title: Intervention,treatmentand care in autistic disorder. Challenging case reports from northern Finland.
abstract: OBJECTIVE
  Autism produces characteristic patterns of behaviour, and individuals with autistic disorder (AD) have a lot in common in terms of behaviour and mannerisms. Individuals with autism, however, also have their own overall personalities, which both underlie and interact with their autism. This article focuses on challenges of identifying AD and delivering appropriate services in face of long distances and limited resources.
  
  
  METHODS
  This study is a retrospective descriptive chart review and cases series. Hospital records and data on the treatment/habilitation status of 187 children and adolescents with autistic disorder aged 3-18 years were evaluated from Northern Finland.
  
  
  METHODS
  Nine subjects, representing the age group of 9- to 17-year-olds, did not show any improvement on the Childhood Autism Rating Scale (CARS) and in the clinical examination during the follow-up period 1990--97. In this study, these children and adolescents with AD were evaluated more carefully.
  
  
  RESULTS
  The treatment programs and therapies varied, depending on the availability of trained staff. There were various reasons for the absence of the most suitable treatment, or habilitation, at the individual level. The difficulties also varied over time and between individuals. In addition, after the follow-up period, four of the nine (55.6%) individuals showed more positive outcome when the level of autism had been taken into account in the planning of the intervention for, treatment and care of AD.
  
  
  CONCLUSIONS
  The possible reasons for poor outcome included the level of mental disability, impairments of speech and communication, lack of knowledge of autism at the municipal level, long distance to services, severe epilepsy, additional medical diagnosis, parental acceptance of the child's autism and late start of the intervention for, or habilitation of autism.
authors.affiliation: Department of Paediatrics, Clinic of Child Psychiatry, University of Oulu, Finland. marko.kielinen@autismiliitto.fi
authors.forename: Marko
authors.initials: M
authors.lastname: Kielinen
authors.forename: Erland
authors.initials: E
authors.lastname: Hjelmquist
authors.forename: Irma
authors.initials: I
authors.lastname: Moilanen
authors.forename: Leena
authors.initials: L
authors.lastname: Syrjälä
mesh_terms: D000293:Adolescent; D001321:Autistic Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D001521:Behavior Therapy / Q000379:methods; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007361:Intelligence Tests; D008297:Male; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D011619:Psychotropic Drugs