634 CHAPTER 14
- He complains about strong stimuli, such as the sun, loud noises.
- Abnormalities of attention, including the ability to shut people out and be ab-
sorbed in something trivial for a long time. - Loves nature, will stand and look at the moon for as long as he is allowed, despite
freezing weather. - Has a strong aversion to strangers, groups, and crowds.
- Obsessive.
- Ritualistic.
- Lines up [Lego bricks or matches them by color, but] doesn’t build. Always destroys.
- Occasionally plays with feces.
- Doesn’t dress or undress—just beginning to put on trousers and coat.
- Could recognize simple words at twenty months.
- Has a strong reaction to colors.
- Never asks questions except where is Mummy, Daddy, Sam.
- Only just starting to correlate facial expressions of others to emotion.
These behaviors might not be that unusual for a toddler, but they are defi nitely not
typical for a 4-year-old. The items on George’s mother’s list span the problem areas
that are the hallmarks of autism: impaired social interactions, impaired communica-
tion, and restricted and repetitive behaviors. Some of George’s symptoms—symptoms
of autism—overlap with symptoms of childhood schizophrenia; playing with feces,
not dressing oneself, and becoming very upset in response to unwanted change could
be signs of disorganized symptoms of schizophrenia. However, symptoms of autism
are present before age 3, and symptoms of childhood schizophrenia arise after age 3.
When assessed with an intelligence tests that includes both verbal and visual ele-
ments, many individuals with autism are also diagnosed as having mental retardation.
When researchers use an intelligence test that does not rely on verbal instructions or
responses, however, intelligence scores of individuals with autism are often signifi cantly
higher—in or above the average intelligence range (Dawson et al., 2005). Moreover,
unlike those with mental retardation, people with autism may not be impaired in all do-
mains (though, as a rule, the impairments are general enough to be considered “perva-
sive”). In fact, about 20% of people with autism have pockets of unique skills relating
to art, music, numbers, or calendars, such as the ability to identify the day of the week
on which a given date fell, even when the date is many years in the past (Hermelin,
2001); such people are sometimes referred to as autistic savants. James, the person de-
scribed in Case 14.2, has a remarkable ability to remember information he has heard.CASE 14.2 • FROM THE OUTSIDE: Autistic Disorder
James was the third of four children, born following an uncomplicated pregnancy and la-
bor. His health during the first 3 months of life was good, but shortly thereafter his mother
expressed concern because of his sensitivities to light and sound, his failure to make an an-
ticipatory response to being picked up, his fl uctuating moods between inconsolable crying
and extreme passiveness, and his failure to look at her when she fed him. She reported that he
preferred lying in his crib, staring at the mobile, to being held or played with. Because his mo-
tor milestones appeared at the appropriate times, James’s pediatrician reassured his mother
that his development was fi ne. By age 16 months, James had not begun to babble or say single
words, and spent most of his time in a corner, repetitively moving toy cars back and forth. At
20 months, other symptoms emerged: he developed unusual hand movements and body pos-
tures; his obliviousness to people increased; he reacted to even the most subtle interruption
in his routine or other changes in the world with extreme disorganization and panic; he devel-
oped a fascination with light switches and with studying tiny bits of paper and twigs.
At 4 years, James had not yet begun to speak socially to others, but could identify by name
many numbers and all of the letters of the alphabet.... He persisted in lining up objects in
the most complex patterns, but could never use objects appropriately.... At about the age of