Understanding the Nature of Autism And Asperger's Disorder: Forty Years Of Clinical Practice And Pioneering Research

175 Pages·4.186 MB·English

by  Edward R., M.D. Ritvo

Understanding the Nature of Autism
and Asperger’s Disorder
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Understanding the Nature
of Autism and Asperger’s Disorder
Forty Years of Clinical Practice
and Pioneering Research
Edward R. Ritvo, MD
Foreword by Tony Attwood
Jessica Kingsley Publishers
London and Philadelphia
First published in 2006
by Jessica Kingsley Publishers
116 Pentonville Road
London N1 9JB, UK
and
400 Market Street, Suite 400
Philadelphia, PA 19106, USA
www.jkp.com
Copyright © Edward R. Ritvo 2006
Foreword copyright © Tony Attwood 2006
The right ofEdward R. Ritvo to be identified as author ofthis work has been asserted by
him in accordance with the Copyright, Designs and Patents Act 1988.
Diagnostic criteria for autistic disorder and Asperger’s disorder reprinted with permission
from theDiagnostic and Statistical Manual ofMental Disorders, Fourth Edition, Text Revision,
(Copyright 2000). American Psychiatric Association.
All rights reserved. No part ofthis publication may be reproduced in any material form
(including photocopying or storing it in any medium by electronic means and whether or
not transiently or incidentally to some other use ofthis publication) without the written
permission ofthe copyright owner except in accordance with the provisions ofthe Copy-
right, Designs and Patents Act 1988 or under the terms ofa licence issued by the Copyright
Licensing Agency Ltd, 90 Tottenham Court Road, London, England W1T 4LP. Applications
for the copyright owner’s written permission to reproduce any part ofthis publication should
be addressed to the publisher.
Warning: The doing ofan unauthorised act in relation to a copyright work may result in
both a civil claim for damages and criminal prosecution.
Library ofCongress Cataloging in Publication Data
Ritvo, Edward, 1930-
Understanding the nature ofautism and Asperger’s disorder : forty years ofclinical practice
and pioneering research / Edward R. Ritvo ; foreword by Tony Attwood.
p. cm.
Includes index.
ISBN-13: 978-1-84310-814-6 (pbk. : alk. paper)
ISBN-10: 1-84310-814-3 (pbk. : alk. paper) 1. Autism. 2. Asperger’s syndrome. I. Title.
RC553.A88R58 2005
616.85’8832—dc22
2005018076
British Library Cataloguing in Publication Data
A CIP catalogue record for this book is available from the British Library
ISBN-13: 978 1 84310 814 6
ISBN-10: 1 84310 814 3
ISBN pdfeBook: 1 84642 453 4
Printed and bound in Great Britain by
Athenaeum Press, Gateshead, Tyne and Wear
I wish to dedicate this book to
Riva Ariella Ritvo, and to our three wonderful children,
Victoria, Skye, and Max.
Also, I respectfully dedicate this book to the memory of a
young man who died in an automobile accident in April
1999, and to his courageous parents who donated his organs
so others could live. I received his heart and treasure the gift
of life they provided for me. If this volume helps but one
person or family with autism or Asperger’s disorder, or one
professional, or one student, then they too owe him and his
family a similar debt of gratitude.
Lastly, I wish to honor the memory of two men who shaped
my early life and guided my professional career, my father,
Max Ritvo MD, and my uncle, Joseph Weinreb MD.
“The quest to understanding others
begins at the end of the road to
self-acceptance.”
Max Joseph Ritvo,
age 13 (2004)
Contents
Foreword by Tony Attwood 9
Acknowledgements 11
Introduction 13
Why I’m writing this book 13
What this book is not 15
An apology to my readers who have autism or Asperger’s disorder 15
1. Understanding How to Understand a Disease 17
The medical model of disease 17
What did the Romans think? 19
The Dark Ages ofchild psychiatry – before 1940 20
Professor Leo Kanner (1894–1981) 20
Professor Hans Asperger (1906–1980) 23
2. The Clinical Symptoms: From Severe Autism to
Asperger’s Disorder 25
Some general points 25
Symptoms due to developmental delays 28
Autism and intelligence 50
3. The Life Course of Autism and Asperger’s Disorder 53
The life course ofsevere autism 54
The life course ofmild/high-functioning autism 57
The life course ofAsperger’s disorder 61
4. Searching the Brain for Clues 67
A model to guide the search for abnormal brain development 68
Studying brain wave activity 70
Spinning chairs, movie cameras, and microscopes 74
Neurotransmitters and “Nervous Mice” 78
Some concluding comments 86
5. Searching for Causes 87
Searching medical histories for possible causes 87
Our “Rolls Royce” study in Utah 88
Questions ofgenetics 95
6. Supportive Treatments: Which Ones, When,
and for Whom 101
Some general points 101
Specific supportive programs and support systems 104
Unproven theories about the causes ofautism, and
treatments to avoid 118
7. My Casebook 121
Children and adults with autism or Asperger’s disorder 122
Autistic parents ofautistic children 138
8. The Importance of Obtaining a Diagnosis 149
On diagnosis 149
9. The “Official Diagnostic Criteria” 157
Diagnostic criteria for autistic disorder 158
Diagnostic criteria for Asperger’s disorder 160
Epilogue 163
Suggestions for Gathering Further Information 167
Index 169
List of Tables
1 The life course ofautism and Asperger’s disorder 55
2 A detailed medical model of autism and Asperger’s disorder 166
List of Figures
1 The medical model of disease 18
2 Comparison ofdevelopmental pathways in normal development,
autism and Asperger’s disorder 29
3 A computer model ofthe brain 69
Foreword
Over the last forty years, Edward Ritvo, MD has conducted many of the
seminal research studies examining the medical aspects of autism. He
observed and contributed to the dawn of our scientific knowledge on
autismandAsperger’sdisorderthatbeganinthelate1960s.Today,youn-
ger scientists and clinicians tend to focus on contemporary research and
overlooksomeoftheoriginalstudies.Butnewlightcanshinethroughold
windows. As Edward Ritvo, MD describes the context for his original
researchandinterpretstheresults,thereaderbecomesawarethatthestud-
iesconductedtwentyorthirtyyearsagoarestillcontributingtoourunder-
standing of autism and our current theoretical models and treatments.
Therearefewpeopleintheworldthatcanuseanhistoricalperspective
overmanydecadestoperceivethechangingconceptualizationandtreat-
mentstrategiesofautismspectrumdisorders.Weneedthewisecouncilof
EdwardRitvo,MD insuchdiverseareasasdiagnosis,aetiology,treatment
andespeciallyprognosis.Whatautismisandwhatareitscausesandtreat-
ments along with how children with autism can develop, are the central
themes of this book.
Parents will be delighted to read the advice of an extremely experi-
encedclinician,arealistandoptimist,basedonthepersonalexperienceof
diagnosing,studyingandtreatingthousandsofchildrenandadultswhose
expressionofautismhasrangedfromseveretorelativelymild.Ofparticu-
lar interest is the seminal description of adults with autism or Asperger’s
disorder who are parents. Clinicians first thought that someone with
autism could never marry and have children. Over ten years ago, Edward
Ritvo,MDdocumentedandprovedthatsomeonewithautismcanexperi-
enceanintimateandlovingrelationshipwithapartnerandhavechildren.
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