In normal development, the head will maintain a vertical position. A child with an autistic spectrum disorder will often fail to keep his head vertical, instead holding the head in line with the rest of the body.
The following information applies generally to adults who discover that previous misdiagnoses or no diagnosis with a "lifelong feeling of being different" has led them to the point of their seeking the proper label. For all adults, the diagnostic process, conducted by a competent, knowledgeable and sensitive professional or professional team, is a life-changing experience. Whether one discovers autism, non-verbal learning disability, attention deficit disorder (inattentive or combined type), or any combination of other developmental or mental health conditions that finally seem to fit, the following description of the process seems to make sense for most individuals.
Discussion of Infant-Toddler Social and Emotional Assessment (ITSEA), and Preschool Age Psychiatric Assessment (PAPA).
While the team may choose to administer a series of tests to the student, by law assessment must involve much more than standardized tests. It is also important that assessment be an ongoing process.
Thorough assessment depends on information gathered through a variety of methods and relies on the collaboration of many individuals including, professionals, family members, and educators.
The research included 91 children seen by developmental pediatrician James Coplan, M.D., between 1997 and 2002. The children had autistic spectrum disorders (ASD), which include classic autism, pervasive developmental disorder and Asperger's syndrome. Dr. Coplan looked at the relationship between the severity of the disorder, IQ measurement, and time. One of the main findings of the study is ASD children in the normal range of intelligence show significant improvement in their autistic symptoms over time. This means doctors can let parents know their child will improve, giving them hope for the future.
Friday, May 05, 2000 All Things Considered
On good practice in diagnosis with an implication for seeking increased provision to match the needs identified, and how to share a diagnosis with the individual concerned, and with siblings, peers, and significant others.
The guidelines suggest two levels of evaluation are needed to detect autism. First, a general developmental screening for any atypical development or risk factors for autism and second, a specific evaluation and diagnosis.
There is a widespread tendency to diagnose 'autism' liberally, even when the clinical picture is diverse. We must agree to such tendency in many clinical aspects.
The rise in autism cases is not evidence of an epidemic but reflects better diagnosis of autism by schools, according to a study released last week. The number of children classified by US special education programs as mentally retarded or learning disabled has declined in tandem with the rise in autism cases between 1994 and 2003, the study's author said, suggesting a switch of diagnoses.
Autism in children can be detected as early as age 14 months, a new study shows. Autism is rarely diagnosed before a child is 3 years old. Cutting that time in half means less precious time lost in getting autistic children the treatment they urgently need -- when it's likely to do the most good. The new finding comes from researchers including Rebecca Landa, PhD, director of the center for autism and related disorders at Kennedy Krieger Institute in Baltimore. Landa tested motor, language, and visual skills in the younger siblings of autistic children. Such children are 100 times more likely to be autistic than other children.
Autism is rarely diagnosed before a child is 3 years old. Cutting that time in half means less precious time lost in getting autistic children the treatment they urgently need -- when it's likely to do the most good. The new finding comes from researchers including Rebecca Landa, PhD, director of the center for autism and related disorders at Kennedy Krieger Institute in Baltimore. Landa tested motor, language, and visual skills in the younger siblings of autistic children. Such children are 100 times more likely to be autistic than other children.
Early detection and intervention significantly improve outcome, with about one third of autistic persons achieving some degree of independent living.
The term 'autism' covers a spectrum of developmental disorders that can be difficult to differentiate from other neurologic and psychiatric conditions. These experts describe the diagnostic process that works for them.
Although there are clinical criteria specific for autistic disorder, diagnosis is difficult due to the patient's age and possible underlying disorders.
The purpose of the guidelines is to assist those who authorize and provide health care to children with special needs in determining medical necessity for therapy services, including recommendations for frequency and intensity of therapy.
Most adults who are diagnosed with AS, no matter what process they have to work through in understanding and self-acceptance, find the diagnosis a meaningful revelation in their lives. Substantial enough in scope, is this diagnosis, that it can mean the difference between a life of self-recrimination, self-loathing, self-hatred, isolation, alienation, or an increased understanding of self that enables those diagnosed with AS to make much more sense out of their lives and experiences.
This paper reviews the complex challenges in the identification of school age children with ASD, including definitions of autism, referral and screening issues, diagnostic best practices and assessment procedures. Following this discussion, current practices in Illinois are reviewed and placed in a national context.
Five behavior abnormalities were observed be-tween birth and 1 year of age: poor social attention,lack of social smiling and appropriate facial expres-sions, hypotonia, and unstable attention.
The signs of autism may be evident in early infancy in at least some children, although such symptoms are probably too subtle to definitively diagnose the disease until later in life.
Using a structured approach to screening for behavioral problems is being recommended in this Webcast because a number of research studies have shown that usual care misses a substantial portion of behavioral problems.
Unless specifically trained in the area of DD's, physicians and psychologists may have little experience with ASD's. it's important to look for someone who shows respect for the parents and regards parents as experts on their children.
Mental health clinical assessment is the process of gaining a better understanding of an individual's concerns, needs, and strengths. A thorough clinical assessment helps the consumer and his family make more informed decisions.
Clinical observation is the process of learning about a person's mental health by watching him in his day-to-day routines at home, school, or work environments.
No single gene, environmental factor, combination of genes and/or environment, or other risk factors, can consistently cause autism. I doubt that we will find such a gene or agent but we will most certainly continue to identify new causes, potential treatments, comorbidities, categories, and labels cleaved from the idiopathic autism realm. There's a lot to sort out before we can say that one thing is caused by another so our only option for now is to ignore symptoms that may or may not be associated with being autistic, or continue to discuss these things as potential comorbid conditions. Humans will always sort, catalog, and label all we encounter. We need to exercise great caution when we approach categorizing humans by comorbidities.
This study compares DSM-IV symptoms in children (ages 6 to 12 years) with pervasive developmental disorder (PDD), clinic controls, and community-based samples. Parents/teachers completed the Child Symptom Inventory–4 for four samples: PDD (N= 284/284) and non-PDD psychiatric clinic referrals (N= 189/181) and pupils in regular (N= 385/404) and special (N= 61/60) education classes. The PDD group received higher symptom severity ratings than the regular education group, but was similar to the non-PDD clinic sample. Screening prevalence rates were highest for ADHD, ODD, and generalized anxiety disorder. PDD subtypes exhibited differentially higher rates of psychiatric symptoms. The magnitude of rater and gender differences in symptom severity ratings was modest. Clinic-referred children with PDD exhibit a pattern of psychiatric symptoms highly similar to nonPDD clinic referrals. Although much additional research is needed on comorbidity, these symptoms have important treatment implications.
Intended for those cases where a person has approached their GP for a referral to a doctor or medical team with a specialist knowledge of autistic spectrum disorders and has been refused.
Types of Evaluators; Types of Evaluations; Components of an Evaluation; Psychometrics
Parents may hear more than one label applied to the same child. These labels don't describe differences between children as much as they indicate differences between professionals' training, vocabulary and exposure to autism .
Learning your child has a disability can be a very traumatic experience in itself, but you may be experiencing many emotions and reactions that you feel are confusing and upsetting for you. These reactions, and feelings are completely normal.
A triaxial model for autistic spectrum disorder (ASD) is presented, incorporating age, degree of intelligence, and severity of autistic features. As the name implies, ASD can vary in degree of expression from minimal to profound. Furthermore, the symptoms of ASD change in predictable ways with the passage of time.
It is possible to remediate the pragmatics of children with autism at a relatively early age. These children are receptive to intervention techniques which have previously been used with older children within a school setting.
I will describe methods of evaluating and diagnosing developmental disorders, but the principles and techniques also apply to evaluating development during any comprehensive psychiatric assessment.
Developmental disorders are common, often complex in form and not infrequently accompanied by co-morbid psychiatric and behavioural disturbances. Assessment must be undertaken carefully and systematically by a multidisciplinary group of professionals.
This report provides a selective overview of an evolving field beginning with a brief history. The work of Michael Rutter, MD, FRS, F Med Sci, Professor of Psychiatry, Institute of Psychiatry in London and of Dante Cicchetti, MD, McKnight Presidential Chair and Professor, Institute of Childhood Development and Department of Psychiatry, University of Minnesota, Minneapolis pioneered the fusion of epidemiology and developmental psychopathology, an area of study into which more recent investigators have folded new techniques using genetics and biomarkers. Included in the long list of conclusions presented: "Comorbidity can be expected in almost every child seen in a mental health setting." "Onset before adulthood may be a characteristic of the majority of adult psychiatric disorders."
Autism and related disabilities, such as PDD-NOS, Asperger's syndrome, and Rett's syndrome, are difficult to diagnose, especially in young children where speech and reasoning skills are still developing.
ASDs are difficult to diagnose, especially in young children where speech and reasoning skills are still developing. A child may be three years old before the full characteristics of these disabilities are apparent.
It is essential that the process of diagnosing Autism and related disabilities include the assessment and evaluation of an individual's development, communication, and social skills.
It is essential that the process of diagnosing autism and related disabilities include the assessment and evaluation of an individual's development, communication, and social skills.
A brief observation in a single setting cannot present a true picture of an individual's abilities and behaviors. Parental (and other caregivers') input and developmental history are very important components of making an accurate diagnosis.
In this paper, we give an overview of the diagnostic categories of autism and other pervasive developmental disorders (PDDs) and discuss the changes in the DSM classification system over the past 20 years. We describe each subtype of PDD, along with comorbid psychiatric conditions, assessment guidelines, and tools for diagnosis. The epidemiology of autism has generated much discussion and research; we report the most recent data, as well as recent findings about controversial issues purporting to cause the increased prevalence rate observed in the past decade. Finally, we discuss the prognosis for individuals with autism, indicating the challenges faced by patients, families, and professionals aiming to optimize their outcome.
In this presentation by the UC Davis M.I.N.D. Institute, Dr. Randi Hagerman reveals the latest findings on autism, including how to accurately diagnose this growing epidemic and which treatments and therapies are most effective.
Parents want autism to be diagnosed as early as possible, and early intervention may improve long term outcomes. The authors of this review discuss the identification and assessment process for children with autism and autistic spectrum disorder.
As many as ten percent of persons with Down syndrome may also suffer from autism. Many cases go undiagnosed, or are diagnosed at a later age. Diagnosis and treatment of autism is much more critical than for Down syndrome.
Overall, I would like to encourage physicians to not eliminate autism as a possibility when talking to parents of particular children -- especially when you haven't seen that child in a positive social relationship. In other words, be very careful not to tell parents that this isn't autism. Those are words that parents will hang on to for many years. Again, it's harder to rule out autism in very young children than it is to identify it. So, when in doubt, it is really important for the physician to get help and refer the child on to a specialist.
I was told that I was the only child psychiatrist in the country who could not come up with a diagnosis in one session. Always listen to the patient, for therein lies the path to diagnosis.
The ADOS allowed for good assessment of certain types of behaviour. However, to confirm the diagnosis of infantile autism, additional information from parents is required.
Diagnostic criteria for autism and background characteristics used by 937 Indian psychiatrists, psychologists and pediatricians were examined. Participants were asked to rate 18 behaviors as necessary for a diagnosis of autism, helpful but not necessary, or not helpful in a diagnosis of autism, and were asked to provide other information about their experiences with autism. Professionals' experience with diagnosing cases did not vary by profession and, in general, the three professions agreed about the characteristics most necessary for a diagnosis. However, within-group differences were found on the agreement over the usefulness of individual characteristics and amount of experience diagnosing cases as autistic. Comparisons with DSM-III and DSM-IV criteria suggest that Indian professionals may adhere to these systems. Conclusions about diagnosis in a cultural context and areas for future research are suggested.
Autistic spectrum disorder is a complex, developmental disability which can make diagnosis difficult. In this article we present information to help health professionals in recognising the early signs of this disability.
A lot has been written about autism and spectra, but there's one spectrum that is seldom described in clear terms; that of the supposed quality of one's diagnosis, whichever one happens to have.. Remote or Post-mortem Diagnosis; Self-Diagnosis; Diagnosis by Random Psychologist; Diagnosis by Specialist Diagnostician; Diagnosis by Specialist Team, Including Lots of Tests; Diagnosis by Famous Diagnostician
Formal assessments are norm referenced and validated with use on 1,000 plus kids (if the tests are any good) and with different ethnic groups. In other words, they give the test to 1,000 kids in the same age group and find the absolute middle in grades.
This study establishes to which extent the routine checks contributed to the early detection and assessment of cases of PDD.
Slide presentation: DSM IV criteria; triad of impairments; core communication deficits; accuracy of SLI/ASD diagnoses; CHAT; Interventions
he more widespread availability of early intervention and growing evidence of its efficacy for children with autism spectrum disorders (ASDs) have led to a recent emphasis on screening and early diagnosis. ASDs, which include autism, Asperger's disorder, and pervasive developmental disorder-not otherwise specified (PDD-NOS), currently have no biological marker. They are defined by behavior, including the absence of normal social engagement and communication, and the presence of unusual repetitive behaviors. Screening and diagnosis require accurate behavioral reports or observations. In this article, we will discuss screening and diagnosis, with reference to current research on identification of children with ASD at age 2 years or younger, through population (level 1) and focused (level 2) screening, and then with standard diagnostic methods.
Short list of communication, social interaction and behavioral characteristics of children with ASD.
The infants with ASD looked at others and oriented to their names less frequently than infants with mental retardation. Infants with ASD and those with mental retardation retardation used gestures and looked to objects held by others less frequently...
The current paper reviews research investigating the earliest manifestations of autistic symptomatology and summarizes best practices guidelines for professionals evaluating developmental disorders in infancy.
It is critical that clinicians maintain a high index of suspicion during developmental surveillance at every well-child encounter, especially prior to age 12 months or shortly thereafter, in order to make the diagnosis as early as possible.
Falling gaze monitoring, protodeclarative pointing and pretending (reported by parent, validated by HV and followed up 12 months later) carries a high risk for autism at 18 months.
Autistic 3- and 4-year-olds respond to pictures of familiar toys, but not to photographs of their mothers. The findings indicate that facial recognition tests could identify autism at younger ages.
Forty-one children with pervasive developmental disorders (PDDs) receiving eclectic services were assessed twice during their preschool years. Measures were compared over time for the whole group and for diagnostic subgroups: Childhood autism (CA group) and Other PDDs group. The mean intelligence quotient/developmental quotient (IQ/DQ) of the whole group was stable (P = 0.209) and scores on the Childhood Autism Rating Scale (CARS) decreased (P = 0.001). At time 2, the CA group was more impaired than the other PDDs group: autistic symptoms were more severe (P = 0.01), adaptive behavior scores were lower (P = 0.014), and a trend for lower IQ/DQs (P = 0.06). Children in this study seemed to fare better than reported in previous follow-up studies on children with autism.
The findings suggest that the specific symptoms that parents initially recognize may be associated with the speed with which they receive a diagnosis, and that the saliency of symptoms may be culturally shaped.
Substantial progress has been made in the ability to describe accurately the social-communicative and behavioral deficits that comprise ASD. Measurement tools that allow the categorization of the autistic spectrum in reliable and valid ways are available.
I try to be really careful about not completely disregarding complementary or alternative sorts of treatments, but I do draw a line around such treatments that I feel may be harmful to the patient. So in patients who are involved in IV chelation, strange behavioral interventions, or taking different sorts of medications that don't have good clinical research backing them up and may have harmful side effects, I do challenge the parents to be careful. And there are a lot of unscrupulous doctors who don't have training in developmental disabilities and who are willing to takes parents' money to perform all sorts of treatments that don't necessarily create any good and may cause significant harm for the kids.
Whilst the numbers of patients with autism on their lists are increasing, provision of effective assessment and referral is not guaranteed. GPs require more guidance and training in identifying signs that a patient may have autism.
The document consists of assessment instrument information and descriptions, student profiles, multidisciplinary assessment team recommendations, general information, and material resources.
ASDs can normally be diagnosed at around the age of two years. In many instances professional workers may spot the tell-tale signs of autism via the normal childhood health checks and this will eventually result in them being formally diagnosed.
While the more overt symptoms of autism are typically more obvious in early childhood, the symptoms of AS may only become apparent with the increasing functional and social demands of adolescence. In the adolescent with AS, the stress of unrecognized disability, limited achievement, and a sense of failure are often revealed by increasing contrast with siblings and peers. Family and peers may become exasperated by the person's self-centered insensitivity, obsessiveness, and rigid inflexibility, further distorting personal relationships. All these factors can add secondary disability and result in dependency that is disproportionate to the person's intellectual ability.
Twenty children who presented with severe interactional and communication difficulties at age 2 underwent a comprehensive assessment for autism, and were reassessed at age 4-5. In common with other recent studies, diagnosis of autistic spectrum disorders at age 2 was found to be reliable and stable. The communication and social skills of the children showed little change overall by the second assessment. However, children whose scores deteriorated in the social domain tended to have presented initially with more significant behaviour problems. Few repetitive behaviours were observed at age 2, whereas these were more apparent by age 4-5. The finding that early diagnosis of autism is reliable and stable has led to the development of an early diagnostic service in Southampton, which is described. The importance of early diagnosis is that it opens the door to early intervention programmes, which in turn prevent many problems from occurring in later life.
Overview and Recommendations; Language and Communication; Motor and Sensory Functioning; Home, School, and Family Approaches; Clinical Evaluation Process; Innovative Models; Neuroscience and Neuropsychology; Intervention Research
To facilitate examination of school psychologist ASD identification roles and responsibilities, this paper begins with an overview of ASD and provides a general discussion of diagnostic and special education eligibility classifications. Next, it specifically identifies potential school psychologist ASD identification roles, responsibilities, and limitations. Finally, the paper provides a detailed discussion of the identified roles and responsibilities. From prior papers by Filipek et al.+ these roles and responsibilities are identified as follows: a) case finding, b) screening and referral, c) diagnostic assessment, and e) psycho-educational assessment.
Early identification of developmental disorders is critical to the well-being of children and their families. It is an integral function of the primary care medical home and an appropriate responsibility of all pediatric health care professionals. This statement provides an algorithm as a strategy to support health care professionals in developing a pattern and practice for addressing developmental concerns in children from birth through 3 years of age. The authors recommend that developmental surveillance be incorporated at every well-child preventive care visit. Any concerns raised during surveillance should be promptly addressed with standardized developmental screening tests. In addition, screening tests should be administered regularly at the 9-, 18-, and 30-month visits. (Because the 30-month visit is not yet a part of the preventive care system and is often not reimbursable by third-party payers at this time, developmental screening can be performed at 24 months of age. In addition, because the frequency of regular pediatric visits decreases after 24 months of age, a pediatrician who expects that his or her patients will have difficulty attending a 30-month visit should conduct screening during the 24-month visit.) The early identification of developmental problems should lead to further developmental and medical evaluation, diagnosis, and treatment, including early developmental intervention. Children diagnosed with developmental disorders should be identified as children with special health care needs, and chronic-condition management should be initiated. Identification of a developmental disorder and its underlying etiology may also drive a range of treatment planning, from medical treatment of the child to family planning for his or her parents.
Assessment and testing procedures are often seen negatively by parents and poorly perceived by the autistic person being tested. It is quite right to observe that that assessments are being too often administered in a cold "Pass-Fail" procedure that is very often cause of negative feelings from the part of the person being assessed. I believe the roots of the problem are two fold: 1) Poor test/assessment procedure design; 2) Poor skills of the test administrator
In viewing the family videos... the Teitelbaums found disorders in some or all of the milestones of early motor development, including crawling, walking, lying down, sitting and the ability to right themselves.
The autistic spectrum, which is a group of developmental disorders, includes the syndromes described by Kanner and by Asperger but is wider than these two subgroups.
In its current state, ISAAC consists of a database of electronically formatted diagnostic and clinical tools most commonly used in the evaluation of autistic children. Clinicians and researchers are able to access these forms via the internet.
Autism and related pervasive developmental disorders are a challenge to diagnose. This review covers diagnostic criteria, conditions to consider in the differential, the evaluation, and treatment options.
Too few pediatricians screen children for autism and autism spectrum disorders (ASD), and a lack of familiarity with screening tools seems to be a major factor, a U.S. study finds. The study of 255 Maryland and Delaware pediatricians found that 209 (82 percent) said they regularly screen their patients for general developmental delays, but only 20 (8 percent) of them said they regularly screen for ASD.
Whilst most individuals with pervasive developmental disorders can be managed effectively by local services, for the most complex or subtle cases there is an ongoing need for specialist assessment and treatment services.
Children with Asperger's Disorder often require much more intensive treatment and different classroom management, while a gifted child may benefit from interventions as simple as the opportunity to interact with appropriate peers.
The way that a doctor presents a diagnosis can strongly influence parents' response to it. Although autistic individuals face significant challenges throughout their lives, it is irresponsible for a doctor to automatically predict that an autistic toddler "will probably never speak." Such a scenario derives from outdated definitions of autism that relegated the label to severely impaired children. In fact, 90% of children on the autistic spectrum develop speech by the age of nine. As diagnostic criteria have broadened and understanding of autism has evolved, so too must clinicians support parents in formulating a realistically positive vision of their children's future.
A multidisciplinary approach gives the possibility of a common language, and the conviction that the contribution of each discipline is important.
This activity is intended for psychiatrists, pediatricians, and other clinicians who may be in a position to detect possible indications of autism. The goal of this activity is to improve the early detection of ASD since the best outcomes are associated with starting intensive treatment by 2 to 4 years of age, with the most robust results on the younger side of this age range.
Most of these cases could have been caught years before the formal diagnosis, had the parents or the child's pediatrician followed the new guidelines and made a referral for an evaluation at the earliest indication of problems.
Higher concentrations of some neuropeptides in the blood of newborns may hint at the later development of autism or mental retardation.
Subtest scatter in a student's WISC results is far more important than the averaged scores, and WISC results should never replace a full neuropsychological evaluation and resulting diagnosis.
It may be said, as a general rule, that where the fatuity is very deep and the child cannot so interpret the senses as to produce voluntary motions, but is a mere passive recipient of sensation, all training is useless.
the time of diagnosis most of the parents wished for a quicker and easier process. In particular, they would prefer the procedure to have a more coherent structure and content.
This practice parameter reviews the available empirical evidence and gives specific recommendations for the identification of children with autism.
A review of psychological tests often used with children and adolescents, highlighting more recently developed or revised instruments, focusing on tests of intelligence, academic achievement, personality, and neuropsychological functioning
Summary of Filipek PA et al, The screening and diagnosis of autistic spectrum disorders.
Children should be identified as soon as possible for assessment of a suspected communications and learning disorder from 12 months of age on if they display any warning signs for developmental delay.
The high specificity and positive predictive value of the CHAT means that it could be used as a screening instrument within a broader surveillance programme to identify cases before they had come to attention by other means. Its limitation is its low sensitivity, with the majority of cases being missed. Hence, the need for it to be placed within a broader surveillance programme.
Children change as they grow and develop, particularly if intervention is effective, so diagnoses can change in either direction.
This practice parameter reviews the available empirical evidence and gives specific recommendations for the identification of children with autism.
Infants displayed movement abnormalities... such as characteristic facial paralysis, falling to one side while walking, and failing to keep the head vertical when the body is tilted (the "tilting test").
Parents often complain about normal temperament characteristics even when there is no associated behavior problem: too sensitive, too shy, too intense, etc.
Classroom Performance Below Intelligence Level Expectations caused by Impaired Skills caused by A Psychological, Cognitive Deficit equals A Learning Disability
Early diagnosis has become increasingly important as recent studies have shown improved outcomes with implementation of early, consistent, and appropriate intervention strategies that have been individually tailored to the needs of the child and parents.
If you're a parent who's just beginning to walk the special education road, here are a few suggestions which I hope will guide you along the way.
When you know both your 'strong suits' and your weak ones, you can learn to use your best abilities to help you deal with your difficulties—and to work toward your goals.
Effective educational decision-making must be based on objective information and facts, not subjective emotional reactions and beliefs.
In the traditional definition, the discipline of child neuropsychology is concerned with understanding brain-behavior relationships in the developing individual.
A panel of US experts from a dozen professional organizations now recommends that all children be screened at well-child visits for autism and related developmental disorders, beginning in infancy.
We report on the validity of the computerized diagnoses of autism in a large case-control study investigating the possible association between autism and the measles, mumps and rubella vaccine in the UK using the General Practitioner Research Database.
Specialist professional knowledge of autistic spectrum disorders is still not as wide spread as we would like to see, one of the results being that those doctors who are reliable diagnosers of the condition tend to have extremely long waiting lists.
Keeping things in perspective and taking time for yourself are vital in reducing the stress that is common when parenting any child, including your child with an autism spectrum disorder.
It is also important to recognize and work through these feelings as you begin to search for understanding, services, and support for your family and for your son or daughter with an autism spectrum disorder.
The "whirling" response or test has been described as highly specific for childhood schizophrenia. The test is performed as follows: The child stands with his arms extended, parallel to each other, and with his eyes closed. In order that he may be distracted, he is asked to count. The head is now passively rotated to one side as far as possible without discomfort. Reaction is noted and the head is rotated to the other side. The positive resonse, or whirling, consists of the child's turning his entire body as long as the examiner turns his head. The negative response consists of a slight rotation of the trunk but the entire body does not turn. Although the validity and relability of the whirling test have never been demonstrated, the test is presented in the literature not only as a diagnostic aid but as a characteristic sign of schizophrenia. Furthermore, the test has been offered as important evidence for the "maturational lag" concept of childhood schizophrenia.