The authors make a synthesized overview of the evolution of the understanding of autism in historical context and a critical analysis of the development of diagnostic criteria in the spirit of the Diagnostic and Statistical Manual (DSM). Based on personal research and extensive clinical experience they put forward a number of debatable issues and own views about the nature of autistic disorder by outlining the trends and directions for future research. Discussed is the issue of "core" and "additional" symptoms of autism and the need for comparison of categorical and dimensional data when constructing empirical studies for the autistic population. The article contains reflections on the underlying impairment which, according to the authors, is a disturbance in the processing and integration of the incoming information, especially at the level of filtration of significant and insignificant stimuli and their linking into a mental sequence appearing at different levels and with varying degree of severity. Noted is the importance of the detailed assessment of mental functioning for early diagnosis and individualized targeting of the therapeutic efforts. In this regard is emphasized the need to search for a new paradigm in the methodology of future research on autism that would make possible the comparison of interdisciplinary results and identification of connections between the relevant scientific achievements. Thus it will be possible to identify trends that will bring us closer to revealing the etiology, perhaps will have an impact on the criteria for diagnosis and on the overall construction of future therapeutic strategies.
The authors present a synthesised review of the methods for assessing mental development and autism, with an emphasis on the general tendency to reduce the age of diagnosis. Based on clinical experience, a number of particularities are described in terms of: testing, working with parents, observing and reflecting on the nature and meaning of autistic behaviours. On focus is a toolkit for detailed assessment of mental development that was elaborated within the inter-university cooperation between Sofia Medical University and Université catholique de Louvain (UCL)-Belgium. Illustrated and discussed are typical profiles of cognitive and socio-communicative functioning of children with ASD and other neurodevelopmental disorders, which help a differential diagnosis to be made by the multidisciplinary clinical team. Further described are the advantages of early assessment of mental development as a basis for future educational and therapeutic programs.
Selective mutism is a relatively rare anxiety disorder, expressed in the inability for verbal communication in specific situations, despite the otherwise good speech abilities. It can lead to an expressed social dysfunction and very often children at school are not able to reveal their potential and are ignored and their needs neglected. With age, the traits of the disorder become more sustainable and resistant which necessitates their early identification and involvement of the children in the relevant therapeutic interventions. The interventions themselves are only efficient when based on the potential and abilities of the specific child, for the purpose of which a psychological assessment is necessary. The present article presents the specifics of the process of psychological assessment of a girl with SM.
Asperger's Syndrome (AS) is an autism spectrum disorder without mental retardation and language delay. AS often remains unrecognized until these children fail to adapt to school or kindergarten. The comorbid psychiatric disorders, achieving clinical significance, were considered as another pathway to diagnosis. This study is aimed to elucidate the reasons for referral, the frequency and the kinds of comorbidities in a clinical sample of consecutive cases of children and adolescents with AS. To this objective, clinical records of children and adolescents, who have received a DSM-IV diagnosis of AS after multidisciplinary assessment in a given time period were reviewed. After excluding 3 cases due to insufficient information, 24 cases of children and adolescents with Asperger's Syndrome (23 boys and one girl) were identified. The mean age at the time of assessment and receiving diagnosis was 9.6 yrs. (age range 4 to 17 years). In twenty-one (87%) of the cases the reason for referral was an episode of disorganized behavior following an attempt to enroll the child at school or kindergarten, and more rare referral occurred within the significant school transition period. In the remaining 3 cases, the reason for referral was a comorbid condition. Comorbid conditions identified at the moment of assessment include: ADHD documented in 4 cases, tics in 3 cases, obsessive-compulsive behaviors in 4 cases, Stereotypic Movement Disorder or Trichotilomania in 4 of the cases. Within the clinical sample, a priori expected to include relatively severe cases, a higher frequency of comorbidity was found as compared to the rates in the general population. Adjustment reactions and comorbidities occasioned the referral, while AS was diagnosed only after specialized multidisciplinary assessment.
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