Childhood autism: its diagnosis, nature, and treatment.

Leo Kanner,I although not the first to describe this serious and intriguing developmental disorder of early childhood,2 so precisely captured its essential features that the clinical account of his first 11 cases has never been bettered. The salient characteristics he mentioned were an 'extreme autistic aloneness' from the beginning of life, delay and abnormality in language acquisition with echolalia and pronomial reversal, and 'an obsessional desire for the maintenance of sameness' in the presence of islets of normality, in particular an excellent rote memory. He saw the primary deficit as an inborn disturbance of affective contact and later described similar, although very mild features of emotional coldness and obsessionality in the parents. Since then research into autism and related developmental disorders has flourished, there is a journal entirely devoted to them and, although they are so rare, their elucidation promises to shed light on many unanswered questions both about normal development of language and sociability and about the nature of a number of clinical conditions. Recent growth areas of research have been the genetics of autism, the relation between autism and allied clinical syndromes, the nature of the psychological dysfunctions of autistic people, and the effects of specific treatment interventions. There have also been changes in how the condition is perceived and classified in the newer systems of diagnostic classification. Before reviewing recent progress, some basic facts must be recalled.