Making sense of autism.

Autistic disorder (AD) is a PODs are Rett's disorder, childhood to define with quantitative, objective disorder of brain development. Its disintegrative disorder, Asperger's diagnostic criteria and to associate the neuropathogenesis and etiology are disorder and PDD not otherwise phenotype with a biological marker. thought to be heterogeneous and are specified (PDD NOS). POD NOS At present neither is available although know in only a small fraction of cases. was included to allow clinicians to the Autistic Diagnostic Observation Genes have a complex indirect and, indicate that a child had a behavioral Schedule (ADOS) offers a meaningful to date, undefined role in AD. This phenotype that was similarto one of the advancement. Diagnostic criteria are chronic neurologic disorder leaves defined PODs but did not meet the full based on a qualitative determination of affected individuals dependent on their criteria for that disorder. In the next the severity of behavioral impairments, families for life. revision of the DSM III infantile autism and demonstrating that a child has was changed to autistic disorder(AD), the DSM IV prescribed number the term used in subsequent editions, of impairments. This qualitative including the DSM IV. determination is subject to the With the explosion of research confounding of observer bias and in the past 25 years, the concept marked rater-to-rater variance. This has emerged that the behavioral confounding variance has been a characteristics observed in children recurring source of considerable with AD are not unique to AD but disagreement among physicians, are distributed in lesser forms and in a disagreement that no doubt has different combinations throughout a perplexed the PCP who is caring for the child and supporting the family. The ADOS offers an observational instrument to reduce the influence of these confounding variables. TERMINOLOGY Autism, autistic disorder and autistic spec'trum disorder need definitions. They are best understood from a historical perspective. In 1943 Leo Kanner, a child psychiatrist, described 11 children, most from prosperous and welleducated parents (several were physicians) with "autistic disturbances of affected contact.'" He borrowed the word autistic from the schizophrenia literature, where it denoted the selfcentered thinking, detached behaviors and resulting isolation observed in schizophrenia. Following his report, the term infantile autism emerged. Kanner's report received little attention in part because the behavioral phenotype was already subsumed under the diagnosis of childhood schizophrenia. However, in the 1950s the psychodynamic theorists resurrected his work and hypothesized that children became autistic because they were not given appropriate emotional nurturing by their "refrigerator" mothers. 2.3This approach to autism was the antithesis of Kanner's speculation that infantile autism had a biologic cause. Infantile autism was formalized as a disorder in 1980 when it was included in the Diagnostic Statistic Manual, third edition (DMS 111).4It was categorized as a pervasive developmental disorder (PPD), a group of behaviorally defined syndromes that share the characteristic of severe and pervasive disruption of development in "..social interaction skills, communication skills or the presence of stereotyped behavior, interests and activities."4 The other "AD AND THE