Light on isolated islets

In 1943 Leon Kanner, working from a sample of 11 disturbed children, coined the phrase "early infantile autism" (derived from the Greek autos, meaning "self"). Today it is believed that up to 1 per cent of all children suffer from an ailment somewhere in this autistic spectrum, which widened considerably one year later when Hans Asperger wrote about another bizarre behaviour pattern found in some older children and adolescents. Such children and adults had existed before, but denied any clinical label they were usually treated as eccentrics or outsiders. A more fortunate example could have been Brother Jupiter, a follower of Saint Francis of Assisi, said to have combined naive innocence with a complete lack of social inhibition or common sense. A sadder case might be the boy thought to be possessed of the devil who was reported to Martin Luther. The man of God recommended that he be taken to a river and drowned because he self-evidently possessed no soul.

Autism and its related disorders continue to remain something of an unknown in public perception. It is always easier to blame parents for the very badly behaved child in the supermarket rather than wonder whether he or she might suffer from autism. Autistic adults in their turn can still safely be mocked for their social incompetence or enjoyed in the shape of that most unfunny of all contemporary television comic characters, Rowan Atkinson's Mr Bean. Hard-pressed parents of autistic children, meanwhile, often up against official apathy, penny-pinching and prejudice, need all the help they can get.

A warm welcome therefore to Autism, an international journal of research and practice published each July and November and now in its third issue. Edited by Patricia Howlin and Rita Jordan, each issue after the debut edition of July 1997 focuses on a particular aspect of autism. One concentrates on epidemiology and intervention; another chooses diagnosis, development and treatment.

The journal's aim is to communicate with a wider audience than the usual academic in-group focusing on a chosen area of research. Parents of autistic children, often a well-informed bunch, are particularly targeted. It was mainly through their efforts that Kanner's original conviction that parents bore some responsibility for a child's autism came to be rejected. Refusing to accept the image of humourless perfectionists who could drive any child into a psychiatric state, parents put their energies into forming the National Autistic Society with the main aim of inspiring and collating more rigorous research.

The history of this whole development is related by Lorna Wing. She notes that when Henry Maudsley first suggested in 1867 that there could be such a thing as childhood psychosis, the idea was seen as an affront to prevailing notions of childhood innocence and purity. Years later, when Kanner wrote his first paper on autism, elements of this lingering idealisation still persisted. Kanner's belief that autistic children were always of great if eccentric intelligence has proved to be false. Whatever the folk myths that have arisen since, autism is found in all ranks of society, and sufferers range from highly intelligent achievers in isolated areas to extreme backwardness over the whole range.

There is still no cure for autism, yet parents generally report relief once a diagnosis has been made. Aware that there is something different about their child usually from about the age of two, parents often have to wait four more years for an official diagnosis. The urgent need for specialised help in the first, often very stressful years may therefore go begging. Today's Teacch programme (Treatment and Education of Autistic and Related Communication Handicapped Children) devised in the United States and described in the journal by Gary Mesibov, works on the assumption that visual information is more easily processed by people with autism than verbal information. Computers can also be extremely effective when it comes to offering clear commands to children for whom ambiguity and enforced human contact can sometimes amount to mental torture. Newer techniques and acronyms like the highly promising Pecs (Picture Exchange Communication System), also devised in the US and only recently introduced into Britain, await the academic scrutiny that this journal offers.

In one article, Barbara Kugler discusses whether autism and Asperger's syndrome are basically the same or different. Both seem to derive from genetic causes and describe a state of social impairment commonly associated with poor eye contact, stereotypical behaviour, resistance to change and a very circumscribed set of social interests. Divergences include language, where Asperger found a marked fluency and sometimes extraordinary originality of thought far more than was the case with autistic children. Within these "islets" of intelligence, Asperger's syndrome children can occasionally outstrip their contemporaries. But there is also a lack of central coherence capable of melding multiple sources of information into a meaningful whole. Yet when it comes to employment, these individuals can often put in excellent performances in areas where face-to-face interaction is less important than the performance of physical skills.

In another paper on native savant talent and acquired skill, Linda Pring and Beate Hermelin consider the case of Stephen Wiltshire, with additional comments from Michael Buhler and Iain Walker from the City of London Art School. A brilliant, intuitive artist whose pictures sold when he was still a child, Stephen possessed a low IQ, which would normally render him unemployable. While his early drawings showed an astonishing grasp of space and perspective, they lacked any sense of tone or feeling. The dilemma for Stephen's teachers once he went to art college was to decide what to teach him. Illustrations of his work show the way in which lessons in tonal values led to some striking developments in technique. But attempts at getting Stephen to add feeling to his pictures were unsuccessful. His teachers concluded that encouraging him to develop a distinctive attitude towards what he draws might never be possible and could be construed as an invasion of his privacy.

Difficult areas of personal choice and behaviour such as this make appropriate material for Autism. At what stage, for example, should eccentric, egocentric behaviour qualify as evidence of Asperger's syndrome? To what extent should it be society that changes its attitudes to non-joiners, rather than always expecting those on the autistic spectrum to behave more like everybody else? What should happen within a normal parental culture of encouragement towards an acceptable mode of behaviour in the family with children who might suffer from attention deficit hyperactivity disorder, dyspraxia, Tourette's syndrome or autism? One of the best features of Autism is the inclusion of first-hand accounts of suffering from an autistic disorder or of living with someone who does. The issues such contributions raise alone are enough to keep researchers, and social philosophers, busy for years.

Nicholas Tucker is lecturer in psychology, University of Sussex.