Chedoke Hospital

The Canadian Association of Occupational Therapists, in collaboration with Health and Welfare Canada have developed and published a conceptual model for occupational therapy, the Occupational Performance model. This paper describes the development of an outcome measure, The Canadian Occupational Performance Measure (COPM), which is designed to be used with these guidelines for client-centred clinical practice. The COPM is an outcome measure designed for use by occupational therapists to assess client outcomes in the areas of self-care, productivity and leisure. Using a semi-structured interview, the COPM is a five step process which measures individual, client-identified problem areas in daily function. Two scores, for performance and satisfaction with performance are obtained. This paper describes the rationale and development of the COPM as well as information about its use for therapists.

Absence of a common diagnostic interview has hampered cross-national syntheses of epidemiological evidence on major depressive episodes (MDE). Community epidemiological surveys using the World Health Organization Composite International Diagnostic Interview administered face-to-face were carried out in 10 countries in North America (Canada and the US), Latin America (Brazil, Chile, and Mexico), Europe (Czech Republic, Germany, the Netherlands, and Turkey), and Asia (Japan). The total sample size was more than 37,000. Lifetime prevalence estimates of hierarchy-free DSM-III-R/DSM-IV MDE varied widely, from 3% in Japan to 16.9% in the US, with the majority in the range of 8% to 12%. The 12-month/lifetime prevalence ratio was in the range 40% to 55%, the 30-day/12-month prevalence ratio in the range 45% to 65%, and median age of onset in the range 20 to 25 in most countries. Consistent socio-demographic correlates included being female and unmarried. Respondents in recent cohorts reported higher lifetime prevalence, but lower persistence than those in earlier cohorts. Major depressive episodes were found to be strongly co-morbid with, and temporally secondary to, anxiety disorders in all countries, with primary panic and generalized anxiety disorders the most powerful predictors of the first onset of secondary MDE. Major depressive episodes are a commonly occurring disorder that usually has a chronic-intermittent course. Effectiveness trials are needed to evaluate the impact of early detection and treatment on the course of MDE as well as to evaluate whether timely treatment of primary anxiety disorders would reduce the subsequent onset, persistence, and severity of secondary MDE.

SUMMARY This paper reports the results of a study to validate a measure of gross motor function in detecting change in the motor function of disabled children. Physiotherapists used this instrument to assess 111 patients with cerebral palsy, 25 with head injury and 34 non‐disabled preschool children on two occasions, the second after an interval of four to six months. Parents and therapists independently rated the children's function within two weeks of each assessment, and a sample of paired assessments was videotaped for ‘blind’ evaluation by therapists. Correlations between scores for change on this measure and the judgments of change by parents, therapists and ‘blind’ evaluators supported the hypothesis that the instrument would be responsive to both negative and positive changes. RÉSUMÉ Appréciation de la fonction motrice globale: validation de la fidélité d'un instrument de mesure L'article rapporte les résultats d'une étude de validation de mesure de la fonction motrice globale, en relevant les modifications de la fonction motrice chez des enfants infirmes. Des kinésithérapeutes ont utilisé cet instrument pour évaluer 111 I.M.C., 25 séquelles de traumatisme cranien, et 34 enfants non‐infirmes d'âge préscolaire, cela à deux occasions, la seconde distante de quatre à six mois de la première. Parents et rééducateurs apprécièrent indépendamment l'activité des enfants dans les deux semaines suivant chaque évaluation, et un échantillon d'évaluations appariées fut enregistré en vidéo pour étude ‘en aveugle’ par les rééducateurs. Les corrélations obervées entre les notes de changement à cette mesure, les appréciations de changement par les parents et les rééducateurs, les évaluations en aveugle, favorisent l'hypothèse de la sensibilité de l'instrument de mesure aux modifications négatives et positives. ZUSAMMENFASSUNG Bewertung der grobmotorischen Funktion: Validisierung einer Methode Diese Arbeit berichtet über die Ergibnisse einer Untersuchung, die das Ziel hatte, einen Bewertungsmaßstab der grobmotorischen Funktion zu validisieren, um Veränderungen der Motorfunktion bei behinderten Kindern. Physiotherapeuten benutzten diese Methode, um 111 Patienten mit Cerebralparese, 25 mit Kopfverletzungen und 34 nicht behinderte Vorschulkinder an zwei Terminen, der zweite fand nach einem Interval von vier bis sechs Wochen statt, zu untersuchen. Eltern und Therapeuten beurteilten die Funktion der Kinder unabhängig innerhalb von zwei Wochen nach jeder Untersuchung. Aus beiden Untersuchungen wurden Beispiele für eine ‘blinde’ Beurteilung durch Therapeuten auf Video aufgenommen. Korrelationen zwischen den Scores für Veränderungen nach dieser Bewertungsmethode und die Beurteilung der Veränderungen durch die Eltern, Therapeuten und ‘blinden’ Gutachter stützen die Hypothese, daß die Methode sowohl negative als auch positive Veränderungen erfassen würde. RESUMEN Medición de la función motora grosera: validación de la capacidad de respuesta de un instrumento evaluativo Esta publicación aporta los resultados de un estudio para validar la medición de la función motora grosera para detectar cambios en niños inválidos. Los fisioterapeutas usan ron este instrumento para evaluar 111 pacientes con parálisis cerebral, 25 con trauma craneal y 34 niños preescolares no inválidos, en dos ocasiones, la segunda tras un intervalo de cuatro a seis meses. Los padres y los terapeutas independientemente valoraron las funciones de los niños en un período de dos semanas después de cada evaluación. Una muestra de cada pareja de evaluación se grabó en video para ser evaluada de forma ‘ciego’ por los terapeutas. Las correlaciones entre los puntajes en los cambios notados en la medición y el juicio dado por los padres, los terapeutas y evaluadores ‘ciegos’, apoyaban la hipótesis de que el instrumento podia responder adecuadamente a cambios positivos o negativos.

We studied the six-month prevalence of four child psychiatric disorders (conduct disorder, hyperactivity, emotional disorder, and somatization) and patterns of service utilization for mental health and social services, ambulatory medical care and special education by different regions of Ontario, urban-rural residence, and age and sex groupings. Among children 4 to 16 years of age, the overall six-month prevalence rate of one or more of these disorders was 18.1%. The prevalences of hyperactivity and one or more disorders were significantly higher in urban areas than rural areas. The utilization data indicated that children with these psychiatric disorders, compared with children without these disorders, were almost four times more likely to have received mental health or social services in the six months preceding this study. However, five of six of these children had not received these specialized services in the previous six-month period. Over 50% of the children in the province had received ambulatory medical care in the last six months. Over 15% of the children in the province had received special education services at some time thus far in their school careers. Implications of these findings, especially for the provision of child mental health services, are discussed.

The reliability and validity of the 12-item General Functioning (GF) subscale of the McMaster Family Assessment Device (FAD) is reported here. Psychometric properties of the FAD have been previously determined, but no independent assessment has been made of the GF subscale, which was used to measure family functioning in the Ontario Child Health Study (OCHS). Reliability was measured by Chronbach's alpha and split-half correlation. Validity was assessed by hypothesizing the relationships expected between the GF scores and other family variables included in the OCHS data set. The results indicate good reliability, and all hypotheses of validity were supported. The brevity and ease of administering the GF subscale recommend it for further use in survey research in which a global assessment of family functioning is required.

Journal Article LEFT HEMISPHERE SPECIALIZATION FOR LANGUAGE IN THE NEWBORN: NEUROANATOMICAL EVIDENCE OF ASYMMETRY Get access SANDRA F. WITELSON, SANDRA F. WITELSON Departments of Psychiatry and Anatomy, McMaster University Medical CentreHamilton, Ontario Search for other works by this author on: Oxford Academic PubMed Google Scholar WAZIR PALLIE WAZIR PALLIE Chedoke-McMaster Child and Family CentreHamilton, Ontario Search for other works by this author on: Oxford Academic PubMed Google Scholar Brain, Volume 96, Issue 3, September 1973, Pages 641–646, https://doi.org/10.1093/brain/96.3.641 Published: 01 September 1973 Article history Received: 07 March 1973 Published: 01 September 1973

We performed a randomized double-blind trial comparing continuous intravenous heparin with intermittent subcutaneous heparin in the initial treatment of 115 patients with acute proximal deep-vein thrombosis. Intermittent subcutaneous heparin as administered in this trial was inferior to continuous intravenous heparin in preventing recurrent venous thromboembolism. The subcutaneous heparin regimen induced an initial anticoagulant response below the target therapeutic range in the majority of patients and resulted in a high frequency of recurrent venous thromboembolism (11 of 57 patients, 19.3 percent), which was virtually confined to patients with a subtherapeutic anticoagulant response. In contrast, continuous intravenous heparin induced a therapeutic anticoagulant response in the majority of patients and a low frequency of recurrent events (3 of 58 patients, 5.2 percent; P = 0.024); the recurrences were limited to patients with an initial subtherapeutic anticoagulant response. The results of this trial establish the efficacy of intravenous heparin in the treatment of proximal venous thrombosis and suggest a relation between the effectiveness of heparin and the levels of anticoagulation achieved; such a relation could explain the observed failure of the subcutaneous regimen.

Acute deep-vein thrombosis is usually treated with intravenous heparin for a number of days, then with oral anticoagulants for weeks to months. We have compared adjusted-dose warfarin sodium with fixed low-dose subcutaneous heparin in the prevention of recurrent deep-vein thrombosis. Sixty-eight patients with acute deep-vein thrombosis confirmed by venography were treated with intravenous heparin and then randomized to secondary prophylaxis. Nine of 35 patients receiving subcutaneous heparin, but none of 33 receiving warfarin sodium, had new episodes of objectively documented venous thromboembolism (P = 0.001). Seven patients on warfarin sodium experienced bleeding complications (of which four were major), as compared with no patients receiving subcutaneous heparin (P less than 0.005). Thus, adjusted-dose warfarin sodium is more effective than low-dose subcutaneous heparin in preventing recurrent venous thromboembolism, but its use is accompanied by a significant risk of bleeding.

Chronic childhood illness, disability, and psychosocial problems are receiving major attention in current pediatric care. Much of the evidence associating chronic physical problems and mental health and adjustment problems has come from clinic-based studies and is often inconsistent in its conclusions. This paper reports the findings of the Ontario Child Health Study, an epidemiologic survey of 3,294 children 4 to 16 years of age in the general community, concerning the relationship of psychiatric disorders and social adjustment problems among children with chronic illness, medical conditions, and long-term disability in contrast to children free of chronic physical health problems. Age- and sex-adjusted risks for psychiatric disorders and social problems, compared with those for healthy peers, were calculated: children with both chronic illness and associated disability were at greater than threefold risk for psychiatric disorders and considerable risk for social adjustment problems. Children with chronic medical conditions, but no disability, were at considerably less risk: about a twofold increase in psychiatric disorders but little increased risk for social adjustment problems was observed. A relative underuse of specialized mental health services by children who might benefit supports the opinion that all physicians in the community who care for children with chronic health problems should become skilled in the recognition of existing or incipient mental health and social problems and familiar with preventive and treatment approaches that may lessen the excessive burden of psychosocial problems among those with chronic ill-health.

The objective of this paper is to present data from the Ontario Child Health Study on the prevalence of attention deficit disorder with hyperactivity (ADDH). The overall prevalence of ADDH was 9.0% in boys and 3.3% in girls. There were no significant differences in the prevalence of ADDH by age or urban-rural status, but the disorder was significantly more common in boys than in girls. The prevalence of various subtypes of ADDH was also explored: attention deficit with and without hyperactivity, situational vs pervasive ADDH, and ADDH with and without other disorders. The clinical implications of these findings are discussed.

Groups of aphasic patients and their spouses generated a series of communication situations that they felt were important in their day-to-day life. Using criteria to ensure that the situations were generalizable across people, times, and places, we reduced the number of situations to 36 and constructed an index that allowed the significant others of 11 recovering and 11 stable aphasic individuals to rate their partners' performance in the situations on two occasions 6 weeks apart. These data were then used to evaluate the psychometric properties of the Communicative Effectiveness Index (CETI) as a measure of change in functional communication ability. Further application of a generalization criterion reduced the final index to 16 situations. Results showed the CETI to be internally consistent and to have acceptable test-retest and interrater reliability. It was valid as a measure of functional communication according to the pattern of correlations found with other measures (Western Aphasia Battery, Speech Questionnaire, and global ratings). Finally, it was responsive to functionally important performance change between testings. Further research with the CETI and its usefulness for clinicians and researchers are discussed.

Specialization of the right hemisphere for spatial processing was studied in 200 normal boys and girls between 6 and 13 years of age. Boys performed in a manner consistent with right hemisphere specialization as early as the age of 6. Girls showed evidence of bilateral representation until the age of 13. The results suggest a sexual dimorphism in the neural organization underlying cognition during a major period of childhood. The results, which have implications for reading instruction, are discussed in terms of a possible sex difference in neural plasticity during development and the clinical consequences of such a difference.

It is common practice to begin anticoagulant treatment of deep-vein thrombosis with a 10-day course of intravenous heparin, with warfarin added on day 5 to 10 and continued for several months. We performed a randomized, double-blind trial comparing a shorter course of continuous intravenous heparin (5 days, with warfarin sodium begun on the first day) with the conventional 10-day course of heparin (with warfarin sodium begun on the fifth day) in the initial treatment of 199 patients with acute proximal venous thrombosis documented by venography. The frequency of objectively documented recurrent venous thromboembolism was low and essentially the same in the two groups (7.1 percent in the short-course group vs. 7.0 percent in the long-course group). Because the observed difference between the groups was 0.1 percent in favor of the long-course group, it is unlikely (P less than 0.05) that a true difference in favor of this group would be greater than 7.5 percent; the difference could be as much as 7.3 percent in favor of the short-course group. Major bleeding episodes were infrequent, and the rate was similar in both groups. We conclude that a five-day course of heparin is as effective as a 10-day course in treating deep venous thrombosis. Furthermore, using the shorter course would permit earlier discharge from the hospital and thus offer substantial cost savings.

BACKGROUND: Febrile, nonhemolytic transfusion reactions are the most frequent adverse reactions to platelets. A number of observations argue against the widely held view that these reactions result from the interaction between antileukocyte antibodies in the recipient and leukocytes in the platelet product. We sought to determine whether substances in the plasma or the cells in the product cause reactions to transfused platelets. METHODS: We separated standard platelet concentrates into their plasma and cellular components and then transfused both portions in random order. Patients were monitored for reactions during all transfusions. Before each transfusion, the concentration of cytokines (interleukin-1 beta and interleukin-6) was measured in the platelet products. Studies were also performed on the platelet products to determine the effect of storage on the concentration of cytokines. RESULTS: Sixty-four pairs of platelet-product components (the plasma supernatant and the cells) were administered to 12 patients. There were 20 reactions to the plasma supernatant and 6 reactions to the cells (chi-square = 6.50, P = 0.009). Eight transfusions were associated with reactions to both products. The plasma component was more likely to cause severe reactions than the cells (chi-square = 9.6, P < 0.01). A strong positive correlation was observed between the reactions and the concentration of interleukin-1 beta and interleukin-6 in the plasma supernatant (P < 0.001 and P = 0.034, respectively). In vitro studies demonstrated that interleukin-1 beta and interleukin-6 concentrations rise progressively in stored platelets and that these concentrations are related to the leukocyte count in the platelet product. CONCLUSIONS: Bioreactive substances in the plasma supernatant of the platelet product cause most febrile reactions associated with platelet transfusions. Removing the plasma supernatant before transfusion can minimize or prevent these reactions.

BACKGROUND: Deep-vein thrombosis is a potentially life-threatening complication of total hip or knee replacement. There are few data on the effectiveness and safety of warfarin as compared with low-molecular-weight heparin as prophylaxis against this problem. METHODS: We therefore performed a randomized, double-blind trial in 1436 patients to evaluate the effectiveness and safety of low-molecular-weight heparin (given subcutaneously once daily) as compared with adjusted-dose warfarin to prevent venous thrombosis after hip or knee replacement. Treatment with the drugs was started postoperatively. The primary end point was deep-vein thrombosis as detected by contrast venography (performed a mean of 9.4 days after surgery in each group). RESULTS: Among the 1207 patients with interpretable venograms, 231 of 617 patients (37.4 percent) in the warfarin group and 185 of 590 patients (31.4 percent) in the low-molecular-weight-heparin group had deep-vein thrombosis (P = 0.03). The reduction in risk with low-molecular-weight heparin as compared with warfarin was 16 percent, and the absolute difference in the incidence of venous thrombosis was 6 percent in favor of low-molecular-weight heparin (95 percent confidence interval, 0.8 to 11.4 percent). The incidence of major bleeding was 1.2 percent (9 of 721 patients) in the warfarin group and 2.8 percent (20 of 715 patients) in the low-molecular-weight-heparin group (P = 0.04), and the absolute difference was 1.5 percent in favor of warfarin (95 percent confidence interval, 0.1 to 3.0 percent). CONCLUSIONS: Our data demonstrate that the small reduction in the incidence of venous thrombosis with low-molecular-weight heparin, as compared with warfarin, was offset by an increase in bleeding complications. Although the use of low-molecular-weight heparin is simpler, because it is administered subcutaneously without the need for monitoring, it may be more costly than warfarin. Warfarin is inexpensive, but the overall cost of its use is increased by the need to monitor the intensity of anticoagulation. At this time it is unclear which of these approaches is the most cost effective.

Possible changes in muscle size and function due to resistance training were examined in prepubertal boys. Thirteen boys (9-11 yr) volunteered for each of the training and control groups. Progressive resistance training was performed three times weekly for 20 wk. Measurements consisted of the following: 1 repetition maximum (RM) bench press and leg press; maximal voluntary isometric and isokinetic elbow flexion and knee extension strength; evoked isometric contractile properties of the right elbow flexors and knee extensors; muscle cross-sectional area (CSA) by computerized tomography at the mid-right upper arm and thigh; and motor unit activation (MUA) by the interpolated twitch procedure. Training significantly increased 1 RM bench press (35%) and leg press (22%), isometric elbow flexion (37%) and knee extension strength (25% and 13% at 90 degrees and 120 degrees, respectively), isokinetic elbow flexion (26%) and knee extension (21%) strength, and evoked twitch torque of the elbow flexors (30%) and knee extensors (30%). There were no significant effects of training on the time-related contractile properties (time to peak torque, half-relaxation time), CSA, or %MUA of the elbow flexors or knee extensors. There was, however, a trend toward increased MUA for the elbow flexors and knee extensors in the trained group. Strength gains were independent of changes in muscle CSA, and the increases in twitch torque suggest possible adaptations in muscle excitation-contraction coupling. Improved motor skill coordination (especially during the early phase of training), a tendency toward increased MUA, and other undetermined neurological adaptations, including better coordination of the involved muscle groups, are likely the major determinants of the strength gains in this study.

Abstract Objective : To review the efficacy of conservative management of mechanical neck disorders. Methods : Published and unpublished reports were identified through computerised and manual searches of bibliographical databases, reference lists from primary articles, and letters to authors, agencies, foundations, and content experts. Selection criteria were applied to blinded articles, and selected articles were scored for methodological quality. Effect sizes were calculated from raw pain scores and combined by using meta-analytic techniques when appropriate. Results : Twenty four randomised clinical trials met the selection criteria and were categorised by type of intervention: nine used manual treatments; 12 physical medicine methods; four drug treatment; and three education of patients (four trials investigated more than one form of intervention). The intervention strategies were summarised separately. Pooling of studies was considered only within each category. Five of the nine trials that used manual treatment in combination with other treatments were combined. One to four weeks after treatment the pooled effect size was −0.6 (95% confidence interval −0.9 to −0.4), equivalent to an improvement of 16 (6.9 to 23.1) points on a 100 point scale. Sensitivity analyses on study quality, chronicity, and data imputation did not alter this estimate. For other interventions, studies could not be combined to arrive at pooled estimates of effect. Conclusions : There is little information available from clinical trials to support many of the treatments for mechanical neck pain. In general, conservative interventions have not been studied in enough detail to assess efficacy or effectiveness adequately. Key messages Many treatments are available and accepted as standard forms of practice Systematic literature searching finds a limited number of clinical trials There is early evidence to support the use of manual treatments in combination with other treatments for short term pain relief, but in general, conservative interventions have not been studied in enough detail to assess efficacy or effec- tiveness adequately Further clinical trials are needed to determine optimal treatment approaches

It is generally assumed that febrile nonhemolytic transfusion reactions are an immunologically mediated reaction involving the recipient's plasma and the white cells in the donor unit. This has led to the use of white cell reduction and pretransfusion medication, to try to minimize these reactions. To better understand febrile transfusion reactions, a prospective study was performed in which all patients receiving platelet and red cell transfusions in a tertiary-care medical center were interviewed before and after transfusion to obtain information about the typical presentation of the syndrome. It was found that transfusion reactions were much more frequently associated with platelet transfusion (30.8%) than with red cell transfusion (6.8%, p < 0.0005). The routine use of antipyretics prevented most episodes of fever but did not prevent the occurrence of other symptoms such as chills, cold, and discomfort. The application of logistic regression analysis revealed that the dominant factor determining the risk of a reaction was not white cell contamination, but the age of the component (p < 0.005). The significant relationship between reaction and the increasing age of the component suggests that cytokines released in the component during storage may be responsible for many reactions to blood components.

Although it is generally accepted that negative venography excludes deep vein thrombosis (DVT) in patients in whom it is clinically suspected, there is no evidence to support this conclusion. To test the correctness of withholding anticoagulant therapy in these patients, we followed 160 consecutive patients who had clinically suspected DVT and negative venograms to determine the frequency of postvenographic DVT. Anticoagulant therapy was withheld in all patients. No patient died or developed pulmonary embolism during 3 months of follow-up. Two of the 160 patients (1.3%) attended the clinic on an emergency basis during follow-up with new symptoms of DVT and in both patients, DVT was confirmed by objective testing. These events developed within 5 days of venography, which suggests that they were induced by venography. Nevertheless, the findings indicate it is safe to withhold treatment in patients with clinically suspected DVT and negative venograms.

SUMMARY The authors compared children with Asperger syndrome (AS) with high‐functioning autistic children and psychiatric outpatient controls on measures of early history and outcome. In terms of their early history, the autistic probands showed more social impairment, a higher frequency of echolalia and pronoun reversal, and a more restricted range of activities than the AS group. Cluster analysis suggested refinements to the diagnostic criteria, which resulted in larger differences between the groups on these early history measures. In terms of their outcome, the autistic probands spent more time in special education classes but developed fewer accessory psychiatric symptoms than the AS children. It was clear, however, that there were no substantive, qualitative differences between the AS and autistic groups, indicating that AS should be considered a mild form of high‐functioning autism. The inclusion of AS among the autistic spectrum of disorders has implications both for aetiological studies and for prevalence estimates of the pervasive developmental disorders. RÉSUMÉ Syndrome d'Asperger et autisme: comparaison sur l'histoire précoce et le devenir Les auteurs comparent des enfants présentant un syndrome d'Asperger (AS) avec des enfants à autisme avec riche symptomatologie et des contrôles consultants externes en psychiatrie, sur les caractéristiques de I'histoire précoce et le devenir. En terme d'histoire précoce, les sujets autistiques présentaient plus de troubles de la relation sociale, une plus grande fréquence d'écholalie et de reversion des pronoms, et une étendue d'activités plus réduites que le groupe AS. L'analyse de groupe suggerait des précisions dans les critères diagnostiques se traduisant par des plus grandes differences entre les groupes sur ces caractéristiques d'histoire précoce. En terme de devenir les sujets autistiques passaient plus de temps dans les classes d'éducation spécialie mais développaient moins de symptomes psychiatriques accessoires que les enfants AS. Il était cependant claire qu'il n'y avait pas de difference qualitative substentielle entre les groupes AS et autistiques indiquant que l'AS pourrait être considéréd comme une forme mineure de l'autisme à riche symptomatologie. L'inclusion de l'AS dans le spectre autistique des troubles a des implications à la fois pour des études étiologiques et pour les estimations de prévalence des troubles développementaux envahissants. ZUSAMMENFASSUNG Asperger Syndrom und Autismus: Vergleich von Frühanamnese und Outcome Die Autoren vergleichen Kinder mit Asperger Syndrom (AS) mit hochbegabten autistischen Kindern und psychiatrischen ambulanten Kontrollpatienten hinsichtlich Frühanamnese und Outcome. In ihrer Frühanamnese hatten die autistischen Kinder stärkere Störungen im sozialen Bereich, ein häufigeres Auftreten von Echolalie und Pronomenumkehrung und einen eingeschränkteren Aktivatätsradius als die AS Gruppe. Die Gruppenanalyse empfahl eine Verfeinerung der diagnostischen Kriterien, die bei diesen frühananamnestischen Parametern zu gößeren Unterschieden zwischen den Gruppen führte. Hinsichtlich ihres Outcome waren die autistischen Kinder längere Zeit in Sonderklassen, aber sie entwickelten weniger psychiatrische Begleitsymptome als die AS Kinder. Es war jedoch klar, daß es erhebliche qualitative Unterschiede zwischen den AS Kindern und den autistischen Kindern gab, so daß das AS als milde Form des Autismus mit hoher Begabung angesehen werden sollte. Die Einbeziehung des AS in das Spektrum der autistischen Erkrankungen ist sowohl für die äthiologischen Untersuchungen als auch für die Prävalenzbestimmungen der pervasiven Entwicklungserkrankungen von Bedeutung. RESUMEN Síndrome de Asperger y autismo: comparaciones en la historia precoz y la evolución Los autores compararon niños con el síndrome de Asperger (AS), con niños autísticos de alto funcionamiento y controles psiquiátricos de dispensario por lo que hace a la historia precoz y el curso evolutivo. En término de su historia precoz los autísticos probandos mostraron una alteración social mayor, una mayor frecuencia de ecolalia y de reversión pronominal y un margen de actividades más restringido que el grupo AS. Un análisis más proximo sugirió unos refinamientos en los criterios diagnósticos, lo cual dio lugar a mayores diferencias en los dos grupos en sus historias precoces. En términos de su evolución, los autistas probandos pasaron más tiempo en clases de educatión especial, pero desarrollaron menos síntomas psiquiátricos accesorios que los niños AS. Sin embargo quedaba claro que no habia diferencias substantivas ni cualitativas entre los grupos AS y los autísticos, lo que indica que AS debe ser considerado como una forma moderada del autismo altamente funcionante. La inclusión del AS en el espectro de los autistas tiene implicaciones tanto para los estudios etiologicos, como por la prevalencia de estimación de las alteracions pervasivas del desarrollo.