Burnout is a well-documented entity in Care Workers population, affecting up to 50% of physicians, just as it is equally well established that managing an infectious disease outbreaks, such as confirmed in the COVID-19 pandemic, increases Post-Traumatic Stress Disorder and the psychological burden. Mental health support, in the form of formal or remote sessions, has been shown to be helpful to health care staff, despite the organizational difficulties in an emergency. During the first emergence of COVID-19 in Italy, the Scientific (...) Institute for Research, Hospitalization and Health Care Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo Foundation, the Italian hospital that treated “patient 1,” has activated an agreement with the Soleterre Foundation, an international Non-Governmental Organization that manages health emergency projects, to provide psychological support. A task force of psychologists was created with the aim of designing and administering a Therapeutic Mental Health Assessment for COVID-19 Care Workers to evaluate and support health care workers’ mental health. The assessment battery was developed to evaluate symptoms and behaviors associated with trauma and the corresponding maladaptive behaviors. Once the TMHA COVID-19 CWs had been developed, the team of psychologists regularly visited healthcare staff in the ward to administer it. One hundred seven care workers across Intensive Care Units, the emergency room and medical ward were administered the TMHA COVID-19 CWs. PTSD symptoms were reported as severe by 13% of the population. Depressive symptoms as severe for 7% and Anxiety symptoms as severe for 14%. Severe psychotic symptoms were experienced by 2% and severe suicidal thoughts by 1% of the population. The possibility of acting upon the results of the TMHA COVID-19 CWs allowed an early intervention through individual session beyond the cut-off level for PTSD in NSESSS. In fact, 280 individual support sessions were offered. Therefore, we considered our project a protective and support factor for healthcare workers’ mental well-being and we recommend implementing a mental health screening program in ward involved in COVID-19 patients’ care. (shrink)

Asperger syndrome (AS) is an autistic spectrum condition that shares the range of social impairments associated with classic autism widely regarded as disabling, while also often giving rise to high levels of ability in areas such as maths, science, engineering and music. The nature of this striking duality of disability and ability is examined, along with its implications for our thinking about disability and the relevance of levels and kinds of disability to reproductive choices. In particular, it may be (...) seen as posing a challenge to John Harris's influential position in reproductive ethics relating to disability. The paper argues that if, as Harris maintains, there is a quite general moral obligation to avoid bringing disabled lives into the world regardless of the level of disability, then AS must be seen as having a strong claim to be exempt from such an obligation. However, a broader critique of Harris's position leads to the conclusion that, in fact, this putative obligation does not exist. (shrink)

This chapter highlights the complexity of the relationship between enhancement of mood and cognition on the one hand and the improvement of people's well‐being on the other. To do so, two psychiatric conditions, Asperger's syndrome and bipolar disorder, are presented in the chapter. Even though there are both negative and positive aspects to Asperger's syndrome or to bipolar disorders, taking away even these negative aspects would not necessarily promote well‐being. It might also be impossible to isolate the positive (...) aspects of these disorders. An increase in specific forms of cognition might be intrinsically connected to a decrease in specific aspects of mood. A decrease in specific aspects of mood might be intrinsically connected to an increase in creativity. Neither is necessarily linked to any changes in some general form of “well‐being.”. (shrink)

The study examines the argumentative competencies of people with Asperger syndrome (AS) and compares this with those of normal – or what are called neurotypical (NT) – subjects. To investigate how people with AS recognise, evaluate and engage in argumentation, we have adapted and applied the empirical instrument developed by van Eemeren, Garssen and Meuffels to study the conventional validity of the pragma-dialectical freedom rule (van Eemeren, Gars- sen & Meuffels 2003a; 2003b; 2005a; 2005b; van Eemeren & Meuffels, 2002). (...) Our paper begins with some background information on Asperger syndrome and how it impacts upon communication and argumentation; then it addresses the research questions and methods used; thirdly, it presents some initial findings; finally, it will conclude with some im- plications for those people with AS, for those they come into contact with and for the pragma-dialectic model in general. (shrink)

Asperger's syndrome is a pervasive developmental condition characterized by features of autism. As observed in clinical practice, individuals with Asperger's syndrome present an impairment related to inflexibility in their everyday routine, an immediate manner of experiencing and relating, and difficulties in estimating periods of time. Following a phenomenological perspective, this study is an attempt to examine these aforementioned aspects in terms of temporality. Thirteen participants with Asperger's syndrome, from 13 to 20 years old, were interviewed about their (...) experience of periods of time, personal history, their past, present and future; and their concept of time and finitude. After the interviews, it was possible to identify three general themes which emerged in the invariant aspects of their experience of time: factual experience of present and future dimensions, chronological time and the past experience. Moreover, participants' descriptions evidenced aspects of experience based on the specificity of lived facts and a sense of time specifically related to what was lived in the past. (shrink)

In this paper, we attempt to make a distinction between egocentrism and allocentrism in social cognition, based on the distinction that is made in visuo-spatial perception. We propose that it makes a difference to mentalizing whether the other person can be understood using an egocentric (‘‘you'') or an allocentric (‘‘he/ she/they'') stance. Within an egocentric stance, the other person is represented in relation to the self. By contrast, within an allocentric stance, the existence or mental state of the other person (...) needs to be represented as independent from the self. We suggest here that people with Asperger syndrome suffer from a disconnection between a strong naı¨ve egocentric stance and a highly abstract allocentric stance. We argue that the currently used distinction between first-person and third-person perspective-taking is orthogonal to the distinction between an egocentric and an allocentric stance and therefore cannot serve as a critical test of allocentrism. (shrink)

In his case report, A Logic in Madness, Aaron Hauptman details the case of Mr. A, an intelligent college student with Asperger’s syndrome, who became severely depressed subsequent to what he perceived as a rejection by what he viewed as “the love of his life.” Dr. Hauptman describes Mr. A as suicidal and as suffering from all the hallmarks of a major depression. At the urging of his family, he presents himself to a psychiatric inpatient unit and agrees to (...) a voluntary hospitalization. However, he refuses pharmacological treatment or electroconvulsive therapy, both of which his clinicians are considering given the severity of his case. Dr. Hauptman describes the young man’s response... (shrink)

Background: There is a growing interest in using cognitive behavioural therapy with people who have Asperger Syndrome and comorbid mental health problems. Aims: To examine whether modified group CBT for clinically significant anxiety in an AS population is feasible and likely to be efficacious. Method: Using a randomised assessor-blind trial, 52 individuals with AS were randomised into a treatment arm or a waiting-list control arm. After 24 weeks, those in the waiting-list control arm received treatment, while those initially randomised (...) to treatment were followed-up for 24 weeks. Results: The conversion rate for this trial was high, while attrition was 13%. After 24 weeks, there was no significant difference between those randomised to the treatment arm compared to those randomised to the waiting-list control arm on the primary outcome measure, the Hamilton Rating Scale for Anxiety. Conclusions: Trials of psychological therapies with this population are feasible. Larger definitive trials are now needed. Declaration of Interest: None Trial Registration: ISRCTN 30265294, UKCRN 8370. (shrink)

Este artigo tem como objetivo realizar uma compreensão daseinsanalítica do ser-nomundo do adolescente Christopher, protagonista do romance O Estranho Caso do Cachorro Morto, explicitando as relações do personagem com as pessoas de seu mundo. Partindo do diagnóstico de Transtorno de Asperger, demonst..

Bowler, Gardiner, and Grice have shown a small but significant impairment of autonoetic awareness or remembering involved in the episodic memory experiences of adults with Asperger’s syndrome. This was compensated by an increase in experiences of noetic awareness or knowing. The question remains as to whether the residual autonoetic awareness in Asperger individuals is qualitatively the same as that of typical comparison participants. Three experiments are presented in which manipulations that have shown differential effects on different kinds of (...) conscious awareness in memory in typical populations are employed with a sample of adults with Asperger’s syndrome. The results suggest that the experiences of remembering reported by such individuals, although reduced in quantity, are qualitatively similar to those seen in the typical population. The results are discussed in the context of current theories of awareness in episodic memory. (shrink)

ABSTRACTThe judgment of blame was studied in a group of 28 teenagers, 14 with Asperger syndrome and 14 typically developed. Teenagers in each group were matched by age, cognitive development and academic level. They were presented with 12 short vignettes in which they had to judge an action according to the intent of the actor, the consequences of the action and the seriousness of the situation. Results showed a significant difference in the patterns of judgment of both groups. The (...) AS group judged the action according to the physical consequence of the action more than the intent of the actor; the opposite was observed with the control group. In addition, the AS teenagers were less capable than the control group of grading injury to a person when apportioning blame especially when they were not familiar with the social situations. This result suggests that the judgement of the seriousness of the outcome of the social interactio... (shrink)

In light of a well-documented deficit in theory of mind found in high-functioning individuals with autism and Asperger Syndrome, this article explores HFA and AS children’s social-cognitive understanding of other people as reflected in their linguistic performance when answering mundane, everyday questions posed by their family members during dinnertime interaction. Ethnographic observations and video recordings of spontaneous interaction at home reveal that, contrary to findings in cognitive psychological research, the majority of the time the children were able to detect (...) their interlocutors’ communicative intentions and produce relevant responses that were marked by their conversational partners as acceptable. This article proposes that this success is due in part to parents who, through different strategies, facilitate their HFA and AS children’s access to socio-cultural perspective-taking and their interlocutors’ intentions, and better their children’s communicative skills. (shrink)

This study draws upon naturalistic ethnographic data to expand current understandings regarding the socio-communicative capabilities and challenges of children with autism spectrum disorders in mid-childhood. Affording a view of the children’s spontaneous interactions within naturally occurring family and community settings, the study explores a range of discursive resources utilized by the children to accomplish socially reciprocal positive politeness practices in tandem with others. Emphasizing contextualized deployment of politeness forms in interaction, the practice-based conception developed here construes positive politeness as a (...) discursive process encompassing both socio-cultural and interpersonal knowledge/skills; and contributes to a perspective in which social and communicative realms are conceptualized as integrated domains of functioning. (shrink)

Extreme conditions like savantism, autism or synaesthesia, which have a neurological 2AH, UK basis, challenge the idea that other minds are similar to our own. In this paper we report a single case study of a man in whom all three of these conditions co-occur. We suggest, on the basis of this single case, that when savantism and synaesthesia co- occur, it is worthwhile testing for an undiagnosed Autism Spectrum Condition (ASC). This is because savantism has an established association with (...) ASC, and the combination of ASC with synaesthesia may increase the likelihood of savantism. The implications of these conditions for philosophy of mind are introduced. (shrink)

If each of the subtypes of autism is defined simply as constituted by a set of symptoms, then the criteria for its observation are straightforward, although, of course, some of those symptoms themselves might be hard to observe definitively. Compare with telling whether or not someone is bleeding: while it might be hard to tell if someone is bleeding internally, we know what it takes to find out, and when we have the right access and instruments we can settle the (...) issue. But matters are not so simple for the autism subtypes. For one thing, how do we settle which symptoms to group together under one heading? One key difference between “autism disorder” and “Asperger’s disorder” is that the former exhibit language delays (sometimes extreme), whereas the latter do not. But is that a sign of genuinely distinct conditions or is that an artifact of the distinct groups of subjects that Leo Kanner and Hans Asperger worked with? And in general, although there are certainly types of behavior that are taken to be indicative of autism, none by itself is taken by diagnosticians to be either necessary or sufficient for a definitive diagnosis for any of the autism subtypes. What is the diagnostician to do? This is not merely an academic issue, as many parents can attest. Are we in a situation, then, that each practitioner has his or her own “pet” signs that are the “real keys” to the diagnosis? That would suggest that the term “autistic” might meet the fate of the outdated term “neurotic,” which turned out to be a pseudo-scientific term for an inexact clumping together of unrelated phenomena. The assumption amongst specialists seems to be that we will reach the point with "autism" that we have with "water": there will be a root essence to autism whose presence or absence settles a diagnosis. If that is to be the case, however, we have to settle the level of application of the concept. Does the term apply to people who exhibit particular behaviors? Or is it possible to exhibit “autistic” behaviors without actually being autistic, because autism is instead a particular feature of the mind (as, for example, in Baron-Cohen’s “impaired theory of mind module” theory, discussed below) which usually but not necessarily has behavioral effects? Or is autism located instead in the brain, perhaps in damage to key areas, which in turn would typically have an effect on modules of the mind? Or perhaps autism is located in genetics or biology, so that some people with damage to the brain caused by accidents so that they exhibit autistic symptoms would not actually be autistic. Conversely, supposing one had an “autistic brain” but showed none of (or not a sufficient number of) the symptoms, would one not be autistic? The assumption is that the genotypes and phenotypes will line up neatly, but if they do not, what happens to the concept “autistic?” (There is an analogy in the philosophy of sex and gender: androgen insensitive individuals tend to self-identify as female and have outward female traits, but have XY chromosomes—should we go with chromosomes or self-identity in assigning sex category?) Finally, the implications for these complications for diagnosis and categorization, with the attendant social and medical implications is discussed. The typical assumption of the medical profession is that autism cannot be “cured.” That assumes that autism is not simply the symptoms. However, at the same time, the tests used to diagnose ASDs work simply from the symptoms (for example, Baron-Cohen’s Sally/Anne test, which ASD children of a certain age almost all fail, but which practically no ASD adult fails). This implies an inherent confusion over the status of the concept. I conclude that attempts to make sense of some true or accurate summary of what it is to be autistic (such as one would find in the DSM) are almost certainly misguided and will vanish into history along with “neurotic.” But as with racial terms, which are similarly shifting and perverse, the term has already passed into the public sphere and will have a lasting and dangerous influence beyond its short scientific shelf-life. (shrink)

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was published in 2013 containing the following changes from the previous edition: gone are the subcategories ‘Autistic Disorder,’ ‘Asperger Syndrome’ and ‘PDD-NOS,’ replaced by the single diagnosis ‘Autism Spectrum Disorder,’ and there is a new category ‘Social Communication Disorder.’ In this paper I consider what kind of reasons would justify these changes if one were (a) a realist about autism, or (b) one were a constructivist. I (...) explore various analyses of autism in the research literature that portray it as essentially either a psychological, neurological or genetic phenomenon, and discuss these by reference to the diagnostic criteria and by analogy with the way we understand race and sex categories. I conclude that no realist reasons are available to justify the changes in the diagnostic criteria, and further, that the only way the changes could be justified is if one takes the position that the DSM categories are social constructs. I conclude by exploring what implications follow from this. (shrink)

In this chapter, I describe my “post-diagnosis” experiences as the parent of an autistic child, those years in which I tried, but failed, to make sense of the overwhelming and often nonsensical information I received about autism. I argue that immediately after being given an autism diagnosis, parents are pressured into making what amounts to a life-long commitment to a therapy program that (they are told) will not only dramatically change their child, but their family’s financial situation and even their (...) entire mode of existence. Moreover, despite information overload, many treatment programs for autism rely on empty jargon and make completely unrealistic promises, so parents are left feeling overwhelmed and panicked. Even well respected therapy programs encourage parents to spend liberally. Indeed, autistic therapists, who help construct what I refer to as the Culture of Autism, advise parents to commit to a minimum of 35 to 45 hours of intensive therapy every week. The implications are clear: for a parent who works full-time, their autistic child becomes a second full-time job. Autism is big business right now, and therapists are pushing parents to the brink of desperation. So it is not too surprising that there is a desperate cry for a more permanent solution—which is why researchers seek to cure autism. But there are two ways to conceptualize cure. A Therapeutic Cure model (TC) conceives of a cure as a beneficial treatment for the patient that eliminates or ameliorates the harms of the disease or condition. But the notion of a therapeutic cure for autism is highly implausible, given the complexities of autism. Indeed, at this point, the vast majority of researchers have come to the conclusion that the idea of a therapeutic cure for autism is simply a non-starter. Therefore the bulk of research seeking a cure for autism focuses instead on a second approach, which I refer to as the Negative Eugenics Cure model (NEC). With this model, the intention is to eliminate the disease or condition without regard for the health or well-being of the organism carrying the disease or condition. So, with regard to autism, researchers are focusing on identifying genetic markers for autism that can be detected in utero, or in embryos, so that autistic fetuses can be eliminated and autism eradicated by preventing the existence of autistic individuals. I review both models and argue that both fail to provide convincing arguments that the “solution” either offers is desirable. Both rest on the assumption that autism renders a life not worth living which, all things considered, is false. Instead of pushing to cure autism, an idea pervasive in this Culture of Autism, I contend that autistics are individuals with lives worth living. Moreover, rather than expend millions on research to search for the means to eliminate autism, we should instead expend our resources to ensure autistic individuals have access to support they may need. If the phenomenology of autism were better understood and appreciated, the panicked demand for a cure for autism might abate and perhaps autism could be seen as having value in and of its own right. (shrink)

Autism and Asperger syndrome are psychiatric conditions diagnosed primarily on the basis of deficits and problems in social behaviour; interaction and communication. At present the explanation of these behavioural features is dominated by three cognitive models. However, it is a characteristic of each of these models that they only explain a sub-set of the overall features.The aim of this paper is to suggest an alternative conceptual theory of autism and Asperger syndrome that unites the current three models. Thus, (...) the aim is to situate the existing models as special cases of the one being proposed here. This alternative conceptualisation draws heavily on distinctions and ideas present in the philosophy of science, most especially in the area of critical realism. Central to the theory is the idea that the core “problem” in autism and Asperger syndrome concerns ontological depth. More specifically, that people with these conditions find it difficult to cope with phenomena characterised by depth , open systems and high internal relationality. (shrink)

This article offers an anthropological perspective on autism, a condition at once neurological and social, which complements existing psychological accounts of the disorder, expanding the scope of inquiry from the interpersonal domain, in which autism has been predominantly examined, to the socio-cultural one. Persons with autism need to be viewed not only as individuals in relation to other individuals, but as members of social groups and communities who act, displaying both social competencies and difficulties, in relation to socially and culturally (...) ordered expectations of behavior. The article articulates a socio-cultural approach to perspective-taking in autism in three social domains: participating in conversational turn-taking and sequences; formulating situational scenarios; and interpreting socio-cultural meanings of indexical forms and behavior. Providing ethnographic data on the everyday lives of high-functioning children with autism and Asperger syndrome, the article outlines a cline of competence across the three domains, from most success in conversational turn-taking to least in inferring indexical meanings. Implications of these abilities and limitations are considered for theoretical approaches to society and culture, illuminating how members of social groups are at once shaped by, and are agents of, social life and cultural understanding. (shrink)

The ability of a group of adults with high functioning autism (HFA) or Asperger Syndrome (AS) to distinguish moral, conventional and disgust transgressions was investigated using a set of six transgression scenarios, each of which was followed by questions about permissibility, seriousness, authority contingency and justification. The results showed that although individuals with HFA or AS (HFA/AS) were able to distinguish affect-backed norms from conventional affect-neutral norms along the dimensions of permissibility, seriousness and authority-dependence, they failed to distinguish moral (...) and disgust transgressions along the seriousness dimension and were unable to provide appropriate welfare-based moral justifications. Moreover, they judged conventional and disgust transgressions to be more serious than did the comparison group, and the correlation analysis revealed that the seriousness rating was related to their ToM impairment. We concluded that difficulties providing appropriate moral justifications and evaluating the seriousness of transgressions in individuals with HFA/AS may be explained by an impaired cognitive appraisal system that, while responsive to rule violations, fails to use relevant information about the agent’s intentions and the affective impact of the action outcome in conscious moral reasoning. (shrink)

ABSTRACT: Simon Baron-Cohen has argued that autism and related developmental disorders (sometimes called “autism spectrum conditions” or “autism spectrum disorders”) can be usefully thought of as the condition of possessing an “extreme male brain.” The impetus for regarding autism spectrum disorders (ASD) this way has been the accepted science regarding the etiology of autism, as developed over that past several decades. Three important features of this etiology ground the Extreme Male Brain theory. First, ASD is disproportionately male (approximately 10:1 in (...) the case of Asperger’s Syndrome or high-functioning autism (HFA) and approximately 4:1 in the case of autistic disorder). Second, ASD is not psychogenic but biological in origin, and hence is not the product of sexist conditioning or childrearing practices, although these may affect the development of the disorder. Third, ASD is regarded as a spectrum developmental disorder, unlike other disorders such as Down Syndrome that are diagnosed by a (nearly) binary criterion. Down Syndrome, for example, is diagnosed by the presence in all or most cells within a given individual of an extra copy of Chromosome 21. Autism, on the other hand, is diagnosed by the presence of a set of symptoms that vary in their intensity and in their milder forms seem to conform to purported sex differences in cognitive, emotional, and social functioning. -/- In this paper, I do not challenge accepted science regarding the etiology of autism, and I do not challenge the idea of ASD as a disorder. Nor do I wish to offer an alternative account of what autism is. Instead, I focus on the usefulness of thinking of a disorder as an extreme version of ordinary sex differences. Does it follow from the fact that a disorder is more often found in men that we should think of it as an extreme form of maleness? If not, what other conditions must be met in order to warrant this way of thinking about ASD? What does it mean to say that ASD is a form of “extreme male brain”? Feminists are rightly skeptical of theories that make claims about male and female brains, so how should we respond to the clear evidence that the differences between typical and ASD individuals are not caused by childrearing practices? I explain what I take to be Baron-Cohen’s central argument that autism should be seen as the extreme male brain, and critique that argument. I conclude that there is no good argument that autistic symptoms should be regarded as an extreme form of male mental traits, and that Baron-Cohen’s claim does not help us to understand autism, women, or men. His claim is a speculative thesis that is readily mobilized for sexist practices. As such it requires a higher threshold for evidentiary support and rigorous argumentation—support and argumentation that does not exist. -/- KEYWORDS: autism, brain, gender, neuroscience, feminism, male . (shrink)

Autism provides a model for exploring the nature of self‐consciousness: self‐consciousness requires the ability to reflect on mental states, and autism is a disorder with a specific impairment in the neurocognitive mechanism underlying this ability. Experimental studies of normal and abnormal development suggest that the abilities to attribute mental states to self and to others are closely related. Thus inability to pass standard ‘theory of mind’ tests, which refer to others’ false beliefs, may imply lack of self‐consciousness. Individuals who persistently (...) fail these tests may, in the extreme, be unable to reflect on their intentions or to anticipate their own actions. In contrast, individuals with high‐functioning autism or Asperger syndrome often possess a late‐acquired, explicit theory of mind, which appears to be the result of effortful learning. An experimental study with three people with Asperger syndrome suggested that level of performance on standard theory of mind tasks was strongly related to the ability to engage in introspection. Qualitative differences in the introspections of high‐functioning people with autism are also reflected in autobiographical accounts which may give a glimpse of what it is like to be autistic. (shrink)

In this study, we investigated the relationships between judgments of intentionality and moral evaluation in individuals with High Functioning Autism (HFA) or Asperger Syndrome (AS). HFA or AS are neurodevelopmental disorders characterised by severe deficits in communication and social functioning. Impairments in Theory of Mind (ToM), i.e., the ability to attribute mental states to oneself and to others, are thought to be the core features of autism. Of all mental states, the concept of ‘intentional action’ is particularly important. People (...) normally distinguish between actions that are performed intentionally and those that are performed unintentionally and this distinction plays a crucial role in social understanding and moral judgment. Recently, Knobe (Analysis 63: 190–193, 2003a ), (Philosophical Psychology 16: 309–324, 2003b ) showed that people’s moral evaluations might serve as input to the process by which people intuitively arrive at the intentionality judgments. Here, by using two pairs of vignettes, the Knobe’s Harm/Help cases and Murder/Bull’s-eye cases, we showed that, as already observed in typical population, in individuals with HFA/AS judgment of intentional action is informed by the moral appreciation of the action outcome. However, the two groups differed on praise judgments and moral justifications, suggesting that these processes were poorly influenced by the agent’s psychological states. We concluded that, although under certain circumstances, individuals with HFA/AS and people with typical development have similar intuitive judgments of intentionality, over-assignment of praise judgments and the reduced use of folk-psychological concepts in moral judgment likely reflect difficulties using intentionality information for moral reasoning. (shrink)

Selection against embryos that are predisposed to develop disabilities is one of the less controversial uses of embryo selection technologies. Many bio-conservatives argue that while the use of ESTs to select for non-disease-related traits, such as height and eye-colour, should be banned, their use to avoid disease and disability should be permitted. Nevertheless, there remains significant opposition, particularly from the disability rights movement, to the use of ESTs to select against disability. In this article we examine whether and why the (...) state could be justified in restricting the use of ESTs to select against disability. We first outline the challenge posed by proponents of ‘liberal eugenics’. Liberal eugenicists challenge those who defend restrictions on the use of ESTs to show why the use of these technologies would create a harm of the type and magnitude required to justify coercive measures. We argue that this challenge could be met by adverting to the risk of harms to future persons that would result from a loss of certain forms of cognitive diversity. We suggest that this risk establishes a pro tanto case for restricting selection against some disabilities, including dyslexia and Asperger's syndrome. (shrink)

A preimplantation genetic test to discriminate between severe and mild autism spectrum disorder might be developed in the foreseeable future. Recently, the philosophers Julian Savulescu and Guy Kahane claimed that there are strong reasons for prospective parents to make use of such a test to prevent the birth of children who are disposed to autism or Asperger’s disorder. In this paper we will criticize this claim. We will discuss the morality of selection for mild autism in embryo selection in (...) a hypothetical in vitro fertilization (IVF) situation where preimplantation genetic diagnosis is performed and compare this with a similar selection for congenital deafness. To do this we first discuss relevant human differences. We then introduce the principle of human capabilities (PC) and compare this principle with the principle of procreative beneficence (PB) introduced by Savulescu and Kahane. We apply the two principles to selection for mild autism and selection for congenital deafness. We argue that PC allows for the selection for mild autism but rules out selection for congenital deafness. PB will not give clear answers; the ruling of PB depends to a large extent on expected social, cultural and political developments. We will argue that PC is preferable to PB. We will discuss arguments for the value of mild autism for individuals who have this condition and argue that they are able to lead a life with human dignity provided autism-friendly social circumstances are present. Neither PC nor PB yields strong reasons for prospective parents to seek to prevent the birth of children who are disposed to mild autism spectrum disorder. (shrink)

This paper seeks to demonstrate the structural difference in communication of schizophrenia and autism. For a normal adult, spontaneous communication is nothing but the transmission of phantasía (thought) by means of perceptual objects or language. This transmission is first observed in a make-believe play of child. Husserl named this function “perceptual phantasía,” and this function presupposes as its basis the “internalized affection of contact” (which functions empirically in eye contact, body contact, or voice calling me). Regarding autism, because of the (...) innate lack of affection of contact, intersubjective perceptual phantasía does not occur spontaneously. Consequently, autistics do not engage in make-believe play but in stereotyped and solipsistic play. Without the formation of perceptual phantasía, there is no differentiation between phantasía and perception. For this reason, people with Asperger's syndrome consider conversation not an immediate communication of thought but a logical transmission of concepts. Schizophrenia is characterized by a distortion in the internalized affection of contact, resulting in a disturbance of perceptual phantasía, and this later is covered by various symptoms—for example, delusion as a pathological kind of communication of thought. This delusion is based on the pathological internalized affection of contact represented by a terrifying Other. (shrink)

The merit system is based on a person’s ability to achieve. The concept of merit hence rejects a process that awards any particular entitlement explicitly based on disability. Brian Barry says that under the merit principle, people can compete for positions or advantage. This paper argues that the idea of merit, as explained by Barry, is unjust. Iris Marion Young points out that a person with cognitive disability faces a different situation compared to other people. Under normal circumstances, persons can (...) have skills that enable them to do things with ease, something that is not readily available to individuals with autism or Asperger’s syndrome. The problem is also exacerbated by policies that do not recognize the diverse needs of individuals with impairment. In this regard, practical ethics demands that a law or national policy must ensure a level playing field for everyone. (shrink)

Spontaneous play, important for forming the basis of friendships and peer relations, is a complex activity involving the management and production of talk-in-interaction. This article focuses on the intricacies of social interaction, emphasizing the link between alignment and affiliation, and the range and importance of verbal and nonverbal interactive devices available to children. Analysis of the way in which two girls, one of whom has been diagnosed with Asperger’s Syndrome, engage in spontaneous activities demonstrates the potential for interactional difficulty (...) due to the unscripted nature of the interaction. The article argues for further research into how improvised, unscripted interactions are initiated within moment-by-moment talk, how they unfold, and how they are brought to a close in everyday contexts in order to understand how children create their social worlds. (shrink)

The origin of moral agency is a much-debated issue. While rationalists or Kantians have argued that moral agency is rooted in reason, sentimentalists or Humeans have ascribed its origin to empathic feelings. This debate between rationalists and sentimentalists still stands with respect to persons with mental disorders, such as individuals diagnosed with mild forms of Autism Spectrum Disorder, without intellectual impairment. Individuals with ASD are typically regarded as moral agents, however their ability for empathy remains debated. The goal of this (...) paper is to investigate the mechanisms of moral actions in people with ASD, by finding arguments for the origin of their moral actions, supporting either the sentimentalist or the rationalist view of the dispute. We propose to revisit the debate using Interpretative Phenomenological Analysis to study the autobiographies of individuals with High-Functioning Autism and Asperger Syndrome. While conducting the systematic analysis of 10 autobiographies, we re-examined both the rationalist and the sentimentalist positions, considering the links between empathic feelings and moral agency. The investigation of the temporal dimensions of emotional experiences, an aspect overlooked by previous research, indicated that individuals with ASD empathize with others, but in different ways as compared to neurotypicals. A relationship between emotional experience and the type of moral agency exhibited by individuals with forms of ASD was established. As a consequence, our analyses support the sentimentalist stance on moral action. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Yet Life Keeps ComingPatricia Romanowski BasheWhile the guidance offered to authors of commentary articles suggests they not write about their personal experiences, the fact is, I would not be here were it not for my personal experience as the mother of a young man with autism spectrum disorder and other diagnoses. Though I left a successful writing career to become a special education teacher and then a Board Certified (...) Behavior Analyst (BCBA), it was not, strictly speaking, a career decision. It was a mom decision. When asked how I came to where I am today, I say, “Well, one day, I looked across the table at an individualized education program (IEP) meeting and asked myself, ‘Could I do as good a job as the people sitting across from me?’ And the answer was, yes.” Some people believe I am joking. I am not.To parent a child with autism is to be confronted daily with a dream of his future and the realization that you probably cannot achieve that alone. Instead, you will rely on a world of professionals, institutions, and systems to make it happen. How well that works out for you depends on a number of factors that should not matter but ultimately do: where you live, how well funded and law abiding your local school district is, how much access you have to qualified professionals, and how well your state agencies charged to care for individuals with disabilities after they leave school does its job. Though essential, love, dedication, and hope may not be enough to hoist your child over the hurdles, whether they are set by immovable bureaucracy or mercurial brain chemistry. We each strive to clear the track, to level the road, and I chose to do that by “going pro” and becoming a small part of the system that will serve my son and countless others with ASDs throughout their lives. Even so, I find myself as daunted by the transition to adulthood and the prospect of preparing him for a life without me as anyone writing here. Anonymous Three, who recounts her son’s struggle for independence, captures the questions that most of us might never get to answer but can’t stop asking: “What happens when we can no longer care for him?”When a pediatric psychiatrist diagnosed my own son with Asperger disorder in 1997, I wished to be one day free of the obligation to explain his diagnosis to people who had never heard of it. Today, thanks to major campaigns to promote autism awareness and the public recognition of a handful of celebrities with autism, there is less explaining required. It seems that everyone knows someone who has a child with autism, and everyone knows Temple Grandin’s story. Contrast this to the world of 1993, shortly after my friend and coauthor Barbara L. Kirby (Romanowski Bashe and Kirby 2001, 2005) turned to the internet to make sense of her son’s Asperger diagnosis. There was no Google, no Bing. It would be months before the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), which included Asperger’s for the first time, was published. Local doctors and teachers had never heard of it; parents and professionals were still gathering facts, trying to put the pieces together to form a coherent picture of what it meant to have autism. [End Page 183]Some things are different now, nearly twenty years later. Professionals, parents, and individuals with autism have developed a culture of autism, complete with opposing views on everything from applied behavior analysis and classroom inclusion to medication and guardianship. As a number of narratives illustrate, parents often find themselves making tough choices around these issues, and the best option in the abstract is not always the best option or even a possibility in the real world, on the ground. These narratives depict how the parents of individuals with ASDs struggle, sometimes mightily, to bridge the gap between what should be in terms of reliability of diagnosis and prognosis, access to effective, affordable, evidence–based education, treatment, and intervention, and—perhaps most important—meaningful, practical, realistic planning and programming for successful transition to adulthood. And... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Pathology of the Mind: Disorder Versus DisabilityRichard G. T. Gipps (bio)Keywordsorder, disorder, ability, disability, mental illnessAlfredo Gaete (2008) describes mental disorders as impairments in intentionality, phenomenal consciousness, and intelligence that cause harm to the affected person. I found persuasive Gaete’s claim that the concept of ‘mental disorder’ is best understood as nontheoretical and nontechnical. I also find compelling his argument that a previous contribution of my own—which relied in (...) part on specifying different senses of ‘disorder’ in psychological, physiological, and social cases—was misguided. Further, his suggestion that we ought at least to attempt analysis in terms of necessary and sufficient conditions before we seek out less definitive characterizations (in terms of family resemblances) also persuades me, although I find myself less sanguine than he about the general possibility of achieving such analyses.One of Gaete’s principal claims is that mental disorder is helpfully understood in terms of an absence of a capacity—that is, as a disability. There are two related objections—or two aspects of the same objection—that I would like to offer the author with respect to this claim. These may well not be conclusive, but will I hope at least function as foils against which the author can usefully sharpen his argument. One objection suggests that there is a viable distinction between the concepts of mental disorder and mental disability, as commonly used in clinical contexts, which the account offered seems unable to respect. The second suggests that the account may not be able to theorize what is argued to be the essential contribution of the concepts of order and disorder (as opposed to ability and disability) to the everyday concept of mental disorder. Accordingly, it questions the power of a disability approach such as Gaete’s to capture the essential nature of mental disorder.In his paper, Gaete classifies mental retardation and developmental, or (what in the United Kingdom are known as) learning, disabilities (autism, etc.) as cases of mental disorder. I found this surprising because it is not common linguistic practice in the psychological circles in which I operate. It would also seem to make a nonsense of commonly accepted ideas like: “Mental disorders are more likely to occur in patients with developmental disabilities (e.g., in autism, Asperger, or Down syndrome) than in the general population.” (For an example, see Campbell and Malone [1991]). On Gaete’s classification, it would appear that people with autism eo ipso have a mental disorder, and [End Page 341] hence the commonly accepted idea would need to be interpreted as merely a statement about comorbidities of different disorders of the same general (i.e., mental) type. But that is not, I believe, how the term is commonly used, and Gaete’s suggestion must therefore be treated as revisionary rather than descriptively analytical.One way of reconstructing a rationale underlying the distinction between mental disabilities and mental disorders is as follows. A developmental disability involves a failure of (certain aspects of) the mind to grow and reach an expected level or type of organization. A mental disorder by contrast involves a disturbance or disorganization (not simply an impoverishment) within the mind at whichever level of organization it has reached. As the mind develops, and reaches new levels or types of organization, the forms which mental disorders may take accordingly change.Autism and schizophrenia provide helpful illustrations of this distinction. Autism represents a failure of (among other things) the social mind to develop in childhood. The person with moderate to severe autism may attain at best a very shaky grasp on the realities of other minds and social conventions. That is, the degree of mental structure they obtain—their social competencies or capacities—will likely remain limited. It is this fundamental deficit that marks out the disability, and not the social anxieties or other such disturbances that can beset the autistic person.Schizophrenia, by contrast, tends to occur at late adolescence, when the individual has developed higher levels of—albeit often fragile—mental structure. Yet it is not the fragility of such mental structure, but rather the disruptions that can occur within such structures as have developed, that mark them out... (shrink)

Autism spectrum disorders (ASDs) are an issue of growing public health significance. This set of neurodevelopmental disorders, which includes autistic disorder, Asperger syndrome, and pervasive developmental disorder not otherwise specified (PDD-NOS), is characterized by abnormalities in one or more of the following domains: language use, reciprocal social interactions, and/or a pattern of restricted interests or stereotyped behaviors. Prevalence estimates for ASDs have been increasing over the past few decades, with estimates at ~5/10,000 in the 1960s, and current estimates as (...) high as 1/88 (Newschaffer et al. 2007; CDC 2012).1 While ASDs encompass a wide range of phenotypes and degrees of severity, the disorders .. (shrink)

Three complementary points to Jaswal & Akhtar are raised: (1) As a person with autism, I desire sociality despite vulnerability to others’ antisocial behaviour; (2) Asperger's conflation of autism with psychopathy (Czech 2018) likely caused clinicians to disregard social motivation among those with autism; and (3) adverse experiences cause social-engagement diversity to develop in all people, not just those on the spectrum.