Since Kanner and Asperger’s work in the 1940s, and
with the recent refutal of the pseudo-association
between autism spectrum disorders (ASD) incidence
rates and thimerosal (1), autism continues to draw its
share of controversies and interrogations. According to
the DSM-IV criteria, autism is a neurodevelopmental
condition characterized by variable degrees of restricted
stereotyped behavior, impairment in communication
and establishing interpersonal relationships (2). There
has been an exponential increase in interest and
research in the area of ASD which now offers a
fascinating spectrum of theories to find possible
etiologies underlying the condition. These extend from
neuroautoimmunity (3) to environmental factors
affecting genetics (4-6), including parental occupation
and teratogen exposure, with fascinating new
developments that deepen the understanding of the
differences – and similarities – between ASD subjects
and the phenotypic population.Qualifying intelligence as a single parameter, the
intellectual quotient, would be an insult to the
complexity of the human learning experience. As such,
vast areas of study, ranging from population trends to
the anthropologic and evolutionary rationalization of
autism (7-8), and including relatively recent
electrophysiological studies, neurological imaging (9)
and deeper behavioral analysis, testify of the multifactorial
dimension of the autism spectrum disorders.Understanding the thought processing differences
characterizing cognition in ASD would allow the
conception of standardized and effective educational
materials tailored to the specific needs of those with the
condition. A striking example of how targeted
intervention brought about surprisingly rapid gains
involved the creation of a DVD series specifically
conceived to improve social intelligence and
recognition of emotional modalities in children with
pervasive developmental delay (10). The production of
now widely-available educational materials, developed
with federal funding and based on behavioral and
psychological studies, clearly demonstrates how
research in this field can be translated into concrete
improvement in functionality and social integration of
patients suffering from ASD.The concept of mirror neuron system (MNS) –
specific cells independent of any neural circuitry which
fire irrespectively of whether the action is performed by
oneself or witnessed in others – provides an interesting
theory for the impairment in social intelligence
characterizing most if not the entire ASD spectrum (11).
The lack of development of MNS is an example of one of the current hypotheses behind ASD causality, and the
inability to vicariously experience an action or emotion
manifested in a peer could be at the origin of
impairment in empathy and emotional processing.Interestingly, a similar MNS model associating subtle
musicality cues to emotional undertones has been
demonstrated to be more finely tuned in subjects with
ASD (12), providing a rationale and reinforcing the
current pertinence of the use of musicotherapy long
before neurological models were studied.Differences in auditory and visual processing in
subjects with ASD (13-14) should also not be
overlooked, as these provide major answers and can
help ease the burden placed on family members and
peers reaching out to a relative with ASD. Further, the
design of educational resources, such as the use of only
preferred motion patterns in the DVD series noted
above, can help others to begin to understand some of
the fundamental differences of how ASD affects an
individual’s perception of the world around them.Sensorium differences characteristic in the ASD
population (15) provide a better understanding of the
motive behind the stereotypical movements
characterized in ASD, such as hand flapping in young
children, can be viewed as an enjoyable and soothing
stimuli rather than dysfunctional behavior. Furthermore,
those differences in processing and integration of
external sensory stimuli shape the perspective of
children with ASD, which plays a role in the manner in
which they develop aversive or preferential behaviors,
communication and social skills (16) to name a few.The evolutionary point of view approaches
existentialism pondering and offers interesting theories
that translate into different anthropological
considerations of ASD, looking at phylogeny, epistatic
interactions and genomic imprinting among others (7).
The apparent increase in rates of ASD as noted recently
reflects drastic improvements in our ability to recognize
ASD at an earlier age rather than a crude increase in
incidence (8).Although the resources have drastically improved in
the past decade, in parallel to our understanding of
ASD, a lot remains to be done in terms of social
integration, especially during childhood and
adolescence, education and availability of services.
Waiting lists for initial assessment of young children
with ASD are too long – up to one year and a half in
Quebec - considering that the earlier stimulation is
initiated, the better off is the child in terms of autonomy
and acquired skills.As the rates of ASD is currently estimated to be 1 in 150 children (17), it is imperative that healthcare and
education professionals receive tailored training in
order to improve communication and attending the
particular needs of children and adults with ASD. As
awareness is the first step to acceptance and social
integration, education of the general public on one
hand, and adaptation of teaching tools based on the
outcomes of multidisciplinary studies on the other, we
hope to see drastic improvements in both the
functioning and quality of life for our peers diagnosed
with ASD. Rather than a dichotomy, they incarnate an
alternative way of being.We therefore present, in this issue of the MJM, a
collection of papers to provide our readers with a mere
taste of the vast array of exciting advancements being
made in understanding the complex issues associated
with ASD.