Basing case selection on behavioural criteria, the entire 8–10 year old population of the County of Middlesex was screened to identify children with autistic behaviour. Screening was accomplished by behaviour questionnaires, completed by teachers or other supervisors, examination of case records and interviews with selected children and informants. Among 54 children who were found to show some evidence of the syndrome, two “autistic” subgroups and one “non-autistic” subgroup were defined, according to ratings on 24 behavioural items. The 35 “autistic” cases represent a prevalence rate of 4.5 per 10,000. Data for 32 of these were analyzed. Boys were more common than girls in a ratio of 2.6 to 1. The relationship between early development, type of onset and I.Q. at the survey mean age of 9 years 9 months, is discussed. The numbers of autistic children found are compared with those of children with other handicaps such as blindness. It is pointed out that sub-division according to the presence of developmental retardation is necessary for the useful comparison of reported groups, particularly with respect to estimates of prognosis.

Epidemiology of autistic conditions in young children

A clinical study of changes in mental function, subjectively experienced by a group of 40 young schizophrenic patients, is reported. Various phenomena related to disturbances in attention, perception, memory, motility and speech are described and discussed, with special reference to early diagnosis. It is suggested that these phenomena may be subjectively experienced by the patients long before signs of established disease appear overtly. It is argued that the clinical data presented support the view that schizophrenia is an organic psychosis, and also that the impairment in speech in this disease is aphasic in nature. It is suggested that the alteration in the perceptual and psychomotor functions in schizophrenia results in a flooding of consciousness with sensory data to a degree beyond the limits of normal experience. Blocking phenomena are regarded as transient disturbances in consciousness which develop in association with a failure to exclude irrelevant stimulation from internal and external sources. A clinical comparison is made between the latter phenomenon and epileptic disturbances of consciousness, the important differences being noted. Various emotional changes, catatonic symptoms and the development of delusions are discussed in relation to particular defects in perception and cognition. Finally, the tentative suggestion is made that the clinical approach outlined might be utilized, in conjunction with experimental psychological methods, for the purpose of classifying schizophrenic illnesses in a more specific manner.

The early symptoms of schizophrenia.

Schizophrenia is often conceptualized by clinicians and researchers alike as a chronic illness with persisting, relapsing or deteriorating symptoms, and no hope for sustained remission and recovery of functioning. Countering this perspective, retrospective and prospective studies with both chronic and recent onset patients suggest that schizophrenia has a heterogeneous course, which can be favorably influenced by comprehensive and continuous treatment as well as personal factors such as family support and good neurocognitive functioning. The factors influencing recovery are mostly malleable through treatment and may often lead to a sustained remission of symptoms and normal or near-normal levels of functioning.To facilitate future research in this area, an operational definition of recovery from schizophrenia is proposed that includes symptom remission; full- or part-time involvement in work or school; independent living without supervision by family or surrogate caregivers; not fully dependent on financi...

Operational criteria and factors related to recovery from schizophrenia

The Defense Mechanism Inventory, a paper and pencil test which purports to measure the relative intensity of usage of five major groups of defenses, is described. The inventory consists of 10 brief stories, two per conflict area, followed by four questions regarding S's actual behavior, fantasy behavior, thoughts, and feelings in the situations described. Five responses typifying the five defenses (i.e., hostility-out, projection, principalization, turning-against-self, and reversal) are provided for each question, from which S selects the one most representative and the one least representative of his reaction. Reliability, validity, and normative studies are presented, all indicating that this inventory has many potential uses as a clinical and research instrument.

An objective instrument for measuring defense mechanisms.

Progress in the study of infantile autism over the past 10 years was reviewed in terms of classification and diagnosis, relation to other disorders, demographics, parental characteristics, genetics, intelligence, language, perceptual processes, behavioral characteristics, neurobiological, biochemical and pharmacological aspects, behavioral/educational treatment methodologies, prognosis, and theoretical considerations. This decade's research led to the now generally accepted position that infantile autism is a type of developmental disorder accompanied by severe and, to a large extent, permanent intellectual/behavioral deficits. However, its relationship to other forms of developmental disorders and to mental retardation remains to be delineated. Perceptual/cognitive/language defects appear central to the autistic syndrome, but the specific underlying mechanisms are unknown. Most studies indicate that autistic children have more signs of brain dysfunction than do normal children and about the same number as mentally retarded children. The overwhelming evidence suggests that te treatment of choice for maximal benefit to autistic children is a systematic, intrusive behavioral/educational approach. Yet, in spite of significant gains in almost all children treated, the typical prognostic picture is poor in terms of achieving self-supportive adulthood. The parents of autistic children have been found to be essentially similar to parents of children with organic brain disorders, and manifest no psychopathology which conceivably could induce the disorder. The vast majority of theoretical articles appearing in the 1970s proposed some from of neurobiological defect as the causative factor in autism. One of the major goals for future research is to undertake more extensive comparative studies on nonautistic brain dysfunctional children and autistic children that could yield cleared differential behavioral profiles and testable neurobiological hypotheses.

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Ed. Leopold

Papers

Schizophrenia: A Review of the Syndrome