Autism• A complex neurobiological developmental disorder that most typically appears during the first 2 years of life• The diagnosis of autism is based on the display of at least 6 out of 12 symptoms in three categories• The core features of autism must be present for a diagnosis to be made
CORE FEATURES – Social impairment – Verbal and nonverbal communication impairment – Characteristic patterns of behavior that tend to be repetitive and ritualistic• Autism is a lifelong disorder defined by the individuals interactive difficulties, which can range from mild to severely impaired
• 4-5x more common in males than females• Affected females tend to be more severely impaired• There is strong evidence to suggest a genetic etiology• Approximately 75% of people with autism are cognitively impaired, with a wide range of potential IQs.• Autism is seen in approximately 60 - 70 per 10,000 live births.
• A clear cause has not been identified• However, evidence suggests a genetic predisposition• Studies have shown that measles, mumps, and rubella vaccine do not cause autism.• Likewise, thimerosal, a preservative found in many vaccines, does not cause autism• .
• Before diagnosis, parents may be initially concerned about their infants social interactions, delayed or unusual speech development, and reactions to various stimuli (ie, tactile defensiveness)• Individuals with ASD have neuroanatomical differences, including small neuron cell size, increased cell packing, relative macrocephaly, and large third ventricles.
• Early diagnosis leads to earlier interventions, resulting in improved outcomes for these children.• The two major diagnostic challenges in the evaluation of ASD include making the differential diagnosis and searching for the etiologic disorder associated with ASD (ie, 3% to 5% of children with ASD will also have a diagnosis of fragile X syndrome.)
• Comprehensive standardized assessment tools specific for ASD usually require specialized training; these tools include Childhood Autism Rating Scale (CARS), Diagnostic Interview of Social and Communication Disorders (DISCO), Autism Diagnostic Interview (ADI), and Autism Diagnostic Interview Schedule (ADOS)• Alternative treatments, such as nutrition and vitamin therapy, are being investigated but no definitive research has been conclusive to date
• Many children with ASD also have psychiatric comorbidities with such conditions as obsessive compulsive disorder, attention deficit hyperactivity disorder (ADHD), depression, mood disorders, and Tourette syndrome• These conditions can be challenging to diagnose as it may be difficult to assess the child with communication and behavioral problems
• Indeed, health care providers need to be vigilant in screening and monitoring for these comorbidities in order to appropriately ensure optimal functioning of the child with ASD.• Medical comorbidities are also common in children with ASD, such as seizure disorders, sleep disturbances, GI disorders, and dental problems
• As with psychiatric comorbidities, health care providers need to be vigilant in their assessment as it can improve behavior and functioning of the child with ASD• A multidisciplinary team, including primary care provider; medical subspecialists; occupational, speech, and physical therapists; and educational specialist is essential for optimal care