Table Of ContentRelated Titles
Cartledge/Milburn Teaching Social Skills to Children
Goldstein Prescriptions for Child Mental Health and Education
Schwartz/Johnson Psychopathology of Childhood: A Clinical-
Experimental Perspective
Wing Early Childhood Autism: Clinical, Educational, and Social
Aspects, 2nd Edition
iûpTSM
New Directions in
Research and
Education
Edited by
Christopher D. Webster
Metropolitan Toronto Forensic Service
M. Mary Konstantareas
Clark Institute of Psychiatry. Toronto
Joel Oxman
York University. Ontario
Judith E. Mack
York University. Ontario
Pergamon Press
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Copyright © 1980 Pergamon Press Inc.
Library of Congress Cataloging in Publication Data
Main entry under title:
Autism, new directions in research and education.
(Pergamon policy studies)
Bibliography: p.
Includes index.
1. Autism. I. Webster. Christopher D., 1936-
RJ506.A9A923 1980 618.9'28'982 79-19732
ISBN 0-08-025083-1
All Rights reserved. No part of this publication may be reproduced,
stored in a retrieval system or transmitted in any form or by any means:
electronic, electrostatic, magnetic tape, mechanical, photocopying,
recording or otherwise, without permission in writing from the
publishers.
Printed in the United States of America
To George y Lorne Timmy Joey Marlene y Ppinder and the
y y t
many other children and their families
Foreword
Childhood autism and related conditions can be defined by the presence of severe
language impairments, poverty of social interaction, and repetitive stereotyped
activities in place of the imaginative and social pursuits of normal children.
Behind the apparent simplicity of this description lies a bewildering complexity.
The defining characteristics vary in their severity and the precise form they take.
Although some organic conditions are reported more often than others, autism
can be associated with virtually any kind of pathology affecting the central
nervous system. The details of the clinical picture differ between children, and
they also change with the environment and with age. If these facts are not enough
to daunt those working in this field, it is becoming increasingly clear that many
different patterns of language, cognitive, and perceptual impairments can be
found in children with the autistic behavior pattern.
The special interest and pleasure of this book lies in the fact that the editors and
their co-authors acknowledge the diversity of the phenomena classified under the
label of autism, and accept that no universal solution to the problems of aeti
ology, education, and management can be found.
The chapters describing the experiences of the families, and the engaging
account of the trials and tribulations of a psychologist working with an autistic
child are used to underline the necessity for professionals to learn something new
from every child with whom they work. The discussions of the successes and
failures of educational programs continue this theme and lead on to a detailed and
helpful section on the value and limitations of a method of teaching language
through simultaneous use of signs and speech.
An important point emphasized throughout the work, and one with which I am
in whole-hearted agreement, is that an autistic child can be helped only if a
serious attempt is made to see the world from his point of view, so that the
adaptive function of much of his peculiar behavior can be understood in the
context of his handicaps. This contrasts with the rigid behaviorist approach of "if
it is socially unacceptable, eliminate it," but does not preclude the use of behav
ioral methods that have proven useful in practice, as one part of a wide edu
cational approach.
Being closely involved in both aspects of the problems of autism, I particularly
appreciate the collaboration in this book of parents and professional authors.
Readers, whatever their connection with the subject, will find this book
thought-provoking, stimulating, and a source of new ideas, both theoretical and
practical. Lorna Wing
xi
Preface
In the early 1970s, a few of us within the Child and Family Studies Centre of the
Clarke Institute of Psychiatry in Toronto began to work with autistic children and
their families. Our approach initially involved language and socialization training
with a few children and home management programming with their families.
With the formation of a clinical research team, we began a simultaneous com
munication program for a number of nonverbal autistic children. The progress of
the children in that program was quite encouraging, and our efforts to pursue
work in the field became intensified. We began to think that we were finding
some answers to the many puzzling questions about the severe communication
deficits and social isolation of autistic children, and we were soon involved in a
good deal of clinical and research work, teaching and consultation. The hypoth
eses and ' 'answers" which we were beginning to formulate, however, were
increasingly challenged by both old and new questions concerning the etiology of
autism, the actual clinical and developmental progress of the children, and our
sometimes unsatisfactory attempts to design optimally effective educational and
therapeutic procedures for them.
As we came to know each individual child better, we realized that our original
operant-based treatment approach had to be tempered with a greater appreciation
of the complexity of the autistic syndrome itself. We then embarked on a series
of clinical research projects, laboratory, observational, and theoretical studies.
We became concerned, for instance, with normal and atypical patterns in the
development of social play, speech and language acquisition, the communicative
and cognitive functions of speech, gesture and sign language, ethological theory,
microkinesic research, the impact of parental and family involvement on the
child's treatment, and with some of the children's unique ways of gathering
information from their environment. We began to realize the necessity of study
ing each child's ability to make use of perceptual, proprioceptive, and sensory
cues in learning and problem solving.
Through these endeavors, and our involvement with the children and their
families, we came to adopt a certain viewpoint about autism and related dis
orders—a perspective which has guided, and continues to direct, our clinical
work and our understanding of this puzzling phenomenon. In this volume, we
have assembled a series of formal and informal papers in an attempt to describe
this perspective. The various chapters are intended to provide some detail of our
clinical and research effort, and to reflect our particular view on autism. In
offering this collection of articles, we hope to provide information, thoughts, and
xiii
xiv Preface
questions which might prove useful to other researchers, clinicians, teachers, and
students. Our primary objective, of course, is that by elaborating this perspective
on autism, others might employ and expand it in their work; and we especially
hope this study may induce other people at least to study, if not to change, their
own manner of relating to autistic persons.
While the position we offer can be best appreciated by reading at least some of
the chapters contained in this book, it is perhaps necessary to give the reader a
general idea of what this involves, and of what lies ahead. We have come to take
a position which incorporates some aspects of the medical-psychological tradi
tion and some aspects of the descriptive-subjective point of view. The former
position (exemplified by the recent writings of Colman, 1976; and Ritvo,
Freeman, Ornitz, and Tanguay, 1976) may be characterized by a commitment to
carefully controlled laboratory studies, the explicit definition of behavioral
characteristics, and stimulus-response contingencies, and by the study of observ
able and 4tre.liable" indexes of development and functioning. Much of the re
search carried out in this tradition has been concerned with aspects of
information-processing, metabolic errors, genetic abnormalities, and neurolog
ical impairments. That this approach to the study and treatment of autistic people
is of importance can hardly be doubted, and we have followed it in much of our
work.
The descriptive-subjective point of view (characterized by such works as
Kaufman's Son Rise, 1976), however, has also been an integral part of our work
and study. Articles and books in this tradition are often the contributions of
articulate parents, siblings, and teachers of autistic children. Those writing from
this perspective are concerned with providing detailed, personal accounts of their
children, and of their successes and failures in trying to help the children cope
with the demands of an often difficult world. Importantly, it would seem that our
clinical and research endeavors should be aligned with the expressed priorities
and values which so many parents hold for their children. Our structured inter
views with parents, some of which are outlined in the text, remind us that we
must have an eye to ensuring that the child derives enjoyment and satisfaction
from life. As we attempt to show, important and challenging positions, some
times similar to those found in the medical-psychological tradition, have recently
come from this orientation.
The overall view of autism which we have adopted, then, is one which com
bines various contributions from both of these major traditions. Our own and
others' research over the past decade has made it quite clear that autistic children
are beset by extensive and severe learning disabilities. We propose that the
children's extreme difficulties with the perception, processing, and retention of
sensory information begin in infancy. Such deficits would seem to be integrally
related to problems of cognitive and affective development and functioning. It
appears quite probable, as well, that the academic, communicative, and social
problems of many autistic children may be the result of neurological, biochem
ical, and/or genetic abnormalities. Our approach to working and interacting with
the children aims at taking these factors into account. Providing the children with
Preface xv
an appropriate and usable perceptual environment is a central aspect of our
approach, as is helping the children to discover and employ their strongest
information-processing and communicative modalities. The reader will note that
we have placed very heavy emphasis on simultaneous communication (sign
language together with spoken words) as an avenue through which relationships
can be formed. There are several reasons for doing this: first, no other book on
autism has stressed this approach; second, the ideas underlying the use of the
technique seem fundamentally useful in teaching; third, our experience with
these methods has been rewarding for us and, we believe, for the children.
While we do not subscribe to the view that autism results from inadequate
mothering in early childhood, our own and others' studies of interactional or
ganization have strongly suggested that the cognitive and perceptual deficits
associated with autism can result in severe disruption and retardation of social
and emotional development. In^particular, we have come to appreciate the very
central role of communication deficiency in the development of the autistic
syndrome, and stress the need to employ educational and therapeutic procedures
which might, at least partially, alleviate the child's aloneness.
The perspective we present, then, is one characterized by an overriding con
cern for meeting the autistic child in mutual territory. We expect of the children
that they attempt to learn and approach our conventional manners of com
municating and interacting. At the same time, however, we demand of ourselves
that we try to approach the children in their world. Quite obviously, such en
deavors require careful consideration of experimental findings on the modality
preferences and conceptual capacities of the children, as well as a thoughtful
consideration of their motivations and hesitancies to interact with others.
Our point of view is one which advocates the inclusion of our intuitions about
the children along with our laboratory findings in an attempt at building a model
of autism which might make our understanding of this puzzling phenomenon a
little clearer. This means that we must try to be both ' 'objective' ' and ' 'subjective' '
about the children and about the study of autism. It is just such a rapprochement
between the two traditions discussed, we believe, which is called for in the study
of this disorder and in a sensitive approach to treatment and communication with
the children. Our hope is that the present effort to write a book combining these
two points of view may help to bring together parents and clinicians for the
benefit of autistic children. In addition to the parents and clinicians, the book is
addressed to the eager college or university student who is searching to under
stand the many facets of the world of the autistic child. Over the years we have
worked with many bright and stimulating students and have come to appreciate
that it is their hard work and dedication that may help us overcome the many
constraints that still prevent us from understanding fully this unique disorder.
Acknowledgments
We would like to thank all of those parents who allowed us to contribute their
material to this book. Also we acknowledge with thanks the publishers of the
Journal of Autism and Childhood Schizophrenia for allowing us to report the
1973 article by Webster et al., the 1977 comment on punishment, and two
figures from the Sherman and Webster (1974) paper. Academic Press is to be
thanked for allowing us to reproduce figures from an article by Konstantareas et
al. (1978); and the Journal of Child Psychology and Psychiatry for allowing us to
reproduce three tables and a figure from another article by Konstantareas et al.
(1979). We thank the Journal of Applied Behavior Analysis for permission to
publish parts of an article by Wintre and Webster (1974) and also for permitting
us to quote from a paper by Lovaas et al. (1973) as well as including one figure
from that paper. We thank Child Care Quarterly for allowing us to reproduce a
version of the Webster et al. (1978) article. We also wish to thank Sign Language
Studies for permission to reproduce Oxman et al. (1978) in its entirety. The
reader will note that we have made extensive use of Helen Keller's The Story of
My Life, first published by Grosset and Dunlap, 1904.
Dr. Harvey Golombek, as Chief of the Child and Family Studies Centre at the
Clarke Institute of Psychiatry, gave our work much needed support as did his
successor, Dr. Gordon Warme. We would also like to extend our appreciation to
Dr. Frederick Lowy, Director of the Institute, for providing an atmosphere
conducive to research. We also thank students in a three week 1976 summer
credit course on autism at the University of British Columbia for their comments
on an early draft of this book. Ms. Erison Taylor took those comments into
account as she completed an overall revision of the draft. There can be no doubt
that without her good sense, hard effort and editorial skill this book would not
have come into being.
The project as a whole would never have been completed had we not received
financial support from the Ruth Schwartz Foundation, The Clarke Institute of
Psychiatry Research Fund, Health and Welfare Canada to CD. Webster (Grant
No. 606-1050-29) and to M.M. Konstantareas (Grant No. 606-1240-44), The
Ontario Mental Health Foundation (Grant No. 469), The University of Victoria
Faculty Research Fund, and the British Columbia Medical Research Foundation.
The publication of this book was assisted by a grant kindly made to the authors
by the Hospital for Sick Children Foundation.
To our typist, Linda Prichard, many thanks. Thanks are due to Mrs. Margaret
McKay for helping with many of the final details of the manuscript. Our appreci-
xvii
x viii Acknowledgments
ation is also extended to the editorial staff of Pergamon Press. But our warmest
praise needs to be saved for all the children and parents who participated so
willingly and cheerfully in all our testing sessions, interviews, and experiments.
