Neurotribes

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This wide-ranging and accessible bestseller is the first popular science book to win the prestigious Samuel Johnson Prize. It addresses a question which remains hugely controversial. What is autism?

Autism is a subject which still invokes myths, fear and stereotypes. It was first identified in the 1930s as a type of psychosis. US physician Leo Kanner saw it as a rare childhood condition caused by cold and unfeeling parents, later called “refrigerator moms”. This misogynist view was discredited in the 1970s, partly due to the rediscovery of the work of Hans Asperger. He saw autism as a lifelong impairment and diverse continuum, and developed creative forms of education to suit individual need.

Working under Nazi rule in a Vienna clinic, he deliberately focused on high achievers among the children — the “little professors” — to prevent their murder under Hitler’s genocidal Aktion T-4 programme. These factors contributed to the neglect or distortion of Asperger’s work for over 30 years, and to its association with a specific sub-type of autism, Asperger’s Syndrome.

Autism is now seen as a diverse and highly differentiated spectrum, and as genetically inheritable (although not in a straightforward way). Agreement on a “triad of impairments” — affecting communication, social behaviour and flexibility of thought — led to new diagnostic criteria, published in the Diagnostic Services Manual in 1987. This in turn led to a massive increase in the number of diagnoses, and much talk of an “epidemic”.

Adults with autism later formed their own organisations, challenging the idea that the key issue is changing, curing or controlling the “abnormal” child — rather than changing the environment, or adapting teaching or care methods. Their term neurodiversity made common cause with people with specific learning difficulties such as dyslexia, illustrating that variation in our brains is both natural and normal, and also resisting discrimination. Campaigns for greater recognition and improved services led in the UK to the passing of the Autism Act in 2009.

Despite plentiful evidence, autism remains widely attributed (particularly in the US) to vaccines, pollution or the wrong diet, to be cured with drugs, vitamins or behavioural modification. Silberman’s book, which began as an investigation into the prevalence of autism among IT buffs, is therefore timely, valuable and thought-provoking.

One possible quibble might be that he is insufficiently critical of the term autism, and the way our society demands definite diagnostic labels. Autism raises wider questions about disability, not least about what it is to be “normal”, and rising diagnostic rates, particularly at the outer edges of the spectrum.

He concludes that “instead of investing millions of dollars a year to uncover the causes of autism in the future, we should be helping autistic people and their families live happier, healthier, more productive, and more secure lives in the present.” One of the many autistic people quoted in the book declares, “If normal is being selfish, being dishonest, killing, having guns, and waging war, I do not want any of it.” Highly logical — and highly recommended.