Toward a neuropsychological model of infantile autism: are the social deficits primary?

Although infantile autism was first described as a disorder of “affective contact,” in the past 20 years it has been largely regarded as a cognitive disorder, with socially deviant behavior seen as a secondary manifestation. After a discussion of diagnostic issues, the nature of the socially deviant behavior is described, and a brief history of theories to account for this behavior is presented. It is then suggested that the social symptoms may more fruitfully be viewed as primary because of (1) the dissociability of social and cognitive impairments both within and across developmentally disabled populations, (2) the special difficulty autistic children may have with social or affective stimuli, and (3) the rarity of social isolation even in severely damaged babies, and its resistance to modification in autistic children. In addition, the specific cognitive deficits suggested to be central to autism (4) can be found in at least as severe a form in sociable retarded children, (5) are theoretically inadequate to explain autistic aloofness, (6) cannot be found in all autistic children, and (7) may be the very cognitive abilities which rest most heavily on social functioning. Some implications are drawn for neuropsychological models of autism.