Definition Autistic disorder, also known aschildhood autism, infantile autism, orearly infantile autism, is by far the bestknown of the pervasive developmentaldisorders. characterized bydisturbances in social interactions,language and communication, and thepresence of stereotyped behaviors andinterests.
“Qualitative impairment in social interaction,communication, restricted repetitive andstereotyped patterns of behavior, interest andactivities, delays in abnormal functioning”. - DSM IV “A pervasive developmental disordercharacterized by a total lack of responsiveness topeople, gross language developmental deficits ordistortions, bizarre responses to environmentalaspects e.g. resistance to change or peculiarinterest in an animate or inanimate object”. - American Psychiatric Association,(1980).
It is a severe pervasive disorder of emotions, speech andbehavior starting in early childhood after a brief period ofnormal development.Onset : Delays social interaction, language, or play byage or abnormal functioning in 3 yrSex Ratio : Studies based on both clinical andepidemiological samples have suggested a higherincidence of autistic disorder in boys than in girls.Prevalence: 1/1000
Etiology and PathophysiologyCurrently, the precise etiology andpathogenesis of Autism is unknown, organicbrain insult is suggested.Strong evidence for genetic bases for thedisorders.The condition was always caused by a“refrigerator” mother who was not responsiveto the childs emotional needs.Removal of the child from the family.
Continue..Studies of twins indicated high concordance,especially for monozygotic twin pairs, withreduced concordance for fraternal, or dizygotic,same-sex twin pairs.In families of approximately 2 to 3 percent ofautism among siblings.prenatal, perinatal, and neonatal complications.congenital rubella.
Features: 1. Inability to relate: No emotional interaction with people. Emotional responses to parents, strangers and inanimate objects are the same. Gaze avoidance is a characteristics feature.
continuing 2. Language impairment: Interpersonal verbal communication is markedly affected. 3. Preoccupation with certain objects and rituals with resistance to change (e.g. the same food).
continuing 4. Other features:Labile mood and non-specific anger and fear.Overactivity and distractibility.Disturbed sleep.Varying degrees of mental retardation are present in 75 % of cases.Epilepsy may develop in adolescence in 20 – 25 % of severe cases.Enuresis and encopresis may occur.
Social interactionQualitative least two interaction, asmanifested by at impairment in social of the following: • Marked impairment in the use of multiple nonverbal behaviors (e.g. eye-to-eye gaze) • Failure to develop peer relationships appropriate to developmental level • Lack of spontaneous seeking to share enjoyment with other People. • Lack of social or emotional reciprocity
CommunicationQualitative communication as manifested by at least one of the impairments of following: • Delay in, or total lack of, the development of spoken language • Marked impairment in initiating or sustaining a conversation with others, in individuals with adequate speech • Stereotyped and repetitive use of language • Lack of varied, spontaneous makebelieve, or imitative play
BehaviorRestricted, stereotyped patterns of behavior, as manifested by one repetitive, and of the following: • Preoccupation with one or more stereotyped or restricted patterns of interest • Adherence to nonfunctional routines • Stereotyped and repetitive motor mannerisms • Persistent preoccupation with parts of objects
Mood and affect of the autistic children -exhibit sudden mood changes with bursts oflaughing or crying for a no apparent reason . Improper response to sensory stimuli -Autistic children may be over responsive orunder responsive to sensory stimuli and mostlythey are deaf. Autistic children injure themselvesvery severely and not cry, enjoy music andvestibular stimulation such as spinning, swingingand up and down movements.
Assessment and Differential Diagnosis There are no diagnostic laboratory tests for A D. The diagnosis of Autism first involves completing a comprehensive psychiatric examination.History Particular attention to Developmental phases of language, social interactions, play Family history of psychiatric and neurological disease
Course and Prognosis Autistic disorder is a lifelong disability, Varies depending on several factors such as IQ, language development, and early treatment. About 15 % can lead independent life. About 50 % can acquire some useful speech but continue to have disturbed behaviour and cold emotions.
Treatment No specific treatmentGoals for TreatmentAdvancement of normal development, particularly regarding cognition, language and socialization Promotion of learning and problem solving Reduction of behaviors that impede learning Assistance of families coping with autistic disorder
Psychosocial interventionsEducationalCurricula that target communicationBehavioral techniquesStructured milieuVocational interventions such as speechtrainingother specialized and language therapy,physical therapy and occupational therapySocial skills trainingIndividual psychotherapy for high-functioningindividuals
Psychopharmacology No pharmacological agent has proved curativeCertain medications may be of benefit forspecific symptoms such as self-injury,aggression, stereotyped movements, and overactivity.