В. Е. Kagan offers the following definition of autism (based on the consideration of communication as a function of the psyche): autism as a psychopathological syndrome is characterized by a lack of communication formed on the basis of primary structural disorders or irregular development of communication prerequisites and a secondary loss of the regulatory influence of communication on thinking and behavior. The prerequisites of communication are understood as:
- The possibility of adequate perception and interpretation of information
- sufficiency and adequacy of expressive means of communication
- mutual understanding with its regulative influence on thinking and behavior
- the possibility of adequate planning and flexible variation of behavior, choice of method and style of communication.
One of the most important issues within the problem of autism is the issue of differential diagnosis of autistic conditions of different origin. Its importance is emphasized by many domestic and foreign researchers and is determined by the need to develop therapeutic and psychological and pedagogical correctional strategies for each specific case. The importance of the differential diagnosis according to V.E. Kagan is determined by the fact that children with autistic manifestations are justifiably a group of the raised risk of development of schizophrenia. Thus, E. S. Ivanov focuses on early diagnosis, the task of which should be to differentiate RDA from autism syndromes in other diseases and states of mental underdevelopment. In his opinion, the differential diagnosis should be based on the knowledge of the nuclear manifestations of ASD as distorted mental development, on the knowledge of the stages of normal mental development of the child. Early diagnosis of RDA seems to be possible, since Kanner syndrome with an appropriately shaped symptom-complex manifests itself already in early childhood. Diagnosis must be done very carefully and carefully, and the symptomatology must not obscure the child’s personality from the investigator. If diagnosis is difficult, the child should be assigned to a risk group and remain under dynamic observation by a neuropsychologist and special psychologist. (E.S. Ivanov).
Among criteria of differential diagnosis in domestic researches, dynamic observation is of crucial importance. Questions of differential diagnostics of ASD are covered in detail in works by S. S. Mnukhin, D. N. Isaev and V. E. Kagan where autism is characterized as a kind of astheno-tonic form of residual-organic mental disorders and is described differentially in schizophrenia and other illnesses.
Autism as a holistic mode of mental existence, distinct from others, is also spoken of by the “high-functioning”, i.e. quite socialized, autistic individuals themselves, who describe their childhood, adolescence and adult years. (T. Grandin).
Compensated high-functioning autistic individuals, although having a different cognitive style and building relationships with the world around them differently, by talking about their experiences, about their inner states and feelings, are capable of a critical relationship to themselves, to the experience of their mental existence.
M. Rutter (1978), one of the most famous researchers on autism, summarizing and analyzing clinical experience, formulated the following criteria for pronounced forms of RDA, which are adhered to by many who deal with autism
- profound impairments in social development
- Delayed and irrelevant language development, regardless of intellectual level
- The desire for permanence, which manifests itself in stereotypes, an over-dependence on objects, and a resistance to environmental change
- The appearance of impairments before 30 months of age. This last point has recently been amended to allow for the appearance of the first symptoms up to 48 months of age.
Current international diagnostic systems ICD-10, DSM-1Y, while emphasizing the significance of underlying biological disorders, name psychodynamic and environmental causes, organic neurological and biological disorders, biochemical pathology and genetics as causes of autism as an independent disorder, define childhood autism (Kanner syndrome) as a developmental disorder that is clinically manifested as a disorder (deviation or delay) in attention development, reality testing and social, language and motor development and includes three main sets of diagnostic criteria for development and behavior:
- impairment in social interaction
- impaired communication skills and imagination
- Significant decrease in interests and activities