AutismAutism

Definition and historyDefinition and history

Information supplied by National Autistic Society

• Displays indifference • Joins in only if adult insists and assists• Indicates needs by using an adult's

hand• One-sided interaction• Does not play with other children• Echolalic – copies words like a parrot• Talks incessantly about one topic• Bizarre behaviour • Handles or spins objects• Lack of creative, pretend play• Variety is not the spice of life• Eye contact is odd• Inappropriate laughing or giggling• But some can do some things very

well, very quickly but not tasks involving social understanding

HistoryHistoryAsperger (1944); Kanner Asperger (1944); Kanner (1943)(1943)

Innate inability to form the usual biologically provided Innate inability to form the usual biologically provided affective contact with peopleaffective contact with people

Poverty of facial expressionPoverty of facial expression Many stereotypical movements that do not convey Many stereotypical movements that do not convey

meaningmeaning Impulsive and stimulus drivenImpulsive and stimulus driven Can have excellent logical and abstract thoughtCan have excellent logical and abstract thought Kanner’s cardinal features:Kanner’s cardinal features:

Autistic alonenessAutistic aloneness Obsessive insistence on samenessObsessive insistence on sameness

Wing’s (1979) triad of impairmentsWing’s (1979) triad of impairments Socialization, communication, imaginationSocialization, communication, imagination

DiagnosisDiagnosis ICD 10 (International classification of disorders)ICD 10 (International classification of disorders) DSM IV (Diagnostic and statistical manual)DSM IV (Diagnostic and statistical manual) DISCO (Diagnostic Interview for Social and Communication DISCO (Diagnostic Interview for Social and Communication

Disorders)Disorders) ADI (Autistic Diagnostic Instrument)ADI (Autistic Diagnostic Instrument) 1 Impairment of social interaction1 Impairment of social interaction

• The most severe form is aloofness and indifference to other people The most severe form is aloofness and indifference to other people although most enjoy certain forms of active physical contact and show although most enjoy certain forms of active physical contact and show attachment on a simple level to parents or carers. attachment on a simple level to parents or carers.

2 Impairment of social communication2 Impairment of social communication • A lack of appreciation of the social uses and the pleasure of A lack of appreciation of the social uses and the pleasure of

communication is always present in one form or anothercommunication is always present in one form or another 3 Impairment of imagination3 Impairment of imagination

• In children, inability to play imaginatively with objects or toys or with In children, inability to play imaginatively with objects or toys or with other children or adults is an outward manifestation of this impairment.other children or adults is an outward manifestation of this impairment.

Stereotyped activitiesStereotyped activities Simple stereotyped activities include: Simple stereotyped activities include:

flicking fingers, objects, pieces of string watching things that spinflicking fingers, objects, pieces of string watching things that spin

tapping and scratching on surfacestapping and scratching on surfaces

inspecting, walking along and tracing lines and anglesinspecting, walking along and tracing lines and angles

feeling special texturesfeeling special textures

rocking, especially standing up and jumping from back foot to front rocking, especially standing up and jumping from back foot to front footfoot

tapping, scratching or otherwise manipulating parts of the bodytapping, scratching or otherwise manipulating parts of the body

repetitive head banging or self injuryrepetitive head banging or self injury

teeth grindingteeth grinding

repetitive grunting, screaming or other noisesrepetitive grunting, screaming or other noises

Other stereotyped activitiesOther stereotyped activities Complex stereotyped activities involving objects include: Complex stereotyped activities involving objects include:

• intense attachment to particular objects for no apparent intense attachment to particular objects for no apparent purposepurpose

• a fascination with regular repeated patterns of objects, soundsa fascination with regular repeated patterns of objects, sounds• arranging objects in lines or patternsarranging objects in lines or patterns• the collection, for no apparent purpose, of large numbers of the collection, for no apparent purpose, of large numbers of

particular objects, such as plastic bottles, pebbles, or the tops particular objects, such as plastic bottles, pebbles, or the tops from tubes of Smarties from tubes of Smarties

Complex stereotyped activities involving routines include: Complex stereotyped activities involving routines include: • insistence on a lengthy bedtime ritualinsistence on a lengthy bedtime ritual• repetition of a sequence of odd bodily movementsrepetition of a sequence of odd bodily movements

Complex verbal or abstract repetitive activities include: Complex verbal or abstract repetitive activities include: • fascination with certain topics, such as electricity, astronomy, fascination with certain topics, such as electricity, astronomy,

birds, train timetables, even specific persons, asking the same birds, train timetables, even specific persons, asking the same series of questions and demanding standard answers series of questions and demanding standard answers

IncidenceIncidenceBaird et al (2006)Baird et al (2006)

Within a total population cohort of 56 946 children aged 9–10 years, we screened all those with a current clinical diagnosis of ASD (n=255) or those judged to be at risk for being an undetected case (n=1515).

The prevalence of childhood autism was 38·9 per 10 000 (95% CI 29·9–47·8) and that of other ASDs was 77·2 per 10 000 (52·1–102·3), making the total prevalence of all ASDs 116·1 per 10 000 (90·4–141·8).

Prevalence of autism and related ASDs is substantially greater than previously recognised. Whether the increase is due to better ascertainment, broadening diagnostic criteria, or increased incidence is unclear.

CausesCauses Girls with Turner’s syndrome (Skuse et al, 1997)Girls with Turner’s syndrome (Skuse et al, 1997) Concordance rates (Bailey et al, 2000)Concordance rates (Bailey et al, 2000)

• 36% in identical twins, with 82% language and/or intellectual 36% in identical twins, with 82% language and/or intellectual impairmentsimpairments

• 0% in fraternal twins, with 10% language/or intellectual 0% in fraternal twins, with 10% language/or intellectual impairmentimpairment

• Wider phenotypeWider phenotype ComorbidityComorbidity

• PKUPKU• Fragile XFragile X• Learnining disabilitiesLearnining disabilities

A third of adolescents have epileptic seizuresA third of adolescents have epileptic seizures Many have abnormal EEGMany have abnormal EEG Persistence of infantile reflexesPersistence of infantile reflexes Stereotypic movementsStereotypic movements