Autistic disorder
Autistic disorder: Excerpt from Professional Guide to Diseases (Eighth Edition)
A severe, pervasive developmental disorder, autistic disorder is marked by unresponsiveness to social contact, gross deficits in intelligence and language development, ritualistic and compulsive behaviors, restricted capacity for developmentally appropriate activities and interests, and bizarre responses to the environment. Autistic disorder may be complicated by epileptic seizures, depression and, during periods of stress, catatonic phenomena. Autism usually becomes apparent before the child reaches age 36 months but, in some children, the actual onset is difficult to determine. Occasionally, autistic disorder isn’t recognized until the child enters school. (See Other pervasive developmental disorders, page 420.)
The prognosis for autistic disorder is poor; most patients require a structured environment throughout life.
Causes and incidence
The causes of autistic disorder remain unclear but are thought to include psychological, physiologic, and sociological factors. Much evidence has accumulated to suggest a biological substrate. The parents of a child who’s autistic may appear distant and unaffectionate. However, because children who are autistic are unresponsive or respond with rigid, screaming resistance to touch and attention, parental remoteness may be merely a frustrated, helpless reaction to this disorder, not its cause.
Some children who are autistic show abnormal but nonspecific EEG findings that suggest brain dysfunction, possibly resulting from trauma, disease, or a structural abnormality. Autistic disorder has also been associated with maternal rubella, untreated phenylketonuria, tuberous sclerosis, anoxia during birth, encephalitis, infantile spasms, and fragile X syndrome. Studies have established a link with abnormalities in neurotransmitters, including (in some cases) increased dopamine and increased serotonin. There appears to be a genetic component as well; between 2% and 4% of siblings of those with autism also had autistic disorders at a rate higher than the general population.
Autistic disorder is rare, affecting 4 to 5 children per 10,000 births. It affects three to four times more boys than girls.
Signs and symptoms
A primary characteristic of infantile autistic disorder is unresponsiveness to people. Infants with this disorder won’t cuddle, avoid eye contact and facial expressions, and are indifferent to affection and physical contact. Parents may report that the child becomes rigid or flaccid when held, cries when touched, and shows little or no interest in human contact.
As the infant grows older, his smiling response is delayed or absent. He doesn’t lift his arms in anticipation of being picked up or form an attachment to a specific caregiver. Furthermore, he doesn’t show the anxiety about strangers that’s typical in the 8-month-old infant.
A child who’s autistic fails to learn the usual socialization games (peek-a-boo, pat-a-cake, or bye-bye). He’s likely to relate to others only to fill a physical need and then without eye contact or speech. The end result may be mutual withdrawal between parents and child.
Severe language impairment and lack of imaginative play are characteristic. The child may be mute or may use immature speech patterns. For example, he may use a single word to express a series of activities; he may say “ground” when referring to any step in using a playground slide.
His speech commonly shows echolalia (meaningless repetition of words or phrases addressed to him) and pronoun reversal (“you go walk” when he means, “I want to go for a walk”). When answering a question, he may simply repeat the question to mean yes and remain silent to mean no.
He shows little imagination, seldom acting out adult roles or engaging in fantasy play. In fact, he may insist on lining up an exact number of toys in the same manner over and over or repetitively mimic the actions of someone else.
A child who’s autistic shows characteristically bizarre behavior patterns, such as screaming fits, rituals, rhythmic rocking, arm flapping, crying without tears, and disturbed sleeping and eating patterns. His behavior may be self-destructive (hand biting, eye gouging, hair pulling, or head banging) or self-stimulating (playing with his own saliva, feces, and urine). His bizarre responses to his environment include an extreme compulsion for sameness.
In response to sensory stimuli, he may underreact or overreact and he may ignore objects — dropping those he’s given or not looking at them — or he may become excessively absorbed in them — continually watching the objects or the movement of his own fingers over the objects. He commonly responds to stimuli by head banging, rocking, whirling, and hand flapping. He tends to avoid using sight and hearing to interact with the environment.
A child who’s autistic may exhibit additional behavioral abnormalities, such as:
❑ cognitive impairment (most have an IQ of 35 to 49)
❑ eating, drinking, and sleeping problems, for example, limiting his diet to just a few foods, excessive drinking, or repeatedly waking during the night and rocking
❑ mood disorders, including labile mood, giggling or crying without reason, lack of emotional responses, no fear of real danger but excessive fear of harmless objects, and generalized anxiety.
Diagnosis
For characteristic findings in patients with this condition, see Diagnosing autistic disorder.
Treatment
The difficult and prolonged treatment of autistic disorder must begin early, continue for years (through adolescence), and coordinate efforts to encourage social adjustment and speech development and to reduce self-destructive behavior.
Behavioral techniques are used to decrease symptoms and increase the child’s ability to respond. Positive reinforcement, using food and other rewards, can enhance language and social skills. Providing pleasurable sensory and motor stimulation (such as jogging or playing with a ball) encourages appropriate behavior and helps eliminate inappropriate behavior. Drug therapy with an agent, such as haloperidol, may be helpful. Risperidone has been used successfully to diminish aggressiveness and hyperactivity.
Treatment may take place in a psychiatric institution, in a specialized school, or in a day-care program; however, the current trend is toward home treatment. Because family members tend to feel inadequate and guilty, they may need counseling. Until the causes of infantile autism are known, prevention isn’t possible.
Special considerations
❑ Reduce self-destructive behaviors. Physically stop the child from harming himself, while firmly saying “no.” When he responds to your voice, first give a primary reward (such as food); later, substitute verbal or physical reinforcement (such as saying “good” or giving the child a hug or a pat on the back).
❑ Foster appropriate use of language. Provide positive reinforcement when the child indicates his needs correctly. Give verbal reinforcement at first (for example, by saying “good” or “great”); later, give physical reinforcement (such as a hug or a pat on the hand or shoulder).
❑ Encourage development of self-esteem. Show the child that he’s acceptable as a person.
❑ Encourage self-care. For example, place a brush in the child’s hand and guide his hand to brush his hair. Similarly, teach him to wash his hands and face.
❑ Encourage acceptance of minor environmental changes. Prepare the child for the change by telling him about it beforehand. Make initial changes minor; for example, change the color of his bedspread or the placement of food on his plate. When he has accepted minor changes, move on to bigger ones.
❑ Provide emotional support to the parents, and refer them to the Autism Society of America.
❑ Teach the parents how to physically care for the child’s needs.
❑ Teach the parents how to identify signs of excessive stress and the coping skills to use under these circumstances. Emphasize that they’ll be ineffective caregivers if they don’t take the time to meet their own needs in addition to those of their child.
❑ Help the parents understand that they aren’t responsible for their child’s condition and shouldn’t feel guilty about it.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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