autism

Autism refers to a spectrum of neurologic conditions in which the primary or most noticeable component is disordered verbal and nonverbal communication with other people. It has its onset before 2-1/2 years of age. The incidence in children is 3 or 4 cases per 10,000 children; there is about a 4 to 1 male:female predominance.

Autism itself falls under the broader umbrella of pervasive developmental disorders (PDDs). These include

Most common symptoms and signs are

nondeveloped or poorly developed verbal and nonverbal communication skills
abnormalities in speech patterns
impaired ability to sustain a conversation
abnormal social play
lack of empathy
inability to make friends
stereotypical and repetitive body movements
a striking need for sameness
very narrow interests
preoccupation with parts of the body are also frequent
withdrawn, often spending hours in solitary play
ritualistic behavior
tantrum-like rages with disruptions of routine
minimal or absent eye contact
visual scanning of hand and finger movements
features of speech if present
- echolalia (senseless repetition of anything another says)
- pronomial reversal
- nonsense rhyming

Autistic children were once considered to be all uniformly retarded and nonverbal. Study and better diagnostic classification of these children shows that there can be a large range of language ability, intelligence, and social communication ability.

The cause of autism is unknown. Genetic factors are probably to blame. Despite ideas popular in the past, it is now known that parents do not cause autism in their children.

There is no single best treatment for autism and other PDDs. Therapy is both specialized and highly individualized for each child's needs. Early detection and treatment of PDDs is known to improve long term outcome. Children entering treatment under age three do better than those who are not referred for treatment until age 5 or later.

The prognosis for autistic children is "guarded." While some children may grow up to live independently in the community, for some, institutional care is the ultimate outcome. Children with higher intelligence, functional speech, and less bizarre symptoms and behavior have better outcomes.

Parents and physicians should be aware of certain warning signs that require immediate referral for investigation:

no babbling by 12 months (this would raise serious concern about hearing ability as well)
no gesturing (point, waving bye-bye) by 12 months
no single words by 16 months
no two-word spontaneous phrases by 24 months
any loss of language or social skills at any age

Chris Johnson, M.D. "Screening and Diagnosis of Autistic Spectrum Disorders" Neurology 2000; 55:468-479

Further information on autism can be obtained through the Autism Society of America.

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