The Italian rizzoli-larousse encyclopedia was forced to amend its entry on autism last year because of an outcry over the original definition. The paragraph that caused most offense stated that an autistic child could be cured if he received appropriate treatment that was "followed up by his relatives (who are often the cause of the syndrome, especially when they overstep the mark and insist on an over-perfectionist upbringing)." Autism support groups were enraged that the notion of a cold, unloving parent, or "refrigerator mother," has persisted so long after they thought it had been thoroughly discredited.

In Italy, France and Spain, many in the psychoanalytic establishment still maintain that a child's upbringing is what makes him or her autistic. Elsewhere in Europe, the increasing recognition of autism as a developmental disorder that most likely involves complex genetic factors has led to enormous advances in the care, treatment and education of affected children, though the wide range of associated disabilities can still make a correct diagnosis difficult.

Donata Vivanti, president of Autism Europe and the mother of severely autistic twin boys, knows how hard parents sometimes have to fight. "In Italy, there is still the tendency to attribute autism to a difficult relationship between child and mother," she says. Instead of proper and practical treatments to increase the autonomy of autistic people, the children are often pushed into psychotherapy along with their parents. It took Vivanti three-and-a-half years to get a correct diagnosis for her sons, and she herself underwent six months of psychotherapy at the suggestion of her children's doctors. "The effect is disastrous," she says. "Families end up looking for their own solutions."

Even in Britain, where autism has long been accepted, it is sometimes hard for parents to have their child's condition correctly diagnosed because of the wide range of symptoms. Hannah Hall's autism was not recognized until she was 21, partly because she also has severe learning difficulties and complex medical problems, and she displays challenging behavior. It was only after her father, Barry, read a paper on autism that he realized "Hannah had the three core impairments of autism: imagination, socialization and communication. It was a big relief, because if you don't know what you're dealing with you're in a disaster scenario."

Once the diagnosis is made, positive outcomes can be achieved. In the Neth- erlands, Ina van Berckelaer-Onnes, professor of remedial education, specializing in autism at the University of Leiden, has developed a treatment regime that concentrates on a child's practical needs within the family. The system, known as the Leiden method, involves a process of guided association through which children come to link specific objects with specific daily routines. This is very important because a common characteristic of children with autism is the fear of an abrupt or unexpected change in activity, which often results in hysterical behavior.

Froujke Lokerse uses the Leiden method with her five-year-old son Thomas. At his special school in Amersfoort, Thomas has learned that when he is given a small green plastic disk he must stop what he is doing and move on to the next activity. "In the past this would make him very upset," says Lokerse. "He would scream hysterically and often make himself sick because he had no comprehension of what was going to happen." Now, Thomas knows that if he is given the disk he must go to the cupboard and open the top drawer and use whatever he finds there: a beaker means lunch, a hip bag means going outside. "He's so much calmer now," says Lokerse, adding that the benefits extend to Thomas' six-year-old sister Laura: "We're relaxed enough to be able to give her the attention she needs. And at last she can bring her friends home to play without Thomas shredding all their drawings." But Van Berckelaer-Onnes is realistic about the Leiden method's limits. "You can't cure autism," she says, "but you can improve the quality of life for those with the disorder."

One of autism's many mysteries is why boys are four times more likely to be affected than girls [EM] and why 10 times more boys than girls have the related condition called Asperger syndrome. Christopher Gillberg, a professor of psychiatry at the University of Gothenburg who has carried out some of the most comprehensive epidemiological studies of the conditions, believes that the prevalence of Asperger's in boys may be exaggerated, since girls' social and communications skills are generally better developed than those of boys. "There are factors to suggest that the symptoms in girls are often not recognized as autistic," he says. "Several of the autistic characteristics can be perceived as exaggerated male features," such as insistence on identical routines, obsessional interests, preoccupation with certain objects as well as superior visual and spatial skills.

For example, girls are often diagnosed with an unspecified learning disorder or perceptual problem while their social and communication deficits may go unrecognized. Hannah Hall, who is now 26, is recognized as belonging to an autistic group called active but odd. Her parents both know how difficult her behavior can be. She will often show inappropriate attention to total strangers, hugging and kissing them. If she hears on the radio about something that she wants to go to, her father says, "you're faced with having to go. There's no deceiving her and thinking that she's not quite the full ticket." His worst moment came on a trip to the supermarket, when Hannah decided she didn't want to go in. She kicked up such a fuss in the car park that store staff called the police. "It was like a scene out of a TV show," recalls Hall. "All of a sudden a big police car appeared in front of us, then a policeman appeared on either side of the car trying to open the doors." Hall didn't take Hannah out of the house for months for fear that the scene might recur.

Help and advice for the families on how to cope can come from the many national and local support groups that follow and promote research into the condition. There are currently studies across Europe investigating the genetic component of autism, but one project looking at sex hormones might indicate another factor contributing to the condition. Researchers at the Cambridge Autism Research Centre are following up recent work that suggests that excess amounts of the male hormone testosterone in the womb may adversely affect the development of social skills.

The researchers found that children who had experienced high testosterone levels in the womb tended to be poor at maintaining eye contact, a symptom of the adverse socialization skills associated with autism. Simon Baron-Cohen, professor of psychopathology and head of the Centre, speculates that "the condition may simply be one end of a continuum. In other words, social skills may be like height: some people are smaller than others, then you get a cutoff point where you start to talk of dwarfism. The same may be true of autism."

Daily life for autistic people and those who care for them is very difficult. But awareness and understanding of the condition [EM] and how best to help autistic individuals and their families [EM] are improving all the time. And perhaps the most important starting point is the realization that parents are not responsible for their child's condition

With reporting by ABI DARUVALLA/Leiden, JEFF ISRAELY/Rome and ULLA PLON/Gothenburg

	FOOD & DRINK Chefs Who Shine Nothing in the food world beats a Michelin star. TIME talks to the five European chefs receiving top honors PROFILE Model Example Waris Dirie wants to alert the world to the plight of millions of young women BUSINESS No Picnic Teddy bear rivals feud over new "make-your-own" models ARTS Urban Legends Young British artists are opting for cityscapes with a hint of darkness