Dr Diane Mullins, RCSI Tutor in Psychiatry, St Ita’s Hospital, Portrane

Childhood autism / autism / clinical description and treatment of autism
Diagnostic criteria (DSM-IV)
 A pervasive developmental disorder (PDD) defined by the presence of abnormal
and / or impaired development that is manifest before the age of 3 years
 Characterised by abnormal functioning in three areas:
o Social interaction
 Impaired use of non-verbal behaviours (i.e. poor eye contact, facial
expression, body postures, and gestures to regulate social interaction)
 Failure to develop peer relationships
 Lack of spontaneous seeking to share enjoyment, interests or
achievements with other people (e.g. by showing, bringing or pointing
out objects of interest)
 Lack of social or emotional reciprocity
o Communication
 Delay in, or total lack of, the development of spoken language
 In people with adequate speech, marked impairment in the ability to
initiate or sustain a conversation with others
 Stereotyped and repetitive use of language
 Lack of varied, spontaneous make-believe play or social imitative play
o Restricted, repetitive behaviours and interests
 Preoccupation with one or more stereotyped and restricted patterns of
interest that is abnormal either in intensity or focus
 Inflexible adherence to specific routines or rituals
 Stereotyped and repetitive motor mannerisms (e.g. hand or finger
flapping or twisting, or complex whole body movements)
 Persistent preoccupation with parts of objects
Other clinical features
 ~ 40% have IQ < 50, only 30% > 70
 Neurological features
o Seizures (1/3 of autistic people develop seizures during adolescence)
o Motor tics
o ↑ head circumference
o ↑ ambidexterity
 Psychological features
o Unusually intense sensory responsiveness (e.g. to bright lights, loud noise,
rough textures)
o Absence of typical response to pain or injury
o Abnormal temperature regulation
 Behavioural problems
o Irritability
o Temper tantrums
o Self-injury
o Hyperactivity
o Aggression
Epidemiology
 Males > females (3-4 : 1)
 Prevalence: 5-10 per 1,000 people
1

Olanzapine. abnormal dermatoglyphics suggest neurodevelopmental basis o ↑ with maternal rubella. Individuals who experience a theory of mind deficit have difficulty determining the intentions of others. parietal and temporal lobes Differential diagnosis  Deafness  Mental retardation with behavioural symptoms  Developmental language disorder  Childhood schizophrenia  Disintegrative psychosis (i.e. Quetiapine. tuberous sclerosis. Rett’s syndrome o Autoimmune (anecdotal MMR: not proven) o Neurochemistry:  ↑ CSF HVA associated with autistic stereotypies  ↑ 5-HIAA associated with symptom severity o Hypothesis of ‘refrigerator parents’ now discounted (i. difficulty seeing things from any other perspective than their own. Risperidone. and have a difficult time with social reciprocity) o MRI: ↑ brain volume in occipital. psychometric and educational assessments  Rating scales: o Autistic Diagnostic Interview Revised (ADI-R) o Autism Diagnostic Observation Schedule (ADOS) Management  No specific treatment  Counselling and support for parents.e. PKU. self-help groups  Educational placement  Behaviour modification. St Ita’s Hospital.social behaviour. lack understanding of how their behavior affects others. MZ>DZ twins. 3% prevalence among siblings of autistic people o Excess of perinatal complications. language skills etc  Drug treatment: Haloperidol ↓ behavioural symptoms and stereotypes but risk of tardive dyskinesia. RCSI Tutor in Psychiatry. Clozapine and Ziprasidone have also been used Course and prognosis  IQ and development of language skills related to prognosis 2 . minor physical anomalies.e.Dr Diane Mullins. severe & sustained impairments in social relationships. autistic behaviors stem from the emotional frigidity of the children's mothers) o Lack of theory of mind (i. Portrane Aetiology  Cause is unknown but hypotheses exist: o Genetic: ↑ in Down’s syndrome and Fragile X syndrome. speech and language with onset after 30 months of age)  CNS disorders (tuberous sclerosis etc) Assessment (involve parent & child)  Full evaluation of physical & mental state  Specific developmental.

RCSI Tutor in Psychiatry.Dr Diane Mullins. St Ita’s Hospital. Portrane o Severely handicapped: 2/3 o Fair adjustment: 1/6 o Adequate social adjustment: 1/6  In adult life 75% of children met criteria for schizotypal personality disorder 3 .