As a Doctor you can expect to come across children and adults with Autistic Spectrum Disorder (ASD).
Should you feel that you are not wholly confident as regards your knowledge and understanding of this disorder, we would like to offer you this brochure for your reference and referral.
The detection of children with Autistic Spectrum Disorder, in their formative years is vital. As a Doctor you are an important role player in this essential early detection.
Autistic Spectrum Disorder is the result of disordered brain development and function, NOT a psychological or emotional disorder. It is not the result of bad parenting and children with Autistic Spectrum Disorder do not choose to misbehave.
Autistic Spectrum Disorder is a complex, pervasive developmental disability, which seems to stem from a multi-factorial origin and causes disturbances in the brain. Estimates of prevalence vary greatly. Recent small scale, but intensive studies give higher numbers than earlier ones, this being due to the criteria for autistic disorders having been considerably widened over the years. The highest estimates for the whole spectrum, range from around 40 to around 90 per 10 000 births, but the true figures are still being investigated. ASD affects 4 times as many boys as girls. Of all the developmental disorders, ASD is the most researched and validated syndrome.
The onset of ASD is from birth or before the age of 3 years. Various subgroups are referred to within the autistic spectrum disorders. The ICD 10 system (International Classification of Diseases, 10th edition, World Health Organisation, 1992) and the DSM IV (Diagnostic and Statistical Manual, 4th Edition, American Psychiatric Association, 1994) suggest some subgroups, the best known of which are “childhood autism / early infantile autism” and “Asperger Syndrome” There is a fair amount of academic argument concerning the criteria differentiating these subgroups. However, in clinical practice, the most helpful approach to diagnosis is to establish if the child or adult concerned, has an autistic spectrum disorder and then to provide information concerning their present level of varying abilities. This type of detail is far more useful for identifying a person’s needs, rather than just putting him or her on a diagnostic subgroup.
Although children and adults with ASD present with many different levels of severity and also display a wide range of individual characteristics, they are all affected by the “Triad of Impairments”.
In addition to this Triad of Impairments, you may well observe the following additional features:-
The presence of additional disorders such as epilepsy, sensory and intellectual impairments can co-exist with ASD.
Remember that ASD can vary widely and there is no single feature that, if not present, excludes the possibility of Autistic Spectrum Disorder.
The two internationally used systems of diagnosis and classification are the DSM IV and the ICD 10.
Problems of Diagnosis
It is imperative to distinguish Autistic Spectrum Disorder from the other disabilities such as hearing, visual, cognitive, other psychiatric and psychological disabilities. Differences between ASD and other primarily intellectual disabilities can be overlooked.
Compared to the pattern found in generalised developmental delay, where all areas of development are affected, the individual with ASD displays impairments in the timing, rate and sequence of many basic psychological, as well as cognitive developmental functions. Severe qualitative impairments for any stage of development are usually present.
The difficulties in diagnosis experienced by clinicians arise mainly because of the following reasons:-
The Process of Diagnosis
The pitfalls described above can only be avoided if the clinician bears in mind the possibility of ASD, when faced with a worried or puzzled parent describing odd behaviour in their child.
ASD is a developmental disability caused by chemical dysfunction in the brain. The pattern of abnormal behaviour unfolds over time. The correct diagnosis can be made only by taking a detailed developmental history from infancy and obtaining equally detailed information concerning behaviour in different settings and at different ages.
A definite diagnosis cannot be made by briefly observing or testing the child in the doctor’s room. Observation should be performed by people specialising in the field of ASD and over an extended time frame, in varying situations.
The initial apparent absence of the typical discrepant pattern, does not rule out a possible diagnosis of ASD.
We suggest that if you suspect that ASD is the diagnosis, you mention this to the parents as a possibility and that you would like to refer the patient to a diagnostic team who specialise in the field of ASD.
International Organisations involved with Autistic Spectrum Disorder:-
National Autistic Society - United Kingdom
393 City Road. London EC1V 1NE. England. Tel: 0944 20 7833 2299 Fax: 0944 20 7833 9666; E-mail: firstname.lastname@example.org; Website: http://www.oneworld.org/autism_uk/
Autism Society of America
7910 Woodmont Avenue. Suite 650. BETHESDA. MD 20814. USA. Tel: 091 800 328 8476. Fax: 091 301 657 0869. Website: http://www.autism-society.org/
Autism Research Institute
4182 Adams Avenue. SAN DIEGO. CA 92116 ; USA Tel: 091 619 281 7165. Fax: 091 619 563 6840 ;Web site: http://www.autism.com/ari
All these books, plus many more and a wide range of papers and journals are available from the UK National Autistic Society (contact details previously provided).
Please refer to the Web Site addresses supplied above, of other international organisations, for additional reading material that is available.
Reprinted by permission of The Autism Societe of South Africa Jill Stacey
Note: The listing of resources is given on an information only basis. It is not to be construed as an endorsement by Puterakembara of any of the profesionals, treatments, opinions, publications or products offered by those mentioned above