A medical model of autism: etiology, pathology and treatment.
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Biomedical subjects
Publications and source records attributed to E R Ritvo.
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The present study is being conducted to explore the hypothesis that genetic and/or congenital factors are etiologically significant in certain persons with the syndrome of autism. To initiate the project, the UCLA Registry for Genetic Studies in Autism was established in 1980. To date 254 families have enrolled. Extensive clinical material and past medical data are being gathered from each family. Information presented in this preliminary report is based solely upon parental reports and prior medical and school evaluations, as the diagnoses have not yet been verified by the authors. Clinical data and family pedigrees will be analyzed by computer-based methods. Blood studies including chromosomes, gene markers, T-cell and B-cell functions, and antibody levels are being conducted on families meeting specific research criteria.
The authors are developing the Behavior Observation Scale to objectively differentiate autistic, normal, and mentally retarded children aged 30--60 months. They describe operational definitions and procedures and report data on the frequency of selected behaviors among 114 children. Prior studies have revealed that to assess the clinical significance of behaviors in autistic children, both frequency of occurrence per subject and the number of children exhibiting the behaviors must be considered concurrently. This study confirms the hypothesis that it is critical to consider the IQ of the child when assessing the clinical significance of individual behaviors and groups of behaviors.
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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.
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The purpose of the present experiment was to examine the reinforcing effects of repetitive vestibular stimulation. While both autistic and retarded children would push a button for vestibular stimulation, frequency of stimulation was an important parameter for autistics but not for retardates. These results were interpreted as evidence for central rather than peripheral locus of control of motility disturbances in autistic children.
Thirty normal children (aged 3--68 months) and 16 autistic children (aged 36--62 months) were recorded during nonmedicated sleep and data pertaining to rapid eye movements (REM) were measured during the first three REM periods of the night. When time of night from which data were gathered was held constant, normal children showed a significant relationship between age and the organization of eye movements into discrete bursts. When autistic children were compared to age-matched normal controls, they showed an immaturity in this phenomena, their results being similar to those found in children less than 18 months of age. Such an immaturity could result from dysfunction at a number of diverse levels and sites in the central nervous system.
The authors review the clinical features and behavioral characteristics of autism; differential diagnosis of the syndrome; clinical, neurophysiological, and biochemical research; and its medical management and treatment. They conclude that autism is a behaviorally defined, specific syndrome that is manifested at birth or shortly thereafter. Its symptoms are expressive of an underlying neuropathophysiological process that affects developmental rate; modulation of perception; language, cognitive, and intellectual development; and the ability to relate. The long-term prognosis is guarded; almost all patients manifest severe symptomatology throughout their lives. Further basic research into the neuropathophysiological process underlying the syndrome is necessary in order to reach the ultimate goal of developing etiologically specific treatment programs.
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