Eighty-five patients with childhood-onset pervasive neuropsychiatric disorders (infantile autism, pervasive developmental disorders, developmental language disorders, severe attentional deficit disorders with learning difficulties, and Tourette's syndrome of chronic multiple tics) underwent computed tomographic scanning of the brain. Clinical assessments of each image of the patients' scans by a diagnostic radiologist, who was "blind" to the neuropsychiatric diagnosis, were used in the first phase of the study, which is reported here. Twenty-four percent of the scan series revealed clear abnormalities and 13% showed mild asymmetries in ventricular and/or hemispheric size. Of the children with pervasive developmental disorders, 59% had abnormal scans, as did 44% of those who were language impaired and 38% of those with Tourette's syndrome. No distinct abnormality was isolated by which diagnostic categories could be separated, nor was an increased prevalence of scan abnormalities associated with overall severity of symptoms. Mild asymmetries, involving increased size of the left hemisphere and/or left ventricular system, were found in all diagnostic groups, and may be associated with one or more behavioral or cognitive disturbances found in the five syndromes. No systematic relationship was found between computed tomography (CT) scan abnormalities and EEG abnormalities. Critical methodologic issues involving diagnostic formulation and assessment of brain status through computed tomographic scanning are discussed.
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