Abstract
Neurologists use the term ‘autistic' to describe a quality of social behaviour and communication rather than ‘autism' as a diagnosis. It has an organic basis and is commonly, and increasingly, found to be associated with specific medical diagnoses. Epilepsy is as common as in severely mentally handicapped children but whereas in the latter it is often evident in the early years it commonly emerges in adolescence in autistic children. There is a genetic component to autism and in the absence of a specific diagnosis an empirical recurrence risk of 1-2% is given. Fragile-X chromosome disorder is a relatively common explanation but the investigation is expensive and subject to restriction in spite of the enormous implications for affected families. The male preponderance and the neurological explanation for autism have not yet been explained.
The reasons for autistic behaviour lie beyond the crude investigative techniques of neurology. Computerised tomography scanning has not found the ‘bad' bit (Damasio, Maurer, Damasio & Chui, 1980; Caparulo, Cohen, Rothman, Young, Katz, Shaywitz & Shaywitz, 1981; Prior, Tress, Hoffman & Boldt, 1984), leading to more speculative explanations in terms of disordered dendritic interconnections. Nevertheless, autistic behaviour is a helpful clue to an underlying disorder. Its investigation has proved to be a fascinating and increasingly successful medical activity for the neurologist. In turn, we have learned from our colleagues how disabling the communication, social skills and symbolic deficits are for these young people, and how difficult it is to teach them, either individually or in groups (Rotter, 1987). The current scope of neurological treatment is limited to use of anticonvulsants when appropriate, genetic counselling and management of associated disabilities. Psychiatrists help the diagnostic process, help families to come to terms with their predicament and explain the nature of the disorder to other agencies.
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