Barbara K. Caparulo

A Longitudinal Study of Patients with Severe Developmental Disorders of Language Learning

Longitudinal data on 28 children diagnosed during the past decade as aphasic are reported. These subjects have been involved in a series of studies on the biological, psychological, social, and linguistic correlates of neuropsychiatric disorders of childhood. Results reveal that half this group of children with severe language deficits evidence some features similar to autism. Progress in language and behavioral areas is generally modest at best, although a few subjects make great gains. Children with and without autistic characteristics who have some strengths in the comprehension of language tend to make gains in social engagement, even if social skills were very poor to begin with. The implications of these; findings for research into the natural history of developmental language disorders are discussed.

Primary Childhood Aphasia and Childhood Autism: Clinical, Biological, and Conceptual Observations

Abstract Congenital, developmental, and idiopathic acquired aphasia form a spectrum of primary childhood aphasias characterized by profound disturbances in expressive language, relatively much better language comprehension; by the capacity for inner language, imaginative play, gesture, mime, and warm social relations; and by a variety of associated behavioral and cognitive difficulties (dependency, immaturity, hyperactivity, encoding and decoding problems). The presence of paroxysmal electroencephalographic abnormalities suggests cortical dysfunction. In contrast to this spectrum, the childhood autism syndrome appears earlier in life (during a prelinguistic developmental phase) and is characterized by an impoverishment of inner language; paucity of mime, gesture, and imitation; and much greater disturbance in social attachment and regulation of anxiety. Midbrain and brainstem dysfunctions involving catecholamine pathways may underlie some aspects of this syndrome. Because of complex, reciprocal effects between various neurological systems in the central nervous system, there may be mixed aphasic-autistic syndromes and familial clustering of both types of disorders. Intensive language training starting in the preschool years and possibly introduction of systematic sign language may be useful for both groups and especially valuable for aphasic children with more intact language competence.

Cognitive Structures, Language, and Emerging Social Competence in Autistic and Aphasic Children

Abstract The autistic childs attentional, motivational, and cognitive impairments, evident during the earliest periods of sensorimotor development, may later become masked by more striking peculiarities in language and social attachment, and by contrasting talents in specific, isolated areas. In primary childhood aphasia, the cognitive structures necessary for social attachment and early symbolization are relatively intact, but conceptual development is limited by linguistic handicaps and may eventually resemble the though disturbance of childhood psychosis. When a childs spontaneous, socialized language is impoverished, he may make use of fixed verbal codes which are tied, loosely or closely, to the immediate social and affective context. Analysis of such language features and their relation to other types of performances reveals the distinction between creative language use and normal imitation, on the one hand, and the adaptive mechanisms of autistic children, on the other. Since language is enriched in parallel with the formation of representations of oneself and others, central language disorder blocks the path toward the normal regulation of anxiety and appreciation of feelings. Meticulous observation of language-deviant children over long periods of time, guided by theory of normal linguistic and cognitive development, can reveal underlying competencies and patterns of dysfunction, and help clarify the structural basis and functional significance of symptomatic behavior.

Decreased Urinary Free Catecholamines in Childhood Autism

Abstract Urinary free catecholamines were reduced in a group of boys with childhood autism when compared to normal boys of similar age. This may reflect a difference in brain and peripheral noradrenergic activity in autistic children, and is a possible correlate of altered modulation of attention, arousal, and anxiety.

EEG Profiles of Neuropsychiatrically Disturbed Children

Abstract The use of the electroencephalogram (EEG) in clinical research and as a diagnostic tool requires operationally defined diagnostic criteria and objective EEG reporting. We studied the EEGs of 119 children with neuropsychiatric disorders, including childhood autism, aphasia, schizophrenia, and chronic multiple tics (Tourette syndrome). It was possible to discriminate between select populations on the basis of clusters of EEG findings, despite overall similarity on the normal-abnormal dimension. Examination of individual EEG parameters and sex differences suggests different pathways to similar behavioral phenotypes. EEG profiles may be related to differential patterns of disorganization of cerebral functioning in child psychiatric population.

Agreement in Diagnosis: Clinical Assessment and Behavior Rating Scales for Pervasively Disturbed Children

Abstract Clinical research in child psychiatry requires operationally defined, reliable, and valid diagnostic criteria. We studied the relationships between diagnostic assessment procedures, using three different methods of evaluation for a group of 27 pervasively disturbed children with childhood autism, aphasia, psychosis, and mental retardation. Ratings based on detailed clinical evaluation were in high agreement with a structured method of direct behavioral observation. A parent symptom checklist diagnosed 2 children as having classical autism (Kanners syndrome) out of 13 children diagnosed as primary autistic by the other two methods. Each system of diagnosis may have different advantages for treatment planning, evaluation, and biological correlations.

Childhood Autism: Cerebrospinal Fluid Examination and Immunoglobulin Levels

Abstract. The cerebrospinal fluid (CSF) of 15 children afflicted with primary childhood autism was examined. There were no abnormalities of glucose, protein, cells, or folate. There is evidence that slow virus infections may underlie a variety of chronic neurological diseases and it has been hypothesized that slow viruses may play a role in the etiology of adult schizophrenia. We have evaluated this viewpoint in relation to childhood autism. Preliminary studies of CSF immunoglobulin levels in children with autism offer no support to the hypothesis

Developmental language disability as a consequence of prenatal exposure to ethanol

Two pre-school-aged patients with a history of prenatal exposure to ethanol had abnormal head size and developmental delay. Both children were strikingly similar in physical appearance, behavior, and cognitive dysfunction. Facial features were typical of fetal alcohol syndrome. Head circumference greater than 97th percentile without hydrocephalus and no evidence of prenatal or postnatal growth failure were unusual for ethanol teratogenicity. Each child had a similar pattern of verbal and behavioral dysfunctions characterized by (1) marked hypervigilence, (2) distractability, and (3) cognitive confusion manifested as anxiety and behavioral disorganization. It is suggested that a history of prenatal exposure to ethanol associated with (1) large head circumference, (2) facial features of fetal alcohol syndrome, and (3) early developmental delay, particularly in language acquisition, and impaired modulation of attention and arousal may represent a possible new effect of alcohol teratogenicity.