الفهرس 
material and methodsيوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Autism, is a relatively new diagnosis, although the disorder itself
has probably always existed. A great deal has been learnt about the
syndrome since it first received a name. While there is often debate as to
the value or danger of labeling children as having specific disorder, it
seems unlikely that so much a progress would have been made over the
last 50 years, had not Kanner and Asperger put a name to features which
seemed to characterize a group of very special children.
The ICD 10 (International Classification of Diseases ) (1993)
described childhood autism as one of the pervasive developmental
disorders that is characterized by the presence of abnormal and/or
impaired development that is manifested before the age of three years and
by the characteristic type of abnormal functioning in all 3 areas of social
interaction, communication and restricted, repetitive behaviour.
Other features that are found within the symptoms of autism include
the peculiar pattern of intellectual abilities; the repetitive phenomena of
rituals; disturbance in response to objects; disturbance of sensory
modulation; disturbance of motor central and motor imitation;
inappropriate emotional response and instability of mood; abnormalities
of autonomic functions; impairment in the theory of mind tasks.
Although the detection and diagnosis of autism may be delayed
until middle childhood, 3-4 years after its onset, yet early detection could
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be facilitated by screening for early signs and symptoms using tests like
the checklist for Autism and Toddlers (CHAT).
The onset starts as early as from birth or begins after a period of
relatively normal development up to the age of 18 to 24 months.
However, it has been reported that the onset may be delayed as late as
from 4 to 14 years of age (in cases associated with acute
encephalopathies).
The present study was intended to have a broader outlook on early
screening via conducting the newly established questionnaire checklist
for autism in toddlers (CHAT). It was performed with the intention of
detecting autism as early as 18 month of age through health visitors and
general practitioners. Accordingly autistics may be taken to the specialist
at an earlier age for early intervention.
The CHAT was translated to colloquial Arabic and was adapted to
enable its use by the nurses and health practitioners.
In the current study several nurses at the different health offices
were introduced and familiarized to the syndrome of autism. They also
understood the difference between autism and other conditions as mental
retardation.
The epidemiological studies in Benha city revealed that between
the beginning of February 1997 and the end of January 1998, a total of
5875 infant children were bom. Moreover, the number of toddlers who
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Summary
received the booster dose for polio in the period from the beginning of
August 1998 till the end of January was 5795.
from the total number of children coming to receive the booster
dose of polio (5795), only 4000 performed the CHAT.
Two cases were detected from the total population screened. The
two cases met the criteria for autism risk group as they failed all three key
items of the checklist. This comes in accordance with international rates,
since the most excepted figure for prevalence of autism is between 2 - 6 :
10,000.
The male to female ratio of the detected autism cases by the CHAT
was 1:I These are suggested to be only a coincidence or may be due to
the small number of samples that exact sex ratio could not be established.
Due to the paucity of cases detected, already known cases suffering
from autism were randomly chosen for consequent consideration for
chromosomal study. CHAT was performed and chosen cases failed all 3
key items that were diagnostic.
Another important fmding was the consistent failure of the
protoimperative pointing, which is item (A6), by the children already
diagnosed as autistic. Moreover all autistic children except one failed
item (A2) which is evaluating the interest of the autistic child to be in the
company of others. Nevertheless, the one who passed it was the least
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affected of all. All children failed item (A9) that evaluates the bond
between the child and his parents. This is again an important symptom of
autism.
Minor physical anomalies, results of difficult pregnancies and
births, occur more frequently in autistic than in non autistic children. It
was observed that all of the families involved in the study had one or two
complications throughout the pregnancy and labour.
Two cases had a positive history of miscarriages in earlier
pregnancies. Four cases had excessive vomiting than normal and also
four received different types of medications during their pregnancies
while two cases received antibiotics after the delivery.
All selected cases along with parents and siblings underwent a
chromosomal study in an attempt to elucidate one of the etiological
factors of autism. A total of24 individuals (8 autistic children, the rest
are the family members) performed a chromosomal G-banding technique.
Presently it has been verified that one autistic child (case 3) of the
studied cases had ”47 XY + mar”. This marker chromosome was found
between chromosomes 3 and 4. Also delineated was the terminal deletion
of the short arm of chromosome 16 (16p) in the father of case 3.
Although he does not demonstrate specific behavioural, psychiatric or
developmental problems. No chromosomal anomalies were speculated in
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the monozygotic twin brother. Furthermore the other 21 individuals
joining the study showed no chromosomal abnormalities.
It might be suggested that the present studies do not delineate
clearly the nature of the chromosomal defect, or whether one or more
genetic mechanisms are operating thus calling for more profound studies.
It is worth mentioning that in the current research several parents
reported to be less social and more isolated and shy than others. Others
were reported to be a little obsessive and sometimes resist changes, are
meticulous and have some stereotypy in their behaviours. One mother
reported that she walks on her toes (case 6) and another family (case 7)
believes that their son is quite unsociable and has a limited number of
friends.