Diagnostic, Clinical, Psychopathological, Psychological Aspects of the Examination of Children with Autism Spectrum Disorders

Objective: recently, much attention has been paid to the problem of autism spectrum disorders (ASD) in childhood. Despite the abundance of psychometric approaches to the diagnosis of autism in childhood, questions remain about the validity of their use in everyday practice. In recent years, works began to appear in the United States calling into question the practice of mandatory use of the “gold standard” methods for diagnosing ASD. Russia has many years of experience in multidisciplinary cooperation of medical psychologists and clinicians in child psychiatric practice, which makes it possible to more accurately determine the depth and severity of autistic manifestations, as well as to determine the dynamics of a child’s development, which will make it possible to provide targeted effective assistance. Aim: to develop diagnostic, clinical-psychopathological, psychological approaches to the diagnosis of autism spectrum disorders in childhood.Patients and methods: the sample consists of 254 patients aged 4–17 years (average age 7.3 years) with different forms of ASD according to ICD-10 (heading F84). The patients were examined by clinical-psychopathological, clinical-dynamic, clinical-follow-up, psychological methods.Results: the study made it possible to define the profiles of six main forms of ASD from a clinical and psychological standpoint: Asperger’s syndrome (F84.5); childhood autism dysontogenetic (F84.0); childhood psychosis (F84.02); Kanner’s syndrome (F84.01), syndromic atypical autism (F84.11),and atypical childhood psychosis (F84.12).Conclusion: the results obtained are presented in a multidisciplinary aspect, which allows the most accurately diagnose one form or another of autism spectrum disorders and to develop personalized routes of patient management.

Longitudinal Observation of the Psychosocial and the Intellectual Development of a Patient with Autism

The article describes the experience of observation and medical support of a patient with Kanner’s syndrome from an early age to 27 years in the framework of complex medical, psychological and educational support. Long-term medical and psycho-educational support and family work allowed the patient to develop social skills and artistic abilities. The positive dynamics of intellectual and aesthetic development, smoothing of negative behavioral characteristics of the patient are demonstrated. The importance of joint well-coordinated work of a psychiatrist, speech therapist-special teacher, psychologist and parents is emphasized. The complex of rehabili- tation measures of professionals and parents gave a positive result: the young man is socialized and no longer needs special continuous medical and psychological support. As part of the supported employment, he attends an art workshop at the monastery and is engaged in painting. His personal exhibition had success. Such cases are an incentive for the constant active work of parents and teachers with children with severe forms of autistic disorders, and for the development of new effective methods of treatment, habilitation and rehabilitation, espe- cially in difficult to manage cases.

Steroid Metabolites Support Evidence of Autism as a Spectrum

Objectives: It is common nowadays to refer to autism as a spectrum. Increased evidence of the involvement of steroid metabolites has been shown by the presence of stronger alterations in Kanner’s syndrome compared with Asperger syndrome. Methods: 24 h urine samples were collected from 20 boys with Asperger syndrome, 21 boys with Kanner’s syndrome, and identically sized control groups, each matched for age, weight, and height for comprehensive steroid hormone metabolite analysis via gas chromatography–mass spectrometry. Results: Higher levels of most steroid metabolites were detected in boys with Kanner’s syndrome and Asperger syndrome compared to their matched controls. These differences were more pronounced in affected individuals with Kanner’s syndrome versus Asperger syndrome. Furthermore, a specific and unique pattern of alteration of androsterone, etiocholanolone, progesterone, tetrahydrocortisone, and tetrahydrocortisol was identified in boys with Kanner’s syndrome and Asperger syndrome. Interestingly, in both matched samples, only androsterone, etiocholanolone, progesterone, tetrahydrocortisone, tetrahydrocortisol, and 5a-tetrahydrocortisol groups were positively correlated. In the Asperger syndrome group, all metabolites showed a positive correlation. In the Kanner’s syndrome group, 5-a tetrahydrocortisol with androsterone showed a positive correlation. Conclusions: Due to differences in the level of alteration, the premise that Asperger syndrome is on the mild side of the autism spectrum and that Kanner’s syndrome is on the severe side is supported, but alteration patterns yield different phenotypic expressions.

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

SynopsisKanner's descriptions of the children showing the abnormal behaviour pattern he observed and named 'early infantile autism’ are summarized. E. A. and N. Tinbergens' 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’.