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Diagnosis and Subclassification of Autism

Concepts and Instrument Development
  • Michael Rutter
  • Ann LeCouteur
  • Catherine Lord
  • Hope Macdonald
  • Patricia Rios
  • Susan Folstein
Part of the Current Issues in Autism book series (CIAM)

Abstract

Since Kanner first described the syndrome of autism in 1943, there has been substantial progress in the diagnosis and classification of the disorder (see chapter by Rutter and Schopler, this volume). As a result, both ICD-9 (World Health Organization, 1978) and DSM-III (American Psychiatric Association, 1980), the two major systems of psychiatric classification, broadly agree on the main features to be taken into account in diagnosis. In essence, the main weight is placed on a particular type of deviance in language, a particular type of deviance in social relationships, and particular patterns of repetitive and stereotyped behaviour, together with developmental abnormalities that have been evident from before the age of 30 months. The recently published guidelines for DSM-III-R (American Psychiatric Association, 1987) and the draft guidelines for ICD-10 (World Health Organization, 1987) follow the same general principles, although both have attempted to provide somewhat greater specification on the patterns of abnormality in these areas that are thought to be most characteristic of autism. In addition, because of practical difficulties in the application of the 30-month cutoff for developmental abnormalities, this has been raised to 3 years of age. Most of the published interview, questionnaire, and observational methods of assessment (see Rutter and Schopler, Chapter 2, this volume) have focused similarly on these diagnostic features, although they differ somewhat in their emphasis. Most have been primarily concerned with the diagnosis of autism in mentally handicapped children, as the majority of autistic individuals show some degree of mental retardation. The instruments have been developed with the main aim of making diagnoses for treatment purposes or for decisions on placement in different service facilities. The instruments work reasonably well in meeting these objectives, but there are now new purposes that require some modification in methods of assessment. This chapter describes some measures developed to meet these emerging needs.

Keywords

American Psychiatric Association Developmental Disorder Autistic Child Autism Diagnostic Observation Schedule Communicative Behavior 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. American Psychiatric Association. (1980). Diagnostic and Statistical Manual of Mental Disorders—DSM-III (3rd ed.). Washington, D.C.: American Psychiatric Association.Google Scholar
  2. American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders—DSM-III (3rd ed., rev.). Washington, D.C.; American Psychiatric Association.Google Scholar
  3. Attwood, T. (1986). Do autistic children have unique learning problems. Communication, 20, 9–11.Google Scholar
  4. August, G. J., Steward, M. A., & Tsai, L. (1981). The incidence of cognitive disabilities in the siblings of autistic children. British Journal of Psychiatry, 138, 416–22.PubMedCrossRefGoogle Scholar
  5. Baron-Cohen, S. (1988). Social and pragmatic deficits in autism. Journal of Autism and Developmental Disorders. Google Scholar
  6. Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a “theory of mind”?. Cognition, 21, 37–46.PubMedCrossRefGoogle Scholar
  7. Baron-Cohen, S., Leslie, A. M. & Frith, U. (1986). Mechanical, behavioral and intentional understanding of picture stories in autistic children. The British Journal of Developmental Psychology, 4, 113–25.CrossRefGoogle Scholar
  8. Bartak, L., Rutter, M. & Cox, A. (1975). A comparative study of infantile autism and specific developmental receptive language disorder. I. The children. British Journal of Psychiatry, 126, 127–42.PubMedCrossRefGoogle Scholar
  9. Bemporad, J. R. (1979). Adult recollections of a formerly autistic child. Journal of Autism and Developmental Disorders, 9, 179–98.PubMedCrossRefGoogle Scholar
  10. Bregman, J. D., Dykens, E., Watson, M., Ort, S. I., & Leckman, J. F. (1987). Fragile X syndrome: Variability of phenotypic expression. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 463–71.PubMedCrossRefGoogle Scholar
  11. Brown, G. W., & Rutter, M. (1966). The measurement of family activities and relationships: A methodological study. Human Relations, 19, 241–63.CrossRefGoogle Scholar
  12. Brown, W. T., Jenkins, E. C., Cohen, I. L., Fisch, G. S., Wolf-Schein, E. G., Gross, A., Waterhouse, L., Fein, D., Mason-Brothers, A., Ritvo, E., et al. (1985). Fragile X and autism: A multicenter survey. American Journal of Medical Genetics, 23, 341–52.CrossRefGoogle Scholar
  13. Cromer, R. F. (1987). Language acquisition. In W. Yule & M. Rutter (Eds.), Language Development and Disorders. (Clinics in Developmental Medicine, No 101/102). London: MacKeith Press/Blackwell Scientific.Google Scholar
  14. Ekman, P., & Friesen, W. V. (1976). Pictures of facial affect. Palo Alto, CA: Consulting Psychologist Press.Google Scholar
  15. Fleiss, J. L. (1986). The design and analysis of clinical experiments. New York: Wiley.Google Scholar
  16. Folstein, S. & Rutter, M. (1977). Infantile autism: A genetic study of 21 twin pairs. Journal of Child Psychology and Psychiatry, 18, 297–321.PubMedCrossRefGoogle Scholar
  17. Folstein, S. & Rutter, M. (1987). Family aggregation and genetic implication. In E. Schopler & G. Mesibov (Eds.), Neurobiological issues in autism (pp. 83–105). New York: Plenum.Google Scholar
  18. Gillberg, C. (1985). Asperger’s syndrome and recurrent psychosis—A case study. Journal of Autism and Developmental Disorders, 15, 389–97.PubMedCrossRefGoogle Scholar
  19. Graham, P. & Rutter, M. (1968). The reliability and validity of the psychiatric assessment of the child. II. Interview with the parent. British Journal of Psychiatry, 114, 581–92.PubMedCrossRefGoogle Scholar
  20. Hagberg, B., Aicardi, J., Dias, K., & Ramos, O. (1983). A progressive syndrome of autism, dementia, ataxia and loss of purposeful hand use in girls: Rett’s syndrome: Report of 35 cases. Annals of Neurology, 14, 471–9.PubMedCrossRefGoogle Scholar
  21. Hermelin, B., & O’Connor, N. (1970). Psychological experiments with autistic children. Oxford: Pergamon.Google Scholar
  22. Hobson, R. P. (1983). The autistic child’s recognition of age-related features of people, animal and things. British Journal of Developmental Psychology, 1, 343–52.CrossRefGoogle Scholar
  23. Hobson, R. P. (1984). Early childhood autism and the question of egocentrism. Journal of Autism and Developmental Disorders, 14, 85–104.PubMedCrossRefGoogle Scholar
  24. Hobson, R. P. (1986). The autistic child’s appraisal of expressions of emotion. Journal of Child Psychology and Psychiatry, 27, 321–42.PubMedCrossRefGoogle Scholar
  25. Hobson, R. P. (1988). Beyond cognition: A theory of autism. In G. Dawson (Ed.), New perspectives on diagnosis, nature and treatment. New York: Guilford.Google Scholar
  26. Le Couteur, A., Rutter, M., Lord, C., Rios, P., Robertson, S., Holdgrafter, M., & McLennen, J. D. (in press). Autism diagnostic interview: A standardized investigator-based instrument. Journal of Autism and Developmental Disorders. Google Scholar
  27. Le Couteur, A., Rutter, M., Summers, D., & Butler, L. (in press). Letter: Fragile X in female autistic twins. Journal of Autism and Developmental Disorders. Google Scholar
  28. Lockyer, L., & Rutter, M. (1969). A five to fifteen year follow up study of infantile psychosis. IV. Patterns of cognitive ability. British Journal of Social and Clinical Psychology, 9, 152–63.CrossRefGoogle Scholar
  29. Lord, C., Rutter, M., Goode, S., Heemsbergen, J., Jordan, J., Mawhood, L., & Schopler, E. (in press). Autism diagnostic observation schedule: A standardized observation of communictive and social behaviour. Journal of Autism and Developmental Disorders. Google Scholar
  30. Macdonald, H., Rutter, M., Howlin, P., Rios, P., Le Couteur, A., Evered, C., & Folstein, S. (1988). Recognition and expression of emotional cues in autistic and normal adults. Submitted.Google Scholar
  31. Olsson, B., & Rett, A. (1985). Behavioral observations concerning differential diagnosis between the Rett syndrome and autism. Brain Development, 7, 281–9.PubMedCrossRefGoogle Scholar
  32. Quinton, D., Rutter, M., & Rowlands O. (1976). An evaluation of an interview assessment of marriage. Psychological Medicine, 6, 577–86.PubMedCrossRefGoogle Scholar
  33. Reiss, A. L., Feinstein, C., & Rosenbaum, K. N. (1986). Autism and genetic disorders, Schizophrenia Bulletin, 12, 724–38.PubMedCrossRefGoogle Scholar
  34. Rutter, M., & Brown, G. W. (1966). The reliability and validity of measures of family life and relationships in families containing a psychiatric patient, Social Psychiatry, 1, 38–53.CrossRefGoogle Scholar
  35. Schopler, E. (1985). Editorial: Convergence of learning disability, higher-level autism and Asperger’s syndrome. Journal of Autism and Developmental Disorders, 115, 359.CrossRefGoogle Scholar
  36. Szatmari, P., Bartolucci, G., Finlayson, A., & Krames, L. (1986). A vote for Asperger’s syndrome. Journal of Autism and Developmental Disorders, 16, 515–17.PubMedCrossRefGoogle Scholar
  37. Wing, L. (1981). Asperger’s syndrome: A clinical account. Psychological Medicine, 11, 115–30.PubMedCrossRefGoogle Scholar
  38. Wing, L., & Gould, J. (1979). Severe impairments of social interaction and associated abnormalities in children: Epidemiology and classification. Journal of Autism and Developmental Disorders, 9, 11–30.PubMedCrossRefGoogle Scholar
  39. Witt-Engerstrom, I., & Gillberg, C. (1987). Rett syndrome in Sweden. Journal of Autism and Developmental Disorders, 17, 149–50.PubMedCrossRefGoogle Scholar
  40. Wolff, S., & Barlow, A. (1979). Schizoid personality in childhood: A comparative study of schizoid, autistic and mentally retarded children. Journal of Child Psychology and Psychiatry, 20, 29–46.PubMedCrossRefGoogle Scholar
  41. Wolff, S., & Chick, J. (1980). Schizoid personality in childhood: A controlled follow-up study. Psychological Medicine, 10, 85–100.PubMedCrossRefGoogle Scholar
  42. World Health Organization. (1978). International Classification of Diseases (9th rev.). Geneva: World Health Organization.Google Scholar
  43. World Health Organization. (1987). ICD-10 1986 Draft of Chapter V: Categories F00-F99 Mental, Behavioural and Developmental Disorders. Geneva: World Health Organization.Google Scholar

Copyright information

© Springer Science+Business Media New York 1988

Authors and Affiliations

  • Michael Rutter
    • 1
  • Ann LeCouteur
    • 1
  • Catherine Lord
    • 2
    • 3
  • Hope Macdonald
    • 1
  • Patricia Rios
    • 1
  • Susan Folstein
    • 4
  1. 1.Department of Child and Adolescent Psychiatry, Institute of PsychiatryUniversity of LondonLondonEngland
  2. 2.Department of PediatricsUniversity of AlbertaEdmontonCanada
  3. 3.Department of PsychologyGlenrose Rehabilitation HospitalEdmontonCanada
  4. 4.Department of Psychiatry and Behavioral ScienceJohns Hopkins University, School of MedicineBaltimoreUSA

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