Autism

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Chapter 6 AUTISM

Jonathan M. Wong

General Discussion

Autistic disorder is a pervasive developmental disorder defined behaviorally as a syndrome consisting of abnormal development of social skills (withdrawal, lack of interest in peers), limitations in the use of interactive language (both speech and nonverbal), and sensorimotor deficits (inconsistent responses to environmental stimuli).

The development of impairments is varied and characteristically uneven, resulting in good skills in some areas and poor skills in others. Common impairments include deficiencies in social skills, the use of interactive language, sensorimotor skills, symbolic thinking, protodeclarative pointing, and delays in developmental milestones. These delays in developmental milestones may include slow development, development out of sequence, or regression of previously attained milestones.

Common behaviors in autistic disorder include stereotypic behaviors such as rocking or nonproductive movements of the hands and fingers as well as self-injurious behaviors and self-stimulation. Seizure disorders and mental retardation are also seen frequently in autistic disorder. Table 6-1 below lists the Diagnostic and Statistical Manual (DSM)-IV Diagnostic Criteria for Autistic Disorder.

Table 6-1 DSM-IV Diagnostic Criteria for Autistic Disorder

I. A total of six (or more) items from (A), (B), and (C), with at least two from (A), and one each from (B) and (C)

A. Qualitative impairment in social interaction, as manifested by at least two of the following:

1. Expression, body posture, and gestures to regulate social interaction

2. Failure to develop peer relationships appropriate to developmental level

3. A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)

4. Lack of social or emotional reciprocity (Note: The description gives the following as examples: not actively participating in simple social play or games, preferring solitary activities, or involving others in activities only as tools or “mechanical” aids

B. Qualitative impairments in communication as manifested by at least one of the following:

1. Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)

2. In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

3. Stereotyped and repetitive use of language or idiosyncratic language

4. Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

C. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least two of the following:

1. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

2. Apparently inflexible adherence to specific, nonfunctional routines or rituals

3. Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting or complex whole-body movements)

4. Persistent preoccupation with parts of objects

II. Delays or abnormal functioning in at least one of the following areas, with onset before age 3 years:

A. Social interaction

B. Language used in social communication

C. Symbolic or imaginative play

III. The disturbance is not better accounted for by Rett’s disorder or childhood disintegrative disorder

Autistic disorder occurs at a rate of 5 to 10 in 10,000 persons. The male-to-female ratio is 2:1 in severely handicapped individuals and 4:1 in moderately handicapped individuals. The occurrence rate in siblings is suspected to be from 3% to 7%, representing a 50- to 100-fold increase in risk.

Autism can be thought of as a spectrum of disorders in which patients may range from very highly functioning (e.g., Asperger syndrome) to severely mentally retarded. Most individuals with autism manifest some degree of mental retardation, which typically is moderate in severity.

Medications Associated with Autism

• Thalidomide (intrapartum exposure)

• Valproic acid (intrapartum exposure)

Causes of Autism

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