Running Head: DISABILITY ACROSS THE LIFESPAN
Disability Across the Lifespan
Jaime San Miguel
Florida International University
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The human lifespan encompasses a constant state of developmental milestones that most
humans will encounter at certain ages throughout their lives. Developmental milestones such as
learning how to walk, a child’s first words, and becoming potty trained are some prominent
examples of early human development that help identify whether a child is meeting
developmental milestones appropriate for their age. Although the actual age at which children
reach these developmental milestones can vary slightly, it is important that they be reached
within certain age parameters. Children typically learn to walk between 9-17 months of age and
can walk on their tip toes between 16-30 months of age. Learning how to walk after the age of 16
months has become an established marker of atypical development (Onis, 2006b) and has been
found to support early language development (West et al. 2017; Walle and Campos 2014). These
studies show that children born with autism spectrum disorder exhibit delayed achievement of
certain developmental milestones which are used as an indicator of developmental delays.
Autism spectrum disorder (ASD) refers to a group of developmental disorders with an
onset beginning in the early preschool years. The disorder is characterized by difficulties in
social interaction and communication along with restricted and repetitive patterns in behaviors,
interests and activities (American Psychiatric Association 2013). Autism is becoming prevalent
among American children, as one in 44 children at the age of 8 were reported to have autism as
of 2018 and is four times more common in boys than in girls (Maenner et al., 2021).
John doe is a 64 year white Hispanic male born and raised in south Florida. John was
diagnosed with severe autism spectrum disorder as a teenager and lived with his parents until
their death, after which he was transferred to live in a group home due to his inability to care for
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himself independently due to factors attributed to his condition. John is nonverbal due to his
severe autism and has limited communication skills, mainly communicating with group home
staff with the use of a picture exchange communication system (PECS). John was born to parents
of Colombian descent and was raised with both parents as well as two older brothers in the same
household. As a child John Does brothers report him learning to walk at around 19 months of
age, well ahead of the expected 9-17 month window babies are expected to walk. Jean Piaget’s
Sensorimotor stage spans the first two years of a child’s life and describes various methods
babies use to understand their world. The sensorimotor stage is divided into 6 substages detailing
adaptive behaviors babies obtain at certain ages throughout the sensorimotor stage. Behaviors
such as reaching for and manipulating objects are encountered during substage four, between 8
and 12 months of age. Neurotypical infants at this age can identify objects hidden behind another
object and move the object to gain access to the desired object. According to Adrien et al (1995)
Autistic infants have a comparably tougher time in resolving object permanence tasks and tend to
hesitate, looked under the wrong areas for desired objects, and stopped searching altogether, and
engaged in other activities unrelated to finding the desired objects (Adrien et al., 1995). Despite
the difficulties exhibited by the infants in the study, they were able to successfully locate the
desired object, albeit at a lower rate compared to neurotypical peers (Adrien et al., 1995). John
Does siblings reported that as an infant, he had difficulty making and maintaining eye contact
with them and his parent as well as did not face them when they called his name. John would
substitute language with physical prompts to communicate his needs, such as giving his parents a
closed bottle for the parents to open. John was also nonverbal as a child and was only able to
learn simple sentences as he progressed in age. In relation to Piaget's Sensorimotor stages, this
anecdotal evidence shows a lack of development during the preoperational stage of development.
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Piaget’s preoperational stage states that children typically engage in make-believe play
which helps to strengthen their newly acquired representational schemes of their surroundings.
Make-believe play at this age is characterized by less self-centered play, where children become
detached from the toys they play with and centers around objects engaging in activities while the
children act as a sort of audience to the occurring events. Neurotypical children in the
preoperational stage engage in play that includes more complex combination of schemes that
allow children to engage in sociodramatic play where they can act out social situations such as
drinking water or eating models of food in a pretend manner. Autistic children such as John
differ in that they are more to likely engage in parallel play, a play style common in autistic
children in which they play alongside their peers in a solitary fashion, preferring not to engage in
group play with other children. Research has shown that children with autism have significant
delays in the development of symbolic play (Jarrold et al. 1993; Baron-Cohen 1987). Autistic
children in the preoperational stage frequently engage in functional play, playing with objects in
line with their intended function, and are more likely to engage in repetitive actions while
playing, such as repeatedly stacking cups and tossing them to the floor or throwing dirt or
throwing loose objects into the air repeatedly. John Doe’s siblings recall him becoming fixated
with objects that were hyper-stimulating to one of the five senses, such as toys that created
strong vibrations or had multi-colored, rapidly spinning lights which John would stare at for
extended periods of time. These toys could have functioned as stimulatory objects that provided
a more intense sensory stimulation that may have reinforced John's preference to play with those
certain toys. Autistic children are also known for engaging in restricted and repetitive behaviors
(RRB), such as hand flapping, repetitive use of speech or objects, and intense interest in a given
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subject or object, for greater frequencies and durations than neurotypical children (Jacques et al.
2018).
The third stage of Piaget's stages of cognitive development is the concrete operational
stage and includes children between the ages of 7 and 11. In this stage, children's reasoning
becomes logical, flexible, and organized. Children at this age begin to exhibit proficiency in
observation tasks, the ability to understand how items retain their original form in some way
even after being altered visually. An example would be knowing that a certain amount of water
retains its mass even if it's moved into differently shaped receptacles. Reversibility is also seen in
children at this stage, where an individual can think through steps and backtrack if needed to the
first step in the process. Seriation is the ability to order items according to quantitative
dimensions, such as weight or length, a skill that is acquired by children at this operational stage.
Research by Yirmiya and Shulman (1996) finds that autistic children performed worse in solving
seriation tasks compared to neurotypical counterparts (Yirmiya & Shulman, 1996). This
difficulty in arranging items according to their physical characteristics could have affected John
as a child while performing daily tasks in school and at home such as stacking measuring cups
inside one another or being able to stand in line at school by height order. Transitive inference is
the ability to seriate mentally, an ability also found in children in the concrete operational stage
which allows children to infer certain characteristics of objects given in their relation to other
objects. A child at this stage can deduce that if object A is longer than object B, and object B is
longer than object C, than object A is also longer than object C. A study conducted by Solomon
et al (2015), in which autistic and neurotypical children were placed in a magnetic resonance
imager (MRI) machine, demonstrated that neurotypical children recruited more of the prefrontal
cortex, parietal cortex, and anterior cingulate cortex compared to their autistic peers (Solomon et
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al, 2015). The study reinforces the concept that individuals with autism process information
regarding their physical and social environment differently than neurotypical children. Given that
John's autism is severe enough to prevent him from becoming a functional, independent adult we
can assume that John’s ability to employ transitive inference is even more restricted compared to
individuals whose autism is less severe. Spatial reasoning in this stage has improved and children
are able to construct cognitive maps of their surroundings more accurately than children in the
preoperational stage. Cognitive maps include mental representations of areas familiar to children
such as their homes, schools or neighborhoods. It is unclear how John’s autism may have
affected his ability to create cognitive maps as a child but as an adult he is reported to
successfully navigate his group home and can walk to common areas such as the kitchen and
bathroom without assistance.
Piaget's final stage, the formal operational stage begins at age 11 and is where children
develop the capacity for abstract, scientific thinking. At this stage, the children have entered
adolescence and become capable of hypothetico-deductive reasoning. Individuals use abstract
thought to brainstorm possible solutions to situations and rationalize them in real-world
environments. Propositional thought evaluates the logic of propositions without referring to reallife circumstances. These characteristics require a thorough understanding of language and other
symbolic forms of communication, such as mathematical expressions, for this stage to be
considered fully mastered. Given that John’s severe autism diagnosis prevented him from
successfully mastering the concrete operational stage of development, we can infer that he has
also failed to master the formal operational stage and will likely never be able to due to the
severity of his developmental delay.
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In order to give a detailed discussion of John Doe’s transition into adulthood, Erik
Erikson’s psychosocial theory will be discussed to provide insight on how individuals with
severe autism navigate their disability across the remainder of their lives.
The psychological conflict present in Erikson's theory in the stage of early adulthood is
that of intimacy vs isolation, where individuals strive to build long-term, meaningful
relationships with friends and romantic partners. Adults at this stage must preserve a strong sense
of own identity which will then foster the attainment of intimacy sought after during this stage.
Adults who fail to do so risk becoming isolated from their peer group. Generativity also becomes
a focus in this stage, as adults begin to concern themselves with child rearing and contributing to
society via their profession or community. In relation to John and autistic individuals in general,
this population has a more difficult time establishing friendships, engaged in more unacceptable
behavior when pursuing romantic interests, and persisted in pursuing relationships when non
mutual interests were apparent (Stokes et al, 2007). This results in many individuals with autism
feeling unfulfilled in their pursuits of meaningful social and romantic connections. John’s
siblings reported few significant relationships, mainly the siblings and his parents until their
passing. These details, unfortunately, reveal that John was isolated from others throughout this
stage of development.
Erickson's psychological conflict during midlife is known as the generativity versus
stagnation period. It is noted for individuals reaching out and contributing to the welfare of the
next generation by way of child-rearing, mentoring for young adults and modeling what an
individual who has successfully navigated this stage should be. Stagnation refers to adults who
have become self-absorbed and self-indulgent despite having attained success in marriage, child
rearing and achieving career goals. Erikson describes these individuals as selfish who only look
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out for themselves and prefer to meet their own needs and lack interest in further bettering
themselves or society. In this context, John has little hope to achieve any sort of generativity
given his severe diagnosis and his extreme lack of communication skills.
The final conflict in Erikson’s theory is integrity versus despair. This conflict involves
individuals coming to terms with what they achieved or failed to achieve in their life. Individuals
who have successfully navigated Erikson’s prior stages and achieved fulfillment in their
profession, marriage and community will achieve integrity. Despair is the feeling of having
committed many errors in one's life. Individuals might struggle to accept that their lives have
been riddled with failure and attempt to find other ways to achieve integrity. These individuals
become bitter and tend to express the contempt they have for themselves towards others in the
form of anger. As John continues to advance in age he is unlikely to exhibit either of these traits
as his limited communication skills will likely prevent him from conveying any sort of
meaningful conversation. John’s limited capacity for abstract thought may also deny him the
opportunity to reflect on his life and make any sort of impactful observations of his past.
Throughout my research, while completing this assignment, I was reminded of the many
similarities found in some of the children I have worked with throughout my time as a Registered
Behavior Technician. Many of the anecdotes provided by John Does family members have been
actual experiences I have faced while working with children with disabilities. This paper has
helped me reflect on the many difficulties individuals with disabilities face as they age. Most
people have limited experience seeing let alone interacting with people with disabilities and
mostly do so when these individuals are school age children between the ages of 5-18. As this
population ages, many are either confined to living at home with their parents or sent to live in
an adult living facility due to their caregiver's inability or unwillingness to continue to care for
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the individual. An unfortunate reality is that many individuals with autism will inevitably be
impacted throughout their lives based on the severity of their condition. A family friend of mine
who was diagnosed with what used to be labeled “Asperger syndrome” lives a relatively normal
life, complete with a career, romantic partner, and a social circle of friends who treat him the
way he and all other individuals with autism deserve to be treated, as equals. Unfortunately, as
the severity of an individual’s autism increases, their capacity to live what most people would
call an “ordinary” life dwindles. We as a society should continue to strive for inclusion that
accepts and celebrates our differences and foster a loving environment for everyone, regardless
of any developmental disability.
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