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Sharon 77
current social and communication skills are essential in any treatment
approach. To divorce social skills from systematic attempts to improve
communication and play skills will reap fewer benefits, and time must
be devoted to treating all components of the autism triad.
* * *
In the end, I could not give Sharon a diagnosis of AS. To qualify for
that diagnosis there has to be substantial impairment. Sharon’s insight
into her own predicament was just too good and her accomplishments
too impressive. However, there were two other possibilities worth considering.
One of the findings of the genetic research in ASD is that some
of the relatives of children with autism themselves have ASD-like traits
that fall short of a diagnosis. Parents sometimes report that they are, or
a more distant relative is, socially awkward, with difficulty initiating
and maintaining friendships or being empathic and intimate with others.
Some relatives even develop intense interests in esoteric subjects
such as astronomy, census data, election results, or computers and math
problems, hobbies that occupy them to the exclusion of other family activities.
It was conceivable that Sharon had these traits, although there
was no family history of autism among her relatives. What she described
to me was certainly analogous to the experiences of people with
ASD. We know that these traits exist in the general population, perhaps
as frequently as five to ten percent. It may be that the genes that give
rise to autism are not all that uncommon in the general population.
Maybe the symptoms of all the ASDs appear along a continuum and
that subclinical cases—those without true impairment in functioning—
exist in the general population. Perhaps as these ASD-like traits become
more severe, the capacity for insight diminishes as well, until a certain
threshold is crossed, or a level of impairment is reached, and a diagnosis
of ASD is made.
Another possibility was that Sharon had had AS as a child but had
now recovered to such an extent that, even though she might have some
symptoms, she did not have any associated impairment. Some people
with AS and autism do recover to a remarkable extent (see Chapter 7),
though it is, admittedly, uncommon. I have followed some children
with AS from early childhood (where it was clear they had an ASD) into
adolescence and adulthood. Some of the children with AS (about
twenty percent) were functioning in the average range on their social