Family Factors. In: Rutter M, Schopler E, editors. Autism. Boston: Springer US; 1978. pp. 269-96. [DOI: 10.1007/978-1-4684-0787-7_18]

Peer interactions of autistic children and adolescents

Two observational studies of verbal, high-functioning children and adolescents with autism; nonautistic, behaviorally disordered youngsters of equivalent verbal skills and chronological age; and verbal age-matched normally developing students during integrated summer day camps are reported. In the first study, observations were made of spontaneous peer interaction and play over the course of 2 weeks of day camp. The eight autistic subjects were consistently more likely to not be interacting and less likely to be engaged in any purposeful activity than the 16 other children. During the 2 weeks, time interacting and purposeful activity increased overall. In the second study, the quality of spontaneous peer-directed initiations was observed during free time in similar day camps the following summer. The 11 autistic children and adolescents produced fewer initiations than did the 20 other children and were less likely to smile or coordinate several behaviors with eye contact during an initiation. Autistic subjects were consistently more likely not to receive a response to their initiation than the other groups, although there was no identifiable relationship between the quality of the initiation and the likelihood of it receiving a response.

[Early childhood psychosis versus early childhood autism? Differential diagnosis based on one week observation in an inpatient setting]

We report on the case of a 4-year old child suffering for the past six months from a lingering psychotic development. Several months of outpatient observation did not permit a clear differential diagnosis of either childhood autism or an early psychosis. During a one-week inpatient stay at our hospital recurring productive-psychotic episodes were observed that finally led to the exclusion of the diagnosis of "childhood autism" (ICD-10 F 84.0 (Dilling et al., 1993)) and to the diagnosis of "other disintegrative childhood disorder" (ICD-10: F 84.3 (Dilling et al., 1993)).

A broader phenotype of autism: the clinical spectrum in twins

The diagnostic boundaries of the behavioural phenotype for autism were examined in 28 MZ pairs and 20 DZ same-sex twin pairs, where one or both twins had autism. In the non-autistic cotwin (i.e. in twin pairs discordant for autism) it was common to find language impairments in childhood and social deficits persisting into adulthood. Concordance for this broader phenotype was much greater in MZ pairs than DZ pairs, indicating a strong genetic component. Behavioural and cognitive manifestations of autism were compared both within and between MZ twin pairs. The variation was as great within MZ twin pairs as between pairs, suggesting that it does not index genetic heterogeneity (although aetiological heterogeneity probably exists). Current diagnostic practices need re-evaluation.

Social language use in parents of autistic individuals

Social language use (pragmatics) in parents of autistic individuals and controls was compared. Autism parents displayed atypical pragmatic behaviours more often than controls. Preliminary factor analysis suggested three parsimonious groupings of pragmatic abnormalities: Disinhibited Social Communication, Awkward/Inadequate Expression, and Odd Verbal Interaction. The pragmatic features observed in some autism parents are milder but conceptually similar to the social language deficits of autism. Possible reasons for familial aggregation of pragmatic language deficits are discussed.

Asperger's syndrome: who is being abused?

Six case histories of children referred and admitted to a psychiatric inpatient unit at a tertiary referral centre because of concerns about poor functioning and possible emotional abuse are presented. On initial assessment the children appeared to be well functioning and the impression was confirmed that their emotional needs were not being met by their parents. After detailed inpatient appraisal the diagnosis of Asperger's syndrome was made in all six cases, exemplified mainly by a formal concrete way of thinking and an inability to identify and understand human emotions and relationships. The impact of the diagnosis on the parents and their consequent relationships with their child and their willingness to work with professionals is discussed.

Attachment behaviors in autistic children

The social behaviors of 14 autistic children and 14 normal children of equivalent mental age were observed during a free-play situation as well as during separation from and reunion with their mothers and a stranger. As a group, the autistic children showed evidence of attachment to their mothers, directing more social behaviors and more physical contact to their caregivers than to the stranger during the reunion episodes. Within the autistic group, the children who showed an increase in attachment behaviors in response to separation and reunion demonstrated more advanced symbolic play skills than those autistic children who showed no change in attachment behaviors. One possible explanation may be that autistic children require more advanced levels of symbolic ability to form attachments to others than is necessary for the development of attachments in normal children.

Understanding autism

Although much is known about autism, misconceptions persist. A case report is presented and used as a framework for dispelling some common myths about the condition. A simple, practical model for understanding autism is proposed and recommendations are provided for the practitioner managing a child with autistic-like features.

Is infantile autism a universal phenomenon? An open question

What we have tried to do in this paper is to question the universality of Infantile Autism as implied by the various definitions which have been provided. Our research of the literature has convinced us that infantile autism appears to be an illness of Western Civilization, and appears in countries of high technology, where the nuclear family dominates. We indicated that no research studies were located in the U.S.A. on Hispanics, in spite of their large number. Furthermore, it was found to be quite rare among Black families. We also saw that the illness seems to be quite infrequent in Latin American countries, Africa, and India, while the rate is high in Japan, but only in westernized families. Tinbergen (1974) likewise feels that infantile autism is "actually on the increase in a number of Western and westernized societies". Two major variables which are interconnected seem to be responsible for the confusion in the findings. One of them is the problem of diagnosis. It would seem that many researchers have extended the definition of infantile autism to include other seriously afflicted children, including those who are brain-damaged. This is no surprise, since such conflicts exist as Ritvo (1981) estimating that there are 300,000 autistic children in the U.S., while a report by the National Institute for Handicapped Research estimates the number of autistic children to be 71,000 (1981). Another aspect of the findings which has been contradictory is that some investigators have found that parents of autistic children tend to be of higher S.E.S., particularly in European studies, while some studies in the U.S.A. did not find such a difference among the parents of autistic and non-autistic children. We have provided some illustrations to indicate that studies which have found no differences were not dealing exclusively with autistic children as defined by Kanner, and often used childhood schizophrenia and autism interchangeably. Cantwell, Baker, and Rutter (1978) have pointed out that this persistent difference of superior S.E.S. of parents of autistic children is an embarrassing finding which is very hard to explain if one holds that the disease is organically determined. In conclusion to his review of the literature on the universality of adult schizophrenia, Torrey (1973) wrote the following: "Studies must be done soon or it will be too late to do them at all. But, until the universal prevalence of schizophrenia becomes an open question, this task is unlikely to be undertaken". The writer of this paper is of the same opinion.(ABSTRACT TRUNCATED AT 400 WORDS)

The functional neuroanatomy of infantile autism

Infantile autism is a behavioral syndrome consisting of specific disturbances of social relating and communication, language, response to objects, sensory sensitivity and motility. The uniqueness of this syndrome suggests one underlying pathophysiologic mechanism, although multiple etiologies, which could activate or replicate such a mechanism, have been demonstrated. Review of considerable experimental evidence and clinical observation suggests that the symptomatology of autism, including the disturbances of social relating and communication, can best be explained as a disorder of sensory modulation. This in turn suggests a neurophysiologic mechanism consisting of dysfunction of a cascading series of neurophysiologic levels or interacting neuronal loops in the brainstem and diencephalon which subserve modulation of sensory input. Some of those same systems modulate motor output in response to sensory input, and their dysfunction may release the abnormal perseverative motility of infantile autism. Other experimental evidence and clinical observations stress the language deficits of autism and implicate dysfunction of cortical structures. Brainstem and diencephalic centers project rostrally to telencephalic structures and these, in turn, modify brainstem and diencephalic function. Theories of rostrally and caudally directed sequences of pathoneurophysiologic contributions to the system dysfunction in autism are compared. It is concluded that the symptoms of autism can best be explained in terms of dysfunction of brainstem and related diencephalic behavioral systems and their elaboration and refinement by selected higher neural structures.