Autism

The NHS Information Centre (UK) reported that About 700,000 people in Britain with Autism, the prevalence in children is around 1% of the UK population. More boys are diagnosed as autistic than girls with a ratio of approximately 4:1.

Autism is a lifelong condition with no cure but the difficulties children with autism face in life can be significantly managed through appropriate intervention at an early age by providing skills and coping strategies learned by children have lifetime application and can make an enormous difference to their ability when they become adults with autism to make the most of their lives.

What causes autism?

The exact cause of autism spectrum disorder (ASD) is unknown. It is broadly considered to be a multi-factorial condition resulting from genetic and non-genetic risk factors

Genetic factors:

Includes gene defects and chromosomal anomalies have been found in 10-20%

of individuals with ASD. Positive family history of ASD have a 50 times greater

risk of ASD.

Metabolic Disorders
Various environmental factors such as advanced parental age , exposure to teratogenic agents, and viral infections, low birth weight, post natal infection or toxicity

Assessment & Diagnosis

A multidisciplinary assessment carried out by a multi Specialist professional team, including Consultant child and Adolescent Psychiatrist, Child clinical psychologist, Family therapist, Occupational therapist , speech and language therapist, and paediatrician, will conduct an assessments to help to achieve a formal diagnosis of autism.

It is extremely helpful to reach an accurate and timely diagnosis, thus will help children with Autism and their parents or teachers to understand the explanation of the symptoms, behaviours and the treatment plan.

What are the treatments for autism?

Although there is no cure for autism yet, there are standard treatments and training programs of support that can be implemented. It has been recommended that early behavioural intervention such as Applied Behaviour Analysis ( ABA) to ensure children learn life skills and coping mechanisms that will prepare children with autism to cope with life within mainstream education and adult life. ABA can be delivered as an individually designed programme at an early age can help transform the lives of children with autism and their families.

The specialised Team helps children with autism achieve their potential and to enable children to overcome difficulties with communication, learning and life skills and teach families the skills and strategies to cope with autism through the use of Applied Behaviour Analysis (ABA), the required service will provides support, advice, education for families and teachers and a professionals intervention to children with Autism from schools, special training or rehabilitation centre.

*ICD-10 CRITERIA FOR CHILDHOOD AUTISM

A. Abnormal or impaired development is evident before the age of 3 years in at least one of the following areas:

receptive or expressive language as used in social communication;
the development of selective social attachments or of reciprocal social interaction;
functional or symbolic play.

B. A total of at least six symptoms from (1), (2) and (3) must be present, with at least two from (1) and at least one from each of (2) and (3)

1. Qualitative impairment in social interaction are manifest in at least two of the following areas:

a. failure adequately to use eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction;

b. failure to develop (in a manner appropriate to mental age, and despite ample opportunities) peer relationships that involve a mutual sharing of interests, activities and emotions;

c. lack of socio-emotional reciprocity as shown by an impaired or deviant response to other people’s emotions; or lack of modulation of behavioUr according to social context; or a weak integration of social, emotional, and communicative behaviours;

d. lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g. a lack of showing, bringing, or pointing out to other people objects of interest to the individual).U

2. Qualitative abnormalities in communication as manifest in at least one of the following areas:

a. delay in or total lack of, development of spoken language that is not accompanied by an attempt to compensate through the use of gestures or mime as an alternative mode of communication (often preceded by a lack of communicative babbling);

b. relative failure to initiate or sustain conversational interchange (at whatever level of language skill is present), in which there is reciprocal responsiveness to the communications of the other person;

c. stereotyped and repetitive use of language or idiosyncratic use of words or phrases;

d. lack of varied spontaneous make-believe play or (when young) social imitative play

3. Restricted, repetitive, and stereotyped patterns of behaviour, interests, and activities are manifested in at least one of the following:

a. An encompassing preoccupation with one or more stereotyped and restricted patterns of interest that are abnormal in content or focus; or one or more interests that are abnormal in their intensity and circumscribed nature though not in their content or focus;

b. Apparently compulsive adherence to specific, nonfunctional routines or rituals;

c. Stereotyped and repetitive motor mannerisms that involve either hand or finger flapping or twisting or complex whole body movements;

d. Preoccupations with part-objects of non-functional elements of play materials (such as their oder, the feel of their surface, or the noise or vibration they generate).

C. The clinical picture is not attributable to the other varieties of pervasive developmental disorders; specific development disorder of receptive language (F80.2) with secondary socio-emotional problems, reactive attachment disorder (F94.1) or disinhibited attachment disorder (F94.2); mental retardation (F70-F72) with some associated emotional or behavioural disorders; schizophrenia (F20.-) of unusually early onset; and Rett’s Syndrome (F84.12).

*World Health Organisation. (1992). International classification of diseases: Diagnostic criteria for research (10th edition). Geneva, Switzerland: Author.

Autism Vs. Asperger’s Syndrome Diagnosis

The DSM IV - Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.

includes Pervasive Developmental Disorders PDD-NOS, Asperger’s, and Autism. The most notable diagnostic criteria difference between kids with Asperger’s and Autism is that there was no marked delay in language early in life.

Asperger’s Syndrome does have diagnostic differences from “autism” but in 2013, the new version – DSM-5 removed all the variations and leaving one diagnosis: Autism Spectrum Disorder.

DSM V diagnostic Criteria- Autism Spectrum Disorder

Must meet criteria A, B, C, and D:

A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:

1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction,

2. Deficits in nonverbal communicative behaviours used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.

3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behaviour to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people.

B. Restricted, repetitive patterns of behaviour, interests, or activities as manifested by at least two of the following:

1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).

2. Excessive adherence to routines, ritualised patterns of verbal or nonverbal behaviour, or excessive resistance to change; (such as motor rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).

3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).

4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).

C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)

D. Symptoms together limit and impair everyday functioning.

There are also Three new “Severity Levels” for ASD.

Level 3: ‘Requiring very substantial support’

Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning; very limited initiation of social interactions and minimal response to social overtures from others.

Preoccupations, fixated rituals and/or repetitive behaviours markedly interfere with functioning in all spheres. Marked distress when rituals or routines are interrupted; very difficult to redirect from fixated interest or returns to it quickly.

Level 2:‘Requiring substantial support’

Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions and reduced or abnormal response to social overtures from others.

RRBs and/or preoccupations or fixated interests appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress or frustration is apparent when RRB’s are interrupted; difficult to redirect from fixated interest.

Level 1:‘Requiring support’

Without supports in place, deficits in social communication cause noticeable impairments. Has difficulty initiating social interactions and demonstrates clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions.

Rituals and repetitive behaviours (RRB’s) cause significant interference with functioning in one or more contexts. Resists attempts by others to interrupt RRB’s or to be redirected from fixated interest.

Dr. Akeel. A.Abdul Wahab

Fellow & Member of The Royal College of Psychiatrists (UK)

FRCPsych. (UK), MRCPsych. (UK), Board NeuroPsych. (London University ,UK), Dip.Psych. (London University, UK), MB.ChB.(Basra University , Iraq )

Formerly Senior Consultant Psychiatrist & Clinical professor