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AUTISM SPECTRUM DISORDER
 


SYNOPSIS

Childhood Autism F84.0 - ICD10 Description, World Health Organization

A type of pervasive developmental disorder that is defined by: (a) the presence of abnormal or impaired development that is manifest before the age of three years, and (b) the characteristic type of abnormal functioning in all the three areas of psychopathology: reciprocal social interaction, communication, and restricted, stereotyped, repetitive behaviour. In addition to these specific diagnostic features, a range of other nonspecific problems are common, such as phobias, sleeping and eating disturbances, temper tantrums, and (self-directed) aggression.

    F84.1 Atypical Autism
    A type of pervasive developmental disorder that differs from childhood autism either in age of onset or in failing to fulfil all three sets of diagnostic criteria. This subcategory should be used when there is abnormal and impaired development that is present only after age three years, and a lack of sufficient demonstrable abnormalities in one or two of the three areas of psychopathology required for the diagnosis of autism (namely, reciprocal social interactions, communication, and restricted, stereotyped, repetitive behaviour) in spite of characteristic abnormalities in the other area(s). Atypical autism arises most often in profoundly retarded individuals and in individuals with a severe specific developmental disorder of receptive language.
Autism Spectrum Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with autism spectrum disorder needs to meet all of the following criteria:

  • Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive):

    • Deficits in social-emotional reciprocity, ranging, for exampe, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.

    • Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.

    • Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

  • Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive):

    • Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).

    • Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficultties with transitions, rigid thinking patterns, greeting rituals, need to take same route to eat same food every day).

    • Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscreibed or perseverative interests).

    • Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifferene to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

  • Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).

  • Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

  • These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

    Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger's disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but lack restricted, repetitive patterns of behavior, should be evaluated for social (pragmatic) communication disorder.

Individuals with this disorder must show symptoms from early childhood, even if those symptoms are not recognized until later. This disorder is characterized by (1) deficits in social communication and social interaction and (2) restricted repetitive behaviors, interests, and activities (RRBs). Because both components are required for diagnosis of autism spectrum disorder, social communication disorder is diagnosed if no RRBs are present. These individuals are socially isolated (because of their trouble reading social cues and recognizing other people's feelings, plus their avoidance of eye contact). They obsessively pursue a single interest and talk about little else. They show repetitive, obsessional, and/or perfectionistic behaviors. They usually are overly dependent on routines, highly sensitive to changes in their environment, or intensely focused on inappropriate items. The symptoms of individuals with this disorder fall on a continuum, with some individuals showing mild symptoms and others having much more severe symptoms. Higher functioning individuals with this disorder may have normal intellectual capacity and language development. However, lower functioning individuals with this disorder frequently have low intellectual capacity, and all have delayed speech. One third of children with autism have epilepsy. Long-term outcome in adulthood is variable; the majority live either in 24-hour residential care or at home with community supports. Most of these adults are unemployed, single and socially isolated.

New Evidence Shows That Autism Begins During Pregnancy

Researchers have found that there are patches of disorganization in the neocortex of the frontal and temporal lobes of the brains of children with autism. These brain abnormalities are present in the second and third trimester of pregnancy. This research conclusively shows that autism begins during pregnancy, but what causes this prenatal brain disorganization is still not known.

Ineffective Therapies

No medication is effective against the core features of this disorder. However, risperidone and aripiprazole reduce aggression, and methylphenidate reduces hyperactivity. None of the psychological treatments for this disorder have robust evidence of their effectiveness.

Overburdening Caregivers

In many developed countries, there are little or no community supports given to individuals with Austism once they become adults. Thus the devoted parents of these individuals are usually left to shoulder the entire burden of caregiving for Austic adults - which usually is an impossible task. That is why it is essential that governments subsidize community supports for adults with Austism. Governments must offer these adult patients adequate medical and psychiatric services, free pharmaceuticals, disability pensions, supervised group homes, and specialized day programs. Otherwise these individuals end up being hospitalized at great expense (or abandoned to roam the streets).

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