Autism Is Not Necessarily a Pervasive Developmental Disorder

cases illustrate the exient and duration of behavioural disturbance that may be associated with iis use. There is a suspicion that patients with underlying structural brain damage (three of our cases) are more susceptible to this type of change3, which may be misattributed to constitutional factors in a child who has not been seen before. Before clonazepam is started, hyperactivity and antisocial behaviour, or their absence, should be recorded so that behavioural deterioration can be identified. When children have been on clonazepam f r o m an early age, a clear history of change may be difficult to elicit and chronic toxic behavioural reactions are harder to recognise. Behavioural side-effects with clonazepam may be minimised by increasing the dose gradually4. If behavioural changes d o occur, a reduction in dosage can sometimes help’, but it may be necessary to withdraw the drug. I f a benzodiazepine must be used, we suggest replacing it with ciobazam6. This is effective against a similar spectrum of seizure types, has fewer side-effects’ and in some cases may reduce impulsivity, aggression and hyperactivity’. Two of the three patients we switched to clobazam did not have further behavioural problems and we share Aicardi’s view8 that i f a benzodiazepine is lo be prescribed, clobazam should be the drug of first choice.

efficacy in epilepsy.’ Drugs, 12, 321-361. 5. Browne, T. R. (1976) ‘Clonazepam-a review of a new anti-convulsant drug.’ .4rchir,es of Neurology, 33, 326-332. 6. Sato, S., Penry, J . K., Dreifuss, F. E., Dyken, P. R. (1977) ‘Clonazepam in the treatment of absence seizures: a double-blind clinical trial.’ Neurology, 21, 37 I . 7. Farrell, K., Jan, J . E . , Julian, J . V . , Betts, T. A , , Wang, P. K . (1984) ‘Clobazam in children with intractable seizures.’ Epilepsia, 25, 657. 8. Aicardi, J. (1986) Epilepsy in Children. Neu York: Raven Press.

U \o

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Autism Is Not Necessarily a Pervasive Developmental Disorder SIR- The inclusion of childhood autism

among the developmental disorders in the late 1970s was a major step forward. Autism has much more in common with, f o r instance, mental retardation than with, f o r instance, emotional disorders of childhood. The introduction of the word ‘pervasive’ as a compulsory prefix to ‘developmental disorder’ when referring to autism and autistic-like conditions seems to us to have been a serious mistake. Autism and autistic-like conditions are not necessarily ‘pervasive ’. Rather, they constitute disorders in which there are specific deficits in social/cognitive functioning. If anything, particularly when there is not associated mental retardation, they may be classified more appropriately as coming within the specific developmental disorders category. The inappropriateness of the pervasive label is particularly evident MARTINCOMMANDER when one considers those highSTUART H. GREEN MICHAELPRENDERGAST functioning individuals with autism: how can we confidently tell them and their nearest that they have ‘pervasive The Children’s Hospital, developmental disorder’ or ‘PDD’? Lady wood Middleway, The conceptual unsoundness of PDD Birmingham B16 8ET. becomes striking when one considers the fact that the most pervasive of all References developmental disorders, viz. severeI . Robertson, M. M. (1986) ‘Current status of the 1.4 and the 1.5 benzodiazepines in the profound mental retardation, is not treatment of epilepsy: the place of clobazam.’ included among the pervasive Epilepsia, 27 (Suppl. I), 27-41. developmental disorders in the current 2. Browne, T . R . (1978) ‘Clonazepam.’ New England Journal of Medicine, 299, 812-816. classification systems. 3 . Stores, G. (1975) ‘Behavioural effects of antiThe term PDD is not much used in epileptic drugs.’ Developmental Medicine and Child Neurology, 17, 641-658. clinical practice, in spite of its having 4. Pinder, R. M., Brogden, R. N., Speight, T. M., been on the scene f o r a decade. Most Avery, G . S . (1976) ‘Clonazepam: a review of laymen in the field, including politicians its pharmacological properties and therapeutic

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and administrators in charge of services and decision-making in connection with constitutional rights, have heard about autism. Who has heard of PDD? We are already aware of people with autistic-like conditions who have not been given their lawful ‘autism rights’ because they were diagnosed as having PDD. (Did you ever think about Rain Man as ‘PDD’?) We would like to urge the scientific community and all others concerned with the field of autism to think about these things and not unreflectingly accept the concept of PDD.

GILLIAN BAIRD,London SIMONBARON-COHEN, London MICHAELBOHMAN,Umei MARYCOLEMAN, Lake Forest UTA FRITH,London CARINA GILLBERG, Goteborg CHRISTOPHER GILLBERG, Goteborg PATHOWLIN,London GARYMESIBOV,Chapel Hill THEOPEETERS, Antwerpen EDWARDRITVO, Los Angeles

SUZANNE STEFFENBURG, Goteborg DAVIDTAYLOR,Manchester LYNNWATERHOUSE, Trenton LORNAWING, London MICHELEZAPELLA,Siena

NOTICES 12th Brazilian Congress on Electroencephalography and Clinical Neurophysiology Gramado, Brazil, 1st to 5th September 1991 Further information from Symposius e Eventus, Av. Taquara 198, Sala 302, 90430 Porto Alegre, Brazil.

Prevention of Child Abuse and Neglect Leicester, 16th to 19th September 1991 The British Association for the Study and Prevention of Child Abuse and Neglect will hold its first National Congress in Leicester from 16th to 19th September 1991. The general theme will be ‘Turning Research into Practice’, and the Congress will provide an opportunity for professionals from many areas to present their own work and to share the latest research findings and practice developments in the prevention of all forms of child abuse and neglect. Further information from Kate Penny, Conference Administrator, Continuing Education Unit, University of Leicester, University Road, Leicester LEI 7RH. Tel.: 0533 522464.

Society for the Study of Behavioural Phenotypes-(SSBP)

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The inaugural meeting of this Society took place at an international symposium on behavioural phenotypes organised by the Behavioural Phenotypes Study Group in the UK in November 1990. The focus of interest, as stated in the constitution, is ‘those biologically determined disorders which in addition to producing distinct physical characteristics do by their effect on brain function cause recognisable disorders of behaviour’. The Society will bring together persons with research interests in

these disorders or in closely related topics. Founder members are drawn from paediatrics, adult psychiatry, child and adolescent psychiatry, clinical psychology, molecular genetics and clinical genetics. It is anticipated that other disciplines will become involved. The president of the Society is Professor Thomas Oppe. Honorary officers are Dr. Martin Bax (Chairman), Dr. Jennifer Dennis (Secretary) and Professor William Yule (Treasurer). Further details can be obtained from Dr. Jennifer Dennis, The Park Hospital for Children, Oxford OX3 7LQ. Tel.: 0865 226322.

Community Care and the Contract Culture -a series of RADAR training seminars: ‘Budgeting for and negotiating contracts’ Sandwell Education Development Birmingham, 18th April RADAR, London, 7th May The Dene Centre, Newcastle, 13th May

Centre,

For further details and a registration form, contact: Rachel Scott, Conference Officer, The Royal Association for Disability and Rehabilitation, 25 Mortimer Street, London WIN 8AB. Tel: 071 637 5400. ext. 339.

Normal and Abnormal Visual Development in Infants and Children: third meeting of the Child Vision Research Society Rotterdam, The Netherlands, 12th to 14th June Further details may be obtained from Dr. J. Van Hofvan Duin, Department of Physiology I, Erasinus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. Tel.: (31 10) 408 7567; Fax: (31 10) 436 7594.