The Mystery of Autism
When I was a psychiatric resident in the 1960s, I evaluated a 6-year-old boy who was unlike any child I had ever seen. He was a handsome, chubby, freckled-faced child with short blond hair and an impish smile. He was marching robot-like around the room and made no eye contact when I addressed him. When his mother said "Say hello to Dr. Kestenbaum," he repeated in a high-pitched voice, "Say hello to Dr. Kestenbaum."
Harry's parents knew he was different (he wouldn't cling to his mother, reach up, or point to something he wanted, or cry when his mother left him in a strange place). He did not speak until he was 4, and then exhibited the kind of speech I noted, repeating verbatim what was said to him ("echolalia"). He had always been overactive. He needed things to be kept exactly the same way. He would have recurring tantrums if a newspaper or book was out of place. His pediatrician said Harry would outgrow his strange mannerisms, but he never did.
Harry was diagnosed with "early infantile autism," a rarely (at the time) diagnosed disorder first described by Leo Kanner in 1943. Since then, there has been a tremendous interest in studying children like Harry — although we still have few answers about what causes the condition, or why so many children today exhibit its symptoms. While the most severe form of autism is rare, thousands of children display behaviors along the autistic spectrum; they are called children with pervasive developmental disorder (PDD) in the psychiatric literature. Some are retarded, have little or no speech, and need constant care. Others, however, are extremely intelligent and may have special skills — incredible memory for things such as train schedules, maps, or dates. Some are musical. Others display exceptional artistic ability.
Autism is identified by the time a child is 2. Sometimes she appears deaf, not responding to a loud noise. Sometimes she exhibits strange body movements, such as rocking, whirling, or teeth grinding. If autistic disorder is suspected, the child should have a complete evaluation including clinical history, neuropsychological testing, and a hearing test. Several special instruments have been developed to assess autism.
In Harry's time there were no services for children with autism. Today there are hundreds of programs, support groups for families, and a plethora of treatments — many experimental and even controversial. A special school or class in a public school should provide individual speech and language intervention, but most importantly, in my opinion, is a social skills group for such children, and help for their parents in learning how to work with them. For more information about services, begin by contacting your pediatrician, your school district (even if your child is younger than 5), or the American Academy of Child and Adolescent Psychiatry (www.aacap.org; 800-333-7636).
