Monday, December 27, 2010

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We've come a long way, Baby!

I have been doing some research for my own use, and have found some interesting things I thought I would pass on. I must warn you that it is lengthy, but it was never intended to be a blog post, as such. I invite those who may have more information for me on this subject to share it! PLEASE!

The way I figure it, this should be good for a couple days' worth of blogs....  ;)

In 1887, the term “Idiot Savant” was first used by Dr. John Langdon Down to describe individuals with a developmental disorder, who also had areas of expertise that were in contrast to the individual's overall limitations. Later, this term was described to be a misnomer, because not all cases of idiot savants fit the definition of “idiot”, originally used to describe someone with very severe mental retardation. “Autistic savant” was also used as a diagnosis for this disorder, but over time was found to be a misnomer as well, because only one half of those diagnosed with Savant Syndrome were actually autistic. (1)

It has been more than 150 years since the term “Idiot Savant” first appeared in a German scientific journal, and more than 120 years since Dr. Down first described savant syndrome (2) as a distinct condition.

I came across the following in an article written by Darrold Treffert, MD (3)

“...There has been much progress since that time, including substituting the term “savant syndrome” for the understandable at its time, but now regrettable term, “idiot savant.” In a 1988 paper in the American Journal of Psychiatry, and in my Extraordinary People book in 1989, I suggested using the term “savant syndrome” to cover this “range of abilities that occurs in several conditions” and I am pleased to say that there has been fairly universal adoption of “savant syndrome” to replace the outdated, now pejorative term, “idiot savant.”

Then that same year came the movie Rain Man, which made the term “autistic savant” household words, providing a great deal of public information about, and acceptance of, this remarkable condition.

And, as documented on this Web site, there has been a great deal of other progress as well such as better answering the “how do they do it?” question; better understanding the types of savant syndrome, including the ‘acquired’ savant; better recognizing the overlap between prodigy, genius and savant syndrome; better acknowledging the important role that families and caretakers play in discovering and nurturing the special gifts; better realizing the benefits that ‘training the talent’ can bring; and focusing increasingly on a-bility rather than dis-ability in all persons with handicaps or limitations.

Much more research remains to be done, certainly, to fully utilize the special opportunity that savant syndrome provides, given the unique window into the brain that savant syndrome affords. Those efforts are accelerating now with new tools to assess not only brain structure, but brain function as well.

... One reason that many savants, or many autistic persons for that matter, have IQ scores below 70 is that IQ measurement depends so heavily on verbal scales, and many autistic individuals, including those with savant syndrome, have language (verbal) deficits as an intrinsic part of the underlying disorder...

... In summary, some savants do have IQ scores above average. Most do not. Therefore IQ level is not a sole determinant as to whether an individual is a savant or not. Savant syndrome exemplifies ‘islands of genius’ superimposed on an underlying developmental or other disability that can be associated with sub-normal, normal or elevated IQ as measured by formal IQ testing as one single measure of “intelligence.” And in assessing the meaning of IQ scores with respect to ‘retardation’, one has to be careful to differentiate ‘functional’ retardation for ‘actual’ retardation. IQ scores assess only the latter...

But somewhere in this disease de jour culture in which we exist, we have begun, in my view, to apply the diagnosis of Asperger’s disorder or autism much too easily to persons who are in fact, prodigies or geniuses. That trend notwithstanding, “Prodigy” and “Genius” do exist as real entities. They are not always closet Asperger’s or unrecognized autism.

Beyond that, some “normal” (neurotypical is the proper word now) children simply read very early, for example. Some have advanced musical ability. Some draw with impressive talent. Some do math problems precociously. Some have attention-grabbing memory. My posting on hyperlexia on this Web site outlines several kinds of early word recognition abilities and precocious reading skills that range, diagnostically, from normal, to autistic-like (for a time) to autism itself. Not all hyperlexic children are autistic. Some are perfectly normal children who happen to read very early. That posting on hyperlexia points out the importance of accurate diagnosis before terms such as autism are applied with all that such a diagnosis implies with respect to treatment, prognosis and outcome.

In short, prodigy and genius do exist as separate entities. Not all such persons are savants nor do they all have Asperger’s disorder or Autistic disorder.

Why is that distinction important? Because many parents, based on the “I’ve got a son or daughter who…” e-mails that I get from this Web site regularly, are concerned that their child who reads at 18 months, or draws at two years, or hums back all the melodies he or she hears, or likes to line up railroad cars, resists certain foods, or memorizes license plate numbers, or insists on routine, or has certain fears ‘could’ be autistic. They look up autism on the web and are both convinced, and frightened, that their son or daughter has “autism.” But not every child who likes to line up railroad cars, or plays tunes quite prolifically and precociously on the toy piano, or excels in drawing is autistic, any more than every hyperlexic child has Asperger’s.

There is wide variation in the range of ‘normal’ childhood behaviors, as any parent with several children can tell you, and there is a wide range, and overlap as well, between normal, gifted and talented, prodigy and savant syndrome classifications in children. Such differential diagnosis requires skill, and caution. While I support early identification of autism in youngsters, those efforts need to be balanced with sensible caution lest parents be unnecessarily frightened and overwhelmed by premature, and erroneous, diagnosis. In my experience, except in truly ‘classic’ cases, often some time of watchful observation needs to elapse before the ‘natural history of the disorder’ reveals the real diagnosis. And I have had some very pleasant surprises along the way with such ‘watchful observation’ and diagnostic caution.

The beginning of wisdom is to call things by their right name. Asperger’s, autism, and savant syndrome surely do exist. But so do normal, gifted and talented, prodigy and genius. The important thing is to know the difference. “


@jencull (jen) said...

I have to say I had been unsure of the meaning of savant but did know that it wasn't necessarily a term to just go with autism (though that does seem to be the popular use for it). Thanks, always good to learn something. Jen

lebelinoz said...

My experience is that people overdiagnose when they're learning something new. College students studying psychology often diagnose themselves and everyone around them with every disorder in the book! So I hear what you're saying about parents wondering if they're kids are autistic just because they have one or two quirks.

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