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AUTISM (Kanner's Syndrome) - A syndrome of early childhood characterized by abnormal social relationships; language disorder with impaired understanding, echolalia, and pronominal reversal (particularly using you instead of I or me when referring to one's self); rituals and compulsive phenomena (an insistence on the preservation of sameness); and uneven intellectual development with mental retardation in most cases.

Autism is two to four times more common in boys than girls. The concordance rate is significantly greater in monozygotic than dizygotic twins, indicating the importance of genetic factors. The syndrome is defined by its behavioral manifestations. The level of intellectual function and the presence or absence of neurologic damage are recorded separately using a multiaxial diagnostic system.

CT scans have isolated a subgroup of autistic children with enlarged ventricles, and MRI has recently identified a subgroup of autistic adults with hypoplasia of the cerebellar vermis. Individual cases of autism have been associated with the congenital rubella syndrome, cytomegalic inclusion disease, phenylketonuria, and the fragile X syndrome.

Symptoms, Signs, Diagnosis, and Prognosis - Autism usually is manifest in the first year of life; its onset is not later than age 3. The syndrome is characterized by extreme aloofness (lack of attachment, failure to cuddle, avoidance of eye gaze, failure to form reciprocal relationships); insistence on sameness (resistance to change, rituals, morbid attachment to familiar objects, repetitive acts); speech and language disorders (ranging from total muteness to delayed onset of speech to markedly idiosyncratic use of language); and uneven intellectual performance.

Autistic children are difficult to test; they usually do better on performance than on verbal items in standard IQ tests and may show instances of age-appropriate performance despite retardation in most areas. Nonetheless, an IQ test administered by an experienced examiner provides a useful predictor of outcome. Children with an IQ
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