Clinical Description | Social Interaction | Communication Impairment | Patterns of Behavior | Epidemiology | Etiology | Course and Prognosis | Diagnostic Evaluation | Treatment
First formally described by Kanner (1943), "early
infantile autism" was characterized by autistic disinterest
in the social environment and obsessive insistence on sameness.
Additional features included speech delay, echolalia and pronoun
reversal, and unusual repetitive motor behaviors (or stereotypies).
Kanner's use of the word autism may
have unintentionally contributed to an unfortunate and long-lasting association
with Bleuler's description of schizophrenia, and for decades,
autism was considered by many to be the first manifestation of schizophrenia.
Various terms (e.g., childhood schizophrenia, infantile or symbiotic
psychosis) were used in response to prominent theories regarding
autism's etiology, and numerous diagnostic criteria were
put forth. In 1968, Rutter proposed four essential
characteristics that emanated from the existing evidence and were
present in nearly all children with autism: 1) lack of social interest
and responsiveness, 2) impaired language, 3) bizarre motor behavior,
and 4) onset prior to the age of 30 months. In 1980, with the development
of DSM-III (American Psychiatric Association 1980),
Rutter's basic criteria predominated, and the diagnosis
of infantile autism was included with the new class of "pervasive
developmental disorders." In DSM-IV (American Psychiatric Association 1994), the diagnosis of autistic disorder was
established via a large multisite study (Volkmar et al. 1994),
and emphasis was placed on developmental aspects of the disorder.
Minor adjustments to the diagnostic criteria were made in DSM-IV-TR
in an attempt to facilitate clinical use (Table 21–12).