Autistic Spectrum Disorder

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Introduction

Autism or autistic spectrum disorder is a neurodevelopmental disorder characterized by qualitative impairments occuring in a child before the age of 36 months, in three key areas; social interaction (often the earliest features of Autistic Spectrum Disorder-ASD), communication, interests and activities.

The clinical presentation is varied and may encompass children with severe manifestations of the above features or with more subtle behavioural deficits, hence the use of the term Autistic Spectrum Disorder.

Learning disability in this condition is very common and the risk of epilepsy is significant..

Causes of autistic spectrum disorder

  • No clear aetiology
  • Genetic

Symptoms of autistic spectrum disorder

The following are the symptoms of autistic spectrum disorder

  1. Absence of joint attention (i.e. failure to show interest, follow gaze, lack of social smiling and limited use of gestures e.g. shaking head, waving or clapping)
  2. Communication deficit
    • Receptive: fails to acquire language or delays in understanding language
    • Expressive: delays in use of language Limited range of interests (limited play with toys and other objects)
  3. Repetitive activities (e.g. spinning objects)
  4. Global developmental delays (e.g. walking, speech etc.)
  5. Learning difficulties
  6. Attention deficit
  7. Sleeping difficulties
  8. Feeding difficulties

Signs of autistic spectrum disorder

  1. The signs of autistic spectrum disorder include the following:
  2. Lack of pointing to objects by 24 months
  3. No single words by 18 months
  4. No two word spontaneous phrase by 24 months
  5. Loss of language
  6. Avoidance of eye contact

Investigations

Usually none required

  • Electroencephalogram (EEG) if seizures suspected
  • Brain CT or MRI only in special circumstances e.g. abnormal physical features present

Treatment for autistic spectrum disorder

Treatment objective

  • To correct social communication difficulties using a multidisciplinary behavioural and educational approach

Non-pharmacological treatment

  • Applied Behaviour Analysis (ABA) teaching based on teacher request, prompt assistance to child, child response and feedback

Pharmacological treatment

A. For aggression, irritability or self-mutilation

Evidence Rating: [B]

Risperidone, oral,

Children:

  • 5-18 years (body weight > 50 kg); 0.5 mg daily. May increase by 0.5 mg on alternate days (max. 1 mg daily)
  • 5-18 years (body weight < 50 kg); 0.25-0.5 mg daily. May increase by 0.25 mg on alternate days (max. 0.75 mg daily)
  • < 5 years; Not recommended

B. For sleep problems

Evidence Rating: [B]

Melatonin, oral,

Children 1 month-18 years;

  • 2-3 mg daily (before bedtime) then increase if necessary after 1-2 weeks to 4-6 mg (daily before bed time) max. 10 mg

C. For significant hyperactivity-in children ≥ 4 years

Evidence Rating: [B]

Methylphenidate, oral,

Children

  • 6-18 years; 5 mg 12-24 hourly; then increase if necessary at weekly intervals by 5-10 mg (max. of 20 mg 8 hourly)
  • 4-6 years; 2.5 mg 12 hourly then increase if necessary by 2.5 mg at weekly intervals (max. 0.4-0.5 mg/ kg 8 hourly)

Note

Discontinue if there is no response after a month

Referral Criteria

  • All suspected cases of autism should be referred to a Tertiary centre.

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