Autism

Definition

Autism is a specific type of communication disorder which has some overlap with semantic/pragmatic disorders of language but also with other types of neurodevelopmental disorder. Pulled straight from the Powerpoint slides of one of our lecturers. Essentially, autism is a developmental disorder with a variety consequences.

Asperger's syndrome is a milder form of autism in terms of the social problems with mostly normal speech development.

Epidemiology

Commoner in boys and usually presents in early childhood with a prevalence of about 3/1000.

Risk Factors

The first thing to say is that the MMR vaccine is NOT...I repeat...NOT a risk factor for autism. Anybody who says it is, is wrong. The study which said otherwise has been widely discredited and as of this writing Dr Andrew Wakefield was defending himself against professional misconduct charges.

Clinical Features

In autism there is a triad of difficulties which define it. These are:

1. a severe language disorder

This ranges from half who will never speak to delayed speech, poor comprehension and no imaginative play. You often have to repeat things to them in their early years and they use 'you' instead of 'I' when referring to themselves.

2. a profound difficulty relating to others

Essentially, there is a lack of expression of emotion, possibly even a lack of emotion, full-stop. They do not look for comfort when distressed, don't share pleasure in things which interest them and don't make friends or form close relationships. They prefer to be alone.

(Raj's personal note: I spent some time involved in a research project into formally testing for autism. One way it has been described is 'mindblindness'. If a horse kicks you in the face, I would be able to tell that you're likely to be pissed off and annoyed. An autistic person won't - this is partly where their disability lies.)

3. routines and rituals

Sufferers like things to be the same everyday. Food is a classic example. They often become obsessed with a particular set of information like learning lists of football match results or the names of all the different fish. Changes to these routines can be incredibly distressing.

(Watch Rain Man: Dustin Hoffman is pretty accurate in depicting somebody with severe autism, even if you want to punch Tom Cruise in the face. Not because he's a bad actor but just for being Tom Cruise.)

Management

There is not cure and not medication which can cure or even reduce the symptoms of autism; it is incredibly devastating handicap. Support for parents is incredibly important and behaviour modification can help children from getting themselves into dangerous situations. Admission to a special school is often necessary as they do not always fit in well at mainstream ones.