, Volume 19, Issue 3, pp 409-424

Infantile autism: A syndrome of multiple primary deficits?

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Attempts to explain infantile autism in terms of just one underlying neurological or psychological deficit may be misguided. As in the case of many neurological syndromes, autism may involve multiple functional deficits due to multiple coexistent neurological deficits. Comparison with Asperger's syndrome and the developmental dysphasias suggests that the autistic syndrome results from the coexistence of at least two distinct constellations of functional impairments: deficits in mechanical language skills, as in the developmental dysphasias; and deficits in social relatedness, play, and nonverbal communication, as in Asperger's syndrome. Possible neurological underpinnings are considered, including the relative contribution of the two cerebral hemispheres. Implications for etiology and research are discussed.

I am greatly indebted to many colleagues who read earlier versions of this article and made helpful suggestions and criticisms. I am particularly grateful for the guidance and encouragement of Professors M. Rutter and P. Graham. This article was prepared during the tenure of a Wellcome Clinical Research Training Fellowship held in the Department of Child Psychiatry at the Institute of Child Health, London.