[Functioning of memory in subjects with autism]. / Fonctionnement de la mémoire chez les sujets avec autisme.

INTRODUCTION: Autism is an early developmental disorder with cognitive impairments that leads to learning and social integration disabilities. The characterization of memory functions in individuals with autism has been the subject of numerous investigations, with widely varying conclusions. The notable differences between these studies can be attributed to variations in the age, intelligence and level of severity of the participants with autism. LITERATURE FINDINGS: The purpose of our review of the recent literature is to describe the memory function of individuals with autism. Some of the different memory subtypes are intact, others are impaired. Short-term memory (digit span) is not impaired while working memory is impaired in some of its components, but the findings are inconsistent. More recent studies demonstrate reduced spatial working memory abilities in autism and extend previous findings by demonstrating that these deficits are significant when tasks impose heavier demands on working memory. Episodic long-term memory, as measured by free recall, cued recall or recognition tasks, is intact, but participants with autism perform significantly less well than controls as the complexity of the verbal or visual material to be recalled increases. Source or contextual memory involves a variety of characteristics specifying the conditions under which specific items or facts are acquired: it has been investigated in individuals with autism with different methods. Deficits in source memory for temporal information have been found, but there were no reality monitoring deficits. Recent findings indicate that the nature of source memory confusion in autism does not appear to reflect a generalized deficit in attaching context to memories, but rather is dependant on the specific to-be-remembered information that involves social aspects of context. The self-reference effect is missing, with individuals with autism recalling events performed by themselves less well than the events performed by a peer, suggesting they have difficulties in relation to processes involving the self. Studies involving assessment of subjective states of awareness during recognition show less conscious recollection and more feelings of familiarity. Recent investigations are consistent in demonstrating memory impairments related to the failure of subjects with autism to use organizing strategies or meaning to support memory, an effect which grows with the increasing complexity of the material. Memory deficits in autism may be related more to retrieval and less to encoding, as deficit in source memory in participants with autism is largely eliminated when source was supported at test. DISCUSSION: The neuroanatomical basis of the specificities of memory impairment in autism is still uncertain, but it is suggested that autism involves an impairment in the conversion of limbic inputs into medial prefrontal outputs. Memory deficits found in individuals with autism may explain some of the clinical symptoms. Failure to encode all the information, especially its social aspects, may therefore contribute to dysfunction in the social, communication, and reasoning domains. Abnormal memory functioning in autism is also related to more general cognitive impairments, including executive function deficits and central coherence weakness. Evidence of the normality of certain memory capacities, at least in individuals with moderate autistic symptomatology, is encouraging for adaptive improvements in cognitive functioning.

[Clinical guidelines for the screening and the diagnosis of autism and pervasive developmental disorders]. / Recommandations pour la pratique clinique du dépistage et du diagnostic de l'autisme et des troubles envahissants du développement.

UNLABELLED: Autism is the best defined category among PDD. Its high prevalence, its onset in very young children and its persistence in adulthood arise many questions about early screening and early diagnosis. The aim of the study was to identify professional best practices about screening and diagnosis of autism in order to propose clinical guidelines and actions for the future. Scientific experts and parents take part to this procedure. Literature and previous guidelines were analyzed, experts in various fields were interviewed, a national study about the medical practices of the diagnosis of autism was made and questionnaires were send to 1600 psychiatrists and pediatricians. Guidelines built around 2 levels were proposed about screening and diagnosis. CONCLUSION: Diagnosis needs a multidisciplinary approach, validated instruments and more communication between professionals and parents. Finally one of the more important aims of the diagnosis of autism is to facilitate intervention program.

[Childhood psychoses and organic pathology: results of a study of 144 cases]. / Psychoses infantiles et pathologie organique: résultats d'une étude sur 144 cas.

The records of 144 patients of Child Psychiatry Units of Alsace (France), with childhood psychosis (CP) or pervasive developmental disorders (PDD) have been systematically screened for previous or associated pathological events. Half of the children studied have been or are still affected by severe somatic disorders, but none of the diagnostic subcategories (referring to DSM III or CFTMEA) appeared significantly more frequently affected. In our population, the severity of organic disorders was positively correlated with: the age of the mother: more severe cases were reported when the mother was younger than 20 or older than 40 at the moment of childbirth; pathological events during pregnancy; early mother-child separation during the first year of life. The most frequent associated disorders however (neonatal pathology 45% of the cases, epilepsy 17% of the cases, neurological or neurosensorial pathology 15% of the cases) were associated neither with a specific diagnostic nor with a clinical and social specific pattern. The only statistically significant correlation was found between neurological pathology and a relatively low level of cognitive and social functioning. All these results were confirmed by multivariate statistical analysis. A main component analysis integrating all quantified data concerning organic pathology was performed: it emphasizes the independence of the different pathological events reported. The factorial analysis including the clinical, diagnostical and somatic event-related data failed to show any statistical profile associating functional features of the children with any particular previous or existing somatic disorders. Our results suggest that a history of organic pathological events is frequent not only in autistic disorders but in any kind of PDD or early CP - associated with moderate to severe mental retardation, in most cases of our study. However, this does not demonstrate that this type of pathological events constitute the direct and unique cause of PDD and CP: the concept of the aetiology of these severe diseases must take account of other factors - such as relational disruption -, also frequently seen in these children.

[Development of long term memory in the child]. / Développement de la mémoire à long terme chez l'enfant.

The relatively recent development of research on memory has considerably improved knowledge on the subject. The cognitive approach allowed to consider memory as a multiform phenomenon, implicating separate processes and based on independent systems. Memory presently appears as an active process, beginning to get organized as soon as the first interactions between child and environment. Recent research data show that infants memory seems to present specific characteristics, different from those of older subjects. This is a further argument to the theory of independent mnemonic systems, growing at different periods of development.

[Short term memory and severe language disorders in the child]. / Mémoire à court terme et troubles sévères du langage chez l'enfant.

Memory, and particularly short-term memory or "working memory" (Baddeley), is involved in language acquisition in children. We have studied short-term memory, with verbal-and non verbal tests, of 8 children suffering from developmental dysphasia compared with other ones, matched in terms of age and performance I.Q. (W.I.S.C.-R.). The digit span did not significantly differ in the two groups, while the visuo-spatial span was lower in the dysphasic group. The memorization of a list of monosyllabic words by dysphasic children was poor in the absence of visual presentation and improved by it. Differences between dysphasic and control-children are unlikely to be due to speech rate which does not significantly differ from one group to the other one. The results suggest the existence, in language disordered children, of cognitive functions disorders much more important than those directly involved in the speech production.

[Intrafamilial bone marrow donation: the role of the parents]. / Don de moelle osseuse intrafamilial: la place des parents.

Bone marrow transplantation (BMT) is the last chance of recovery for some children suffering from malignant hemopathy or congenital blood disease. BMT with related donor radically alters previous family relationships: each member of the nuclear family becomes actively involved. Parents and siblings all undergo HLA typing. Only 30% of those who would benefit from bone marrow transplantation are lucky enough to have an HLA matched related donor, brother or sister. Our retrospective study concerned related donors and their parents. This paper reports the parents study. It was carried out at Strasbourg University Hospital. Parents were invited to speak about the child's illness, the graft reasons and their own position to regarding the choice of donor. Semi-structured interviews were used and their content analysed. The results highlight the expression by the parents of the need to maintain some control over the action which will save their child and establish an other gift system to keep their parental status.

[Fragile X chromosome in autism and psychotic disorders in children]. / Chromosome X fragile dans l'autisme et les psychoses infantiles.

Three cases of fragile X (fra X) have been identified in a systematic survey of 30 boys, aged 3 to 14, with infantile autism or psychotic disorders, associated with mental retardation. Only one of these children exhibited a dysmorphy characterizing the Martin-Bell syndrome. Two fra X cases fulfilled the DSM III criteria for autism; none corresponded to the Kanner's description of infantile autism. The prevalence of fra X among children with psychotic disorders (6%) is much higher than in the general population; however it is close to the prevalence observed in non psychotic mentally retarded patients. Given the inconsistency of the somatic phenotype, the screening should benefit from the recent discovery of abnormal methylation of DNA.

[Epidemiological study of maternal depression as a risk factor in the developing of early childhood psychosis]. / Etude épidémiologique sur la dépression maternelle comme facteur de risque dans la survenue d'une psychose infantile précoce.

After reviewing epidemiological literature on the relationships between depression in parents and onset of a psychiatric disturbance in children as well as investigations of the interactions between a depressed mother and her infant, the authors discuss the psychoanalytical concepts of these interactions and the findings of their research. This epidemiological research is based on the assumption that depression in the mother during pregnancy and the first few months of the post-partum constitutes a risk factor for the onset of an early psychosis in the child. This research is a comparative study between a group of mothers with early onset psychotic children and a group of mothers with non patient children, the age and sex of the children in both groups being equally distributed. The methodology includes two instruments aimed at a retrospective assessment of mothers' depression: the SADS-LA questionnaire and a standardized scoring system for semi-structured interviews investigating the mother's feelings during pregnancy and early development of her baby. Results show that there is a statistically significant relationship between a major depressive condition in the mother during pregnancy and/or during the first year of the infant's life and the onset of an autism in the child. It might be that major depressive conditions starting before delivery could by themselves account for the risk. Depression in the mother therefore constitutes a risk factor for early psychosis, the relative risk being about four. This study also emphasizes particular features of the mother's depressive conditions: difficulties to accept the real child, difficulties in perceiving the infant's psychic evolution, decrease of interactive skills. The statistically significant relationship in no way points to a linear causal relationship, which hypothesis seems to be negated by the statistical findings of this research.

[Paradoxes in adolescence: break and continuity]. / Paradoxes à l'adolescence: rupture et continuité.

The psychopathological studies on adolescence underline the paradoxical behaviours during this period of life. After the analysis of its concept we show in which way the paradox helps to maintain the continuity of psychological life during the crisis. Thus impossible choices which are part of the contradiction in adolescents be avoided. It will be necessary to provoke the emergence of the paradox from the contradictions linked with hospitalization through on hospitalization to make the most of the letter in the therapeutic process.

[Disorders of catecholamine metabolism in infantile autism. Comparative study of 22 autistic children]. / Les troubles du métabolisme des catécholamines dans l'autisme infantile. Etude comparative de 22 enfants autistes.

In a group of 22 autistic children aged 5 to 16 y., and a group of normal controls matched for age and sex, catecholamines metabolism has been investigated in plasma, platelets and urine. This investigation was part of a research project in which several biological parameters (including serotonin) were simultaneously explored in the same children. In the autistic group, epinephrine and norepinephrine and dopamine were significantly lower in isolated platelets, and no significant difference was found between the two groups for the urinary excretion of epinephrine, norepinephrine, dopamine, DOPAC and MHPG. Other differences between the two groups in the statistical correlations of several biochemical parameters (plasma norepinephrine and dopamine with platelet MAO activity, platelet norepinephrine with platelet dopamine, platelet dopamine, platelet dopamine with platelet serotonin) also suggest abnormalities of bioamine metabolism in the platelets of autistic children.

[Metabolism of serotonin in autism in children]. / Métabolisme de la sérotonine dans l'autisme infantile.

In this controlled study of 22 autistic children and 22 normal controls matched for age and sex, the frequency of hyperserotonemia in infantile autism was confirmed. Platelet serotonin was elevated in patients. Comparative to controls, serotonin was also high in urine of autistic patients, while, on the contrary there was no difference for the urinary excretion of 5-HIAA. No difference was observed either for serotonin uptake and efflux or for MAO activity, in isolated platelets. The elevation of plasma free tryptophan - significant only with the Kolmogorov Smirnov test - suggests that 5-HT biosynthesis might be enhanced. In the group of patient reported in this study, disorders of serotonin metabolism are associated with disturbances of platelet catecholamines, and also with elevated immunoglobulins and enhanced cellular immunity reactions.

[Immune status in infantile autism. Correlation between the immune status, autistic symptoms and levels of serotonin]. / Etat immunitaire dans l'autisme infantile. Corrélations entre état immunitaire, symptômes autistiques et taux de sérotonine.

In sixteen autistic children high values of IgG and a high level of lymphocyte stimulation with PHA were observed. Principal component analysis showed: 1) a significant correlation between basic lymphocyte mitogenic activity and the clinical symptoms opposition and hyperactivity, 2) a significant correlation between high Ig levels, high PHA stimulation responses and the main autistic symptoms (withdrawal, inaffectivity, hypoactivity, mannerism, stereotypy and negatively echolalia), 3) a significant correlation with serotonin uptake by platelets and high immunological responses. Such correlations are strongly in favor of an immunologic component in autistic disease.

Serotonin metabolism and other biochemical parameters in infantile autism. A controlled study of 22 autistic children.

The serotonin metabolism was extensively studied in 22 couples of autistic children and age- and sex-matched controls. Histamine, calcium, and uric acid were also measured in urine and whole blood or plasma. Autistics and controls did not differ in histamine, and only minor changes were noticed in calcium content. According to previous reports, serotonin levels were often, but not always, elevated in the blood of autistic children. Based on data including urinary serotonin and 5-hydroxyindoleacetic acid, platelet serotonin uptake and efflux, platelet monoamine oxidase and glutathione peroxidase activities, and uric acid and plasma tryptophan, the origin(s) of such hyperserotonemia in autism appear(s) to be of metabolic origin, i.e., a decreased catabolism and/or an increased biosynthesis of serotonin.

Catecholamines metabolism in infantile autism: a controlled study of 22 autistic children.

In a group of 22 autistic children aged 5 to 16 years and a group of normal controls matched for age and sex, catecholamines metabolism was investigated in plasma, platelets, and urine. This investigation was part of a research project in which several biological parameters (including serotonin) were explored simultaneously in the same children. In the autistic group, epinephrine and norepinephrine were significantly elevated in plasma, while epinephrin, norepinephrine, and dopamine were significantly lower in isolated platelets. No significant difference was found between the two groups for the urinary excretion of epinephrine, norepinephrine, dopamine, DOPAC, and MHPG. Other differences between the two groups in the statistical correlations of several biochemical parameters also suggest abnormalities of bioamine metabolism in the platelets of autistic children.

[Early infantile autism and its biochemistry]. / Autisme infantile précoce et biochimie.

In the first part of this paper the different orientations of biochemical research in early infantile autism are recalled. The most significant results of these studies concerning the dopaminergic, noradrenergic and indolaminergic (serotonin, efflux, uptake) systems as well as the various enzymatic complexes are also reviewed. In the second part, the methodologic problems which arise in biochemical research in the field of autism are addressed.