Two Terms—One Meaning: The Conundrum of Contemporary Nomenclature in Autism

TOPIC:  Autism as a diagnostic construct in the last decade has undergone a process of rapid evolution in the way that it is operationalized. A by-product of the important conceptual shift is that we have been left with two terms, autistic disorder and Asperger's disorder, that point to the same thing. The existence of two terms that cannot be clearly delineated results in confusion and an added element in an already anxiety-laden mix for all those trying to come to terms with the concept of autism.
PURPOSE:  This paper moves beyond contemporary arguments of whether autistic disorder and Asperger's disorder are different entities and uses a case study to consider the mechanism of the confusion caused, and highlight the importance of referent clarity.
SOURCES:  A review of sources in journals and texts related to the topic is included to complement the progressive review of the case study as the clients move through a 1-hour initial consult.
CONCLUSION:  The current diagnostic criteria are ambiguous posing the risk of confusion to parents, clinicians, and researchers. Nurses have an important role in assisting parents' construction of a unified concept of autism clinically, and through research. This paper moves beyond merely acknowledging the confusion that exists by considering the nature of the confusion, and through sharing the experience of one possible way of navigating it.     

Relaxation: With or without imagery?

Although the benefits of relaxation are widely recognized, clinicians need to remain cognizant of its possible adverse effects. Equally, some people with mental illness may experience an exacerbation of their symptoms with the injudicious use of relaxation techniques that use imagery. This paper explores two conditions where vivid, often emotionally charged, images are problematic: (i) post traumatic stress disorder; and (ii) hallucinoses. Individuals who have these disorders may have difficulty controlling shifts between these internal and external events, or difficulty even recognising events as internal rather than external. Employing a relaxation technique that encourages imagery is likely to produce a stronger reaction because the impact of the imagery is increased by relaxation. This would result in an increase in arousal, the antithesis of relaxation. This paper suggests that relaxation techniques that avoid imagery or consider the patient's experience would be less likely to provoke unwanted reactions.