Autism spectrum disorders
Disorders in this cluster, also
called pervasive developmental disorders (PDD), have common clinical features
in the areas of communication, social relatedness, movement, and intrapersonal
relations. Nosological issues include the diagnostic distinctiveness of
syndromes and whether presentations can change over time. Autism spectrum
disorders include:
· Autism (prevalence 71/1000).
· Rett’s syndrome (prevalence 1/15
000).
· Asperger’s disorder (prevalence
3–4/1000).
It is likely that the autism
spectrum disorders are heterogeneous in aeti-ology. Most believe there are
underlying complex genetic vulnerabilities with subsequent environmental
influences and factors that trigger gene expression. Recent functional
neuroimaging studies have led to a wide variety of neurobiological hypotheses.
It is likely numerous neural systems are involved with a focus on areas
typically implicated in emotional regula-tion such as the limbic lobe. (See
references for Cochrane reviews discuss-ing benefit of diet, vitamins, and
auditory integration training.1–3)
· Usually identified in the
pre-school years, but may be found later in individuals with above average IQ.
· Problems with social interactions
include appearing aloof, impaired non-verbal behaviours, difficulty
establishing friendships, and poor or absent emotional reciprocity.
· Language problems include marked
delay of or lack of speech, inability to converse, and abnormal speech
including stereotypical speech.
· Behaviour problems include
preoccupied, stereotypical behaviours (e.g. hand flapping). In adolescence
aggressiveness, mood variability, and sexually inappropriate behaviour can be
problematic.
· Mental retardation, language
delay, ADHD, and medical complications such as epilepsy often coexist with an
autism spectrum diagnosis.
No single intervention appears
superior. Psychosocial interventions, of-ten with an emphasis on behaviour
management and parent involvement, can often lead to increased child skills and
have high parent satisfaction. However, such improvement does not usually lead
to significant changes either on standardized measures or improve the overall
developmental trajectory. Recent studies with atypical neuroleptics (e.g.
risperidone) hold much promise for improvement of global functioning. For an
in-depth dis-cussion of recent assessment, aetiological, and treatment research.4
· 70% remain severely handicapped.
· 50% develop useful speech.
· 5% will lead independent adult
lives.
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