How far back do you think autism research goes? There have almost undoubtedly been autistic people as long as there have been people, but surprisingly, it was not until the 1940s that autism was discussed as its own psychiatric entity. Furthermore, there is not a true consensus as to whose research was at the forefront of Autism research. What can a philosophical inquiry tell us about the nature of Autism?
History of Autism Diagnosis
In 1943, Leo Kanner published a paper in which he claims to have discovered a new disorder unreported in medical literature. His vivid descriptions of eleven autistic children have an influential hold over autism research even to this day. In 1944, a few months after Kanner’s paper appeared, Hans Asperger published his thesis in which he makes a similar claim to discovery as Kanner. There has been some debate as to which of these authors discovered autism first (and if it was even them at all). However, ultimately, it was Kanner’s paper which drew the most attention at the time, and whose shadow is still cast over autism research.
Since these initial descriptions in the 1940s, innumerable theories have been proposed to explain and understand autism. In this article, we will discuss three of them: the theory of mind account, weak central coherence account, and enhanced perceptual functioning account. I have chosen these three partly for their influence over the autism research literature, and partly because these theories in particular came about in chronological order and in dialogue with one another, as will be made clear in the main discussion. Of course, a detailed analysis of these theories is beyond the scope of this article, however this discussion should serve as a brief introduction to their main claims and sources of evidence.
Autism, According to the DSM-5
Before we launch into the theories, it will be useful to first learn the current diagnostic criteria for autism. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, sets out five broad criteria.
First, the person must experience “persistent deficits in social communication and social interaction across multiple contexts” (APA 2013: 50). This is perhaps the most common and obvious autistic trait which all theories of autism aim to explain to some extent.
Second, “restricted, repetitive patterns of behavior, activities, or interests” (ibid.). This trait was described extensively by both Kanner and Asperger, and the fact that some autistic people have “special interests” is now common knowledge.
Third, these symptoms must be “present in the early developmental period” (ibid.), and fourth, “cause clinically significant impairment in social, occupational, or other important areas of current functioning” (ibid.).
Finally, the symptoms must be “not better explained by intellectual disability” (ibid.). Within these broad categories are a number of more specific symptoms listed, for which a certain number has to be present before a diagnosis can be made.
Theory of Mind
Perhaps the most influential theory of autism was published in 1985, and it sets out to answer the question of whether autistic children possess a “theory of mind.” Social traits are often the ones most highlighted in diagnostic criteria, so the authors suggest a possible cognitive mechanism that underlies the social difficulties. In particular, autistic people lack a theory of mind, defined as the “ability to make inferences about what other people believe to be the case in a given situation allows one to predict what they will do” (Baron-Cohen et al. 1985: 39).
The primary source of evidence for this claim is the Sally-Anne test, a staple experiment in autism research. In the test, there are two dolls – Sally and Anne. Sally places a marble in one of two baskets and leaves the room. While she is away, Anne switches the marble into the other basket. Sally then returns. The experimenters ask the subject where Sally will look for the marble. The test is designed to see whether the subject understood that the knowledge available to Sally differs from their own. If the subject answers the question correctly, this demonstrates that the subject has the ability to infer Sally’s possible mental states, and predict where she will look.
The experiment found that 16 out of the 20 autistic children (80%) failed the test. The authors conclude from this result that “the autistic children did not appreciate the difference between their own and the doll’s knowledge” (ibid. 43). The authors continue: “We conclude that the failure shown by the autistic children in our experiment constitutes a specific deficit … that is largely independent of general intellectual level and has the potential to explain both lack of pretend play and social impairment by virtue of a circumscribed cognitive failure.”
Weak Central Coherence
In 1994, almost a decade after the theory of mind account was introduced into autism literature, Frith and Happé presented an alternative theory which they believe better accounts for the non-social features of autism. While the authors are impressed with the theory of mind account, they write that it is “silent on functioning in non-social areas” (Frith and Happé 1994: 117). For example, it cannot explain the repetitive patterns of behavior or special interests that form part of the criteria listed in the DSM-5.
Of particular importance is that, even in the original paper, 20% of autistic children still passed the Sally-Anne test, which seems to suggest that some autistic children do, in fact, have a theory of mind to some degree. Thus, the theory of mind account cannot explain all the common traits of autism, nor can it explain all autistic people, either (ibid. 119).
To rectify this, the authors draw on Frith’s earlier work, in particular her concept of central coherence, which they believe can account for these non-social traits. Frith describes central coherence like a river, which pulls together information from all its smaller tributaries (1989/2003: 154).
In other words, central coherence is the brain’s ability to use context to perceive a whole, rather than its constituent parts. They write: “A characteristic of normal information processing appears to be the tendency to draw together diverse information to construct higher-level meaning in context” (1994: 121). Perhaps this aspect of cognition can explain the autistic traits that escape the theory of mind account.
The Embedded Figures Test
The primary source of evidence for the above discussion is the Embedded Figures test, which asks subjects to pick out a simple figure from a more complex drawing (see the above image). Typically, individuals struggle to isolate these embedded figures, often preferring to see the drawing as a cohesive whole. Surprisingly, the autistic children demonstrated a superior performance in this task, even better than the experimenters! The authors write: “Out of a maximum score of 25, autistic children got a mean of 21 items correct, while the two control groups (which did not differ significantly in their scores) achieved 15 or less” (ibid. 122).
This result seems to suggest that the autistic children showed a preference for the constituent parts, rather than the whole. In other words, the autistic children demonstrated weak central coherence. The authors write that “the hypothesis that people with autism show weak central coherence aims to explain both the glaring impairments and the outstanding skills of autism” (ibid. 124).
Enhanced Perceptual Functioning
The third and final theory we will discuss has been less influential than the others, but nevertheless deserves some attention. The authors, Mottron and Burack, are motivated to present this account partly due to the underappreciation of the positive features of autism (enhanced performance in some perceptual tasks, like absolute pitch), and also partly as a reaction to the weak central coherence account, which the authors claim does not capture all instances of enhanced performance or savant skills. The authors support their theory with a slew of neuroscientific literature (far too much to summarize!) but in this article we will restrict our discussion to the essential points.
The basic premise of the weak central coherence account is that “local processing is superior to the global integration of the whole as the latter process is impaired … Accordingly, a lower level of processing is not integrated into higher, or more central, processes” (Mottron and Burack 2001: 132). In other words, weak central coherence states that global processing is deficient.
However, Mottron and Burack entertain the idea that a similar asymmetry can also be achieved not from deficient global processing, but enhanced local processing. They write: “Perception is a basic and early component of processing of all information, and therefore, early problems in this area may lead to a variety of atypical behaviors” (ibid. 133). Perhaps the causal mechanism(s) responsible for autistic traits occurs at this basic, perceptual level, and this has knock-on effects further upstream.
Takeaways From the Account
The authors theorize that the enhancement of perceptual functioning occurs early in child development (ibid. 134). Since perceptual processes are entrenched the earliest, it makes sense that “they are likely to be utilized to compensate for impairments in other domains” (ibid. 135), such as the social domain. Moreover, once this reliance has taken hold, “conditions are in place for the formation of a recurring loop in which increased training and enhanced development continue to perpetuate” (ibid.). A cycle is formed in which the brain becomes overdependent on perceptual processes, and this interferes with the development of other, more complex processes like social functioning.
Thus, enhanced perceptual functioning seems to explain both why autistic people often demonstrate superior performance on perceptual tasks, but also how this might interfere with more complex cognitive processes and cause difficulties in other domains.
Decentering the Neurotypical
Now that we have discussed three influential theories of autism, let us put on our evaluative hats and assess how well these theories capture autism as a whole. How do these theories frame autistic traits? And, more importantly, what implications do these theories have for how we should think about autistic people?
The theories we have discussed here tend to frame autistic differences in terms of deficits, or impairments. For example, the theory of mind account (sometimes called the “mindblindness” account) tells us that autistic people lack the ability to infer mental states; the weak central coherence account tells us that autistic people exhibit a deficit in central coherence; the enhanced perceptual functioning account tells us that perceptual processes shoulder the cognitive burden for an impairment in more complex processing domains. Sure, some autistic people may have certain “islets of ability” (Frith and Happé 1994: 122) as a consequence of their deficits, but one cannot help but read these papers and conclude that, compared to the neurotypical controls, autistic people are somehow worse off.
In the next section of the article, I want to argue that this is incorrect. This might seem a strange argument to make – surely the data analyzed in these papers are empirical and objective? This is true, but it does not follow from this that autistic people are inherently deficient or impaired. If one measures a minority neurotype against the dominant neurotypicality, of course the minority will look deficient. But this is only true so long as we view neurotypicality is the only correct way for a cognitive system to function.
The Double Empathy Problem
The double empathy problem, put forward by Damian Milton, argues against this view. Milton describes the double empathy problem as “a disjuncture in reciprocity between two differently disposed social actors which becomes more marked the wider the disjuncture in dispositional perceptions of the lifeworld … an everyday and often traumatic experience for ‘autistic people’” (Milton 2012: 884). That’s quite dense, so let’s unpack it a little bit.
In social communication, we tend to assume that social norms exist in some objective realm, and we merely follow them. However, the reason that neurotypicals are such experts in the social world is because the social world was created by them and for them in the first place. Thus, when a breakdown in communication occurs (i.e., between neurotypical and autistic people), it is easy for the neurotypical person to place the blame on the autistic person, and conclude all the ways in which the autistic person suffers with “deficits in social communication and social interaction,” as it states in the DSM-5.
Instead of viewing autistic people as deficient because they fail to meet the standards of neurotypicality, Milton argues that neurotypical people similarly lack the ability to understand the norms of autistic people. Or, more generally, any neurotype will struggle to understand any other neurotype to some degree. As soon as we move away from the view that neurotypicality is the only correct way for a cognitive system to function, and towards a view that focusses on the relation between people (and their wider environmental context), then we can see that autistic people are not inherently deficient. The question then becomes: deficient in relation to what? And this question can be asked of any neurotype, even neurotypicality.
Final Thoughts on Philosophical Theories on Autism
In this article, we have discussed the origins of autism in the papers of Kanner and Asperger, and three influential theories of autism which have built on these initial descriptions. What have we learned from this cursory overview?
The fact that Kanner’s description of autism has historically been the most influential has meant that we have inherited a view where autism is, in all cases, severe and rare. This has also meant that our theories of autism have mostly framed autistic traits in terms of deficits and impairments. All three theories we have discussed, to some extent, perpetuate a narrative whereby autistic people are deficient, or less than human, when this is patently not the case. Autistic people can find certain tasks extremely difficult, to be sure, but they can also far outperform neurotypical people in certain situations!
If there is one key takeaway from this article, it should be this: it is not enough to look at the individual alone and call them deficient. Rather, one must look at the individual’s relation to other people and their environment. If we can do this, then we move away from a deficit narrative where autism is just the result of a broken brain, and towards a narrative where there is a responsibility on other people and the environment to accommodate neurodiverse ways of being. We are the ones that decide how our social interactions unfold, and we are the ones that decide how our environment is set up. For me, inclusivity is the only metric by which we can be sure to make the right decisions.
Bibliography
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Washington, DC: American Psychiatric Publishing.
Asperger, H. (1944/1991). ‘Autistic psychopathy’ in childhood (U. Frith, trans.). In U. Frith (ed.) Autism and Asperger Syndrome (pp. 37-92).
Baron-Cohen, S., Leslie, A., & Frith, U. (1985). Does the autistic child have a “theory of mind”?. Cognition, 21(1), 37-46.
Frith, U. & Happé, F. (1994). Autism: beyond “theory of mind”. Cognition, 50(1-3), 115-132.
Frith, U. (1989/2003). Autism: Explaining the Enigma. United Kingdom: Blackwell.
Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2(3), 217-250.
Milton, D. (2012). On the ontological status of autism: the ‘double empathy problem’. Disability & Society, 27(6), 883-887.
Mottron, L., & Burack, J. (2001). Enhanced perceptual functioning in the development of autism. In J. Burack, T. Charman, N. Yirmiya, & P. Zelazo (eds.), The Development of Autism: Perspectives from Theory and Research (pp. 131–148). Lawrence Erlbaum Associates Publishers.
