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PubMed1978

National Society for Autistic Children definition of the syndrome of autism.

It is helpful for the new student of autism to know the clinical and research basis from which our definition of the syndrome has been evolved. The main features and characteristics are no less meaningful for being recognized as working definitions, subject to alteration with the discovery of new knowledge about causation and treatment. Such research can be most useful, even when samples of autistic children with different specific characteristics are selected. However, it is necessary for the specific characteristics, and their selection purpose, to be identified explicitly. Likewise, the limits of applying the findings on such subsamples to other autistic children should be frankly acknowledged.

Adolescent↗
PubMed1976

Differences between mentally retarded and normally intelligent autistic children.

Autistic children with an IQ below 70 and with an IQ above 70 were systematically compared. The two groups differed somewhat in the pattern of symptoms, but were closely similar in terms of the main phenomena specifically associated with autism. However, the low IQ and high IQ autistic children differed more substantially in terms of other symptoms such as self-injury and stereotypies and there were major differences in outcome. The possibility that the nature of the autistic disorder may differ according to the presence or absence of associated mental retardation needs to be taken into account in planning studies of etiology.

Achievement↗
PubMed1977

Integration of a behavior modification program into a traditionally oriented residential treatment center for children.

The historical background and early contributions of the Emma Pendleton Bradley Hospital, the first psychiatric hospital for children in the United States, are described. The focus of this report is on the incorporation of the treatment modality of behavior modification into this traditional psychoanalytically oriented program. Beginning with exploratory studies in the mid-1960s, in recent years within the residential center there has been a separate Autistic Unit, in which the major treatment strategy is consistent application of behavior modification principles and programs. Changes that have occurred in the course of developing the behavior modification program are discussed to show some of the positive and negative aspects of introducing such a radical change into a traditional setting. Case studies are included to reveal both the failures and the successes that have been encountered in treating psychotic children with either psychotherapy or behavior therapy. Description of the current status of the program shows that treatment is comprehensive, including psychodynamic and behavioral approaches, medication when warranted, and special education. The role of parents in the program is now very different from that ascribed to them in traditional psychoanalytically guided treatment.

Activities of Daily Living↗
PubMed1978

Prevalence of self-injurious behaviors in a large state facility for the retarded: a three-year follow-up study.

A combined informant questionnaire and interview survey of self-injurious behavior (SIB) at a large state facility for the retarded was conducted independently three times over a 3-year period. Prevalence consistently was about 10% of the population. SIB cases tended to be younger and institutionalized longer than the rest of the population. Severe cases had a longer history of chronic SIB. SIB cases had more seizure disorders, severe language handicaps, visual impairments, and severe or profound retardation than the rest of the population. They appeared to fulfill most of the Rutter (1966) criteria for autism. But unlike the severely autistic, there was little relation of sex to incidence of SIB. Over 90% of SIB cases changed status over 3 years, suggesting that SIB was amenable to behavior modification in most cases (94%). Psychotropic behavior control medications helped in some intervention programs (32%). SIB remitted spontaneously in 21% of SIB cases where there had been no behavioral or drug intervention.

Adolescent↗
PubMed1978

Suppression of repetitive self-injurious behavior by contingent inhalation of aromatic ammonia.

Two institutionalized children who exhibited high rates of severely self-injurious behaviors were punished with aromatic ammonia inhalation on a response-contingent basis. This contingency was applied throughout all aspects of each child's institutional program which focused on teaching of self-help skills. Suppression of the self-injurious responses was both rapid and general. The contingency was maintained for 2 months, although there was no responding after the first 5 days. Follow-up sessions, conducted 4 months after the punishment contingency was removed, revealed that suppression effects were highly durable. Aromatic ammonia inhalation appears to be an effective alternative for decelerating extremely maladaptive behaviors that do not yield to more conventional nonaversive forms of therapy. However, the procedure should be used with great caution, for it may involve risk to the subject.

Ammonia↗
PubMed1982

Automutilation of the cornea. I. Ophthalmological aspects.

Automutilation of the cornea occurs more frequently than is generally supposed. The patient, particularly at his first visit, certainly will not reveal the cause of the cornea lesion. In two University Eye Clinics 19 patients were seen in whom the diagnosis of automutilation of the cornea could be made. It is important for the ophthalmologist to bear the possibility of automutilation in mind. In 6 of our patients corneal grafts were performed. All these grafts failed because of further automutilation. Corneal transplantation is certainly not indicated; these operations were performed because the patient's true condition had not been spotted in time. Better forms of treatment are tarsorrhaphy or the application of closely occluding bandages. In this way fair results were obtained in 2 cases. It is wrong to force the patient to a confrontation (i.e. to tell him that automutilation is suspected). Confrontation can lead to more severe mental disorders. In all cases psychiatric treatment is absolutely essential. The ophthalmological prognosis for this condition is poor and psychiatric help is quite often refused.

Adult↗
PubMed1982

Automutilation of the cornea. II. Psychiatric aspects.

In connection with a number of ophthalmological patients in whom automutilation was seen, the background to this behaviour is considered. It is usually seen in patients with a borderline personality. Automutilants differ from simulants. In practice, it is important to avoid confrontation and to look out for 'splitting'. Psychiatric treatment is seldom successful.

Borderline Personality Disorder↗
PubMed1986

[Factitious disease. Observations on 44 cases at a medical clinic and recommendation for a subclassification].

From 1971 to 1985, 44 cases of self-induced factitious disorders were observed in the Medical Department of a University Hospital. The diseases were often severe, one patient even died. The various symptoms and diseases presented by the patients, the methods of producing them, and the diagnostic and therapeutic aspects of these cases are described. Patients were analysed with regard to age, sex, profession, psychosocial adaptation, number and duration of hospitalisations, presentation of complaints, behaviour on the ward, relation to the doctor, self-destructive tendencies, readiness to suffer and possible motivations. According to the criteria of the DSM-III, seven patients were malingerers (DSM-III: V 65.20) and 37 had a "chronic factitious disorder with physical symptoms" (DSM-III: 301.51). However, the findings in the patients of the latter group strongly suggest that they form an extremely heterogeneous population. Therefore we propose a subclassification of the DSM-III category 301.51 as follows: Type A. Muenchausen syndrome in the proper sense; dramatic deception of mainly acute illness; pseudologia fantastica; social maladaptation, chaotic life situations; many, mostly short hospitalisations; many interventions; at first well adapted, later hostile; mostly men. Type B. Self-induced, mainly chronic illness; behaviour adequate, highly compliant; often little emotion, contrasting with the sometimes severe illness; socially adapted; history remarkably blank with regard to psychosocial stress; several often longlasting hospitalisations and many interventions; almost exclusively younger women from (para-)-medical professions. Type C. Willfull interference with the healing of wounds, cutaneous ulcers, abscesses or dermatological artefacts; history with marked personal losses or severe chronic medical problems; at first well adapted, later hostile, passive/aggressive; women prevail. A conversion syndrome (DSM-III: 300.11) was not observed. In contrast to malingering, the basis of the disorder in types A, B and C is unconscious in origin, thus similar to the conversion syndrome. Contrary to the latter, however, the production of physical symptoms is under voluntary control. The proposed subclassification represents a hypothesis for testing which might facilitate the analysis of the basic personality disorder, so far lacking. The investigation of the psychopathology of these patients and their treatment is difficult if not impossible because most refuse psychiatric exploration and therapy. Consequently follow-up studies and data on the prognosis are rare.

Adolescent↗