Autistic Disorder is found in DSM-IV under Disorders of Childhood in the category of Pervasive Developmental Disorders.

1. History of Autistic Disorder

2. Diagnosis of Autistic Disorder

3. Etiology of Autistic Disorder

4. Treatment of Autistic Disorder

5. Prognosis of Autistic Disorder

History of Autistic Disorder - in 1943, Leo Kanner of Harvard coined the term "early infantile autism" in his observation of a group of children who displayed unusual patterns of behavior before the age of 30 months. His criteria for diagnosis were essentially (1) social aloofness, and (2) elaborate repetitive routines (Wing, 1996). Kanner distinguished early infantile autism from schizophrenia and mental retardation. The term he chose -autism- refers to self-centered absorption (Murray, 1996).Until recently, autistic disorder was thought to be a behavior disorder which was influenced by the parents and the environment of the individual. With the rise in neurological, neurochemical, and neurotransmitter level studies, the focus has been placed on biological influences (Murray, 1996). Autistic disorder has also been diagnosed and treated outside of the United States. In Israel, from 1946 to 1986, 241 autistic patients were registered with the National League for Autism in Israel. Through the years, different diagnostic criteria have been used. From 1946-1964, the APA classification of mental disorders was used by the National League for Autism in Israel. Through 1964-1975, the ICD-8 was used and from 1975-86, ICD-9 was used for diagnosis of Autism.

Diagnosis - DSM-IV describes the essential features of autistic disorder as noticeably abnormal or impaired development in interpersonal relations and communication and markedly limited interests and activities. The specific symptoms vary greatly with age and developmental level. The diagnostic criteria requires that the individual show signs of a total of six (or more) of the items listed in the following three categories: (1) problems in social interaction, (2) problems in communication, and (3) limited, repetitive, and stereotyped patterns of interests, behavior, and activities. At least two of the items must be from (1) and one each from (2) and (3). Each of the three categories gives examples of how those problems may be manifested in the individuals. Impairment in social interaction can be manifested in problems of nonverbal behaviors, failure to develop relationships with peers that are appropriate to developmental level, lack of spontaneous desire to share achievements, interests, and enjoyment with others, and a lack of emotional or social reciprocity. Problems in communication may manifest themselves in one of the following: lack of make-believe play or social imitative play that is varied or spontaneous and appropriate to developmental level, repetitive or stereotyped language, in those who speak adequately there may be an inability to carry on conversations with others, and an impairment or total lack of spoken language. For limited, repetitive, and stereotyped patterns of interests, behavior, and activities symptoms may be shown through intense preoccupation with patterns of interest that abnormal in focus or intensity, intense preoccupation with object parts, inflexible ritualistic behaviors, or repetitive and stereotyped motor movements. Besides the three categories listed above, DSM-IV also has as its criteria a delay or abnormal functioning in at least one of the following areas before the age of 3 years: (a) interpersonal relations, (b) social communication, (c) imaginitive or make-believe play. Also, in order for an individual to be diagnosed as autistic, the individual must not better fit the criteria for Rett's Disorder or Childhood Disintegrative Disorder.There are a variety of tests used in diagnosing and assessing individuals with autistic disorder. Among them are the Autism Behavior Checklist, which is a 57-item rating scale that is used to discriminate between autism and other developmental disabilities(Shulman, Yirmiya, Greenbaum, 1995); Autism Diagnostic Interview is an interview of the parents of autisitic individuals(Piven, Pulmer, Jacobi, Childress, 1997), and the Childhood Autism Rating Scale is a widely used test for children with autism(Stone, Ousley, Littleford, 1997). Not all individuals with autistic disorder are diagnosed early in childhood. Because some symptoms change with age (like the decrease of language problems, social problems, and compulsive and ritualistic behaviors) a method of diagnosis has been created to assess these individuals. The Adolescent and Adult Psychoeducational Profile is better for the assessment of the older population (Van Bourgondien & Schopler, 1996).

Etiology of Autistic Disorder - autistic disorder occurs in two to five of every ten thousand births; this tranfers into a percentage of 0.05 percent of children. However, there is some evidence available to suggest that there may be a prevalence of 0.33 upwards to 1.6 percent of children with autism (Wing, 1997).Autistic disorder currently affects approximately 400,000 Americans (Kaiser, 1997). The ratio of boys to girls is four-to-one. Autistic disorder occurs in all socioeconomic classes, racial and ethnic groups and often involves a co-occurrence of mental retardation and epileptic seizures (Davison & Neale, 1998). Depression may also occur in autistic disorder from adolescence on into the adult years. Early etiologies of Autistic Disorder were psychogenic and assumed that children with autism must have had rejecting parents. The child's attempts at receiving attention were ignored and hence, the child developed their own world (Bettelheim, 1967). These theories were disproven and studies show that parents of autistic children show nothing remarkable about their parenting styles (Cantwell, Baker, & Rutter, 1978). "Autistic children are not made autistic by parents who do not love them enough. Autism is a rare and tragic event that can hit anyone, any family, without warning" says Ura Frith. Ms. Frith also presents in her book Autism: Explaining the enigma evidences for biological origins of autism including: EEG abnormalities, abnormal nystagmus, abnormal persistence of certain infantile reflexes, and stereotypic movements. Biological causes are the major source of current speculation about autistic disorder and the National Institutes of Health have given a grant of $27 million for a five-year network study to uncover the genetic and neurobiological roots of autism (Kaiser, 1997). One study by Piven et al., has revealed that two of the sub-regions (the body and the posterior) of the corpus callosum are significantly smaller in individuals with autism. This is of interest because the corpus callosum is the largest and most prominent axonal pathway in the mammalian brain (Piven et al., 1997). Other projects, such as The Human Genome Project (HUGO) are attempting to map out human genomes and to discover genetic causes for disease.

Treatment of Autistic Disorder - there is currently no cure for autism. Behavior disturbances such as aggression, obsessive-compulsive behavior, anxiety and hyper-activity (Hirsch, 1997) can best be minimized by a structured educational program that takes into account the impairments and the unique capabilities of the autistic individual (Wing, 1997). Behavioral therapy and the use of operant conditioning seem to be the most promising methods of improving the autistic child's behavior. Training parents in these methods can help them to improve their childs' performance on standardized tests (Koegel in Davison & Neale, 1998). Other co-occurring disorders, such as depression, can be carefully treated with medication (Hirsch, 1997).

Prognosis of Autistic Disorder - disturbed behavior is evident from at least ages two - five however, many parents report noticing disturbed bahavior patterns from as young as three months. From ages six - twelve the child with autistic disorder may improve, with the disorder returning in full force in the adolescent and young adult years. This eventually calms down in the middle to later years (Wing, 1997). Some people with autism eventually hold down jobs, but still live with their parents continuing to remain within the confines of their world (Frith, 1989).

The National Institute of Mental Health's Fact Sheet on Autism

The Autistic Society

The Human Genome Project

Facilitating Education of Children with Autism

Chat about Autism

Autism and Brain Development Research Laboratory

The Autism Society of America (Broome-Tioga Chapter)

This website has been done in partial fulfillment of Dr. Young's Abnormal Psychology Course by Janmarie Young and Heather Watt.

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