Autism history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]
Overview
The characteristic behaviors of autism spectrum disorder may be apparent in infancy (18 to 24 months), but they usually become clearer during early childhood (24 months to 6 years). The three core symptoms associated with autism can be broadly classified as difficulties in social interaction, communicative challeneges and repetitive behaviors. Neuro-psychiatric and gastrointestinal symptoms along with sleep disturbances and facial dysmorphism may accompany the behavioral symptoms in autism
History
When evaluating a patient suspected to be suffering from autism, a detailed history should be obtained from the primary caregiver with focus on the following areas:[1][2]
Past medical history
Behavioral history
- Developmental regression (History of global developmental delay)
- Restricted eye contact
- Repetitive behaviors (hand flapping, arranging toys in long lines etc.)
- Absence of gestures
- Absence of symbolic play
- Aloof
- Resists change
- Inconsolable crying
- Agitation
- Self-injurious
- Unable to understand sarcasm or irony
- Poor language skills
Family history
- ASD
- Language disorders
- Intellectual disabilities
- Learning problems
- ADHD
- Depression
- Schizophrenia or other mental illnesses
- Obsessive compulsive disorder
- Genetic disorders
Socioeconomic status
- Poor socioeconomic status is associated with autism.
Symptoms
- The characteristic behaviors of autism spectrum disorder may be apparent in infancy (18 to 24 months), but they usually become clearer during early childhood (24 months to 6 years).
Social interaction difficulties
Impaired social communication is one of the most common presentations of autism.[3][4][5]
- Absent, preferential or inconsistent social smile.
- Reduced ability to do non-verbal communication (problems with eye-contact, body language and facial expressions).
- Inappropriate response to social overtures:
- Aloofness
- Shyness or fussiness (in forced interactions)
- Reduced attention span
- Inability to initiate a social encounter properly
- Social awkwardness and behaviors mistaken to be ranging from extreme friendliness to aggressive beaviors such as;
- Inappropriate touching
- Stroking
- Pushing or hitting others
- Reduced ability to develop friendships.
- Indifference or excessive clinginess
- Excessive familiarity, absence of social inhibitions and stranger anxiety
Communicative challenges
- Meaningful speech does not develop in 30–50% cases.
- Language is usually delayed or deviant.[6][7][8][9]
Verbal communication
- Children may only exhibit abnormal sounds. These are considered persistent if seen beyond 3 years:
- Meaningless speech
- Echolalia (repetitive speech)
- Neologisms (word substitution by sounds)
- Reduced ability to hold conversations
- Inability or difficulty in understanding sarcasm, jokes or indirect speech
- Excessive inquisitiveness or talking only about restricted topics
Non-verbal communication
- Reduced ability to understand gestures
- Absence of or decreased pointing (either for expressing desire or sharing interest). They may keep crying without pointing or go to great extents to obtain something in order to avoid asking for assistance
- Forcefully ask someone to help indicate something (even trying to drag them)
Repetitive behaviors
Repetitive behaviors are among one of the most common presentations of autism and usually include:
- Stereotyped behaviors[10][11][12]
- Insistence on sameness
- Restricted interests
- Sensory perception[13][14]
Neurological symptoms
(a) Cognitive Impairment [Global developmental delay (GDD) or Intellectual disability (ID)]:
- This has been reported in 50–70% individuals. The wide variability is due to difference in evaluation methods. Assessment should be done by tools that rely predominantly on non-verbal based skills.[3][15][13][16][17]
(b) Epilepsy:
- All types of seizures are seen in 25–30% with bimodal presentation (infancy and adolescence).
(c) Psychiatric Illnesses:
(d) Feeding Disturbances:
- Decreased chewing
- Poor food acceptance
- Picky eater
- Food aversion
- Meal time misbehavior
Gastrointestinal symptoms
- Frequent vomiting
- Gastro-esophageal reflux
- Recurrent diarrhea
- Chronic constipation
- Recurrent abdominal pain
Sleep Disturbances:
Difficulty in falling asleep, repeated nocturnal awakenings, unusual bedtime routines lead to increased daytime behavioral issues and parental stress.
Dysmorphism:
This is observed in 18–20% individuals (syndromic or non-specific dysmorphic features).
References
- ↑ Kong MY (2015). "Diagnosis and History Taking in Children with Autism Spectrum Disorder: Dealing with the Challenges". Front Pediatr. 3: 55. doi:10.3389/fped.2015.00055. PMC 4462094. PMID 26114096.
- ↑ Baron-Cohen S, Allen J, Gillberg C (December 1992). "Can autism be detected at 18 months? The needle, the haystack, and the CHAT". Br J Psychiatry. 161: 839–43. PMID 1483172.
- ↑ 3.0 3.1 Volkmar FR, Pauls D (October 2003). "Autism". Lancet. 362 (9390): 1133–41. doi:10.1016/S0140-6736(03)14471-6. PMID 14550703.
- ↑ De Giacomo A, Fombonne E (September 1998). "Parental recognition of developmental abnormalities in autism". Eur Child Adolesc Psychiatry. 7 (3): 131–6. PMID 9826299.
- ↑ Rapin I (July 1997). "Autism". N. Engl. J. Med. 337 (2): 97–104. doi:10.1056/NEJM199707103370206. PMID 9211680.
- ↑ Johnson CP, Myers SM (November 2007). "Identification and evaluation of children with autism spectrum disorders". Pediatrics. 120 (5): 1183–215. doi:10.1542/peds.2007-2361. PMID 17967920.
- ↑ Volkmar F, Siegel M, Woodbury-Smith M, King B, McCracken J, State M (February 2014). "Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder". J Am Acad Child Adolesc Psychiatry. 53 (2): 237–57. doi:10.1016/j.jaac.2013.10.013. PMID 24472258.
- ↑ Miller M, Iosif AM, Hill M, Young GS, Schwichtenberg AJ, Ozonoff S (April 2017). "Response to Name in Infants Developing Autism Spectrum Disorder: A Prospective Study". J. Pediatr. 183: 141–146.e1. doi:10.1016/j.jpeds.2016.12.071. PMID 28162768.
- ↑ Emerich DM, Creaghead NA, Grether SM, Murray D, Grasha C (June 2003). "The comprehension of humorous materials by adolescents with high-functioning autism and Asperger's syndrome". J Autism Dev Disord. 33 (3): 253–7. PMID 12908828.
- ↑ Mandell DS, Novak MM, Zubritsky CD (December 2005). "Factors associated with age of diagnosis among children with autism spectrum disorders". Pediatrics. 116 (6): 1480–6. doi:10.1542/peds.2005-0185. PMC 2861294. PMID 16322174.
- ↑ Ming X, Brimacombe M, Wagner GC (October 2007). "Prevalence of motor impairment in autism spectrum disorders". Brain Dev. 29 (9): 565–70. doi:10.1016/j.braindev.2007.03.002. PMID 17467940.
- ↑ Barrow WJ, Jaworski M, Accardo PJ (May 2011). "Persistent toe walking in autism". J. Child Neurol. 26 (5): 619–21. doi:10.1177/0883073810385344. PMID 21285033.
- ↑ 13.0 13.1 Filipek PA, Accardo PJ, Ashwal S, Baranek GT, Cook EH, Dawson G, Gordon B, Gravel JS, Johnson CP, Kallen RJ, Levy SE, Minshew NJ, Ozonoff S, Prizant BM, Rapin I, Rogers SJ, Stone WL, Teplin SW, Tuchman RF, Volkmar FR (August 2000). "Practice parameter: screening and diagnosis of autism: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society". Neurology. 55 (4): 468–79. PMID 10953176.
- ↑ Kientz MA, Dunn W (1997). "A comparison of the performance of children with and without autism on the Sensory Profile". Am J Occup Ther. 51 (7): 530–7. PMID 9242859.
- ↑ Dawson G, Meltzoff AN, Osterling J, Rinaldi J (October 1998). "Neuropsychological correlates of early symptoms of autism". Child Dev. 69 (5): 1276–85. PMC 4084601. PMID 9839415.
- ↑ Ozonoff S, Pennington BF, Rogers SJ (November 1991). "Executive function deficits in high-functioning autistic individuals: relationship to theory of mind". J Child Psychol Psychiatry. 32 (7): 1081–105. PMID 1787138.
- ↑ Minshew NJ, Goldstein G, Siegel DJ (July 1997). "Neuropsychologic functioning in autism: profile of a complex information processing disorder". J Int Neuropsychol Soc. 3 (4): 303–16. PMID 9260440.