Autistic spectrum disorder refers to the full range of people affected by a deficit in social interaction, communication and flexible behaviour.
The classification of autistic spectrum disorder was introduced in the diagnostic and statistical manual of mental disorders fifth edition (DSM-5), introduced in 2013. This took previous diagnoses such as Aspergers syndrome and autistic disorder and grouped them into one spectrum disorder, suggesting that the same disorder was responsible for the features of the condition and those affected fall somewhere along the spectrum.
The autistic spectrum has a significant range. On one end patients have normal intelligence and ability to function in everyday life but displaying difficulties with reading emotions and responding to others. This was previously known as Asperger syndrome. On the other end, patients can be severely affected and unable to function in normal environments.
Features
Features vary greatly between individuals along the autistic spectrum. They can be categorised as deficits in social interaction, communication and behaviour. Features are usually observable before the age of 3 years.
Social Interaction
- Lack of eye contact
- Delay in smiling
- Avoids physical contact
- Unable to read non-verbal cues
- Difficulty establishing friendships
- Not displaying a desire to share attention (i.e. not playing with others)
Communication
- Delay, absence or regression in language development
- Lack of appropriate non-verbal communication such as smiling, eye contact, responding to others and sharing interest
- Difficulty with imaginative or imitative behaviour
- Repetitive use of words or phrases
Behaviour
- Greater interest in objects, numbers or patterns than people
- Stereotypical repetitive movements. There may be self-stimulating movements that are used to comfort themselves, such as hand-flapping or rocking.
- Intensive and deep interests that are persistent and rigid
- Repetitive behaviour and fixed routines
- Anxiety and distress with experiences outside their normal routine
- Extremely restricted food preferences
Diagnosis
Diagnosis should be made by a specialist in autism. This may be a paediatric psychiatrist or paediatrician with an interest in development and behaviour. A diagnosis can be made before the age of 3 years. It involves a detailed history and assessment of the child’s behaviour and communication.
Management
Autism cannot be cured. Management depends on the severity of the child’s condition. Management involves a multidisciplinary team to provide the best environment and support for the child and parent:
- Child psychology and child and adolescent psychiatry (CAMHS)
- Speech and language specialists
- Dietician
- Paediatrician
- Social workers
- Specially trained educators and special school environments
- Charities such as the national autistic society
Last updated January 2020