Acta paedopsychiatrica最新文献

The possibility studied of considering simultaneously the role of neuro-physiopathological and psychopathological factors in the genesis of stammering. After recalling the psychoanalytic theory behind this problem and giving a clinical example, the different modes of evolution that stammering can have on the psychic apparatus were examined and the secondary economic function of this symptom, especially in relation to repression is emphasized.

This paper is part of a special section, on 'self-injurious behavior and autism'. Its focus is on the educational management of self-injurious behavior. The author describes, discusses and proposes an empirical methodology that may guide professionals in the description, analysis and monitoring of self-injurious behaviors in autism. A number of detailed case studies (guided by a seven-step intervention model) show that by teaching new competencies that override the needs expressed by challenging behaviors, patients with autism and self-injurious behavior may develop and affirm a better self-regulation of their lives.

This paper is part of a special section on 'psychopharmacotherapy in children' and focuses on benzodiazepine receptors in autism. Infantile autism in an early and pervasive developmental disorder described by Kanner in 1943. Anatomical, pathological and magnetic resonance imaging studies have indicated changes in the cerebellum and hippocampus of autistic subjects. Given the numerical importance and diffuse benzodiazepine receptors, their study by functional brain imaging methods in vivo could be value in cases of infantile autism as a gauge of neuronal potentiality. The main data concerning benzodiazepine complex are presented. The relations between these data and the neurophysiological hypotheses of autism are discussed.

Through early interactional exchange, infants acquire relevant information about themselves, their caretaking persons, and the relationship between themselves and their caretakers. Mutual eye contact is a highly adaptive behavioural system in this respect. There are, however, infants who avoid maternal eye contact and refuse their caretakers' attention. Gaze aversion of this kind is only reported to occur in the first months of life. It is interpreted as a first manifestation of a specific interaction. The present longitudinal study presents evidence for developmental consequences of early eye contact patterns. Infants who avert their gaze from their parents in the first months of life develop maladaptive relationships in terms of interactional harmony within 2 years, low degrees of psychobiological functioning, behavioural problems, and developmental delays for up to 6 years, and, at 2 years of age, explore new objects by means of manipulation for only short amounts of time. Infants with the expected good eye contact behaviour at that early age appear to have a more favourable development during the preschool years.

This study reports on five cases seen in a child psychiatry service in Northern India who met the criteria for disintegrative psychoses of childhood. Their clinical features were different from the described for autistic disorders of childhood supporting the validity of this disorder. The issues of diagnostic criteria and classification of disintegrative psychoses as distinct from autistic disorders is highlighted.

This article is part of a special section on 'self-injurious behaviour and autism' and is mainly based on a book edited by Luiselli, Matson and Singh (1992) addressing empirical data on self-injurious behaviour and mental retardation from a behavioural perspective. Within the overview of the book some information on autism is also presented and critically discussed. Self-injurious behaviour is a poorly understood phenomenon and problematic in many ways; its definition is not easy; little is known about the causes and neuroscientific models. Demographic data are scarce and functional analysis and interventions (behavioural techniques, medication, education) need to be further developed, under the protection of human rights committees.

This paper is part of a special section on 'self-injurious behaviour and autism' and concentrates on behavioural treatment techniques available and useful to reduce self-injurious behaviour in children with autism (e.g. extinction, time-out, differential reinforcement, alternative forms of stimulation, sensory deprivation, physical restraint, crisis management, environmental modifications). It has become increasingly evident that the successful treatment of self-injurious behaviour requires, first, a systematic and detailed (functional) analysis of the variables associated with the behaviour and, second, a hypothesis-testing approach on an individual, naturalistic basis to increase the acquisition of alternative skills and self-control.

There is evidence that autistic persons are deficient both in the expression and recognition of emotion. Emotions are viewed here as in part genetically determined, inborn behaviours with great importance for social regulations. Both in phylogenetic and in ontogenetic development there is a transgression from emotion-bound or signal-reflex-like behaviour chains towards an experience-based coupling of emotional signals with events lying outside emotional exchanges. We conjecture that in childhood autism there is a deficit in linking biologically based emotional signals to emotional experiences and/or a deficit in linking these signals to a third element. Mesocortical areas with close connections to the limbic systems appear to be involved.

The paper is part of a special section on 'psychopharmacotherapy in children'. Drugs not only help to treat symptoms successfully but may also help researchers and clinicians to gain a better understanding of the pathophysiology underlying these disturbances. This is exemplified in three child psychiatric disorders that exhibit disturbances in motor activity as a prominent symptom. These are general motor restlessness (ADHD), tic-disorder (sudden circumscribed motor actions) and stuttering (non-fluent speech). There is evidence that clinically useful drugs increase the cortical-subcortical interaction and tuning mechanisms providing the patients with a better self-regulation related to the motor performance.

Many mentally retarded autistic children can understand the concept of object permanence, but, in comparison to developmental-age matched normal children, the behavioral strategies they employ in carrying out the Casati-Lezine Object Permanence Test are deficient and lead to failure. These deficiencies appear unrelated to interference of stereotypic or other bizarre behavior in task performance. Similar problem-solving deficiencies can be found in mentally retarded children who are not autistic, suggesting that the deficiencies themselves are less related to the social-communication deficits of autistic children, but more to the general problem-solving difficulties found in children with a lower developmental quotient. Nevertheless, the qualitative analysis of results shows a tendency in autistic children, despite their better developmental level, to use less coordinated and regular sequences to solve the task than normal or mentally retarded children.