains theoretically and practically difficult to understand. There are presently three main theories: (1) defect of theory of mind, (2) executive dysfunction, and (3) lack of central coherence, i.e. an inability to integrate sensation and behavior into complex and sensible wholes. CASE REPORT: The patient, Damian S, born 1993, was diagnosed in early childhood with profound autism. He has been closely observed longitudinally by the first author, who is his therapist. Despite the absence of noticeable improvement in standard psychometric tests, he has shown considerable clinical progress. However, he continues to have difficulty in making and maintaining contact with others: he converses spontaneously only with his father and his teacher, and interacts with other persons (including his mother) only in the presence of one of these two persons. However, he has learned to use a computer to communicate. Samples of dialogue are provided to help illuminate how he thinks. CONCLUSIONS: Despite his profound autism, Damian displays awareness of and concern for the thoughts and feelings of others. He is also able to solve problems. On the basis of this and other observations, the authors suggest that the "central coherence" theory better explains the available observations and data.