High Resolution CT Scanning in Infantile Autism: A Quantitative

Approach
SHELLEY ROSENBLOOM, M.D ., MAGDA CAMP BE LL, M .D., A,JAX E. GEORGE , M .D .,
IHVIN 1. KRICHEFF, M.D., ELIZABETH TALEPORO S, PH.D., LILLIA N ANlmRSON, R. N.,
RI CHARD N . RE UBEN , M .D., AND J ULIUS KOREl N, M.D.

Thirteen autistic a nd 10 con tr ol children were studied with high resolution computeriz ed
tomographic (CT) scans. Lin ear and volumet ric measurements of ventricles, subarac hnoid
cist erns and head size were mad e. Evide nce of subt le differences between autisti c and
cont rol children with marked vari an ce wit hin th e autist ic group when compared to t he
control group was reveale d. This st udy confirms pr evious rep orts of hete rogeneity in brain
struc tu re in autism . New and more sophisticated technology now permits a more qu antita-
t.ive approac h to region al brain st ructu ra l features th an has been feasibl e in the past.
J ournal of th e American Academy of Child Ps ychiatry , 2:1, 1:7'2--77, 1984 .

Previ ous comp uterized to mog ra phic (CT) studies in
infan til e autism have been lim ited to subjective as-
ses s me nts and lin ear mea suremen ts of ven t.ricu lar and
brain size (Campbell et aI., 1982; Caparulo et aI., 198 1;
Da rn asio et al., 1980; Hier et aI., 1979; T sai et aI.,
198:2). They ar e based on low res olution scans whic h
ha ve poor definition of brain detail. Jn addition they
wer e ca rr ied out without soph isticate d image an alysis
soft wa re option s, so t ha t they had to be evaluated in
t erms of subject ive impression s or linea r measure-
m e rits of cere brosp ina l flui d {CS F) -cont.aining irr eg-
ula r-cou toured structures suc h as ventricles a nd basal
suba rac h noid cist.ern s. ' I' his a lso renders diffi cul t com-
par isons of left a nd right hem isphe re structures due
to distortion s introduced by slight degrees of h ead t ilt.
For this reason, volumetric measureme nts of ventri-
cles and cist erns afford a better, more quan ti tative
app roa ch to brain st ruc t ur e.
Allot her diffi culty in in te rpreting the resul ts of
some or the CT stu dies in au ti sm is het erogeneity in
t.he au t isti c sa mples, and lack of or inadequ at e contro ls
l ) r. Call1pb d l is L'rajess nr of Ps yc hiat ry, Dr. Geo r/te is Professor
ol ll m liolo!t.\', /J r. 'Tu lcp oro« is Res ca rcli I 'sy ch olo/tisl , M s. A nderson
is U,.sm rch Te am Lea der, /Jr . R euben is I' rofessor of Neurology , and
D r. K orein is Prolessor o] Neurology, all 01 the New Yorh U ni oers ity
Mvdic«! Cvnier. At th e ti m e of th is study , Dr. Rosen bloom was Fellou:
ill Ne u rom rli%gy. l npurt ment of Rari i% M)', N ew Yurh Un ivers ity
Medica! ( " ·IIIN. Sh e is IIOW Assist.an! I' rofessor of Harlio/o/ty , /Je ·
partmen! ol lI adio/oMY, T I/I' J ohn s l lophin « Un iversity, S choo! of
Medicine. Balt.unon-.
Th is u -urh wa s sU/J/lfIrled in pari by N IM H w an ts Mlf · ,1665 an d
1'vl 1/ ·S22 12 [rum the N ational ln s tit u tc of M en ial H ea lt h to IJr.
CWll p!wll , an d was prcs ent i«! at. the 29th Annual Meeting of the
A llw ricWI /vctulcmy of Ch ild Ps vchiat ry , Wa shin/tton, D. C., October
20 2·'/, I!JH2.
/uldrcs« rep rin t req uest s 10 Dr. Ca mpbell, I )epart m enl of P sy clua -
11:\'. Nt 'W Yor l. IIn ioersity M ed ical Ce n ter, 5{)0 Fi rst Ave., N ew York,
N )' 1001 /;
OOO:!·71:1 ~/ ~ '1 / 2 : 1O 1 0072 $02.00/0 ct' J 9R'1 hy th e American Acad-
cr n v o f Child Psych iatry.
72
as shown in Table 1, where the previous studies are
summa r ized. Rep or ts ha ve in cluded subjects ranging
in age from early child hood t.o yo ung adulthood (T able
1). Moreover, pati ents have been in cluded who have
evidence offocal n eurological deficit s, sei zure disorder,
or a known cause of aut ism, so that the qu estion of
whether brain abnormalities a re relat ed to autism or
othe r neurologic disease is rai sed .
The purpose of t h is pilot study was (I) to exa mine
wh a t. high resolution CT t.echnology an d sop histica ted
image a na lys is soft wa re ca n contribute to t he study of
br ain a bnormalitie s in autism , using a group of su b-
jects high ly selected to be as free as po ssibl e from
con comitant neurologic illn ess and confi ned to a n ar-
row age ran ge, a nd (2) to assess whet her subt le or
foca l struct ural diffe re n ces between the brains of au-
ti stic ch ildren and control s can be iden t ified emp loy -
ing linea r and volume t ric measures to quantitate ven-
tricular size ill the left and right hemispheres, volu me
of ba sal cisterns, a nd head size.
T o t he best of our know led ge, thi s is t he first st udy
conduct ed in au ti sti c chi ldren using th is t echnology.
Subjects
Autistic Children. Noncont rast CT scan s were per-
formed in a routin e fash ion on a GE 8800 uni t on 13
auti stic ch ildren , 10 boys and :l girls, ages :l to 8 yea rs
(mea n, 5.0 yea rs) . (T he autist ic ch ild ren were sedated
for t he proced ur e after a 2-ho ur fast ; t hey receiv ed
ch lora l hydrate, 1,500 mg p.o. 1 hour, a nd Ph en er gan@
m inimum 1 mg/kg a nd maximum 2 mg/kg i.m ., :W
min prior t.o the procedure.) T hey were pati ents in the
Therapeutic N u rsery oft.he Ch ildre n' s In pat ient Se rv-
ice of Belle vue Hospital, Psych iat ric Di vision. Of 22
con sec uti ve ad mi ssions of chi ldren diagn osed as aut is-
74 ROSENBLOOM ET AL.
t.ic, th e paren ts of fi (includ ing a pail' of tw ins , concor-
dant for autis m) signe d out against medical advice; in
4 childre n CT sca ns were not successful; and onl y in
1:\ CT sca ns wer e successfully completed. Diagnosis
or infantil e aut ism was ma de indepe nde ntly by three
chi ld psychi atrists, usin g DSM -III crit eria, ax is I.
Symp to ms included failure t o develop socia l rela t ed -
ness since infan cy, withdrawal , various st ereotypies,
a nd non cornmun icative speec h, am on g others. The
socioeco nomic status (S1<:S) of t he chi ldren according
to Hollings head (J 975) , is as follows: one in class II ,
tw o in class Ill, rive in class IV, an d five in cla ss V.
Intellectual fun ctioning was det ermined by Gesell De-
velopme nta l Sch edul es (Gesell a nd Arnat.ruda , 1946);
verba l develop men tal qu oti en ts (DQ) ran ged from 70
to I fl, a nd adapt ive DQs ran ged fro m 67 to 24.
The au tistic childre n received a com plete diagnosti c
workup, including psych iatric observati on , psycholog-
ica l test ing , a nd pedi atri c and neurological , and hear-
ing and speech eva luat ions. Laboratory studies in -
cluded screening of blood for inb orn erro rs of met ab-
oli sm , Wasserman , lead , cyt ogen et ic, and dermato-
glyphic studies, serum chol est erol, thyroxine-iodine
('1',, ), triiodothyr onine (T,), T SH , urinalysis , complet e
blood count (CBC) , hem atocri t , hem oglobin , SGOT,
SG PT, electroence p halogram, and ca rpal roentgen o-
gra m for bon e age (met hod of Gr eulich and P yle
(l9 G9)).
P atients with history of seizure disorders, gross
ncurological deficit, system ic or endocr ine disea se, or
those wit h ide nt ifiable cause for aut ism (axis III of
DSM - III) were not included in t he study . This left a
car efully diagnosed and clinically ho mogeneous group
of you ng aut ist ic children. N o child was on main te-
nance doses of psych oacti ve drugs pri or to or during
t he study .
Con trols. T en children, 7 boys and :3 girls, ages 3 to
10 years (mean , 8 years) wh o had noncontrast GE
scan s of the head wer e selecte d as controls. The indi -
cations for sca n ning were as follows: six had head
t ra uma wit hout neurologic sequelae ; on e was sus -
pected to have ar te rioveno us malformation , one had
headaches, on e had hearing loss in t he left ear, and
on e had a seizure disorder. Prior to the scan all had
neurologic evaluation whi ch was found to be normal.
None had psychi atric disorder or men tal ret ardati on;
family a nd per sonal histori es were unrem arkabl e.
No ne had abnormalit ies identified on CT scan . We
recognize that the control group is not ideal. The
control subjects wer e selecte d retrospectively , were
sign ificantly old er than the aut istics, and had pre-
se nting compla ints. Becau se of et hical cons t raints ,
however , we wer e unable to obt ain a larger or bett er
matched cont rol group.
In defen se of our control group, we can cite the work
of Fukuyarn a et al. (1979) . Twenty-seven neurologi-
ca lly normal children were st udied, 11 of whom were
ages :3 to 4 yea rs, and 16 wer e ages 5 to 9 yea rs.
Bifront al and bicaudate ventricula r ratios were mea-
sured: no age-related differ ences were found in t he
means for the bifron tal diameter (27.2 ± 1.5 vs. 27.5
± 1.5) nor for t he bicaudate diameter (9.6 ± 1.9 vs.
10.2 ± 1.:1). Similarly, no age-related differen ces were
found in t he t hird ven t ricular measuremen ts. With
t he degree of reso lution pr ovided by t he ir scan ner,
however , they were unable to resolve subarach no id
spaces and sylvian fissures within the age groups in
ques t ion . These findings argue again st an y gross age-
relate d changes in ventricular or cisterna l size in t he
3- 10-year age ran ge, wit hin which our su bjects fall.
Methods
Volumetric and lin ear measurem ents were mad e of
all scans .
Axial 10-mm CT slices were obtaine d in routine
fas hion on ea ch ca se from mid posterior fossa or lower
to high convex ity. On each slice, re gions of in t erest
were outlined by a neuroradiologist (S.R.) as con t ain-
ing porti on s of ventricle, por ti on s of subarach noid
cistern, or wh ole brain volume for the slice. Thus
severa l region s of interest were evaluate d for each
slice with separate quantitation s of left and right
te mpora l horn , left and right lateral ven tricle, third
and fourth ventricles, suba rac h no id space ba sal cis -
te rns, and also who le slice brain volume. For CSF
volume measurem ents, whi ch included vent.riculu r and
cist ernal me asurements, th e range of C1' numbers
betwe en -11 and 23 Hounsfield units was empirically
selecte d as representati ve of CSF but exclus ive of
brain. The number of pi xels within eac h region of
in tere st which fell wit hin t h is range of CT numbers
was assessed , yielding an estimat e of area representing
CSF within the designated region of interest. This was
t hen multiplied by a slice t hickness factor to yield a
quantit ation of fluid volu me. Thus t he volume of CSF
within a user-defined area which represen t ed, for ex-
ample, a porti on of te mporal horn of the left lateral
ventricle could be measured, and this amount could
be added t o measurem ents of ot he r portions of the left
lat er al ven t ricle which appeared on other CT slices.
In t his way, a summed volume of the left lateral
vent ricle could be obt ained. Similarly, th e volume of
ot her ventricles and of ba sal sub arachnoid cisterns
was measured. Net ventricul ar volume was calc ulated
as the sum of t he volumes of all CSF-cont aining
region s whi ch represented vent ricle . The volume of
the ba sal suba rac h no id cisterns was summed in an
identical fashion.
 CT S CANNING IN IN FANTI LE AUTI SM
For brain siz e det ermination s, t he range of CT
numbers between -11 an d 100 H oun sfield u nits was
used as rep resentative of brai n and (;S F, bu t exclusive
of bone . T hu s a measurement of the volume of the
skull con te nts was made for eac h CT slice obtai ned,
and t he sum of t he six lar gest slices, VG, was ta ken as
an ind ex of head size. We preferred t his meth od to a
simple sum of the bra in volume for all slices becau se
t he exa minat ions were conducted from t he mid pos-
teri or fossa up ward in eac h case, but d id not all start
cxactly at t he sa me place in t he head or include a ll of
the head . Thus by using the six largest slices , we
avoided bias du e to differences in th e exact number of
slice s a nd location of slices obt ained. Using this meth-
odol ogy, we assesse d th e followi ng volumet ric param-
ete rs: net ventricul ar volume ( ~Ve n ts), vent ricular
volume corrected for head size (:::: Vents / V6), net sub-
ar achnoid ciste rn volu me ( ~ S AS) , subarach no id cis-
t ern volu me corrected for head s ize (::::SAS/VG), left
a nd right lateral vent ricular volumes, left/righ t ven-
t ricula r volume rati os, left and right temporal horn
volum es, left/right t empora l horn ratios, and head
volume (VG) . Using th ese parameters, we were able to
qua nt itate region al ventricular volume and sub arach-
noid ciste rn volume, a nd mak e obse rvat ions of left/
right vent ricular asy mmet ries wh ich wer e objectively
ra th er t han subjectively det er min ed and ind ependent
of head ti lt. All meth odolo gies based on linea l' mea-
sure me nts arc subjective in the se nse t hat t he bord er
of t he vent ricle is vis ua lly det erm ined (t he exact bor -
der is not alw ays clea r) and a slight. degree of head til t.
may br ing more of one la teral ventricl e t han t he ot her
onto t he CT slic e being considered. The volume
met hod obv iat es t hese diffi cult ies by incl uding all
port ions of the ventricles as they appeal' on con ti guous
slices t hrough th e brain and by making t he border s of
t.he ven tricles arbitrarily defined by CT number cri-
te ria. Mor eover , it a llows assessm ent of cister nal size
whi ch could not he add resse d by pr ev ious, less sophis-
ti cated methodologies.
In addition to t he a bove described volumetric mea-
sure me nts, we a lso assessed th e following four lin ear
ventricul ar mea sures: (1) bi fron tal ratio, defin ed as
th e widest span of th e fronta l horns or the la teral
ventricles divided by t he width of the head at. th at
level ; (~) bicaudate rati o, defined as t.he na rr owest.
spa n of th e lateral ven tr icles at th e point of th eir
ind en tation by t he ca udate nu clei divided by t he width
of th e head at. th at level; (:~) t hird vent ricular rati o,
defin ed as t he widest measure of t he width of t he third
ventricle divided by th e width of t he head at t hat level;
a nd (4) lateral vent.ricula r waist ratio, defin ed as t.he
width of the bodi es of the lat eral ventricles at t heir
waist divided by the width of the head at that level.
7fJ
Since linear and ventricular volume m easu rem en ts
ar e both quantitati ons of ven tri cul ar size, corres pond -
enc es in th e measure ments wer e expect cd. Linear
measurements on ly in :3 of th e aut ist ic chi ld ren in-
cluded in t his st udy were reported in a pr evious pap er
(Ca mpbell et a I., 1982).
R esul t s
This study co nfir ms om p revious findin g th at a
sma ll pr opor tion of a ut istic chi ld ren have ventricular
enlarge me nt as s hown in Fi gur e] . A similar pattern
of dist ribut ion of suba rach noid ciste rn al en lar gement
is also revea led as sh own in Figure 2. Th e tw o sca t.t.or-
gra ms show that t he inc reas e in varia nce is du e t.o a
few autistic indi vidu als with measurements which de-
viate co ns ide ra bly fro m th e rest. of th e aut .ist it: group
a nd from th e cont rob.
Mean s and standard deviati on s we re ca lcu lated for
t he four lin ear a nd for nin e volumetric measures ex -
a mined in t his st udy . Th ese ar e pr esent ed in T abl e :2-
Simple I tests wer e applied t.o t hese data to de te rm ine
wh eth er the mean values ob ta ined for nut.ist.ics dif'-
fer ed significant ly from t hose obta ined for co nt rols.
Th e I ratios obtained are also pr esen ted in T ab le 2.
Non e of the l rati os were st.at.i st.ically significa nt at.
th c O.OfJ level.
The a na lyses applied to t hese data were limi ted to
8 0 r--- - - - - - - -- - - - - - - - ,
I ~ controls
auti sti cs
60
40
(f)
, ,
t-
Z
w
> (f (f
lAJ
•~ .- ff9~ :
20
• .0
I I
2 4 6 8 10 12
AGE (year s)
!<')( :. I. Scat t.e rgram re la ti n~ net ve nt ricu lur volume to a~e shows
that a few of' 1:\ aut ist.ic ch ildren had larger ven tri cles tha n the
rem uinin j; autist ics or th e 10 controls .
76 RO S ENBL OOM ET AL.

40 ...------ - - - -- - - - - - - , tw een left and ri ght hemispheres (T angu ay, 1976).

The left/ right vent ricula r ratio showe d a nonsigni fi-
, _ out isti CSj ca nt ten dency to be smaller in aut istics t ha n controls.
o controls
Comments
30 T he resul ts suggest t hat th er e is increased het ero-
geneity in measurements taken of some aspects of
brain struct ure wit hi n t he aut ist ic group. This is par -
T AB LE 2

20 ! Mean Brain Measuremen

-_ .. ._ ---
ts in A utistic and Contr ol Children
. - --- -_ . ._ . ~- - .• . _-- -- _.
(J) Standa rd
cf Va riab le Mea n T
<1 Deviat ion
(J)
III
• cf
Bifron ta l ra t io 0.3145
0.3122
(Con trols)
(Autistics)
0.025
0.0:l5
0.18

•• , •
1/1 cf
Bica udat e ratio 0.07 56 (Controls) 0.011 0.19
10

,
cf 0.074 0 (Autisti cs) 0.027
9
• • 1/1 ~
Th ird ve ntricle

Latera l vent ricl e

0.0 222
0.0246
0.1891
(Con tro ls)
(Autisti cs)
(Contro ls)
0.007
0.009
0.019
- 0.67

- 0. 14
9 wa ist 0.1903 (Autistics) 0.022
-L-L--L.-L-.. V6 (head size) (cc) 894.09 (Co ntrols) 92.74 1.32
2 4 6 8 10 12 842.12 (Aut istics) 94.66
Net ve ntricle 13.S:' (Contro ls) 6.412 - 1.44
AGE ( ye a rs ) vo lume (cc) 22.22 (Autist.ics) 19.713
Ventricu la r volu me 0.01 52 (Co ntrols) 0,Cl06 - 1.54
FIt: . 2. Sca ttergra m relat ing net suba rac h no id space to age in (correct ed for 0.0266 (Aut ist ics) 0 .02 :~
1:, au t istic chi ld ren and 10 cont ro ls. A few aut.istics have enl a rged hea e! size)
cist ern s. T he on e wit h a n en la rge d cistern in th is figure a lso ha d
Subar ac hn oid 8. 7100 (Co nt rols) 4.110 - 1.23
ve nt ricu lar en large me nt.
cistern volu me 12.115 (Autistics) 8.768
(cc)
des cri pt ive and simple in ferenti al methods. T he sam - Ciste rna l volume 0.009 2 (Controls) 0.004 - 1.61\
ple size did not appear to warrant more sophisticated (corr ec te d for 0.0 142 (Aut.istics) 0.009
tec hniq ues. For example, whi le t he groups differed in head size)
L / R ven t riele rat io 1.5120 (Controls) 0.885 1.54
a g e, it w as fe l t i n up p r op ri u t.c t o e x t c n d t h e s e a na ly ses
i.ozuz (A u t is t ics) o.asz
to covar ian ce techniques in which t he age facto r could Lilt te mpo ra l horn 1.2532 (Co ntrols) 1.448 0.4 4
be controlled for st at isti cally. Similarly, mo re complex ra t io 1.0196 (Aut istics) 1.056
repeated measur es and mul ti variate designs were re-
ject ed for application. In fact, t he br ain measures were T ARLE 3
corre lated only to a limited exte nt. Variances of Bra in M easurem ent s in Autist ic._ ..and Control Children
.... -
Using F tests to assess hom ogeneity of vari anc e
Va riabl e F S igni fica nce
betw een t he da ta for t he two groups, we found t hat
Bifront al rat io 1.89 NS
t he var iance in some of t he mea sures was significa ntly
Bicauda te ratio 5.72 p < 0.05 Aut istics > Con t ro ls
higher for autist. ics t han for con trols. Us ing an alpha Thi re! ven tricle 1.56 NS
leve l of 0.05, differ en ces in va riance were found for La tera l ven t ricle 1.41 NS
t he two gro ups as presente d in T able ;-l. F ratios waist
ind icati ng whi ch ones wer e st atistically significant are V6 (he ad size , ce) 1.04 NS
Net ve ntricle vo lume 9.45 p < 0.0 1 Aut isti cs > Co ntrols
included in t he table. The finding suggests t hat aut is-
(ec)
ti cs ar e mor e hi ghly dispersed in several of the mea- Ven tricula r volu me 14.01 p < OJll Autist ics > Co nt ro ls
sureme nts t han cont rols. It is poss ible that a lar ger corr ect.ed for head
sample wou ld reveal subgroups am ong t he au t isti c size
child ren which could be define d by differen t patt ern s S ubarachnoi d cist ern 4.55 p < O.Oli Autis tics > Co ntro ls
vo lu me (cc)
of brain meas ureme nts.
Cist ernal volum e 4.53 p < 0.05 Autist ics > Co nt ro ls
For on e measure, inte restingly, th e aut istic group corrected for head
showed a greater uniformity t ha n th e cont rol group: size
t he left/ right ven t ricular ratio, as shown in T able 2 L/ R ventricle rat io 5.09 p < 0.05 Co ntrols > Auti st ics
a nd Figur e :L This is of par ti cul ar interest inasmuch L/R tempor a l horn 1.88 NS
ra t io
as it suggests an abnorm ality in the re lat ion ship be - .. _-- _._ .. , ...---.- -- --- ..
 CT SCANNIN G IN INFANTILE AUT IS M
4 .0 .--- - - - -- - - - - -- - -,
• out i st i cs I
[ o co n t ro ls
3 .0
o
o
0::
o
» be free of eviden ce of neur ologic disea se other t.han
::J
U 2 .0
~
+-
c
(l)
> Three had show n regression of previously acquired
....-
...c:: .9 cf
OJ 1.0f--
0::
<,
• cf
I I I I
2 6 8 10
AGE (Yea rs )
FI G. :1. Scatte rg ram re lating left / ri gh t ventric ular rat io to a ge
in 18 a u t is t ic ch ildren and 10 co n trols .
ticula rly t rue for su ba ra chnoid cistern size, ventricular
size, left /right vent ricu lar ratio, and rela tive size of
both ventricles and cisterns when correcte d for head
size. The sampl e size of 13 is to o small for an attempt
to sort out and categorize t he combinat ions of abnor-
mal st ru ct ur a l features. In fact , it appears that becau se
of t he com bination of sma ll sample size and int rinsic
heteroge ne ity of brai n struct ure within the autistic
group, we are un abl e to demon strate any signifi can t
differen ces in the mean values of an y of t he four lin ear
or nine volumet ric parameters. In this sen se, we have
failed to demonstrate a ny bra in abno rmalit ies in au-
tis m, and we certai nly have not sho wn any st ructural
featur es which migh t differ en ti ate aut istic fro m con-
trol children. Rather , our data suggest t hat no con -
sistent br ain lesion s exist and t hat t he st ruct ura l
subst rate in autism is a heterogen eous one.
Wh er eas t he scores of t he autistic subject s showed
in cr eased variance in seve ra l st ruct ur al fact ors, t hey
showed less varia nce t ha n controls in left/ right ven-
t.ricular volume rat.ios. T he latera l vent ricles in our 13
autistic subjects were more nearl y equa l in size t ha n
the lateral vent ricles of cont rols, in whom t he left.
vent ricle ten ded to be lar ger t ha n t he right . We feel
t hat t his findin g may reflect a disturbance in t he
re lation between the hemispheres among auti st ics,
This finding appears to be at variance wit h previous
repor t.s of increase d left ven tricular size on pneumoen-
77
cephalography in autism (Hauser et al., 1975). We
believe t hat. CT imaging is more valid for eva lua t ing
vent ricular size t han pn eumoenc ephalogra phy, since
vent ricula r size is not disto rted by introdu cti on of air,
which is kn own to caus e ventricula r enlargemen t (T sa i
et a l., 1982). This is of course not a fact or in C'I'
scanning. Mor eover , our samp le of autist ic ch ildre n is
a mor e uniform group which was carefully selected t.o
autism, and t.herefor e brai n find in gs in t.his group are
less lik ely to be asc riba ble to ot he r disease entit ies.
Fiv e of 18 subjects of Hauser et al. (1975) had seizure
disorders, and five had focal ne ur ological findings.
langua ge skills and one had feta l alcohol syndro me.
All of the se would have been excluded by our criter ia
» for t he study.
The sam ple size of 1:3 is too s ma ll for an attempt to
sort out and catego rize CT scans of aut istic child ren
according t.o com bina tio ns of st ructural abnormali ty
(subarac hnoid cistern and ventricula r volumes, an d
head size) and asymmet ry (left/right ventricular vol-
ume ratio). The avail ab le dat a suggest t hat an ana lysis
of a lar ger sample may reveal subgroups amon g t he
autist ics wit h va rious combinations of st ruct ura l fea -
t ur es. This may pr ove useful in t he ra peutic decisions
and in prognosis.
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