Kasus Autis 3:
Twenty-two-year-old Betsy was referred for evaluation by the staff of her group home. She had been placed in the group home some 3 months previously, following court-ordered “deinstitutionalization” from a large residential facility for the retarded. The evaluation was requested because Betsy “didn’t fit in” with other patients and had developed some problem behaviors, particularly aggression directed toward herself and, less commonly, toward others. Unlike other patients in the group home, she tended to “stay to herself” and had essentially no peer relations, although she did respond positively to some staff members. Her self-abusive and aggressive behaviors usually were triggered by changes made in her routine.
Self-abusive behavior consisted of repeated pounding of her legs and biting of her hand.
Betsy had been placed in residential treatment when she was age 4, and had remained in some kind of residential setting ever since. Her parents had both died, and she had no contact with her only sibling. At the time of her transfer to the group home, she was reported to have had several abnormal electroencephalograms, but no seizures or other medical problems had been noted. When last given psychological tests, she achieved a full-scale IQ of 55, with comparable deficits in adaptive behaviors.
During the evaluation, Betsy spends much of her time reading a children’s book she discovered in the waiting room. Her voice is flat and monotonic. She is unable to respond to any detections about the book she is reading and reacts to interruptions of her ongoing activity by pounding her legs with her fist. She rocks back and forth continually during the interview. She makes eye contact with the examiner initially, but otherwise seems oblivious of everyone around her. She neither initiates activities, imitates the play of the examiner, nor responds to attempts to interest her in alternative activities, such as playing with a doll. From time to time she repeats a single phrase in a monotonic voice, “Blum, blum.” Physical examination reveals extensive bruises covering most of her lower extremities.
Betsy was the product of a normal pregnancy, labor, and delivery. She was noted to have been an unusually easy baby. Her parents had first become concerned when she failed to speak by age 2. Motor milestones were delayed. Her parents initially thought that she might be deaf, but this was obviously not the case, as she responded with panic to the sound of a vacuum cleaner. As a young child, Betsy had been observed to “live in her own world,” had not formed attachments to her parents. Had idiosyncratic responses to some sounds, and always became extremely upset when there were changes in her environment.
By age 4, Betsy was still not speaking, and placement in the state institution was recommended following a diagnosis of Childhood Schizophrenia. In the year after her placement, Betsy began speaking. However, she did not typically use speech for communication; instead, she merely repeated phrases over and over. She had an unusual ability to memorize and became fascinated with reading, even though she appeared not to comprehend anything she read. She exhibited a variety of stereotyped behaviors, including body rocking and head banging, requiring a great deal of attention from the staff.
Permasalahan Betsy sebenarnya sudah lama, termasuk hambatan dalam interaksi sosial (tidak ada perhatian terhadap orang lain) dan hambatan dalam hubungan dengan teman sebaya. Walaupun sudah bisa bicara namun nadanya monoton dan senantiasa mengulang kata-kata. Dia menunjukkan perilaku stereotipik (rocking). Karena gejalanya sudah muncul sejak awal masa kanak maka ditegakkan diagnosis Gangguan Autis. Pada beberapa kasus Gangguan Autis, kadang-kadang dijumpai anak dengan IQ yang normal dan sangat jarang dengan IQ yang tinggi. Pada kasus ini dijumpai Retardasi Mental Ringan.
Saat masuk ke sekolah khusus, dia didiagnosis gangguan skizofrenia masa kanak. Diagnosis tersebut diasumsikan lanjutan dari gangguan masa kanak menjadi gangguan psikotik masa dewasa. Namun berdasarkan beberapa penelitian longitudinal didapati bahwa tidak adanya hubungan antara Gangguan Autis dengan gangguan psikotik masa dewasa. Hal ini dilihat dalam DSM-IV yang menyatakan bahwa gangguan masa kanak tidak dihubungkan dengan “skizofrenia.”