We are pleased to publish, soon after its delivery, the 1998 Emanuel Miller lecture by Michael Rutter on the subject of autism, a masterly review of the history of clinical practice in this condition and the way in which it has both informed and been informed by research. It is now 55 years since Kanner's seminal paper, and that is over half a century of controversy which shows no signs of abating in intensity, although perhaps the focus is changing. Nowhere is this more clearly evident than in the field of clinical practice. As Rutter's review article brings out, empirical research findings have been crucial in bringing about such change. Nevertheless, he emphasises that the traffic has been far from one-way. Many research advances were prompted by astute clinical observations and some extravagant research claims were given a more balanced perspective by being viewed in the light of clinical experience. Progress takes place through a series of fits and starts, and the two-way interplay between research and clinical practice is essential to ensure that the gains are real, rather than misleading. We are still a very long way from having an effective means of preventing or treating autism but the lessons of the past provide a useful guide on how best to move ahead in the future.

Historically there has long been an interest in establishing whether children's reading levels have declined or improved in comparison with previous years. This would seem to be a valid research question and a potentially useful area of investigation. However, in reality it is a minefield. There are several reasons for the explosive nature of this topic.

First, reading holds a central position in children's education. Producing young people who are literate is the sine qua non of an adequate education system—the necessary if not sufficient demonstration that schools are doing their job. Thus, the measure of reading standards is seen as a proxy measure for educational standards more generally.

Second, the rise and fall of reading standards provides a focus for fierce debates about teaching methods, which typically crystallise around traditional versus progressive methods. Currently, the traditionalists champion methods of teaching reading that involve explicit phonics tuition. The progressive movement, sometimes referred to as “the real books approach”, emphasises the importance of purposeful reading for meaning and enjoyment. In practice it is established that eclecticism rules.

Third, there are differences of opinion concerning the most appropriate ways to assess reading levels. In order to plot reading standards over time, both valid and reliable methods of assessment are required. Preferably, too, the same test should be repeated, although parallel versions of valid tests can also be used. In practice this has frequently meant that tests involve either decontextualised word reading or sentence completion. There is agreement that such forms of assessment do not measure all the aspects of reading or literacy. There are those who argue that assessment that fails to take into account a wider range of higher-order skills, such as skimming, scanning, interpretation, and comprehension monitoring, and that uses only a narrow range of decontextualised text, will tell us little that is valuable about the level of children's reading. From this position it is difficult to measure reading standards validly over time. It is also argued that assessment should measure the areas of literacy covered by the curriculum and that as this changes, tests must also change, making comparability over time problematic.

Despite these debates, children's reading levels have been measured over time and even across countries. The question is how valid such exercises are and what conclusions we can draw from the results.

The assessment and treatment of deaf children with psychiatric disorder is intimately related to the individual child's communication, which in turn is affected by a number of factors, medical, social, and cultural. The deafness can be aetiologically related to the psychiatric disorder or can be incidental. Treatment strategies should be adapted to meet the individual child and family's needs. Deaf professionals have a vital role in mental health services for this population. The use of an interpreter can clarify communication and cultural issues for deaf and hearing children, families, and professionals.

The two-way interplay between research and clinical practice in relation to autism is reviewed with respect to: (1) diagnosis and syndrome delineation; (2) the nature of the disorder; (3) intervention studies; and (4) aetiology, as manifest during four time periods; (a) the 1950s and 1960s; (b) the 1970s into the mid 1980s; (c) the late 1980s and early 1990s; and (d) the late 1990s. It is concluded that clinical practice has changed out of all recognition during the last 50 years and that research findings have been crucial in bringing about that change. It has not, however, been a one-way traffic. Many key advances were prompted by astute clinical observations and some extravagant research claims were given a more balanced perspective through the light of clinical experience. Crucial research and clinical tasks remain but the means to meet them are there if the opportunities are taken and attention is paid to the lessons of the past.

Tasks of fluency tap the ability to generate multiple responses spontaneously following a single cue or instruction. The present study compared the fluency performance of subjects with autism and clinical control subjects at two different levels of ability (high-functioning subjects with a verbal IQ of 76 or greater, and globally learning disabled subjects with a verbal IQ of 74 or below). A battery of tasks was employed to assess subjects' word fluency (for letters and semantic categories), ideational fluency (for uses of objects and interpretations of meaningless line drawings), and design fluency (for abstract meaningless designs). Subjects with autism showed reduced fluency for both the word and ideational fluency tasks, generating significantly fewer responses than the clinical control subjects. Results were particularly striking for the ideational fluency tasks. On these tasks, autistic subjects produced very low response totals, with the performance of the high-functioning subjects with autism equivalent to that of the learning disabled subjects with autism and significantly inferior to that of the learning disabled control individuals. In contrast, the results of the design fluency paradigm paint a different picture. This paradigm revealed no significant difference in the quantity of designs generated by the subjects with autism and the control subjects but a clear qualitative difference, with the autistic group producing significantly higher rates of disallowed and perseverative responses. Whilst the results of the word and ideational fluency tasks are suggested to support the hypothesis that individuals with autism are impaired in the generation of novel responses and behaviour, the results of the design fluency task are equally consistent with an impairment in the regulation of behaviour through inhibition and/or monitoring. The implications of these findings for the study of executive function abilities in autism are discussed.

Two tasks were used to assess the processing of whole versus parts of objects in a group of high-functioning children and adolescents with autism (N=11) and a comparison group of typically developing peers (N=11) matched for chronological age and IQ. In the first task, only the children with autism showed a global advantage, and the two groups showed similar interference between levels. In the second task, the children with autism, despite longer RTs, showed similar performance to the comparison group with regard to the effect of goodness on visual parsing. Contrary to expectations based on the central coherence and hierarchisation deficit theories, these findings indicate intact holistic processing among persons with autism. The implications of these findings are discussed in relation to apparently discrepant evidence from other studies.

Thirty-seven pupils attending a special school for children and adolescents with autism were observed for the presence of motor and vocal tics. Subsequent family interviews confirmed the diagnosis of comorbid Gilles de la Tourette's Syndrome (GTS) in three children with autism, giving a minimum prevalence rate of 8.1%. Family history data also suggested this was heritable. The presence of GTS was not associated with superior intellectual, language, or social development. Results suggest that the rate of GTS in autism may exceed that expected by chance. The limited sample size constrains this conclusion. A large-scale epidemiological study testing this association study would appear merited.

This study investigated the reliability and stability of an autism diagnosis in children under 3 years of age who received independent diagnostic evaluations from two clinicians during two consecutive yearly evaluations. Strong evidence for the reliability and stability of the diagnosis was obtained. Diagnostic agreement between clinicians was higher for the broader discrimination of autism spectrum vs. no autism spectrum than for the more specific discrimination of autism vs. PDD-NOS. The diagnosis of autism at age 2 was more stable than the diagnosis of PDD-NOS at the same age. Social deficits and delays in spoken language were the most prominent DSM-IV characteristics evidenced by very young children with autism.

In a study of a total high-school population, 2300 students aged 16–17 years were screened for depression (BDI, CES-DC). Those with a self-evaluation indicating depression, together with controls matched for sex, age, and class were interviewed (DICA-R-A). The 177 pairs, where both individuals were interviewed and the control had no lifetime diagnosis of depression, were analysed in the form of paired differences for psychosocial factors and compared within diagnostic groups. The psychosocial factors were measured with the ISSI subscales and six attitude questions about family climate (KSP). Adolescents with an episode of major depression during part of the last year did not differ from their controls. Those with long-lasting depressive symptoms, i.e. dysthymia with or without episodes of major depression, had a more limited social interaction and were not satisfied with it. They also evaluated their family climate and attachment network as being more inadequate than did their controls. Depressed adolescents with comorbid conduct disorder had a more negative evaluation of availability and adequacy of both social interaction and attachment network than their controls. This group had a very negative view of their family climate. Since this is a case-control study conclusions cannot be drawn about cause and effect.

Investigated stability and change in intrusive and withdrawn interaction behaviours of 23 mothers in Study 1 and 31 mothers in Study 2. Comparisons between mother–infant and mother–boyfriend interactions revealed that mothers who had been withdrawn with their infants were quiet, bored-looking, physically distant, and underinvolved with their boyfriends. Mothers who had been intrusive with their infants were verbally sharp and controlling with their boyfriends. These findings suggested stability across social contexts. Comparing maternal responding to instructions to think about themselves (self-focus) or their infants (infant-focus) revealed that infant-focusing attenuated intrusive behavior among intrusive mothers and self-focusing attenuated negative affect among withdrawn mothers. These findings suggested that cognitive focusing ameliorates nonoptimal maternal behaviours and has differential effects on intrusive and withdrawn mothers.

Sleeping problems in young children are very common, affecting up to 20% of 1-year-olds. Behaviour therapy is the most widely recognised treatment but a significant proportion of parents find it aversive. This suggests that parental cognitions may be important and underevaluated. The aims of this study were therefore fourfold: (1) to describe the development of a new tool to measure maternal cognitions in relation to infant sleeping problems, the Maternal Cognitions about Infant Sleep Questionnaire (MCISQ); (2) to assess the psychometric properties of the MCISQ; (3) to test the hypothesis that maternal cognitions will be associated with, and specific to, infant sleep problems; and (4) to discuss the implications of the findings with respect to aetiological models of infant sleep problems, treatment, and future research. Results showed that maternal cognitions about setting limits, anger at the infant's demands, and doubts about parenting competence were significantly associated with infant sleep problems, whereas cognitions about infant hunger or cot death were not. It is hypothesised that these cognitive responses, if extreme, may disrupt sensitive parent–child interactions, which over time could lead to impairments in the development of infant self-regulation.

Abnormal psychosocial factors, assessed both clinically and by raters blind to clinical presentation, were examined in 21 hyperkinetic and 26 conduct disordered children. Blind raters found the frequency of psychosocial adversities to be similar in the two disorders. By contrast the clinical rater, who did know the diagnosis of patients, rated adverse psychosocial situations as much lower in hyperkinetic children than in children with conduct disorder. Logistic regression showed, particularly in the category of abnormal intrafamilial relationships (Lack of warmth in parent child relationship, Hostility or scapegoating of the child, Intrafamilial discord among adults), effects of the interaction between rater and knowledge of diagnosis. Clinical raters should be aware of abnormal psychosocial situations in hyperkinetic children and assess possible adverse effects on parents and children. Researchers should be aware of a possible bias in research interviews.

Based on parent and teacher ratings of primary school children on a scale comprising the 18 DSM-IV AD/HD symptoms, this study used confirmatory factor analysis to compare three models: all items in one factor; inattention in one and hyperactivity and impulsivity items in a separate factor; and inattention, hyperactivity, and impulsivity items in three separate factors. It also examined the prevalence rates of the three AD/HD Types, and gender and age differences. Results supported both the two- and three-factor models, with the three-factor model only slightly better than the two-factor model. Based on parent-teacher agreement, the prevalence rates were 1.6, 0.2 and 0.6 % for the Inattentive, Hyperactive- Impulsive, and Combined Types, respectively. Overall, the male to female ratio was 5[ratio ]1, and boys were rated higher than girls by both parents and teachers. Age differences were minimal. The implications of the findings in relation to some of the assumptions made in DSM-IV for AD/HD are discussed.

Boys with Attention Deficit Hyperactivity Disorder (ADHD, N=50), Specific Learning Disorder (LD, N=45), combined Specific Learning Disorder and ADHD (LD/ADHD, N=25), and controls (N=51) completed effortful and automatic information processing tasks based on Treisman and Gelade's (1980) “information integration theory”. ADHD and LD/ADHD subjects did not differ from controls at baseline or under feedback and reward conditions, suggesting that they were investing similar levels of mental effort in the tasks. The LD group had a superior performance in the effortful task and an inferior performance in the automatic task compared with the other groups at baseline. The data suggest a potential method of distinguishing primary LD from learning difficulties that occur secondary to ADHD.

The main aim of this study was to determine whether child mental health professionals who regularly use questionnaires to screen for mental disorders know that these questionnaires have a low predictive value when the base rate of a disorder is low. The study was based on a representative sample of professionals who used questionnaires regularly to screen for mental disorders. They were set a problem in which a clinic sample was screened with a questionnaire that, at a certain cut-point, had 80% sensitivity and 80% specificity, and in which the true base rate of disorder was 10%. Only 10% (5/48) of respondents answered correctly that just 30% of individuals who scored above this cut-point would actually have the disorder and more than half of respondents believed that 80% would have the disorder. Both users and designers of questionnaires need to be more aware of and explicit about their drawbacks as screens for mental disorders.

The goal of this study was to evaluate the effect of methylphenidate (MPH) and clonidine in comparison with placebo on response inhibition and state regulation in children with Attention Deficit Hyperactivity Disorder (ADHD). The study utilised a double-blind cross-over design in which children were randomly assigned without replacement to placebo, MPH, and clonidine following baseline assessment. The primary dependent measures were derived from children's performance (reaction time and errors) on a GO–NO GO task under three conditions that altered the inter-stimulus interval (ISI) for presented GO–NO GO stimuli: ISI of 1 sec (fast condition), 4 sec (medium condition), and 8 sec (slow condition). Findings indicated no difference in task performance between groups treated for 7 weeks with placebo, MPH, and clonidine. We concluded that the state regulation problem in ADHD is resistant to MPH and clonidine.

This study examined psychological development in 138 children at the age of 6–7 and 10–11 years, who had suffered prenatal radiation exposure at the time of the Chernobyl accident in 1986. These children were compared to a control group of 122 children of the same age from noncontaminated areas of Belarus. The examination included neurological and psychiatric examination, intellectual assessment, and clinical psychological investigation of parents as well as the estimation of thyroid exposure in utero. The exposed group manifested a relative increase in psychological impairment compared with the control group, with increased prevalence in cases of specific developmental speech-language disorders (18·1% vs. 8·2% at 6–7 years; 10·1% vs. 3.3% at 10–11 years) and emotional disorders (20.3% vs. 7.4% at 6–7 years; 18.1 vs. 7.4% at 10–11 years). The mean IQ of the exposed group was lower than that of the control group, and there were more cases of borderline IQ (IQ=70–79) (15.9% vs. 5.7% at 6–7 years; and 10.1% vs. 3.3% at 10–11 years). The mean value of thyroid doses from 131I 0.4 Gy was estimated for children exposed in utero. No correlation was found between individual thyroid doses and IQ at age 6–7 years or 10–11 years. We notice a positive moderate correlation between IQ of children and the educational level of their parents. There was a moderate correlation between high personal anxiety in parents and emotional disorders in children. We conclude that a significant role in the genesis of borderline intellectual functioning, specific developmental disorders of speech, language and scholastic skills, as well as emotional disorders in the exposed group of children was played by unfavourable social-psychological and social-cultural factors such as a low educational level of parents, the break of microsocial contacts, and adaptational difficulties, which appear following the evacuation and relocation from the contaminated areas.