Abstract

"J" was adopted at age 2 from a Romanian orphanage with no information regarding her family history or prenatal or perinatal course. She lacked functional language skills at the time of adoption and could neither crawl nor walk. Upon arrival in the U.S., she was found to be physically healthy, with a normal 46 XX karyotype. She participated in intensive developmental services with normalization of motor skills yet was diagnosed as autistic at age 3 owing to ongoing language, communication, and interpersonal impairments. Mental retardation was diagnosed at age 5. As early as age 5, J showed sporadic "freezing" (her parents’ words) episodes in which her arm would suddenly shoot out and remain immobile for several seconds. She also developed both vocal and motor tics and was additionally diagnosed with Tourette’s syndrome. Clonidine and trials of antipsychotic drugs did not alleviate the tics, and they led to further behavioral deterioration. J further developed multiple challenging behaviors, including yelling, screaming, and biting her lips and gums. These problem behaviors progressed to include hand-to-head, knee-to-head, and hand-to-body self-injury as well. By age 11, she had developed bilateral traumatic cataracts necessitating surgery and the introduction of protective equipment. She subsequently underwent