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Autism Spectrum Lara Morse, M.D.
In 1943, Leo Kanner first described 11 children between the ages of two and eight years who shared unique patterns of behavior and delayed acquisition of language. When language was present, it was often unusual, echolalic (repeating the words of others), and noncommunicative. The children had significant difficulties in establishing reciprocal relationships. They had a tendency to engage in repetitive, stereotyped, nonimaginative play and had a need for “sameness.” While the diagnostic criteria has undergone much revision, the earlier description became the prototype of the Autistic Spectrum Disorders. These are a group of neurodevelopmental disorders that are characterized by impairment in reciprocal social behavior, impairment in communication abilities and restrictive, repetitive and stereotyped behaviors and interests. There are a wide variability of symptoms within the autistic spectrum. Currently, there are several diagnoses under the umbrella of The Autistic Spectrum Disorders including: autistic disorder, Asperger syndrome, childhood disintegrative disorder, Rett syndrome, pervasive developmental disorder- not otherwise specified and atypical autism. For decades after Kanner’s original paper, autism was considered rare with a prevalence of around 4 per 10,000. Prevalence rates are now higher than ever at approximately 60 per 10,000. This is due to changes in diagnostic criteria, and increasing awareness and recognition of this group of disorders. There is strong evidence that genetic factors play a major role in the etiology of the autistic spectrum disorders; however, no single mode of inheritance or gene abnormality can account for higher incidences of cognitive, communication, learning and executive functioning deficits. Many times parents have concern regarding their child’s lack of language acquisition around 18 months of age. Concern should be raised if the following does not occur: babbling by 12 months; gesturing (pointing, waving bye-bye) by 12 months; single words by 16 months; 2-word spontaneous phrases by 24 months; or any loss of language or social skill.
At the other end of the spectrum a child may be able to speak coherently, but may have impaired pragmatics of speech. These children were described by Hans Asperger, an Australian pediatrician, in 1944, one year after Kanner’s classical description of children with autism. Children with Asperger syndrome are described as socially inept but often socially interested. They typically want the contact with others but they lack the social skills with which to achieve it. They have unusual interests and may become experts in these fields. Many of the children on the spectrum have restricted interests. They have a need for routines and may not tolerate change or transitions. An autistic child may become over focused on parts of toys, losing sight of the function of the toy. For example, instead of playing with cars in an imaginative way, a child with autism may move the car back and forth looking at it out of the corner of his or her eye. Or they may become fascinated with spinning the wheels of the car. Older children may script dialogue from their favorite TV show, displaying nonimaginative and unoriginal thoughts. Many of the children exhibit stereotypical behavior and may flap their hands when they are excited. The initial work-up of a child with a suspected autistic disorder depends on the history and physical examination and the long-term management requires a comprehensive multidisciplinary approach. It has been shown that while the diagnosis of autism is usually not made until a child is two years old, identifying children early and initiating interventions in the form of therapy results in significantly improved outcomes. The Pediatric Developmental Center at Saint Barnabas Medical Center is located at the Saint Barnabas Ambulatory Care Center's Pediatric Specialty Center at 200 South Orange Avenue, Livingston. [ top ] |
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Socially, these children have poor eye contact and little or no interest in establishing friendships. They have difficulty with reciprocal social interaction and are limited in their emotional empathy. They have difficulty with both verbal and nonverbal expression. In the most severely involved children verbal language may never develop. Some of the children may have robotic speech; they may exhibit echolalia or have unusual prosody (intonation and rhythm of speech). Fundamentally, autistic children have poor comprehension of other’s speech and body language.
