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The Changing View of Autism

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The Changing View of Autism NATURE|Vol 446|8 March 2007 BOOKS & ARTS Life at the poles Despite its harsh climate, the the organisms that live there, and Arctic Circle is home to a rich discusses the impact of humans on MICHELSON P. fauna, including the male this fragile environment. ptarmigan pictured here. A year- The World of the Polar Bear (Firefly, round resident of the Arctic, £29.99, $45) features a collection this bird retains his summer of stunning photographs by plumage on his head, with white Norbert Rosing. The book explores winter feathers on his body. In a year in the life of the polar bear A Complete Guide to Arctic Wildlife and the environment it inhabits. (A&C Black, £40), Richard Sale Surviving Antarctica by David N. provides an extensive field guide Thomas, to be published by Natural to the birds and mammals that History Museum Publishing next inhabit this harsh and unforgiving month (£9.99), examines how environment. The book also endemic inhabitants and human provides an introduction to the visitors at the other pole survive geology and geography of the in one of the most inhospitable region, shows how this has shaped regions on the planet. The changing view of autism Unstrange Minds: Remapping the World that, despite the lack of convincing scientific South Korea. Each culture has very differ- of Autism evidence, the increase is due to environmental ent explanations for the strange behaviour of by Roy Richard Grinker causes such as pollution or a combined vac- these children. However, in all societies, the Basic Books: 2007. 304 pp. $26 cination against mumps, measles and rubella main burden of caring for a child with autism (the MMR vaccine). is borne by the mother. During much of the Lorna Wing Grinker firmly rejects this view and rebuts twentieth century, especially in the West, the The term ‘autism’ was coined by Leo Kanner any suggestion of an autism epidemic. He gives distress they suffered was intensified by psy- in 1943 as a label for a disordered pattern of a compelling account of the complex way in chiatrists and psychoanalysts who blamed the behaviour present from infancy that he and his which our understanding of the nature of autis- mother for the child’s strange behaviour. The colleague Leon Eisenberg had observed. They tic conditions has evolved. Children and adults fact that there are no visible signs of the brain defined it very narrowly, as a profound lack of with autistic behaviour have always existed, disorder underlying autism reinforced the ten- affective contact with other people, combined but in the past they were considered to be suf- dency to look for a non-physical reason for the with an obsessive desire for the preservation fering from other conditions such as mental socially unacceptable behaviour. In some other of ‘sameness’ that results in elaborate, repeti- retardation, behaviour disorder or, in some societies, the shame of having a child with a tive routines. cultures, some sort of malign influence. Once developmental disorder adds immeasurably In Unstrange Minds, Roy Grinker combines autism was identified as a childhood condition, to the family’s problems. One of the messages his experiences as an anthropologist and as a researchers, clinicians and parents all contrib- of this book is that personal experience of any father of a teenage daughter with autism, Isabel, uted to the changes in diagnostic criteria. illness or disability is deeply affected by the to provide a fresh view of the challenges posed Autism is no longer seen simply as Kan- culture in which one lives. by this condition. He interweaves three themes: ner’s precisely defined, very rare condition, Isabel’s story is interwoven with the other first, the evolution of ideas about the nature affecting as few as one or two children in every themes. Her parents’ acceptance and love for of autism and the effect of these changes on 10,000 and separate from all other childhood her is evident in everything Grinker writes. She studies of prevalence; second, the intimate con- disorders. It is viewed instead as part of a has typically autistic visuospatial and memory nection between cultural attitudes to autism spectrum of disorders of brain development skills, and a high IQ if the measurement is and the quality of life for those affected and causing impairments in social interaction, based on these abilities. But this is combined their families; and third, the story of his own social communication and social imagina- with the autistic lack of inborn social skills, so daughter’s development and the struggles that tion, along with a limited, repetitive pattern she has trouble adapting her abilities to social he and his wife have experienced in the United of behaviour. This spectrum has very wide demands. It is strange to think how recently States to ensure that Isabel has the support and manifestations that overlap with other develop- psychologists became aware that social skills education she needs. mental disorders and occur in people of any are an important dimension of overall ability. Grinker’s discussion of the changing con- level of ability. The best evidence suggests a As a mother of a daughter with autism, cepts of autism and its prevalence is highly prevalence of around 10 in 1,000, even higher I know that parents will empathize with the topical. Some people believe that the number than the 6 in 1,000 quoted by the author. author and be fascinated by his view of the sub- of children with autism has increased at an Grinker sees the higher reported prevalence ject and the stories he tells. As a professional, alarming rate since the 1990s and describe as good news, as it indicates growing under- I recommend this book to those working in the this as an ‘autism epidemic’. But many others standing and acceptance. field for its thought-provoking examination of think that most, if not all, of the rise in preva- Grinker’s exploration of cultural differ- important themes. ■ lence reported in epidemiological studies can ences in attitudes to autism is very moving. Lorna Wing is honorary consultant psychiatrist be explained by increasing awareness and a He describes the experiences of individual at the Centre for Social and Communication widening of diagnostic criteria. Feelings run children and their families in South Africa Disorders, 113 Masons Hill, Bromley, high, especially among those who believe (a Zulu family), the United States, India and Kent BR2 9HT, UK. 141.
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