Mental health articles

Autistic disorders are also known as pervasive developmental disorders. Most professionals agree that three features are essential to the diagnosis. A general and profound failure to develop social relationships; language retardation and ritualistic and compulsive behaviour. Additionally, these abnormalities should manifest themselves before 30 months.

Prevalence

Community surveys have found prevalence rates of two per 10,000 increasing to 20 per 10,000 depending on how narrowly or broadly the disorder is defined. Boys are affected three times as much as girls.

Social impairment

The impairment of social development often reveals itself in infancy as the child appears aloof, fails to seek comfort from adults and generally shows a lack of interest in people. In half of the children with autism, some social interest and competence develops, although problems with empathy and social reciprocity remain. Roughly 50 per cent of children fail to acquire useful speech. Acquisition of language is delayed and, when present, language abnormalities are common, including poor comprehension, intonation and pronominal reversal (for example using ‘you’ for ‘I’).

Ritualistic compulsive behaviours and interests

Common abnormalities include resistance to change, stereotyped, narrow and repetitive patterns of play (for example, lining up toys). Some children show intensive attachment to unusual objects or preoccupation and interests (train timetables, cricket scores). Early signs of a lack of social interest may be missed but, by the second or third year of life, their social deficits become more noticeable. Some children go through a stage when they lose previously acquired skills. Fifty per cent of children with autism have an IQ less than 50.

Asperger’s syndrome This condition is regarded by some as a milder version of autism. These children are often aloof, distant and lacking in empathy. There is usually no delay in the development of vocabulary and grammar, though other aspects of language are abnormal as in autism.

Management

Management includes appropriate assessment and school placement, and provision of advice and support for parents. Children with autism do well in a structured educational setting with behavioural programmes to reduce ritualistic behaviour, tantrums and aggressive behaviour while encouraging the child in task-orientated work. The use of neuroleptic medication, such as risperidone, chlorpromazine and haloperidol does not improve the core symptoms but does improve symptoms such as behavioural disturbance and aggression. Stimulants may reduce hyperactivity. The prognosis is better in children with higher intelligence and for children who acquire useful speech by the age of 5 years.

Tags: autistic, diagnosis, disorders, symptoms