Child Psychopathology

By Eric J. Mash; Russell A. Barkley | Go to book overview

CHAPTER
NINE
Autistic Disorder

Laura Grofer Klinger

Geraldine Dawson

Peggy Renner

Autistic disorder is one of the pervasive developmental disorders, which are characterized by impairments in the development of reciprocal social and communication skills, abnormal language development, and a restricted repertoire of behaviors and interests. Autism seriously affects multiple domains, making it a challenging disorder to understand and to treat. When writing about her 2-year-old daughter with autism, Catherine Maurice (1993) described how autism affected all aspects of her daughter's development:

It wasn't just that she didn't understand language.
She didn't seem to be aware of her surroundings.
She wasn't figuring out how her world worked,
learning about keys that fit into doors, lamps that
turned off because you pressed a switch, milk that
lived in the refrigerator.… If she was focusing on
anything, it was on minute particles of dust or hair
that she now picked up from the rug, to study with
intense concentration. Worse, she didn't seem to
be picking up anyone's feelings. (pp. 32–33)


HISTORICAL CONTEXT

The term “autism” was coined by Bleuler in 1911 to describe individuals with schizophrenia who had a loss of contact with reality (Bleuler, 1911/ 1950). In the early 1940s, two men—Leo Kanner (1943) and Hans Asperger (1944/1991)—independently described children with disorders involving impaired social relationships, abnormal language, and restricted and repetitive interests. They believed that these children had a loss of contact with reality similar to that described by Bleuler, but without the concomitant diagnosis of schizophrenia.

In his initial report, Kanner (1943) presented case studies of 11 children whom he described as having an “extreme autistic aloneness” (p. 242). He noted that these children had an “inability to relate themselves in the ordinary way to people and situations from the beginning of life” (p. 242). In addition, he wrote that the syndrome led to language deviance characterized by delayed acquisition, echolalia, occasional mutism, pronoun reversals, and literalness. Finally, Kanner described these children as having an “obsessive desire for the maintenance of sameness” (p. 245), characterized by the development of elaborate routines and rituals. Because of their good rote memory and their normal physical appearance, Kanner concluded that these children were capable of achieving normal cognitive abilities.

In 1944, Asperger described a similar, but less severely impaired, group of four children that he diagnosed as having “autistic psychopathy.” Similar to Kanner, Asperger described difficulties in social interaction including eye contact, affective expression, and conversational abilities. In contrast to Kanner's report, Asperger wrote about children who developed good language abilities

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