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The author reviews the history and classification of autistic disorders and describes in details (by months and year periods) clinical symptoms of early children autism from the birth to 6-8 years of age in 41 children. Follow up data on the patient's state at the age 8-14 years, with account for the effects of treatment and correction, are presented as well. The results are discussed in the aspect of critical periods and phases of early ontogenesis, their deviations and pathology.

The aim of the study was to elucidate fundamentals for the phenomenon of universality of childhood autism by comparison of clinical and neurophysiological features of its severest forms--children endogenous autism (CEA) and Rett's syndrome (RS). Each group included 20 patients. Both groups were similar by age-at-disease-onset, clinical appearances during the disease course and dynamics of psychopathological syndromes. The theta-rhythm is common for CEA and RS at the disease stage with marked signs of disease acuity, autism, regress and, therefore, may be regarded as a marker of severity and development delay. The universality of autism phenomenon in its severe forms was confirmed both at the clinical and neurophysiological levels.

An open prospective clinical study included 25 patients with childhood autism aged from 3 to 8 years (mean age 5 years 11 months). Patients received 2 therapeutic courses (15 intramuscular Cerebrolysin injections of 1.0 ml every other day per course) with 2 months interval and basic antipsychotic therapy using typical neuroleptics in age-adjusted dosages. The duration of the study was 180 days. Significant or very significant improvement was achieved after the 1st Cerebrolysin course in 38% patients, after the 2nd course in more than 50% and to the end of the follow-up (180th day) in 71% of patients. There were no cases of deterioration during the trial. The autism severity as measured by the CARS scale consistently decreased from the day 0 to the day 180--from 37.7 to 32.6 scores, respectively (p0.001) in all assessments as compared with the baseline. To the end of the study, the patients demonstrated a significant decrease in mental retardation by 0.2 years. A statistically significant improvement was achieved in cognitive activity, attention during task performing as well as in self-service (by 0.3 years), receptive and expressive speech, cognitive performance and perception (by 0.2 years), fine motor function (by 0.1 years). The combined therapy comprising neuroleptics and Cerebrolysin double course can be recommended for correction of behavioral disorders and cognitive dysfunction in patients with mild moderate and moderate/severe autism.

The authors analyse the trends in the study of childhood autism in the XX century and state of the art in view of nosology, systematics, clinical phenomenology, etiology and pathogenesis of autistic disorders. Mental Health Research Center of Russian Academy of Medical Sciences proposes a new classification of autism in children basing on the study of 500 cases. Each form of autistic disorders is characterized in clinicopsychopathological and pathogenetic aspects. The phenomenon of autism in childhood psychopathology is universal, dependent on peculiarities of ontogenesis of the nervous system, individual development of a child, genetic and environmental factors.

Twenty children with endogenous autism of mild and moderate severity (30-44.5 scores according to the CARS), aged 3-8 years, were treated with choline alfoscerate (CA), 400 mg/day, during 8 weeks in the presence of maintenance therapy with neuroleptics (17 cases). Positive therapeutic effect was observed in 89% of the patients: significant improvement--in 61% and minimal efficacy--in 28%. Statistically significant positive changes in the patient's state were observed in the general improvement of behavior (p0.001), development of social and communicative skills, as well as self-service, reduction of marked speech disturbances (p0.001) and motor sphere (p0.001), enhancement of learning activity and productivity (p0.05). Good tolerability to the therapy, without patient's state worsening was registered. Some patients exhibited strengthening of affective lability in the first weeks of the treatment which attenuated to the 4th week as the CA dosages decreased to 400 mg every other day. CA may be recommended for combined therapy with neuroleptics as an effective and safe medicine for the treatment of cognitive and behavioral disorders in patients with children's autism.

Nineteen children with childhood autism and 8 with Asperger's syndrome aged 2-8 year, were treated with cerebrolysin (CL) in inpatient clinic. All the patients received 10 microinjections (intramuscularly and perinervously) of 0.1 ml CL daily during 5 days. Clinical study was combined with device estimation of cognitive functions and communicative skills. CL therapy resulted in improvement of cognitive functions (expressive and receptive speech, fine motoring, playing). Positive effects were revealed in all the patients with Asperger's syndrome and in 89% of the patients with childhood autism. Any negative effects were not found. With regard to cognitive functions development, therapeutic efficacy proved to be more pronounced in the patients with Asperger's syndrome as compared to childhood autistic group (p0.005).

Rett syndrome is a severe, genetically determined disease of early childhood which produces a defined clinical phenotype in girls. The main clinical manifestations include lesions affecting speech functions, involving both expressive and receptive speech, as well as motor functions, producing apraxia of the arms and profound abnormalities of gait in the form of ataxia-apraxia. Most investigators note that patients have variability in the severity of derangement to large motor acts and in the damage to fine hand movements and speech functions. The aims of the present work were to study disturbances of speech and motor functions over 2-5 years in 50 girls aged 12 months to 14 years with Rett syndrome and to analyze the correlations between these disturbances. The results of comparing clinical data and EEG traces supported the stepwise involvement of frontal and parietal-temporal cortical structures in the pathological process. The ability to organize speech and motor activity is affected first, with subsequent development of lesions to gnostic functions, which are in turn followed by derangement of subcortical structures and the cerebellum and later by damage to structures in the spinal cord. A clear correlation was found between the severity of lesions to motor and speech functions and neurophysiological data: the higher the level of preservation of elements of speech and motor functions, the smaller were the contributions of theta activity and the greater the contributions of alpha and beta activities to the EEG. The possible pathogenetic mechanisms underlying the motor and speech disturbances in Rett syndrome are discussed.

The paper provides clinical and catamnestic descriptions of 240 children with infantile autism; 160 with atypical autism (of them 100 had schizophrenic attacks, 60 presented with mental retardation concurrent with atypical autism (in phenylketonuria, tuberose sclerosis, Down syndrome, Martin-Bell syndrome), 20 with Asperger's syndrome, 60 with Rett's syndrome, 20 with psychogenic paraautism according the Nissen classification. The similarity of autism-like disorders and atypical autism was considered. Syndromal verifications in accordance with ICD-10 (1994) and ICD-10 (1999) in Russian versions and clinical nosological verifications adopted in Russia were studied in all the examinees. New approaches to treating patients with autistic disorders were developed.

Increased central-parietal EEG theta-2 activity (about 6.5 per sec) was found in children with cognitive disorders (in Rett's syndrome, fragile X-syndrome, infantile autism) and in elderly patients with Alzheimer-type dementia (with prevalence of neuropsychological "frontal" disorders) in the presence of suppressed alpha rhythm. This theta-activity was closely associated with cognitive deficits and possessed a specific functional topography, namely it focused in the parietal region and suppressed by both visual stimulation and motor tests. The similar EEG pattern was observed in some patients treated with neuroleptics and/or during hyperventilation. By taking into account the data available in the literature on motor, oculomotor, regional cerebral blood flow and the probability prediction in frontal lobar dysfunction, it is suggested that the theta-activity described appears in the visuomanual coordination system and is a physiological correlate of decreased functional status of frontal lobes.

Rett syndrome (RS) is a severe genetically conditioned disorder of an early childhood with an definite clinical phenotype in girls. Motor and speech disturbances are noted as the essential part of RS clinical picture. The variability of motor dysfunction and degree of speech deterioration were noted at different stages of the illness. The aim of the present investigation was to study dynamics of both speech and motor disturbances during 2-5 years of the course of the illness and to analyze a correlation of motor and speech functions' disorders. The study was performed in 50 girls with classical RS aged from 12 months to 14 years. The data obtained show a gradual involvement of different brain cortex structures in pathological process during the course of RS (especially of frontal and temporal-parietal regions) at the early stage of the illness and subsequent spread of the pathological process with successive involvement of subcortical structures, cerebellum, brain stem and eventually spinal cord. The neurophysiological investigation showed a strong correlation of speech and motor disturbances' degree with the EEG parameters. The level of theta-activity was significantly lower and the level of alpha- and beta-activity was significantly higher in EEGs of RS patients with more preserved speech and motor functions. In discussion mechanisms of motor and speech disturbances in RS were considered.

A level of autoantibodies (aAB) to nerve growth factor (NGF) was measured in blood serum of children from 4 groups: 1) schizophrenic patients; 2) children from the families, in which one of the parents suffered with schizophrenia (high risk groups of schizophrenia); 3) children with residual-organic damages of CNS; 4) control group. This index was also determined in their mothers. Significant elevation of a titer of aAB to NGF was observed in blood of children from groups 1 and 2 as well as in their mothers, as compared with 3 and 4 groups. Among the mothers of the children from 1 and 2 groups there were met women with different endogenous mental disorders, with the disorders of personality as well as mentally healthy women. An increase of a level of aAB to NGF was found in all the women from groups 1 and 2, independently of their mental status including mentally healthy women. Such results allow to consider elevated level of aAB to NGF as a risk factor of mental pathology.

The paper reports the case of sibs, brother and sister, with Martin-Bell's syndrome confirmed cytogenetically. Mental retardation and autism were the main phenomena in the clinical picture. Positive effect was achieved by means of Skvortsov--Osipenko method (metameric injection of cerebral hydrolysates' preparations, stimulation of visual, acoustic and proprioceptive analyzers). A decline of the signs of intellectual retardation and autism were observed in both children.

The level of autoantibodies (AAB) to nerve growth factor (NGF) was examined in blood of mentally healthy children, children with early children schizophrenia as well as with Kanner's and Asperger's syndromes too. The elevated titer of AAB to NGF was determined in blood of children with acute, active state of disease; meanwhile the same titer wasn't changed in the state of stable remission or steady defective state as compared with control group. The correlation was found between the level of AAB to NGF and the degree of disease progression. The correlations which were revealed between AAB to NGF level and peculiarities of the clinical state of patients permitted to use this index as the objective marker of both the acuteness and the severity of the patient's state.

The peculiarities of the development of 45 orphan children who were bringing up in one Moscow's "baby's home" in early age from birth till first 3.5 years had been analysed. The "orphan syndrome" which was characterized by both alteration in affective background of personality and para-autistic appearance of deprivation character had been described. The article emphasized that the conditions of ordinary bringing up which were formed on the basis of standard crèche and kindergarten programmes for normal children were insufficient for orphan children in "baby's home". Deprivation psychopathological manifestations in orphan children must to attract attention of psychiatrists as well as psychologists toward the necessity of correction and prophylaxis of these disturbances with their direction on the softening of maternal deprivation consequences.

Clinical, pathopsychological and neurophysiological studies have been carried out in 85 children with infantile autistic psychosis and in 38 girls with Rett's syndrome. New improved differential diagnostic criteria between these two forms of early childhood autism have been suggested. EEG spectral density values in alpha-1, alpha-2, beta and theta subbands are established to be their neurophysiological markers. Special attention was paid to close relationship between ontogenetic neuromorphogenesis of the brain cortical structures (e.g. physiological lysis of cortical cell populations at the age 8-30 months of the child's life) and the defect severity in the onset of illness at the same age range in patients with the studied forms of early childhood autism. The data obtained are discussed in terms of new approaches to understanding pathogenesis of different forms of early childhood autism.

The results of rehabilitational and psychological correction of mentally ill children and adolescents in hospital, inpatient-outpatient and outpatient conditions and of the follow-up are presented. The problem of prevention and rehabilitation is reviewed in general. Some considerations on further perfection of the aid to mentally ill children are suggested.

36 children with Rett's syndrome were examined in respect to the illness stage and psychopathologic trends. It is supposed that relationship of EEG abnormalities to clinical stages reflects gradual involvement of different brain structures in the pathological process. Possibility of temporary interruptions in the disease progression is demonstrated.

Problems of rehabilitative correction of defect conditions associated with schizophrenia that had occurred in early childhood remain little studied. After the disease attacks the schizophrenic children usually develop severe defect conditions. With no rehabilitation provided to such children, the defect gravity increases due to super-addition of secondary retardation of mental development. The characteristic features of defect conditions were investigated on a material of the follow-up of 75 persons who had suffered schizophrenic attacks of varying structure at the age under 3 years. A complex of measures for their rehabilitation has been elaborated.

The paper is concerned with a study into the characteristic features of language pathology in children with early infantile autism of the process genesis. 68 patients with early infantile autism were entered into the study. The language as the earliest function of the central nervous system may suffer first of all. Language disorders of varying pathogenetic levels consequent on retarded development, catatonic disorders, mental regression, and pathology of the associative process have been revealed. Measures aimed at language pathology rehabilitation have been elaborated.

The examination of 32 children with Kanner's syndrome of early infantile autism permits to assume that this syndrome in some of the cases is expressed only by inborn anomalies which correspond to constitutional psychopathy in adults. In most of the cases this syndrome forms the initial expression of child schizophrenia. In separate cases disorders very similar to Kanner's syndrome may be seen after the first olliterated attack during early childhood (up to 3 years). A comparative study of the same indices of development of 268 children with an early onset of schizophrenic process in spite of some differences confirms that Kanner's syndrome is very close to childhood schizophrenia. An analysis of genealogical data shows genetical relations of Kanner's syndrome with child schizophrenia.

The work deals with the catamnestic substantiation of the systematics of schizophrenia in children. A group of 328 patients was selected in 1982-1987 from a cohort of schizophrenic patients studied in 1962-1972 in which the onset of the disease fell on their first 5 years. The stability of the course patterns was evidenced in the early childhood schizophrenia. A set of subspecies of disorders similar to schizoactive psychoses and peculiar affective schizoid states was differentiated out of the general pool of slow progredient and attack-like schizophrenia. This allowed to prove the notion of the whole continuum of endogenous psychoses in not only adults but also in children.

The article is devoted to the correlation between manifestations of congenital dysontogenesis, the syndrome of Kanner's early infantile autism and early infantile schizophrenia. The article is largely based on the materials of a follow-up study of a cohort of schizophrenics (n = 268) and patients with Kanner's early infantile autism (n = 32). The authors established developmental deviations in the form of a stigmatized, distorted, retarded type in the premanifest premorbid period in patients with early infantile schizophrenia (in 78% of cases). It has been shown that Kanner's early infantile autism is characterized by disorders in the hierarchy of the development of functional systems and their underdevelopment, which allows some authors to refer it to unprogressive dysontogenesis, while others may refer it to congenital apsychotic schizophrenia.

Sixty-seven children with early childhood autism received therapeutic and corrective treatment in a day-time clinic. In 37 cases socialization of children proved possible, and following treatment, they were transferred to specialized, logopedic, and general kindergartens and schools. The authors advocate the advisability of setting up day-time clinics in the framework of childhood psychiatric hospitals and of organization of separate groups for children with early childhood autism in the framework of specialized kindergartens.

The article presents the results of a follow-up of 113 patients suffering from infantile schizophrenia with an unfavourable course. The mean duration of the follow-up in 84 patients was over 11-15 years. In the follow-up period 84% of the patients were characterized by productive predominantly catatonic disturbances with features of pseudooligophrenic dementia, autistic behaviour and apathic manifestations. In the remaining 16% of the patients the state could be assessed as residual with the predominant oligophrenic defect and apatho-autistic behaviour. The author discusses infantile schizophrenia running an unfavourable course at delayed stages of its development, the formation of the defect and also the therapy and care for such children.

Altogether 222 patients with early childhood schizophrenia, including 102 patients with an attack-like slow progressive schizophrenia were followed up. A distinct stability of the singled out forms of schizophrenia with the onset in early childhood was demonstrated. Within the framework of each form of the disease development a variability of the progression inherent to each form is established. Its greatest variability was noted within the range of the attack-like, slow progressive schizophrenia. It is mostly influenced by the ontogenetic, somato- and psychogenic factors.

The paper is concerned with a study of age variants of depersonalizational disturbances in schizophrenia children of early preschool age and preschool age. Depersonalizational disorders proper were found in 25 cases, disturbance of the self-conscious and its deterioration in 59, retardation in the development of the self-conscious formation--in 32 cases. Depersonalizational disturbances appear in children over 3 years, i.e. following the first physiological age crises. The following types of depersonalizational disturbances were distinquished: 1) moderately expressed loss of the self-conscious with disorders in the differentiation of the "I" from the associates; 2) a deeper disorder of the "I" with a substitution of the personal "I", by another "I"; 3) phenomena of estrangement of the self-conscious with a state similar to the splitting of the self-conscious, up to the appearance of the phenomena of a twin; 4) a change of the self-conscious expressed in a pathological play transformation and a substitution of the "I" by another "I", or a splitting of the self-conscious into the syndrome of play transformation near to a delusional; 5) derealization; 6) loss of the conscious of personal sex; 7) estrangement of the conscious of personal actions; 8) disturbance of self-conscious of a physical whole; 9) disturbance of the self-conscious in a deep depression with a loss of "I-vitality" appearance near to "anaesthesia psychica dolorosa" and "nihilistic delusions"; 10) loss of "I" conscious and regress of speech, motor activity, behaviour; 11) retardation in the formation of "I" conscious.

Clinical follow-up covered 40 patients with paroxysmal progressive schizophrenia with a history of 52 affective, anxiety-affective and affective-hallucinatory attacks at the age of 0-10 years and of 70 hallucinatory-delusional attacks at the age of 11-17 years and older. Over one-third of the examined patients were under the authors' personal observation in early childhood. The follow-up lasted for 5 to 22 years. The authors have established a definite stereotype of the development of anxiety-affective, affective-hallucinatory and hallucinatory-delusional attacks. Remissions in this group of patients are characterized by atypical affective disturbances and changes of the personality. The authors have specified clinical characteristics of so-called "premanifest" episodes, attacks, and "premorbid" pseudopsychopathic conditions with manifestations of retardation of personality development and atypical affective disorders.