Stabilizing autism: A Fleckian account of the rise of a neurodevelopmental spectrum disorder.

Using the conceptual tools of philosopher of science Ludwik Fleck, I argue that the reframing of autism as a neurodevelopmental spectrum disorder is constrained by two governing 'styles of thought' of contemporary psychiatry. The first is the historically conditioned 'readiness for directed perception' of, and thinking in terms of, ontologically distinct diseases. The clinical gaze of mental health professionals, the bureaucratic needs of health administration, the clinical and scientific utility of disease categories, and the practices of autism-oriented advocacy groups all imply a bias toward thinking about autism and related disorders as ontologically distinct psychiatric and scientific entities. Second, within the 'neuromolecular style of thought', mental disorders are more and more located at the neurobiological levels of the brain. In autism research, one of the biggest challenges is the identification of autism's neurobiological singularity. However, at a moment when biological and categorical approaches toward autism face serious empirical difficulties, a balance is established that holds together these two styles of thought. With a need to account for some of the most persistent uncertainties and conflicts in autism research, namely ubiquitous heterogeneity and a failure to identify disease specific biomarkers, the reframing of autism as a neurodevelopmental spectrum disorder satisfies the scientific, institutional and socio-political needs for stability and homogenization.

From Kanner to DSM-5: autism as an evolving diagnostic concept.

Seven decades have elapsed since Leo Kanner described the syndrome he termed early infantile autism. Over this time, and particularly over the past two decades, noteworthy changes have occurred in how the condition is conceptualized. Here we provide an overview of these changes, beginning with a brief discussion of the significance of classification in general before discussing Kanner's original paper and subsequent changes. We touch on relevant issues, such as comorbidity, dimensional aspects of diagnosis and screening, and the complex issue of diagnosis relative to eligibility for services. Approaches to diagnosis have tended to swing from emphasizing overarching groups (lumping) to focusing on potentially distinct subgroups (splitting). Autism raises particular problems given the broad range of syndrome expression over age and developmental level. The most recent revision of the American Psychiatric Association's diagnostic taxonomy marks a significant departure from its predecessor and has been the focus of much debate. It remains unclear which of the currently existing categorical approaches will ultimately be most widely applied. We hope to convey a sense of areas in which consensus has been achieved and areas of continued controversy.

Outcomes in adults with autism spectrum disorders: a historical perspective.

In this review, we examine the ways in which researchers have defined successful adult outcomes for individuals with autism spectrum disorders (ASDs) from the first systematic follow-up reports to the present day. The earliest outcome studies used vague and unreliable outcome criteria, and institutionalization was a common marker of poor outcomes. In the past decade, researchers have begun to standardize the measurement of adult outcomes with specific criteria based on friendships, employment, and living arrangements. Although nearly all of these studies have agreed that the majority of adults with ASD have poor outcomes, evolving concepts of what it means to be an adult could have an impact on outcomes measured. For example, some researchers have suggested that taking into account the person-environment fit could reveal a more optimistic picture of outcomes for these adults. Suggestions for future research are discussed.

Historical perspectives on autism: its past record of discovery and its present state of solipsism, skepticism, and sorrowful suspicion.

Concepts of autism have evolved over the twentieth century after Bleuler coined the term to refer to symptoms of self-absorption in those with schizophrenia. Autism nosology changed to the current sesquipedalian constellation of autism spectrum disorders with a confusing archipelago of 5 conditions that often serve as islands of confusion to both the general public and professionals. This article reviews historical links that have led to the current confusing and controversial situation that is encouraging some people to return to magic, mysticism, and mantics for health care, despite the amazing accumulation of progress in vaccinology over the past 2 centuries.

Historia del trastorno autista / History of the autistic disorder

El autismo es un trastorno neuropsicológico que comenzó a diagnosticarse hace relativamente pocas décadas. En 1943, Leo Kanner lo describió por primera vez, suponiendo el inicio del estudio clínico de un síndrome que, hasta ese momento, era desconocido. No obstante, hay evidencias que indican que el trastorno ha existido siempre y son diversas las publicaciones que así lo evidencian. Desde los años 60 hasta la actualidad, se han realizado multitud de investigaciones y aportaciones procedentes de diversas disciplinas que reflejan la enorme complejidad del trastorno. El objetivo de este teabajo es hacer un recorrido histórico que permita conocer cuál ha sido el devenir del estudio clínico y evolutivo del trastorno autista hasta la actualidad. Con esta finalidad, se destacan los momentos más significativos que han contribuido a definir el autismo tal y como se conoce en la actualidad(AU)

The autism is a disorder neuropsicológico that began to be diagnosed relatively a few decades ago. In 1943, Leo Kanner described it for the first time, supposing the beginning of the clinical study of a syndrome that, up to this moment, was not known. Nevertheless, there are evidences that indicate that the disorder has existed always and there are diverse the publications that like that demonstrate it. From the 60s up to the current importance, there have been realized multitude of investigations and contributions proceeding from diverse disciplines that reflect the enormous complexity of the disorder. The aim of this teabajo is to do a historical tour that allows to know which has been to develop of the clinical and evolutionary study of the autistic disorder up to the current importance. With this purpose, are outlined the most significant moments that have helped to define the autism as it is known at present(AU)

Histórico e situaçäo nosológica atual do transtorno desintegrativo da infância / Historical and actual nosologic situation of disintegrative disorders of childhood

Enquanto a classificaçäo do autismo infantil precoce parece estar bem estabelecida nos sistemas diagnósticos atualmente utilizados (CID-10, DSM-IV), os quadros clínicos relacionados a condiçöes autísticas de ínicio tardio, que implicam regressäo do desenvolvimento cognitivo e psicossocial da criança, permanecem ainda como objeto de uma série de controvérsias e discussöes. Apresenta-se, aqui, uma revisäo histórica do tema, iniciando-se por Theodor Heller, que, em 1908, publicou pela primeira vez, observaçöes sobre seis crianças com desenvolvimento considerado normal até o terceiro ou quarto ano de vida que, posteriormente, evoluíram com regressäo e grave deteriorizaçäo do humor, do comportamento social e da funçäo intelectual. Na segunda parte do trabalho, é feita uma discussäo crítica em relaçäo aos problemas de ordenaçäo nasotáxica dos transtornos desintegrativos da infância, com particular ênfase sobre a sua situaçäo na CID-10 e no DSM-IV. Nesse sentido, vários estudos recentes têm suportado evidências para que a síndrome de Heller seja incluída tanto na CID-10 como no DSM-IV, separadamente do transtorno autista.

An outpatient treatment program for young children with pervasive developmental disorder.

Clinical experiences with some fourteen young children (under 3 1/2 years) suffering from pervasive developmental disorder led to the design of an outpatient treatment program. The conceptual basis for the program was facilitated by two important changes in theory. The first was a shift in our understanding of infancy, based on observations rather than reconstruction from adult and child analysis; the second was the gradual evolvement in our understanding of this disorder. The treatment program has three components: (1) a prolonged period of parent-child or adult-child interactions aimed at attracting the attention of the child and helping him or her develop imitations, interaction, and communication; (2) intense instruction, with the help of an occupational therapist, designed to teach the child basic life skills such as eating, dressing and undressing, and toilet training; and (3) exposure to normal social interactions with other children within a day-care or preschool facility to encourage joining in the usual childhood activities. The success of the program depends heavily on coordination among all the people involved: ideally they should include the parents, speech therapist, occupational therapist, teachers, child-care worker, and clinician.

Aspectos organicos na patogenia da psicose infantil: uma revisao / Organic aspects on the pathogenesis of infantile psychose: a review

Esta revisao da literatura refere-se aos trabalhos que abordam hipoteses organicistas na etiologia do autismo infantil. Os trabalhos sao divididos, segundo seu enfoque central em: fatores pre e peri-natais, aspectos neurologicos especificos, sinais significativos (cognicao e linguagem), aspectos bioquimicos e aspectos geneticos.