Autistic Spectrum Disorders Flashcards
Characterised by a ‘triad of impairements’
Social interaction
Imaginative thought
Communication
ICD-10 Childhood autism
Presence of abnormal or impaired development before the age of three years, in at least one out of the
following areas:
1) receptive or expressive language as used in social communication
2) the development of selective social attachments or of reciprocal social interaction
3) functional or symbolic play.
Qualitative abnormalities in reciprocal social interaction, manifest in at least one of the following areas:
1) failure adequately to use eye-to-eye gaze, facial expression, body posture and gesture to regulate social
interaction;
2) failure to develop (in a manner appropriate to mental age, and despite ample opportunities) peer
relationships that involve a mutual sharing of interests, activities and emotions;
3) A lack of socio-emotional reciprocity as shown by an impaired or deviant response to other people’s
emotions; or lack of modulation of behaviour according to social context, or a weak integration of social,
emotional and communicative behaviours.
Qualitative abnormalities in communication, manifest in at least two of the following areas:
1) a delay in, or total lack of development of spoken language that is not accompanied by an attempt to
compensate through the use of gesture or mime as alternative modes of communication (often preceded by
a lack of communicative babbling)
2) relative failure to initiate or sustain conversational interchange (at whatever level of language skills are
present) in which there is reciprocal to and from responsiveness to the communications of the other person
3) stereotyped and repetitive use of language or idiosyncratic use of words or phrases
4) abnormalities in pitch, stress, rate, rhythm and intonation of speech
Restricted, repetitive, and stereotyped patterns of behaviour, interests and activities, manifest in at least two
of the following areas:
1) an encompassing preoccupation with one or more stereotyped and restricted patterns of interest that are
abnormal in content or focus; or one or more interests that are abnormal in their intensity and
circumscribed nature although not abnormal in their content or focus.
2) apparently compulsive adherence to specific, non-functional, routines or rituals;
3) stereotyped and repetitive motor mannerisms that involve either hand or finger flapping or twisting, or
complex whole body movements;
4) preoccupations with part-objects or non-functional elements of play materials (such as their odour, the feel
of their surface, or the noise or vibration that they generate);
5) distress over changes in small, non-functional, details of the environment.
The clinical picture is not attributable to the other varieties of pervasive developmental disorder; specific
developmental disorder of receptive language with secondary socio-emotional problems; reactive attachment disorder or disinhibited attachment disorder; mental retardation with some associated emotional or behavioural disorder; schizophrenia of unusually early onset; and Rett’s syndrome
Atypical Autism
Presence of abnormal or impaired development at or after age three years (criteria as for autism
except for age of manifestation).
Qualitative abnormalities in reciprocal social interaction or in communication, or restricted, repetitive and
stereotyped patterns of behaviour, interests and activities (criteria as for autism except that it is not
necessary to meet the criteria in terms of number of areas of abnormality).
The disorder does not meet the diagnostic criteria for autism
Presentation
50% parents have cause for concern by 12-18 months
Speech delay common first concern
Lack of, or inconsistent use of, eye contact
Lack of social smile, imitation, response to name
Lack of interest in others
Lack of emotional expression
Few directed vocalisations
Absence of joint attention skills (pointing to show, following a point, monitoring others’ gaze and referencing objects or events)
Few requesting behaviours
Few social gestures (such as waving, clapping, nodding and shaking head)
Reduced pretend play
Regression seen in approx. 25% of children, skill may be in language, play or social skills
Associated medical problems
25-30% have seizures, usually appears in puberty
Visual impairment
Hearing impairment
70% also meet diagnostic criteria for another psychiatric disorder
Intellectual disability (IQ <50) in 50%
Underlying medical disorders such as untreated phenylketonuria, congenital rubella, cytomegalovirus or toxoplasmosis, fragile X syndrome or tuberous sclerosis
Pica
Seep disorders
Management
No drug treatments, but can treat specific problems such as extreme anxiety or disruptive behaviour
MDT approach
SALT
Child psychologists
Special education programmes
Strong professional support for parents
15% independent as adults, 15-20% functioning well with support, improved outcomes seen if communicative speech by 5 years
