Autism

The results of a survey of almost I300 parent members of autistic societies in the UK are described. The ages of their children ranged from 2 to 49 years. The survey focused on parents' views of the diagnostic process and data were collected on the age at which diagnosis was made, the time taken to obtain a diagnosis and the professionals involved. Differences in geographical area were also assessed. Overall, the results indicate that children are now being diagnosed earlier than in previous decades, but the average age of diagnosis is still around 6 years. There are also wide regional variations in diagnosis. The survey indicates that many parents continue to experience lengthy and often frustrating delays before they finally receive a diagnosis. Moreover, even when this process is completed, the amount of practical help subsequently provided is generally very limited. Factors related to parental satisfaction with the diagnostic process are discussed in detail.

1941 ofthe 3-6-year-old children living in a community outside Gbteborg on the Swedish west coast were screened with a view to identifying all individuals with severe degrees of autistic behaviour. All children in the population were known to well baby clinic staff, and any child suspected of suffering from autism was referred to a specialized clinical research team. The nurses and doctors working in the well baby clinics were well informed about autism. Clinical and ADI-R diagnoses of autism were established after thorough clinical assessments of each suspected case. All children were seen at least twice, and all were over the age of 3 years at the time of diagnosis. The general population prevalence for autism was 3 I in I o,ooo children (9; percent confidence interval 7/ g;). Classic Kanner autism was found in I o in Io,ooo children (9; percent confidence interval-4/24). These rates appear to reflect higher rates than previously reported. Some reasons for the possibly higher prevalence are discussed.

The relationship between fragile X syndrome and autism is reviewed. Results from a semi-structured questionnaire survey of development and behaviour in boys with fragile X syndrome, Down's syndrome and learning disability of unknown aetiology are presented. A behavioural profile characteristic of many boys with fragile X syndrome was identified which distinguished them from both other groups. Fragile X boys did not show more autism than boys with idiopathic learning disability but they did have a common autistic-like profile of communicatory and stereotypic disturbances, most notably delayed echolalia, repetitive speech and hand flapping. Boys with idiopathic learning disability showed difficulties more in areas of social functioning. Boys with Down's syndrome were characterized by fewer difficulties in social functioning and ritualistic/stereotypic tendencies but this might have been explained by subject ascertainment bias. Behavioural items distinguishing boys with fragile X significantly from both other groups retained their significance even when individuals with autism were excluded from statistical analysis. The findings provide further support for the notion of a behavioural phenotype in boys with fragile X syndrome.

The paper represents an attempt to evaluate the effect of professional art training on savant artistic ability, and focuses on the work of the artist Stephen Wiltshire. It was undertaken jointly by two of Stephen's own tutors at art school and the two principal authors. The context of the research was, by its nature, not experimental but attempted to look at possible artistic and technical developments in relation to characteristics of autistic savant abilities. Savant ability has often been regarded as a fixed entity which cannot be accounted for solely in terms of continuous practice. There have however been few reports of the effect of expert tuition. As the young savant artist investigated here had previously almost exclusively used line drawing, and had rarely employed tonal values (shading), this dimension was focused upon as giving a possible indication of the effectiveness of teaching. In addition, structured interviews concerned with a detailed analysis of Stephen's work showed that although there was considerable progress during his college attendance, autism also appeared to set limits to Stephen's artistic development in regard to artistic intentions and subject agenda.

A young man with Asperger syndrome who presented with severe depression and self-injurious behaviour was treated with Ig sessions of cognitive-behavioural therapy. A decrease in the levels of measured depression and self-injury were found following the therapy. It remained unclear exactly which elements of the intervention brought about the improvements. The use of cognitive-behavioural treatments with people with Asperger syndrome is discussed.