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Chapter: Paediatrics: Child and family psychiatry

Paediatrics: 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.

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).

 

Aetiology

 

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)

 

Clinical features

 

·  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.

 

Management

 

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

 

Prognosis

·  70% remain severely handicapped.

 

·  50% develop useful speech.

 

·  5% will lead independent adult lives.

 

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