Development of low- and high-functioning autistic children

Aspects of developmental sequences and structures were assessed in low- and high-functioning autistic and non-autistic developmentally disabled children. Specific developmental issues examined included sequences, regressions and profiles. Classification into the high- or low-functioning groups was based on a full scale IQ cutoff of 50. In general, there were few differences in the sequences of development among the groups. However, the autistic children were more likely than non-autistic children to display developmental regressions and unevenness across developmental domains. These developmental peculiarities were more pronounced in the low- as compared to high-functioning autistic children. These findings are discussed with regard to issues of developmental processes, classification and autism.

Comorbid association of autism and schizophrenia

OBJECTIVE

In the last several decades, considerable evidence has suggested that autism and schizophrenia are unrelated. However, recent reports have suggested that individuals with autism may be at greater risk for schizophrenia and that the conditions may be more closely related than generally believed.

METHOD

The authors examined detailed case records of 163 adolescents and adults with well-documented histories of autism. These cases included 139 males and 24 females.

RESULTS

Only one individual had an unequivocal history of schizophrenia.

CONCLUSIONS

If the present study group is taken to be representative, it appears that the frequency of schizophrenia among autistic patients (0.6%) is roughly comparable to the frequency of schizophrenia in the general population. It does not appear that the two conditions are more commonly observed together than would be expected on a chance basis; therefore, the current (DSM-III-R) approach to dual diagnosis of these conditions appears reasonable.

Benhaven's residential program

Benhaven, a residential program of group homes providing intensive programming for autistic and neurologically impaired children, is described. Its major program factors of administration and management, treatment, support services, and family and community involvement are presented in detail. Benhaven's mission as an educational placement for preparing residents to function in the least restrictive environment on their way to future living situations is stressed.

A custody and placement evaluation of an infant with a psychotic, mentally retarded mother

An emergency evaluation was requested on a 16-week-old infant and her parents. The child's mother had a long history of schizophrenia and mental retardation and was noted to decompensate following the child's birth; the mother was hospitalized and the child placed in foster care. Although the mother was severely impaired, the family had a reasonable and appropriate plan for the infant's care and reunification of the family was recommended. Aspects of custody and placement recommendations, the risk of the child for subsequent disorder, and legal issues involved in the evaluation are discussed.

Seizure disorders in autism

Several reports have suggested that autistic individuals are at greater risk for developing seizure disorders, particularly in adolescence. In this study the frequency of seizures in a series of 192 autistic individuals was examined; 21% of cases had exhibited a seizure disorder. Seizure disorders were more common among individuals with lower IQ. Age specific incidence revealed a 3- to 22-fold increase in risk for seizure relative to the normal population. In contrast to previous studies, risk for developing seizures was highest during early childhood although it was also elevated during early adolescence.

Disintegrative disorder or "late onset" autism

Ten cases of disintegrative disorder were identified within a larger sample of 165 individuals who met behavioral criteria for autism. These cases were compared to autistic individuals whose disorder had been recognized by age 2 and to those whose disorder had been recognized after age 2. Consistent with previous reports, children with disintegrative disorder had a period of normal development preceding the onset of a profound developmental regression from which they made, at best, only a limited recovery. Both clinical features at the time of regression and various outcome measures support the validity of the diagnostic concept, particularly when such cases are compared to "late onset" autistic ones.

Facial perception in autism

Disturbances in gaze and patterns of facial interaction are prominent aspects of social dysfunction in autism; the nature of this disturbance has up to the present been unclear. This study examined the ability of autistic subjects to use the human face as a source of information. Autistic and age- and MA-matched retarded control subjects assembled a series of puzzles displaying photographs of human faces; puzzles differed in complexity, familiarity of the faces and configuration (normal vs scrambled faces). Significant effects of all three factors, but not of diagnostic group, were observed. The autistic subjects did not exhibit specific deficits in perception of faces.

Whole blood serotonin and tryptophan in autism: temporal stability and the effects of medication

Whole blood serotonin (5-HT) was significantly increased in a drug-free autistic group (n = 17) compared to age- and sex-matched normal control (n = 20). Blood tryptophan (TRP) values and platelet counts were similar in unmedicated autistics and normal subjects; but whole blood concentrations of TRP were significantly lower, and 5-HT values tended to be lower in the medicated group compared to unmedicated autistics. Highly significant intraclass correlation coefficients and low mean percentage differences were found for repeated measures over a year's period of whole blood 5-HT and the platelet count in the unmedicated but not in the medicated group. Blood TRP values were highly variable over time in both the medicated and drug-free autistic groups.

Neurochemical study of dopamine functioning in autistic and normal subjects

Plasma prolactin (PRL) and homovanillic acid (HVA) levels, and urinary HVA and dopamine (DA) excretion, were measured in groups of unmedicated autistics, medicated autistics, and normal controls. No significant differences were found between unmedicated autistics and normal controls in plasma PRL and HVA levels. Excretion rates of urinary HVA and DA were also similar in the unmedicated autistic and normal subjects. Plasma PRL and HVA, as well as urinary HVA excretion, were significantly increased in the autistics on neuroleptic medication compared to the unmedicated autistics. A significant correlation (r = 0.46, p = less than 0.05) was observed between dose of neuroleptics and plasma PRL values; the correlation (r = 0.42) between neuroleptic dose and plasma HVA levels approached significance (p = 0.06). In contrast, no differences were observed in urinary DA excretion between medicated and unmedicated autistics. In general, the findings indicate that peripheral indices of dopamine functioning are normal in autistic subjects.

An examination of social typologies in autism

A system proposed by Wing and coworkers for subtyping autistic individuals on the basis of social interaction is examined in 78 autistic, 39 atypical, and 32 nonautistic, developmentally disordered individuals. Clinical ratings and questionnaire data based on the proposed subtypology were employed. Clinicians were able to reliably group both autistic and nonautistic cases into the three subtypes; these subtypes were strongly related to IQ. Issues relating to the validity and utility of this subtypology are discussed.

DSM-III and DSM-III-R diagnoses of autism

The authors examined the reliability, sensitivity, and specificity of DSM-III and DSM-III-R criteria for autism in relation to each other and to clinical diagnoses in 114 children and adults (52 diagnosed by clinicians' best judgment as autistic and 62 as nonautistic but developmentally disordered). They used a standard, structured coding scheme to evaluate each patient. The reliability of specific criteria was generally high. Although DSM-III criteria were highly specific, they were less sensitive; the reverse was true for DSM-III-R. The authors conclude that the diagnostic concept of autism in DSM-III-R appears to have been substantially broadened.

An evaluation of the Autism Behavior Checklist

The Autism Behavior Checklist (ABC), an assessment instrument for autistic individuals, was evaluated in a group of 157 subjects, 94 clinically autistic and 63 nonautistic. The two groups differed significantly in ratings of pathology. Both false positive and false negative diagnostic classifications were made when the results of the checklist were compared with clinical diagnosis. Effects of developmental level and age were observed. The ABC appears to have merit as a screening instrument, though results of the checklist alone cannot be taken as establishing a diagnosis of autism. Important issues of reliability and validity remain to be addressed.

Phenomenology and classification of the childhood psychoses

Two hundred and twenty-eight cases of children with final clinical diagnoses of childhood psychosis were reviewed using a standard coding scheme; cases were grouped in three broad categories on the basis of clinical diagnosis (autistic, atypical and schizophreniform). These three groups differed significantly in many respects, although the 'atypical' group more closely resembled the autistic group. While it was possible meaningfully to differentiate diagnostic groups using DSM-III criteria, some cases were difficult to classify. Childhood schizophrenia, as strictly defined, was far less common than childhood autism. The development of diagnostic schemes for those children whose disorders are difficult to classify is an important topic for future research.

Whole blood serotonin in autistic and normal subjects

Whole blood serotonin and tryptophan were measured in 87 normal subjects and in 40 autistic subjects. Whole blood serotonin concentrations (mean +/- SE) were significantly higher in drug-free (N = 21) autistics (205 +/- 16 ng/ml) than in normals (136 +/- 5.4 ng/ml). The Gaussian distribution of serotonin levels in the unmedicated autistic group suggests the elevation was not due to a subgroup of autistic subjects. Autistics medicated with anticonvulsants or neuroleptics had significantly lower serotonin levels than did drug-free autistic subjects. Whole blood tryptophan levels and platelet counts were similar in the autistic and normal groups. The possible causes of the hyperserotonemia of autism are discussed.

Urinary 5-hydroxyindoleacetic acid and whole blood serotonin and tryptophan in autistic and normal subjects

Urinary 5-hydroxyindoleacetic acid (5-HIAA) excretion in two consecutive collection periods (5:00 PM-11:00 PM and 11:00 PM-8:00 AM) and whole blood serotonin (5-HT) and tryptophan (TRP) were measured in groups of unmedicated autistics (n = 16), medicated autistics (n = 20), and normal controls (n = 27). Whole blood 5-HT values were significantly higher in unmedicated autistics compared to normal controls. No significant differences were found in 5-HIAA excretion (microgram/mg creatinine, mean +/- SD) between unmedicated autistics (4.07 +/- 1.52) and normal controls (3.50 +/- 1.07), or between medicated (5.35 +/- 2.93) and drug-free autistic individuals. No correlations were found between 5-HT values and urinary 5-HIAA excretion. Urinary 5-HIAA (microgram/mg creatinine, mean +/- SD) was significantly greater in hyperserotonemic autistic subjects (4.88 +/- 0.87) compared to normal controls (3.50 +/- 1.07, total collection period; p = 0.002). The relevance of these findings to the possibility that increased gut production of 5-HT might cause the elevated whole blood 5-HT levels seen in autism is discussed.

Clinical features of autistic children with setback course in their infancy

This study examines the incidence rate of setback in 80 autistic children, the correlation between the type of onset and clinical features, developmental level and prognosis based on an originally developed questionnaire. Moreover, this study seeks to investigate the possibility that infantile autism might be classified into subgroups by the type of onset. 1) The acquired (including questionably acquired) group consisted of 39 cases (49%), while the natal group was made up of 41 cases (51%). 2) The age when the setback occurred was 21-22 months in the acquired group. 3) Precipitating psychological events were observed in 22 cases (56%) of the acquired group. 4) The mental developmental level including speech and socialbility function at 5 years of age was significantly lower in the acquired group than in the natal group. 5) The acquired group showed severe behavioral disorders such as "stereotypic behavior," "extremely hyperkinetic behavior" and "self-abusive behavior" compared with the natal group. 6) The adaptive levels at schools or institutions were lower in the acquired group than in the natal group. 7) There was a higher incidence of epileptic seizures or febrile convulsions in the acquired group than in the natal group. Moreover, there was a higher incidence of severe perinatal abnormalities in the acquired group. 8) The above-mentioned results suggest that infantile autism might be classified into two subgroups, acquired and natal groups, based on the type of onset, and also suggest that some types of brain dysfunctions are more severe in the acquired group than in the natal group.