A five to fifteen year follow-up study of infantile psychosis. II. Social and behavioural outcome

Pharmacotherapy for autistic children: a summary of research

An overview of research involving pharmacotherapy in infantile autism is presented. Methodological issues relating to experimental design, rating instruments and ecological factors are considered. Classification of infantile autism and diagnostic problems are discussed. Research investigations conducted in order to define diagnostic subgroups in the etiologically heterogeneous population of autistic children are described. An attempt is made to relate biochemical findings to clinical drug response. Recent findings are presented indicating that a potent neuroleptic is able to yield simultaneously significant decrease of behavioural symptoms and improved learning under both clinical and laboratory conditions. The drug can be effective in conservative doses and administered over a period of 14 weeks without untoward effects. New research plans are introduced where attentional learning will be assessed in an operant conditioning paradigm using automated procedures.

The effectiveness of operant language training with autistic children

Studies of operant language therapy with autistic children have indicated that behavioral techniques may be of value in increasing the language skills of such children. A review of recent studies, however, suggests that in the absence of adequate experimental controls, misleading conclusions may be drawn about the effectiveness of treatment. It is also apparent that the effects of therapy vary according to the linguistic competence of the children involved, and to the different aspects of language ability being taught. The implications of recent findings for our understanding of the basic deficit underlying early childhood autism are discussed.

Objectively defined linguistic parameters in children with autism and other developmental disabilities

The language of children with autism and other developmental disabilities was examined systematically according to a set of objectively defined linguistic parameters. These criteria were drawn from clinical observations reported in the literature and from developmental norms of language acquisition. Data analysis identified sets of parameters that were correlated with psychiatrists' clinical diagnoses but failed to isolate individual parameters (such as echolalia or noncommunicativeness) that have been suggested to be pathonomic.

Psychiatric disorders in mentally handicapped children: a clinical and follow-up study

The clinical psychiatric syndromes encountered in sixty mentally retarded children treated in a child psychiatric out-patient clinic setting are described. It was possible to classify these syndromes according to the multi-axial classification scheme for psychiatric disorders in childhood and adolescence. The children were followed-up for some years in many cases and the natural history of these disorders was in the main comparable to that of similar disorders in children of normal intelligence, although there was a tendency for some of the disorders to prove unusually persistent. Sometimes the persistence of these disorders seemed to be related to the children's continuing dependency needs arising from their mental retardation and to stresses within the family circle. The disorders responded reasonably satisfactorily to standard child psychiatric treatment techniques, and child psychiatric services should include the assessment and treatment of psychiatric disorders in mentally handicapped children within their remit.

Training and generalization of yes and no as mands in two autistic children

This study presented a practical and replicable procedure to train and generalize the use of "yes" and "no" as mands by a nonverbal boy and a previously echolalic girl, both diagnosed as autistic. The procedure used systematic modeling and reinforcement with detailed criterion for introducing and terminating the training stimuli. The subjects were first trained to use yes and no to mand three food items, following the stimulus question "Do you want...?" and presentation of a food item. The teachers then tested the subjects for generalization of the two mands to successive sets of new food items. The results showed that the nonverbal subject needed to be trained on five sets of food items before generalization occurred. The previously echolalic subject generalized and maintained the two mands after being trained on only one set of items. The study thus demonstrated that the procedure was effective in training two useful mands for the autistic children, and that after such training, the behavior may then generalize to new items without training. Specific response patterns and the importance of intermittent modeling and arrangement of reinforcers in the training are discussed.

Effects of age on adaptive behavior levels and academic skill levels in autistic and mentally retarded children

This study investigated the effect of age on adaptive behavior and academic skill in autistic and mentally retarded children. Subjects were 47 autistic and 128 mentally retarded children from a special school. Cross-sectional comparisons were made between junior and senior groups using ratings obtained from teachers on adaptive behaviors and academic skills. We found that the levels of toilet training, eating skills, participation in group activities, and self-control in the autistic children improved significantly with age. The skills of number concepts in the autistic children also improved with age. However, these adaptive and academic levels were in general significantly lower than those of the mentally retarded children. The levels of initiative did not improve significantly in either the autistic or the mentally retarded children, and they were significantly lower in the autistic children. The implications of these findings in the context of our previous study on the changes of communication and maladaptive behaviors with age in the autistic children are discussed.

Prolonged brainstem transmission time in autism

Brainstem auditory evoked potentials (BAEPs) to clicks presented monaurally were gathered for 16 institutionalized children with a prior diagnosis of autism and with no hearing loss as tested by standard audiometry. Twenty age-matched normal children served as controls. Brainstem transmission time, defined as BAEP interpeak I-V latency, was prolonged significantly on the average in the autistic sample on both left and right sides. Individually, BAEPs for 9 of the 16 autistic children (or 56%) on whom some electrophysiological data were gathered were classified as abnormal when compared to the norms established in the control group. The most common BAEP abnormality was a prolonged interpeak III-V latency on the left side.

A follow-up study of 29 borderline psychotic children 5 to 20 years after discharge

Twenty-nine children who during 1956 through 1970 were hospitalized for borderline psychosis were followed up in 1975. Twelve of them had received inpatient psychiatric treatment for 1-3 years. Seventeen were sent home for local, nonspecific help. At follow-up 67% of the treated group were no longer considered psychotic, compared with 70% of the untreated group. The two groups differ somewhat in a series of parameters, the treated group showing more severe psychopathological symptoms. The differences do not reach significant levels. No useful prognostic criteria were obtained from the study. The prognosis seems to be much better than for other types of psychosis in children.

Manic depressive illness in adolescence and childhood: review and case report

The literature on this topic from its inception by Kraepelin is reviewed. While Kraepelin and the French school always recognized juvenile mania, the Anglo-American school has no such unanimity of opinion. Less than 100 cases are described in the world literature. In Canada affective psychoses are rarely diagnosed under age 10 and of all affective psychoses admitted to institutions less than 5% are under age 20. The differences between child and adult mania are outlined. It is proposed that manic-depressive illness occurs in children but is not diagnosed more often because of its dissimilar presentation to the adult form and doubts about its existence in childhood. The case history of a 14 year old boy who presented in a hypomanic state is described. There was a strong family history of affective disorder. Both his parents and his half-sister were already on lithium for manic-depressive illness.

Effects of age on communication skill levels and prevalence of maladaptive behaviors in autistic and mentally retarded children

This study investigated the effect of age on communication and maladaptive behavior in autistic and mentally retarded children. Forty-seven autistic and 128 mentally retarded children in a special school served as subjects. The cross-sectional method was used to compare junior and senior groups, and ratings on communication skills and maladaptive behaviors were obtained from teachers. We found that the skills of comprehension and conversation in autistic children improved significantly with age, and speech improved somewhat. In spite of this improvement in communication skills, maladaptive behaviors in the autistic children other than hyperactivity did not change significantly with age. Withdrawal improved significantly with age in the mentally retarded children but not in the autistic children.

Speech skill levels and prevalence of maladaptive behaviors in autistic and mentally retarded children: a statistical study

Forty-seven autistic and 128 mentally retarded children, ages 6 to 14, from a special school were assessed in terms of nine maladaptive behaviors and speech skill levels. The results indicated that the group of the mentally retarded children with withdrawal had significantly lower speech skill levels than the group of those without withdrawal, and the group of the autistic children with self-injury had significantly lower speech skill levels than the group of those without self-injury.

Comprehension skill levels and prevalence of maladaptive behaviors in autistic and mentally retarded children. A statistical study

A statistical study on the comparison of the comprehension skill levels between the group with and the group without each maladaptive behavior of nine items was done for autistic and mentally retarded children. Results indicated that the group of the autistic children with hyperactivity or withdrawal had slightly, not significantly, lower comprehension skill levels than the group of those without each of these maladaptive behaviors. On the other hand, the correlation between the prevalence of hyperactivity or withdrawal and lower comprehension skill levels was seen more clearly, with statistically significant differences, rather among the mentally retarded children.

Behavioural syndromes identified by cluster analysis in a sample of 100 severely and profoundly retarded adults

Very little is known about psychiatric disorders in severely and profoundly retarded adults. We have investigated these disorders by systematically recording and collecting data about the behaviour of 100 severely and profoundly retarded hospitalized adults and subjecting the data thus derived to cluster analysis. Eight clusters were isolated. The clinical psychiatric significance of these clusters is discussed and their relationship to cause retardation, duration of stay in hospital and visiting is considered. A diagnostic framework for psychiatric disorder in severely and profoundly retarded adults is put forward and some possible treatment approaches are suggested.

Communication training in mute autistic adolescents using the written work

The expressive and receptive use of three written words was taught to three mute autistic adolescents using a procedure based on Terrace's errorless discrimination model and Premack's language training with chimps. Expressive language was measured by the subject's selection of the appropriate word card from among the available alternatives when the corresponding object was presented. Receptive language was measured by the subject's selection of the appropriate object from among the available alternatives when the corresponding word card was presented. The sequence of the presentations and the order of placement of the available alternatives were randomized. The three subjects required 979, 1,791, and 1,644 trails, respectively, to master both the expressive and receptive use of the three words. The correct response rates for the three subjects over the entire training program were 92, 92, and 90%, respectively. It was concluded that, as concrete visual symbols, written words may provide a viable communication system for the mute autistic. The implications for treatment are discussed and suggestions for future research are made.

Compliance and resistance in autistic children

The study was designed to explore factors related to negativism in autistic children, where negativism was defined as the consistent avoidance of a correct response in a multiple choice discrimination task. A design employed in an earlier study of autistic children (Cowan, Hodinott, & Wright, 1965) was modified to allow a more detailed examination of patterning of the child's responses. A positive relationship was found between use of spoken language and successful performance of the task. However, no child was negativistic. Of the 27 children tested, 18 had a near perfect performance and 9 scored at chance level. A subsequent exact replication of the Cowan et al. method still failed to produce any negativism. A further study using a more difficult discrimination task produced a higher rate of errors but still no negativism. Possible reasons for the failure to replicate are discussed.

Articulation in early childhood autism

Using a standardized articulation test, comparisons were made between the articulation of autistic children and (1) a group of predominantly subnormal language matched controls; (2) developmental receptive dysphasic controls. The autistic children's articulation was significantly superior to that of both control groups. The findings are discussed in relation to differences in the pattern of language impairment in the three groups.

The aetiology of childhood autism: a criticism of the Tinbergen's ethological theory

Kanner's descriptions of the children showing the abnormal behaviour pattern he observed and named "early infantile autism" are summarized. E.A. and N. Tinbergen's ethological theory of the aetiology of this syndrome is outlined and criticized. The major problem in evaluating this theory, apart from the absence of any evidence in its favour, is the lack of precision with which the Tinbergens use the terms "autism" and "Kanner's syndrome".

The genetics, if any, of infantile autism and childhood schizophrenia

A critical examination of the data for and against genetic factors in early infantile autism and childhood schizophrenia is presented. The extreme rareness of both disorders made analysis difficult. No strong evidence exists implicating genetics in the development of childhood psychoses that begin before the age of 5. Family pedigree data fail to support psychogenic transmission because very few siblings of early onset cases are affected. Biological but not genetic etiological agents are more likely. Genetic factors are implicated in the development of psychoses that begin near pubescence and such factors appear to overlap with those for adult schizophrenia. Reevaluation of the minimum age of onset for adult-type schizophrenia is suggested.

Institute of Psychiatry Department of Child and Adolescent Psychiatry

There has been a child psychiatry research group within the Institute of Psychiatry since 1952. At first it constituted a section of the Department of Psychiatry and for a while it formed part of the MRC Social Psychiatry Research Unit. However, in 1973 London University established a Chair of Child Psychiatry and since that time there has been a separate Department of Child and Adolescent Psychiatry. The research in this field undertaken up to 1967 has been described previously (Rutter, 1968a) and the present report brings the account up to date with a summary of work carried out during the last eight years.

A pair of classically early infantile autistic siblings

This case study describes in detail two autistic siblings who were mentioned in Rimland's analysis of checklists for psychotic children, as the only pair of classically early infantile autistic siblings (Rimland, 1971). One of the children, a nonverbal girl, now 13 years old, who developed epileptic seizures at age 41/2, shows all symptoms of early infantile autism even today. Her brother, now 24 years old, however, does not fit any of the known psychopathological patterns of childhood. The boy showed all symptoms of early infantile autism, but also some of the main characteristics of childhood schizophrenia and austic psychopathy. It is suggested that we are dealing perhaps with an unusual mixed type falling within a broad category of genetically determined types of autistic disorders.

Language patterns of adolescent autistics

The language samples of seven verbal autistic adolescents were analyzed. Linguistic deficits were compared to characteristics reported for preteen autistics and described structurally. Only four subjects demonstrated linguistic impairments. These clustered primarily in the area of prosodic features, semantic cooccurrence constraints and general disfluency. No such clustering had been reported for the preteen population. No correlation between linguistic deficits, IQ, and age was found. However, performance on the Seashore Test for Musical Ability correlated highly with linguistic performance. Results suggest that (a) autism includes liguistically, and possibly etiologically, distinct subtroups; (b) the basic linguistic deficits in autism may be more specific than thought previously; and (c) perception of prosodic features may be crucial for decoding and encoding linguistic signals. Autistic children may be lacking in this ability.

Language, communication, and the use of symbols in normal and autistic children

The characteristics of language and other forms of communication in normal and autistic children are described. The main basis of comparison is the extent to which each group can comprehend and use spoken and nonspoken language and also develop inner language. It is suggested that the central problem in early childhood autism is an impairment of complex symbolic function affecting all forms of communication. This problem can occur on its own, but, in the majority of cases, it is associated with other impairments of the central nervous system. The relationship of early childhood autism to mental retardation and to normal intellectual function is discussed.

Minimal brain Dysfunction

Because of the prevalence in our society of children labeled with the term minimal brain dysfunction; physicians who treat children must develop a point of view toward the syndrome and a working procedure for assisting affected children. An approach to this problem can be divided into two parts: detection of somatic disorders and comprehensive management of school problems. The detection of somatic disorders that may have produced or substantially contributed to the school problem requires conventional medical skills for recognition and treatment. Comprehensive management of school problems requires a broader approach by the physician; including counseling of the parents regarding adverse family interactions, advice about educational resources and consideration of the question of drug therapy for behavioral disorders. In all instances parents should be able to rely on the physician to act as a scientific source of guidance on the merits of the plethora of therapies directed toward the child with learning disorders. The ability to function competently in all of these areas will enable the physician to provide a service for children and their families that may profoundly affect their lives.