How severe childhood autism can be ?
Definition of autism
Also known as Kanner's syndrome. Autism represents the severe end of spectrum of pervasive developmental disorders.
Autism presents with triads of presentation:
- language and communication difficulties.
- Poor/absent social interactions.
- Restricted and repetitive behaviour.
This broad category includes Asperger's syndrome and Rett's syndrome .
What cause childhood autism ?
Aetiology remain unknown and there is no sound evidence between MMR vaccine and autism.
Autism is associated with genetic factors. It is common in social class 1 and 2. It is often coexists with learning disability. 40 % with IQ less than 50 , 10% IQ more than 100. Epilepsy is common in adolescence.
How common is autism ?
The prevalence of autism is 2 / 10 000 with male to female ratio is 4: 1.
How does autism present ?
The clinical features of autism includes onset less than 36 months, with 20% develop autistic features after a period of normal development. Early symptoms include floppiness, poor eye contact and sluggish feeding. It is follow by social impairments such as aloofness, lack of interest in people, unresponsive to social cues, poor eye contact, no capacity to share or understand emotions, failure to develop normal attachment.
The language abnormalities includes distorted and delayed speech and language development, echolalia, stilted rate and rhythm of speech, impaired use of gestures and facial expressions. Stereotyped or ritualized behaviour such as hand flapping, rocking, restricted and repetitive behaviour repertoire, insistence on routine, resistance to change, true obsession/compulsions especially in adolescence. May have isolated exceptional abilities.
In mental state examination the child may present with ritualized, stereotyped behaviour, poor eye contact, aloof, may attach to unusual items,the speech is delay, echolalia, stilted rate and rhythms of speech, impaired use of gestures, and facial expression. The mood is normal and the thought is obsessions and compulsions. In term of cognitions may have an exceptional abilities in certain fields such as mathematics. Otherwise delayed language development.Insight is poor.
Full developmental assessment required and sensory deficit such as deafness need to be excluded.
How to manage childhood autism ?
General principles of treatment based on early detection to reduce handicap. In children treatment of comorbid problems such as ADHD or epilepsy is required.Speech therapy to improve language skills, behaviuoral approach to challenging behaviours. Parents/family requires education. Support groups such as National Austistic Society . Family therapy to reduce carer stress. School with special education is needed and encourage social interaction .
What is the complication of autism ?
The complication includes social isolation and inability to live independently in the majority.
What is the prognosis of autism ?
It is a lifelong disorder and better prognosis with early speech acquisition, higher intelligence and signs of diminishing impairments.
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