Kasus Autis 1:
A psychiatric evaluation is requested by the teachers of C.B., a 13-year-old boy. He is of average intelligence, according to the Wechsler Intelligence Scale for Children (WISC; 1974), with better verbal than performance skills. He does well on tasks requiring rote learning, but his teachers are deeply puzzled and concerned about his poor comprehension of abstract ideas and his social naiveté. They find him appealing, but sadly vulnerable to the hazards of everyday life.
His mother dates her son’s problems from age 6 months when his head was accidentally bruised. From that time on, he became socially aloof and isolated and spent most of his time gazing at his hands, which he moved in complicated patterns before his face. At age 1, he began to watch the passing traffic, but still ignored people. He continued to be remote, with poor eye contact, until age 5. He passed his motor milestones at the usual ages and, as soon as he was physically able, began to spend hours running in circles with an object in his hand, and screamed if attempts were made to stop him. He performed many stereotyped movements as a young child, including jumping, flapping his arms, and moving his hands in circles.
At age 3, C.B. was able to recognize letters of the alphabet, and he rapidly acquired skill in drawing; he drew the salt and pepper shakers correctly copying the names written on them, over and over again. For a time this was his sole activity. Following this, he became fascinated with pylons and tall buildings, and would stare at them from all angles and draw them. C.B. did not speak until age 4, and then for a long time used only single words. Later, he repeated phrases and reversed pronouns.
After age 5, C.B.’s speech and social contact markedly improved. Until age 11, he attended a special school, where the staff tolerated a range of bizarre, repetitive routines. At one point, for example, he insisted that, before lessons could begin, all his class and the teacher should wear watches he made from plasticine. Despite all his problem C.B. proved to have excellent rote memory, absorbed all he was taught and could reproduce facts verbatim when asked. He was transferred to a regular public school at age 11.
C.B. uses good grammar and has a large vocabulary, but his speech is naive and immature and concerned mainly with his own special interests. He has learned not to make embarrassing remarks about other people’s appearance, but tends to ask repetitive questions. He is not socially withdrawn, but prefers the company of adults to that of children his own age, finding it difficult to understand the unwritten rules of social interaction. He says of himself, “I am afraid I suffer from bad sportsmanship.” He enjoys simple jokes, but cannot understand more subtle humor. He is often teased by his classmates.
C.B.’s main interest is in map and road sign. He has a prodigious memory for routes and can draw them rapidly and accurately. He also makes large, complicated, abstract shapes out of any material that comes to hand and shows much ingenuity in ensuring that they hold together. He has never engaged in pretend play, but is deeply attached to a toy panda, to which he talks as if it were an adult when he needs comfort.
C.B.’s finger dexterity is good, but he is clumsy and ill-coordinated in large movements, and therefore is never chosen by the other children for sports and team games.
Permasalahan C.B. mulai muncul pada tahun-tahun pertama kehidupan (saat usia sekitar 6 bulan) dengan beberapa hendaya berat di bidang perkembangan (developmental delayed). Dia mengalami hambatan dalam interaksi sosial ditandai dengan tidak adanya perhatian terhadap adanya orang lain (hanya melihat tangan orang lain tersebut). Dia juga tidak menyukai permainan yang dilakukan bersama dengan orang lain. Hambatan perkembangan bahasa ditandai dengan tidak bisa berbicara sampai usia 4 tahun walaupun selanjutnya bisa mengucapkan satu kata saja yang diulang-ulang. Dia juga mempunyai gerakan stereotipik seperti melompat-lompat, flapping his arm, mengerak-gerakkan tangan membentuk lingkaran. Selain itu dia juga mempunyai aktivitas kompulsi terhadap rutinitas dan ritualitas (termasuk temannya harus memakai kacamata saat belajar). Tanda dan gejala di atas menunjukkan Gangguan Autis suatu bagian dari Pervasive Developmental Disorder.
Saat usia 5 tahun, terdapat perbaikan gejala. Tidak dijumpai lagi perilaku bizzare dan distorsi bahasa, walaupun pembicaraannya naive dan imatur. Dia masih mengalami kesulitan dalam memahami peraturan tidak tertulis dalam suatu interaksi sosial. Dengan demikian sindroma penuh Gangguan Autis tidak memenuhi lagi, sehingga diagnosisnya termasuk ke dalam kriteria remisi parsial.
Diagnosis bandingnya adalah Gangguan Asperger. Pada gangguan Asperger tidak didapati adanya hambatan di bidang bahasa, sedangkan pada kasus ini didapati hambatan berbahasa. Walaupun demikian beberapa klinisi berpendapat bahwa istilah gangguan Asperger dimaksudkan untuk menyatakan derajat yang lebih ringan dari Pervasive Developmental Disorder khususnya Gangguan Autis.