Autism: Diagnosis and Treatment. The State of the Art, May 1989

Abstract

Autism (infantile autism, childhood autism, autistic syndrome, autistic disorder) which almost always has its onset before 36 months of age is a behaviourally defined syndrome of neurological impairments associated with multiple medical conditions. Pathophysiology and behavioural dynamics in this spectrum of disorders are not yet fully understood. The spectrum is developmental and is manifested early in childhood by impairments in social relatedness, communication and imagination. These impairments vary in degree and also in form over time. They constitute severe biological handicapping conditions in the child which can lead to deleterious secondary effects on the family and other close persons. The behaviour pattern seen in autism may or may not be associated with other disabilities/disorders, such as mental retardation, epilepsy, dysphasia, and hearing and visual deficits. Social deficits vary from severe to mild. If the child has severe social deficits, diagnosis is more likely to be made in the first few years of life. In cases with milder social deficits, diagnosis may be postponed for many years. Cognitive deficits too vary from profound mental retardation to normal and — in exceptional cases — high IQ. “High — level” autism and so called Asperger syndrome now appear to be clearly overlapping clinical entities.