Diagnostic History and Current Neurological Research
Autism was first described in a 1943 case report by psychiatrist, Leo Kanner as a disorder resulting in children’s “inability to relate themselves” to other people or their environments (Kanner, 1943, p 242). In the early days it was considered part of childhood schizophrenia and thought to be the result of parenting deficits. It was first introduced as a disorder distinct from childhood schizophrenia in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). Today, the DSM-5 classifies ASD as deficits in social skills, and restricted and repetitive behaviors and interests (American Psychiatric Association, 2013). To this day, the exact etiology of Autism Spectrum Disorders (ASD) is still unknown with research pointing to genetic and environmental influences (Bailey, Phillips, Rutter, 1999; Dufour-Rainfray, Vourc’H, Tourlet, Guilloteau, Chalon & Andres, 2011). Narrowing down a specific mechanism for ASD has posed a challenge because of the wide variability in genetic markers and presentation. One theory is that there is disrupted cortical connectivity in ASD youth (Kana, Uddin, Kenet, Chugani & Müller, 2014). This refers to both an underconnectivity and overconnectivity between brain regions resulting in under and over stimulation respectively. Researchers have also found a link between increased paternal age and autism (Alter et al., 2011). It appears that gene expression levels are altered with increased paternal age, which can manifest as autism or other neurodevelopmental disorders. Finally, there is also evidence that exposure to certain teratogens, such as alcohol, during the prenatal period has been linked to ASD (Dufour-Rainfray, Vourc’H, Tourlet, Guilloteau, Chalon & Andres, 2011). This is by no means an exhaustive list of potential biological and developmental factors related to ASD, but rather it is meant to offer a sense of the complexity that is involved in the diagnosis. Currently, the exact biological and developmental underpinnings of autism are still being determined.
Counseling Clients on the Spectrum
Beginning a therapeutic or counseling relationship with an ASD client can require more initial groundwork than with a neurotypical client. The counselor may need to review the expectations and roles for therapy in order to establish a good working relationship that is mutually beneficial for client and counselor (Paxton & Estay, 2007). Modifications such as shorter sessions and written diagrams can help reinforce concepts without becoming overwhelming for the client. Behavioral therapies have been found to be particularly beneficial for ASD clients given the proclivity for restricted behaviors at the expense of other, essential activities. Indeed, behavioral scales have been created specifically for ASD clients in order to assess for potential emotional stress. The Stress Survey Schedule for Persons with Autism and Other Developmental Disabilities asks the client to rate the level of stress he or she experiences during various scenarios (Groden, Diller, Bausman, Velicer, Norman & Cautela, 2001). This can be used to tailor treatment to address the client’s specific stressors, and it can be re-administered to assess progress. Overall, it is vital that the counselor is attuned to the needs of ASD client and modifies treatment in order to provide the compassionate care that is useful for the individual.