CHILDHOOD AUTISM - AN APPEAL FOR AN INTEGRATIVE AND PSYCHOBIOLOGICAL APPROACH

The difficulty that a person with autism has in establishing relations hips, maintaining them (communicating and responding appropriately) is a common experience of those close to them. That impaired perceptual and cognitive processing can underlie this difficulty and the interact ions of people with autism with the material environment has been esta blished in the laboratory. The consequences at a psychological level o f analysis may converge in the inadequacy of second-order representati ons of the world. An attenuation of such endogenous monitoring process es could also indirectly account for features of withdrawal and the st ereotypies often observed. At another level of analysis there are dela ys in neurotransmission in the CNS and a lack of flexibility of physio logical response shown by evoked potential recordings. Tomographic stu dies of blood flow and metabolism illustrate a lack of correlation bet ween information processing centres in the brain that may sometimes ar ise from diffuse gray matter atrophy. A ''stop-go'' form of modulation of central processing is mediated by anomalous ascending serotonergic and dopaminergic function (transmitters with inhibitory and switching functions). On these bases it is no wonder that representations are n ot formed and inappropriate and repetitive behaviors follow, although the link remains somewhat speculative. Both levels of analysis are use ful for an explanation. As behavioral and pharmacotherapy, though helf ul, are severely limited in their efficacy, more effort is required to synthesize the different levels of analysis into a psycho-biological approach to remedial programs and new forms of therapy.