Autism

Autism spectrum disorders (ASD)
1. Characteristics of autistic disorder, a severe form of ASD, include
a. Significant problems with communication (despite normal hearing)
b. Significant problems forming social relationships (including those with caregivers)
c. Repetitive, purposeless behavior (e.g., spinning, self-injury)
d. Subnormal intelligence in many (26%–75%) autistic children
e. Unusual abilities in some children (e.g., exceptional memory or calculation skills). These are referred to as savant skills.
2. Asperger disorder (a mild form of ASD) involves
a. Significant problems forming social relationships
b. Repetitive behavior and intense interest in obscure subjects
c. In contrast to autistic disorder, in Asperger disorder there is normal cognitive development and little or no developmental language delay. However, conversational language skills are impaired.
3. Occurrence of ASD
a. They occur in about 17 children per 10,000.
b. They begin before 3 years of age.
c. The disorders are four to five times more common in boys.
4. Abnormalities that give clues for the etiology of ASD include
a. Cerebral dysfunction (no psychological causes have been identified)
b. A history of perinatal complications
c. A genetic component (e.g., the concordance rate for ASD is three times higher in monozygotic than in dizygotic twins)
d. Immunologic incompatibility between mother and fetus
e. Smaller amygdala and hippocampus, fewer Purkinje cells in the cerebellum, and less circulating oxytocin
C. Other pervasive developmental disorders
1. Rett disorder involves
a. Diminished social, verbal, and cognitive development after up to 4 years of normal functioning
b. Occurrence only in girls (Rett disorder is X-linked and affected males die before birth)
c. Stereotyped, hand-wringing movements; ataxia
d. Breathing problems
e. Mental retardation
f. Motor problems later in the illness
2. Childhood disintegrative disorder involves
a. Diminished social, verbal, cognitive, and motor development after at least 2 years of normal functioning
b. Mental retardation
Management
The goal of treatment is to reduce disruptive behavior and to promote learning particularly language acquisition and communication and self-help skills.
(a) Pharmacological
No pharmacological agent has proved curative but certain medications may be of benefit for specific symptoms such as self-injury, aggression, stereotyped movements and over activity. Haloperidol and Risperidone: May decrease stereotyped behaviors and Agitation. Fluoxetine and Citalopram: Reduce repetitive behavior and impulsive aggressions.
(b) Psychological
Autism is generally considered a lifelong, chronic disability. Nevertheless, specific educational and therapeutic interventions are critical for stimulating development in all areas and improving the person’s adaptive functioning in all settings (home, school, work
and community).
Adolescents and adults with autism frequently need specific help in negotiating the complexities of life demands. Social skills groups, recreational activities, individual psychotherapy, and vocational coaching and assistance can help them acquire skills necessary for a satisfying adult life.
With appropriate educational and treatment services, children with autism will show some improvements. The preschool years are typically the most difficult, because children with autism tend to be the least social, least communicative, and have the most difficulties behaviorally.
IQ remains stable across the lifespan, but the severity of the social and communicative deficits tends to diminish as children grow older. Learning continues throughout childhood and adolescence, as long as children are receiving appropriate services.
Adolescence can be a difficult time for some individuals with autism, because of increased sexual behavior and aggressiveness.
The most important positive prognostic indicators are functional language before age 5, and cognitive abilities above the mentally retarded range (i.e., IQ > 70). Another 30% are reported as achieving some degree of partial independence in adulthood. About 25% of children with autism develop seizures beginning in adolescence or early adulthood.