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Autistic Spectrum Disorders (a.k.a. Pervasive Developmental Disorders) Thomas Nichols Autistic Spectrum Disorders "Inability to relate in an ordinary way to people and to situations"..."an anxiously obsessive desire for the maintenance of sameness" Kanner, 1943 Now not considered rare as diagnostic criteria have changed Organic disorder with genetic component – >60% concordance in mono-zygotic twins Disease Development More common in boys 3:1 ratio Links with William's syndrome, Fragile X (? Conflicting evidence) 40% have raised Serotonin levels 70% have mental handicap 25-40% develop epilepsy during adolescence IQ<70 = poor prognosis Link with Schizophrenia has been disproved The Clinical Triad Deficit in three fields: Impaired Social Relationships Language Abnormalities Repetitive activities Autism Impaired Social Relationships gaze aversion minimal facial expression fail to smile prefers toys to people appear aloof Autism Language Abnormalities slow to speak, and 50% never learn echolalia little non-verbal communication little imagination & fail to develop abstract thinking - no distinction between you and I Autism Repetitive activities ritualistic behaviour patterns repetitive movements such as flicking fingers in front of eyes, rocking, whirling objects, head banging Presentation Parents often think child is deaf because of slow language development May have been odd from birth - may be unresponsive to being held Crying may not be related to anything, or may not cry when expected to Symptoms and signs usually apparent before 30 months Management Establish routines Sleeping tablets if associated sleep problem Brain imaging important - asymmetry in cerebellum and cerebral cortex Behavioural training Other Autistic Spectrum Disorders Autism Rett's Syndrome Described above Regression of skills Loss of purposeful hand use Decreased head growth Asperger Syndrome Language and cognition normal but with poor social interaction Developmental Dysphasias Disease limited to communication and language Conclusion Autism is abnormality in three fields: Impaired social relationships Language & communication Repetitive activities It is an increasingly diagnosed disorder more common in boys, that is apparent by the age of three. It is associated with mental retardation and epilepsy.