This article was downloaded by: [University of Glasgow]On: 05 October 2014, At: 19:24Publisher: RoutledgeInforma Ltd Registered in England and Wales RegisteredNumber: 1072954 Registered office: Mortimer House, 37-41Mortimer Street, London W1T 3JH, UK

OccupationalTherapy in MentalHealthPublication details, includinginstructions for authors andsubscription information:http://www.tandfonline.com/loi/womh20

Recent Studies inAutismTheodore W. Peterson BS OTR aa School Therapy Coordinator,Occupational TherapyDepartment, St. Luke's Hospitals.Fareo. North Dakota 58122Published online: 18 Oct 2008.

To cite this article: Theodore W. Peterson BS OTR (1986) RecentStudies in Autism, Occupational Therapy in Mental Health, 6:4,63-75, DOI: 10.1300/J004v06n04_05

To link to this article: http://dx.doi.org/10.1300/J004v06n04_05

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracyof all the information (the “Content”) contained in thepublications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or

warranties whatsoever as to the accuracy, completeness,or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinionsand views of the authors, and are not the views of orendorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independentlyverified with primary sources of information. Taylor andFrancis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, andother liabilities whatsoever or howsoever caused arisingdirectly or indirectly in connection with, in relation to orarising out of the use of the Content.

This article may be used for research, teaching, and privatestudy purposes. Any substantial or systematic reproduction,redistribution, reselling, loan, sub-licensing, systematicsupply, or distribution in any form to anyone is expresslyforbidden. Terms & Conditions of access and use can befound at http://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [

Uni

vers

ity o

f G

lasg

ow]

at 1

9:24

05

Oct

ober

201

4

Recent Studies in Autism: A Review of the Literature

Theodore W. Peterson, BS, OTR

ABSTRACT. The syndrome of infantile autism is briefly described and the development of knowledge regarding its symptomatology traced from Kanner's first description to Ornitz' division of symp- toms into subclusters. Theories of etiology are discussed and experi- mental studies are reviewed in the areas of cerebral lateralization, brainstem transmission time, and vestibular function. Theories dis- cussing the site of suspected dysfunction within the central nervous system and the issue of morphologic lesion versus neurophysiologi- cal dysfunction are presented. Implications for the practice of oc- cupational therapy with autistic children are given and include a discussion of sensory integrative treatment.

INTRODUCTION

Although rare, the syndrome of infantile autism is one which will be seen occasionally by the pediatric therapist. Since children with this diagnosis present a relatively unique clinical picture, thus requiring correspondingly unique approaches to evaluation and treatment, this paper attempts to present a basic introduction to the syndrome and to draw together implications of recent research for its treatment.

The paper begins with a description of the syndrome's symptorna- tology , given from a historical perspective, and procedes to examine several recent controversies in the areas of etiology and pathophy- siology .

Theodore W. Peterson is the School Therapy Coordinator, Occupational Therapy Depan- ment. St. Luke's Hosoitals. Fareo. North Dakota 58122.

~c.knowledgment is made to ~ & a r e t P. Creedon, PhD and Karin 1. Opacich, MPHE, OTR for their critical review of the manuscript and helpful suggestions and to Jim Yamall for his assistance in manuscript preparation.

Occupational Therapy in Mental Health, Vol. 6(4), Winter 1986 0 1986 by The Haworth Press. Inc. AU rights reserved. br7

Dow

nloa

ded

by [

Uni

vers

ity o

f G

lasg

ow]

at 1

9:24

05

Oct

ober

201

4

&I OCCUPATIONAL THER4PY IN MENTAL HEALTH

SYMPTOMATOLOGY

The syndrome was first described by Kanner (1943) who reported on a group of children seen at Johns Hopkins University between 1938 and 1943. The fundamental disorder seen by him was the chil- dren's "inability to relate themselves in the ordinary way to people and situations. " This "extreme autistic aloneness" was present from earliest life and could be seen in such responses as failure to assume an anticipatory posture before being picked up. These chii- dren seemed to ignore stimuli coming to them from the outside world or, if this failed, to protest and withdraw.

As the children grew, such symptoms as delayed echoloalia, a limitation in the variety of spontaneous activity, and an obsessive desire for sameness in their environment were seen. They were said to possess an excellent rote memory and to be endowed with "good cognitive potentialities." It was noted that all of the children came from highly intelligent families and that few of the parents could be described as warmhearted. Although this last observation was quite striking for Kanner, he felt that, due to the very early manifestations of the symptoms, the syndrome could not be attributed wholly to parental style. Rather, he saw the symptoms as stemming from an innate inability of the children to form affective contacts.

In the years since 1943 researchers have refuted many of Kan- ner's original conclusions regarding the syndrome. In contrast to his claims of good cognitive potential, it is now known that 75 percent of autistic children test in the retarded range and that the syndrome occurs with the same incidence throughout the world, in all social classes, and in all types of families (Ritvo & Freeman, 1984).

Kanner's observations of early onset, autistic aloneness, speech abnormalities, and bizarre reactions to various aspects of the envi- ronment, however, have held true and are included as criteria for the syndrome's diagnosis (AmericanPsychiatric Association [APA], 1980). The syndrome is very rare, occurring in two to four cases per thousand, and is about three times more common in boys than in girls. The syndrome is chronic. One chid in six is able to adjust well enough to do some regular kind of work by adulthood; another one in six makes only a fair adjustment; and two-thirds remain severely handicapped and unable to lead independent lives ( M A , 1980). Or- nitz and Ritvo (1968) have presented a detailed description of autistic symptomatology at advancing age levels, and the reader is referred there for further information.

Dow

nloa

ded

by [

Uni

vers

ity o

f G

lasg

ow]

at 1

9:24

05

Oct

ober

201

4

Theodore W. Peterson 65

Although disturbances of sensory modulation (inability to control stimulation through normal neural feedback systems) motility (the movement patterns which lend such a bizarre ap- pearance to autistic children) are not included in the present diagnostic criteria used in the United States, Ornitz (1983) states that they occur in over 70 percent of autistics. He speculates that, because these symptoms tend to decrease in severity with age, they are underdocumented in some cases where the diagnosis is made after the preschool years. Ornitz (1970) offered a fuller description of the syndrome which

he divides into five subclusters of symptoms. The first subcluster in- volves disturbances of relating to people and objects. It includes symptoms such as poor or deviant eye contact, delayed or absent so- cial smile, delayed or absent anticipatory response to being picked up, apparent aversion to physical contact, a tendency to react to an- other person's hand or foot rather than to the person, disinterest in playing games with others, and a general preference for being alone. It is suggested that these symptoms may be secondary to dis- turbances of perception.

The second of Ornitz' subclusters involves disturbances of speech and language. It includes muteness or echolalia. If communicative speech develops, it is atonal and arrhythrnic, lacks inflection, and fails to convey emotion.

The third subcluster involves disturbances of developmental rate. There is great variation, but the typical pattern is one of spurts of de- velopment which are uneven across areas of function. For example, developmental testing often shows motor skills as the most devel- oped area and personal-social skills as the least developed.

The fourth subcluster involves disturbances of motility. Stereoty- pic movement patterns which may be seen include writhing or twisting of the hands while held in front of the face, hand flapping, toe walking, lunging and darting body movements with sudden stops, body rocking, head rolling or banging, and whirling about the body's axis.

The fifth subcluster involves disturbances of perception. These dishlrbances do not include shape perception or position in space be- tween objects, which are often relative strengths for autistic children. Rather, what is meant are problems in the modulation of sensory in- put, distortions of the normal hierarchy of receptor preferences, and an impaired ability to use sensory input to make discriminations in the absence of feedback from motor responses.

Dow

nloa

ded

by [

Uni

vers

ity o

f G

lasg

ow]

at 1

9:24

05

Oct

ober

201

4

66 OCCUPATIONAL THERAPY IN MENTAL HEALTH

ETIOLOGY

Although psychogenic theories of etiology were onpe widely ac- cepted, the majority of researchers are now in agreement with Or- nitz (1983) who states that "infantile autism can be attributed nei- ther to psychosocial or intrapsychic factors, nor to abnormalities of parenting or family life." This change in perspective was marked by the publication of Rimland's first book (1964) in which he care- fully reviewed the experimental evidence of the time and concluded that it held no support for psychogenic viewpoints. Instead, he saw the evidence as highly consistent with theories of organic pathology. Present etiological theories have moved into the areas of neurophy- siology not only because psychogenic theories have not been sus- tained through research, but also because the "uniqueness of the syndrome suggests a correspondingly unique neurophysiologic mechanism common to all cases" (Oritz, 1983).

Neurophysiologic theories are supported by studies which show greater occurrence of unfavorable obstetrical factors in autistics than would be expected in the general population (Finegan & Quarr- ington, 1979) and the association of such factors as neurologic dis- orders, viral infection, metabolic diseases, and hereditary disorders with autism (Ciaranello, VandenBerg, & Anders, 1982). Although apparently unrelated, these factors all are forms of insult to the brain that can interfere with central nervous system (CNS) development. Ciaranello et al., (1982) suggest that damage to the CNS could oc- cur at later stages of development during the phases of neurite elongation (development of dendrites and axons) and/or synapse formation because at these phases damage could cause problems yet be subtle enough morphologically to escape detection. Damage earlier in development of the CNS would produce detectable le- sions.

The investigation of a genetic link is being pursued through the establishment of a registry program at the University of California at Los Angeles (R~tvo, Ritvo, &Brothers, 1982). The two areas be- ing explored involve attempts to identify families in which autism is produced by direct genetic transmission and those in which defects in the immunogenetic system make the children more vulnerable to insult to the CNS. A genetic factor is suspected because siblings of autistics have been shown to have a higher incidence of autism than does the general population and monozygotic twins have a concor-

Dow

nloa

ded

by [

Uni

vers

ity o

f G

lasg

ow]

at 1

9:24

05

Oct

ober

201

4

lheodore W. Peterson 67

dance of up to 50 percent for autism (Folstein & Runer, 1977; Ciaranello et al., 1982).

LATERALIZATION STUDIES

Mainly because of the speech and language impairment seen in autism, researchers have studied the lateralization of function in au- tistic versus normal children. The development of a preferred hand is generally seen as an indication of cerebral lateralization, and sev- eral studies have investigated this area. Gillberg (1983), Tsai (1982 & 1983), and Colby and Parkison (1977) all found a preponderance of non-right handedness in autistic children; however, a study using control groups of retardates and normals (Barry & James, 1978) found no significant difference in the development of handedness. A significant age effect was found which suggested a developmental trend.

Because handedness is poorly linked to hemispheric specializa- tion, James and Barry (1983) used ear advantage in evaluating reac- tion time. Reaction time was measured for each ear and the differ- ence between the two compared to control groups of normals and retardates. The autistic group showed increased reaction time and less difference between the two ears than either control group. The results were interpreted as being suggestive of decreased cerebral lateralization in autistics which was a function of more than rnatura- tion.

A dichotic listening test study (Prior & Bradshaw, 1979) showed a significant excess of right hemisphere dominance for verbal stimuli in autistics. Dawson, Warrenberg, and Fuller (1982) studied electroencephalograms of autistic children and adults. Seventy per- cent of their subjects showed a lack of left-hemisphere specialization for language. Blackstock (1978) reported autistic children's listen- ing preference for music versus speech suggested they are pre- dominantly right-hemisphere functioners. Neuropsychological test- ing (Hoffmann & Prior, 1982; Dawson, 1983) has demonstrated poorer performance in autistics versus matched controls on left- hemisphere tests.

An auditory brainstem evoked response study (Fein, Skoff, & Mirsky, 1981) showed significantly longer transmission times in au- tistic~ versus controls for the left ear; however, Tanguay, Edwards,

Dow

nloa

ded

by [

Uni

vers

ity o

f G

lasg

ow]

at 1

9:24

05

Oct

ober

201

4

68 OCCUPATIONAL THERAPY IN MENTAL HEALTH

Buchwald, Schwafel, and Allen (1982) obtained this result for only the right ear.

BRAINSTEM EVOKED RESPONSE STUDIES

In addition to the two studies cited above, two other studies mea- suring brainstem transmission time were found. Skoff, Mirsky, and Turner (1980) found delayed brainstem transmission time in autis- tics, particularly in the pontine-midbrain area. Taylor, Rosenblatt , and Linschoten (1982) found delayed transmission time mainly in the early portion of the auditory brainstem pathway.

Tanguay and Edwards (1982) found some autistic children to have a peripheral auditory processing deficit. They speculated that a distortion of auditory input at a critical time in postnatal life may have served as a neuropathologic agent in preventing normal neu- ronal connections from forming. Thus, what is being measured may be the remnant of what caused the problem rather than the problem itself.

VESTIBULAR STUDIES

Ritvo, Eviator, Brown, and Mason (1969) studied postrotary nys- tagmus in "children usually diagnosed as having early infantile au- tism, atypical ego development, childhood schizophrenia, and unus- ual sensitivity." Nystagmus duration was reduced in these children under conditions of rotation in a lighted room (a multiple stimuli situation involving rotation and vision); however, no difference from normals was found under conditions of rotation in darkness (a single stimulus condition). These findings were interpreted as sup- porting a theory of perceptual inconstancy. Nelson, Nitzberg, and Hollander (1980) found high trial to trial variability in autistic children's responses to postrotary nystagmus testing, a fmding that conf i i ed earlier studies which were interpreted as supporting a view of unpredictable responsiveness of autistic motor response to sensory stimuli. Nelson et al., (1980), however, felt that this variability could just as well be explained by subject movement dur- ing testing.

Maurer and Damasio (1979) discussed various studies of vestibu- lar function in autistics. They were critical of the lack of appropriate

Dow

nloa

ded

by [

Uni

vers

ity o

f G

lasg

ow]

at 1

9:24

05

Oct

ober

201

4

7heodore W. Peterson 69

controls, findings related only to certain subgroups of autistics, and findings also seen in non-autistic populations which existed in some of the studies. They reviewed studies showing telencephalic projec- tions of vestibular nuclei and projections from the cortex to the basal ganglia which led them to conclude that what is broadly called vestibular may actually be supramodal and related to function of in- tegrative CNS structures.

SITE OF CNS DYSFUNCTION

Investigators have offered theories in regard to possible sites of dysfunction within the CNS that could explain the symptomatology of autism. Theories have been conceptualized mostly through an analogy process of attempting to match symptoms of autism with those of neurological disturbances in which the area of dysfunction is known. Thus, cortical theories have been put forth by researchers most interested in the languagelsocialization symptoms. These the- ories have, for the most part, failed to adequately explain the symp- toms in the sensation and motility areas. Likewise, researchers most interested in the vestibular symptoms have implicated the brainstem as an area of dysfunction but have failed to adequately explain the language/socialization symptoms (Ornitz, 1983).

Ornitz feels these conflicts can be resolved through a study of the extensive interconnections between the brainstem vestibular nuclei and other brainstem centers and, in turn, between these centers and the thalarnic nuclei. The thalarnic nuclei project downward to the brainstem, thus fonning a cmcial neuronal feedback loop for the modulation of sensory stimuli, and upward to the telencephalon. Thus, a theory of brainstem dysfunction is seen as being adequate to explain the full symptomatology of infantile autism. This view gen- erally supports Maurer and Damasio (1982) who put forth a theory involving the mesial surface of the frontal and temporal lobes as well as the corpus striatum after initially (Damasio & Maurer, 1978) postulating temporal lobe dysfunction.

MORPH0UK;IC VERSUS NEUROPHYSIOLOGIC THEORIES

Several studies have attempted to find morphologic deviations from the norm in the autistic CNS. Heir, LeMay, and Rosenberger (1979) used CT scans to measure asymmetries in the width of the

Dow

nloa

ded

by [

Uni

vers

ity o

f G

lasg

ow]

at 1

9:24

05

Oct

ober

201

4

70 OCCUPAZ'ONAL THERAPY IN MENTAL HEALTH

parietal-occipital regions of the two hemispheres. They found re- versed cerebral asymmetries in autistic patients versus a control group of neurological patients. D'Angelo (1981), however, criti- cized methodology in their data analysis, corrected the error, and reanalyzed the data. On the bases of this reanalysis, the results were found to be nonsignificant. Another study measuring parietal-occi- pita1 asymmetries (Tsai et al., 1982) failed to find significant differ- ences between autistic and controls.

Campbell et al., (1982) found a subgroup of autistics who showed ventricular enlargement on CT scans; however, no significant relationship between ventricle size and clinical variables including birth weight, head circumference, maternal age, language develop- ment quotient, adaptive development quotient, minor physical anomalies, severity of withdrawal, stereotypic movements, and the Rochester Research Obstetrical Scale were found.

After reviewing pneumoencephalographic and CT scan data on autistic children, Ornitz (1983) concluded that studies looking for structural abnormalities have succeeded only in identifying individ- ual cases or perhaps subgroups.

Research investigating neurophysiologic theories of autism seems to have been more encouraging. This area of study is promising according to Ciaranello et al., (1982) because late-stage distur- bances in CNS development (in which chemical factors are par- ticularly influential) can best explain the sweeping clinical handicaps of autism.

Although the neurotransmitter dopamine was once the object of investigation and the basis for a major theoretical paper (Darnasio & Maurer, 1978), no studies have been able to differentiate autistics from other severely developmentally disabled children on this factor (Ciaranello et al., 1982). Recently, interest has shifted to another neurotransmitter, serotonin.

Neurons using serotonin as a neurotransmitter arise in the raphe nuclei (midline brainstem) and project caudally to the spinal cord and rostrally to the limbic system and hypothalamus. These neurons are involved in the regulation of neuroendocrine secretions and the modulation of emotionality as well as with sleep (Ciaranello et al., 1982).

Interest in serotonin involvement in infantile autism began with the finding of a subgroup of autistics who showed elevated blood platelet serotonin levels in 1961, a fmding widely replicated. Inter- est fell due to the lack of a convincing demonstration of the neuro-

Dow

nloa

ded

by [

Uni

vers

ity o

f G

lasg

ow]

at 1

9:24

05

Oct

ober

201

4

Theodore W. Peterson 71

transmitter's impor@nce in the syndrome and to the lack of knowl- edge within the scientific community in regard to the localization of serotonin in the CNS (Ciaranello, 1982).

Interest in serotonin was refocused with the publication of a study (Geller, Ritvo, Freeman, & Yuwiler, 1982) in which fenflurarnine (which was known to cause a decrease in blood serotonin levels in animals) was administered to three autistic boys. Not only did the boys' blood serotonin level fall, but also significant improvements were noted in motor, social affect, speech, object, and sensory mod- ulation areas. These improvements were seen during the time when blood serotonin levels were held at a normal level for each boy's age and persisted for a time after fenfluramine was discontinued and blood levels had returned to pre-treatment values. Follow up three months later, however, indicated that a considerable loss of effect had occurred.

Presently, fenfluramine studies are in progress at 22 medical schools throughout the United States and Canada (Ritvo & Free- man, 1984).

IMPLICATIONS FOR OCCUPATIONAL THERAPY

Despite a large amount of research pertaining to infantile autism, the syndrome remains poorly understood by the scientific cornmuni- ty. There is a multiplicity of opinion regarding etiology and patho- genesis which does not seem to be close to resolution. In the absence of consensus in regard to these areas, it is impossible for a therapist treating autistic 'children to be entirelly secure in his or her ap- proach.

Although Nelson (1984) notes that occupational therapists were probably involved with these patients long before they were so la- beled, the occupational therapy literature does not contain much in- formation on clinical experiences with this population. Ayres (1979) notes that although therapy for autistics has had mixed results, any improvement that can be made in the organization of the CNS of an autistic child in encouraging, as other approaches have been only marginally successful in improving this group's functional abilities. Ayres and Tickle (1980) have suggested a procedure which may be of help in delineating those autistic children likely to benefit from sensory integrative treatment techniques.

In the absence of a solid theoretical basis for occupational therapy

Dow

nloa

ded

by [

Uni

vers

ity o

f G

lasg

ow]

at 1

9:24

05

Oct

ober

201

4

R OCCVPAlTONAL THERAPY IN MENTAL HEALTH

intervention with this population, treatment must, of necessity, be svm~tomatic. It is because the clinical oicture of these children is of- t& Eomplex and even paradoxical tha; els son (198011981) stresses the importance of accurate and thorough evaluation of autistic children. In the same article, he presents a review of several formal evaluations that can be used with autistic children and discusses components of informal evaluation procedures for this population. The reader is referred to it for assistance in this regard.

Ayres has devoted a chapter of one of her books (1979) to the treatment of autistic children through sensory integrative proce- dures. Her view of these children can be discussed in two parts: the sensory processing disorder and the "I want to do it" function. Those children who can be tested using the Southem Cal$omia Sen- sory Integration Tests (Ayres, 1980) resemble dyspraxics in their scores. The dyspraxia seen probably results from p r registration of sensorv stimuli due to deficient attention centers within the limbic system aid from poor modulation of stimuli as seen in gravitational insecuritv and tactile defensiveness. The deficient "I want to do it" system in autistic children refers to their aversion to new experi- ences and to a reduced ability to derive pleasure from activities. Thus, the therapist must be more directive with these children than is usual in sensory integrative therapy. The therapist may often need to push a child to engage in an activity even to the point of imposing it onto him or her. Frequent commands to "Look at me" or repeti- tion of task directions may be needed in order to assure that the chid is attentive to the task presented.

Ayres' ideas are certainly compatible with theories of autistic pathology which emphasize brainstem dysfunction. Ottenbacher's (1982) review of literature, which suggested that a significant per- centage of autistic children evidence some form of vestibular dys- function, lends support to this approach.

While a sensory integrative approach appears to be frequently mentioned in recent literature, it is by no means the only legitimate treatment method. In fact, the variety of symptoms displayed coupled with the lack of a solid theoretical basis for a cohesive ap- proach appears to indicate a variety of treatment techniques is in- dicated.

One rather ingenious example (Miller & Miller, 1973) used con- nected boards, obstacles, tunnels, and bridges elevated three to six feet to form a course useful for enhancing body awareness. Once placed on the elevated boards, the children in the study were

Dow

nloa

ded

by [

Uni

vers

ity o

f G

lasg

ow]

at 1

9:24

05

Oct

ober

201

4

Theodore W. Peterson 73

suddenly more aware of their surroundings as seen in the cessation of autistic mannerisms, the steadiness of eye contact, and the careful checking of foot placement and the direction in which the board led. ~ h r o u ~ h introducing obstacles of varying complexity, the authors were able to encourage problem solving behaviors and goal orienta- tion.

CONCLUSION

Due to a lack of consistent results in handling autistic children and to the lack of published information within the discipline, implica- tions of recent research for occupational therapy are limited. Until researchers are able to agree on the etiology and pathogenesis of the syndrome, therapists must continue to treat those problem areas identified after thorough evaluation that separates inability from inattentiveness or lack of motivation. Documentation of treatment applied and results is very important, for it is only through such grass roots data that researchers will be able to address the efficacy of occupational therapy intervention with this population.

REFERENCES

American Psychiatric Association, The Task Force on Nomenclature and Statistics. (1980) Diagnosric and Statistical Manual of Mental Disorders (3rd ed.). Washington, D.C.: American Psychiatric Association.

Ayres, A.J. Sensory Iniegration and rhe ChiU. (1979) Los Angeles: Western Psychological Services.

Ayres. A.J. Sourhem California Sensory Integration Tests Manual. (1980) Los Angeles: Wesrern Psychological Services.

Ayres, A.I. & Tickle, L.S. (1980) Hyper-respnsivity to touch and vestibular stimuli as a predictor of positive response to sensory integrative procedures by autistic children. American Joumal of Occupatio~l Theropy. 34, 375-381.

Bany, R.J. &James, A.L. (1978) Handedness in autistics, retardates, and normals of a wide range. Joumal of Autism and Childhood Schizophrenia. 8, 315-323.

Blackstock. E.G. (1978) Cerebral asymmetry and the development of early infantile autism. Joumal of Autism and Childhood Schizophrenia. 8, 339-353.

Campbell, M., Rosenbloorn, S., Perry, R., George, A.E., Kricheff, I.L, Anderson, L., Small, A.M., & Jemings, S.J. (1982) Computerized axial tomography in young autistic children. American Journal of Psychinlry. 139, 510-512.

Ciaranello, R.D. (1982) Hyperserotonemia and early infantile autism. New Enghnd Joumal of Medicine. 307, 181-183.

Ciaranello. R.D., VandenBerg. S.R.. & Anders, T.F. (1982) Intrinsic and extrinsic deter- minanrs of n e u r o d development: relation to infantile autism. JoumalofAurism and De- velopmental Disorders, 12, 115-145.

Dow

nloa

ded

by [

Uni

vers

ity o

f G

lasg

ow]

at 1

9:24

05

Oct

ober

201

4

OCCUPATIONAL THERAPY IN MENTAL HEALTH

Colby , K.M. & Parkison, C. Handedness in autistic children. (1977) Journal of Autism and Childhood Schizophrenia 7 , 3-9.

Damasia. A.R. & Maurer, R.G. (1978) A neurological model for chiidhood autism. Archives of Neurology, 35 , 777-786.

D'Angelo, E.I. (1981) Reversed cerebral asymmetries as a potential risk factor in autism: a reconsideration. Perceprual and Motor Skills, 53 , 101-102.

Dawson, G. (1983) Lateralized brain dysfunction in autism: evidence from the Halstead- Reitan neuropsychological battery. J o u m l ojAulism and Developmental Disorders, 13, 269-286.

Dawson, G., Warrenburg, S., & Fuller. P. (1982) Cerebral lateralization in individuals di- agnosed as autistic in early childhood. Brain and Language, 15, 353-368.

Fein, D., Skoff, B., & Mirsky, A.F. (1981) Clinical correlates of brainstem dysfunction in autistic children. Journal of Aurism and Developmental Disorders. 11, 303-315.

Finegan, J.A. & Quarrington, B. (1979) Pre-, peri-, and neonatal factors and infantile autism. Journal of Child Psychology and Psychiorry and allied disciplines, 20, 119-128.

Folstein, S. & Rutter, M. (1977) Genetic influences and infantile autism. Namre, 265, 726-728.

Geller, E., R i m , E.R., Freeman, B.I.. & Yuwiler, A. (1982) Preliminary observations on the effect of fenfluramine on blood serotonin and symptoms in three autistic boys. New England Journal of Medicine, 307. 165-169.

Gilberg, C. (1983) Autistic children's hand preferences: results from an epidemiological study of infantile autism. Psychiatry Research, 10. 21-30.

Heir. D.B., LeMay. M., & Rosenberger, P.B. (1979) Autism and unfavorable left-right asymmetries of the brain. J o u m l of Aulism and Developmental Disorders. 9 , 153-159.

Hoffman, W.L. &Prior, M.R. (1982) Neuropsychological dimensions of autism in children: a test of the hemispheric dysfunction hypothesis. Journal of Clinical Neuropsychology, 4. 2741.

James, A.L. & Barry, R.J. (1983) Developmental effects in the cerebral lateralization of autistic, retarded, and normal children. J o u m l ofAurisrn and Develo~mental Disorders, 13 , 43-56.

Kamer, L. (1943) Autistic disturbances of affective contact. Nervous Child. 2 , 217-250. Maurer, R.G. & Damasio, A.R. (1979) Vestibular dysfunction in autistic children. Develop-

mental Medicine and Child Neurology, 21. 656-659. Maurer, R.G. & Damasio, A.R. (1962) Childhood autism from the point of view of

behavioral neurology. Journal of Autism and Developrnenral Disorders, 12, 195-205. Mffler, A. &Miller, E.E:(1973) Cognitivedevelopmental training with elevated boards and

sign language. J o u m l of Autism and Childhood Schizophrenia, 3 , 65-85. Nelson, D.L. (198011981) Evaluating autistic clients. Occuparionnl Therapy in Menral

Health. 1, 1-22. Nelson, D.L. (1984) Children With Autism a d Other Pervasive Disorders ofDeveloprnent &

Behnvior: Therapy 7hrough Activities. Thorofare, NI: Slack, Incorporated. Nelson. D.L., Nitzberg, L., & Hollander, T. (1980) Visually monitored postrotary

nystagmus in seven autistic children. American Joumnl of Occupnt io~l Ilrerapy, 34 , 382-386.

Ornitz, E.R. (1970) Vestibular dysfunction in schizophrenia and childhood autism. Compre- hensive Psychiatry, 1 I . 159-173.

Omia, E.R. (1983) The functional neutoanatomy of infantile autism. I n r e m t i o ~ l Journal of Neuroscience, 19, 85-124.

Ornitz, E.M. & Ritvo, E.R. (1968) Perceptual inconstancy in early infantile autism: the syn- drome of early infantile autism and its variants including certain cases of childhood schizophrenia. Arichives of General Psychiatry, 18, 76-98.

Ottenbacher, K.J. (1982) Vestibular processing dysfunction in children with severe emotion- al and behavioral disorders: a review. Physical and Occupat io~f lhempy in Pediatrics, 2 , 3-12.

Dow

nloa

ded

by [

Uni

vers

ity o

f G

lasg

ow]

at 1

9:24

05

Oct

ober

201

4

7heodore W. Peterson 75

Pnor, M.R. & Bradshaw, J.L. (1979) Hemisphere functioning in autistic children. Correr, IS, 73-81.

Rimland, B. (1964) Infantile Autism, New York: Appleton-Century-Crohs. Riwo, E X . , Eviatar, A., Brown, M.B., & Mason, A. (1969) Decreased postrotatory

nystagmus in early infantile autism. Neurology, 19, 653458. Ritvo, E.R. & Freeman, B.J. (1984) A medical model of autism: etiology, pathology, and

treatment. Pediatric Annals. 13, 298-305. Ritvo, E.R., Ritvo, E.C., &Brothers. A.M. (1982) Genetic and immunohematologic factors

in autism. Journal ofAurism and Developmental Disorders, 12, 109-1 14. Skoff. B.F., Mirsky, A.F., &Turner, D. (1980) Prolonged brainstem transmission time in

autism. Psychiatry Research, 2 , 157-166. Tanguay, P.E. &Edwards, R.M. (1982) Elecuophysiulogical studies of autism: the whisper

of the bang. Journal ofAutism and Developmen~al Disorders. 12, 177-184. Tanguay, P.E.. Edwards. R.M., Buchwald, I., Schwafel, J. &Allen, V. (1982) Auditory

brainstern evoked responses in autistic children. Archives of General Psychiatry, 39, 174-180.

Taylor, M.J., Rosenblatt, B., & Linschoten, L. (1982) Audiwry brainstem response abnor- malities in autistic children. Canadian Journal of Neurological Sciences. 9. 429-433.

Tsai. L.Y. (1982) Brief report: handedness in autistic children and their families. Journal of Autism and Developmental Disorders 12, 421423.

Tsai, L.Y. (1983) The relationship of handedness to the cognitive, language, and visuo-spa- tial skills of autistic patients. Brirish Jouml of Psychiatry. 142, 156-162.

Tsai, L.Y.. Jacoby, C.G., Stewart, M.A., & Beisler, J.M. (1982) Unfavourable left-right asymmetries of the brain and autism: a question of methodology. British Journal of Psy- chiotry. 140, 312-319.

Dow

nloa

ded

by [

Uni

vers

ity o

f G

lasg

ow]

at 1

9:24

05

Oct

ober

201

4