A case in which diagnosis between autism, Heller's syndrome and childhood schizophrenia is difficult.

At present, although autism has become accepted as a pervasive developmental disorder, renewed attention is being turned upon the relationship between autism and childhood schizophrenia in recent years. Likewise, the relationship among Heller's syndrome, autism, and childhood schizophrenia has also become a focus of clinical interest. The author presents a case in which discrimination among autism, Heller's syndrome, and childhood schizophrenia is difficult, supplementing discussion from the nosological standpoint. The subject is a male, who was 7 years old at first presentation. Early signs of disorder other than a delay in verbal development were not recognized. At around age 3, a tendency to become isolated at nursery school, and a rambling speech without cohesion was noted at home. Also around this time, the subject was seen to take an obsessive interest in written characters and maps. However, a drastic increase in the severity of symptoms occurred at about 1 week after entering 1st grade with the sudden appearance of hyperactive tendency, accompanied by anxiety at night and loss of control over both urinary and bowel functions. This was followed by the appearance of severe self-injurious behavior, for which the subject came under the care of the author. Subsequently, the author has been involved with the subject therapeutically for about 10 years. In that interval, although a tendency of improvement has been noted in his condition, no substantial change has been recognized in terms of the fundamental disease picture.