Criteria:
subsequently lost- Decline in social interaction between 1st
A. Persistent deficit in social communication manifested by
• ≠emotional reciprocity
• ≠nonverbal communication
• ≠understanding relationships).
Specify current severity:
Level I→ require support, lack of support cause noticeable≠
Level II→ require substantial support
Level III→ require very substantial support
B. Restricted repetitive pattern of behaviors 2\4
• stereotyped repetitive behaviors
• insistence on sameness & inflexible
• strong attachment & fixed circumscribed
• hyper or hypo reactivity to sensory inputs.
Specify current severity:
Level I→ require support
Level II→ require substantial support
Level III→ require very substantial support
C. Present in early developmental period
D. Causes significant impairment in function.
E. Exclude ID
Specify if:
• With- without ID
• With- without language impairment
• è known medical, congenital or environmental problem
• è neurodevelopmental, mental, behavioral problem
• è catatonia
change in diagnosis in DSM5:
• were 5 discrete disorders→ autistic disorder, Asperger,
childhood disintegrative disorder, Rett syndrome, &
pervasive developmental disorder NOS.
• rather than 3 categories of syx. (social, language,
repetitive behaviors) → there are now only 2 (social
communication & repetitive behaviors).
• If +ve social communication≠ & criterion B not met→
diagnosis is social communication disorder.
NB. “early infantile autism” described by Kanner
Epidemiology: 1%- or 14\1000- ♂4:♀1- ♀ è ID>♂-
prevalence in siblings in APA 4.5%- Kaplan up to 50%
siblings of child è ASD ↑ risk of other developmental≠
≥ 1\3 è comorbid seizure- grandma 20%- 30% è ID
Up to 25% of ASD cases some language develops & is
& 2nd year of life.
Bio-Markers:
• ↑platelet serotonin→ 1st identified.
• ↑mTOR, mammalian target of rapamycin
• GABA alteration
• ↑ total brain volume
• Head circumference normal→ developed macrocephaly
• ↑ amygdala size in 1st years→ decrease over time
• Striatum enlarged, +ve correlation between it’s size and
presence of repetitive behaviors.
• Rt. Temporal lobe→ theory of mind= ability to
attribute emotional state of others, & to oneself.
• Frontal lobe atypical activation→ social perception &
emotional reasoning.
• Lt. frontal region→ memory & language-based tasks
Clinical observations:
• Child è ASD focus on mouth rather than eye contact.
• Extreme anxiety if usual routine is disturbed
• Toys not used typically→ manipulated in ritualistic way
• Enjoy spinning, banging, & watching water flowing.
• If è sever ID→ ↑ self-injury behaviors
• ↑ dermatological≠ & risk of infection than general pop.
• may have special ability→ math, music, hyperlexia
Assessment Tools:
➢ADOS, autism diagnostic observation schedule
➢CARS, childhood autism rating scale
Rett syndrome:
▪ normal develop. Till 6m→ progressive decline.
▪ head circumference normal→ @ 1Y decelerate
▪ seem primarily in ♀
▪ loss of hand movement, previously acquired speech
skills, irregular respiration while awake only, scoliosis
▪ seizure up to 75%
childhood disintegrative disorder:
▪ called Heller’s syndrome& disintegrative psychosis
▪ normal develop. Till 2Y→loss of (2\5): bladder bowel
control, social, language, play, motor skills.
▪ ♂8:♀1 – associated è seizure
Asperger’s Disorder:
▪ 2\3→ ≠nonverbal communication, ≠peer relationships,
restricted interest.
▪ NO language or cognitive ≠
Formulation:

Predisposing Factors Precipitating Factors

• Genetic • Neglect & maltreatment
➢ Fragile X syndrome: FMNR1 gene, X linked recessive, large face & ear, • ↑ academic & social demands
macroorchidism, ASD+ID
➢ Tuberous sclerosis: autosomal dominant, multiple benign tumor, ASD+ID+seizure
➢ Other chromosomes include: 2-7-16-17
• Advanced maternal & paternal age
• Gestational bleeding, or diabetes, ABO- Rh incompatibility
• First born baby
• Birth complication: trauma, umbilical cord complication, hypoxia
• Fetal distress, low birth wt., small gestational age, low Abgar score
• Infection: Rubella, Toxoplasmosis, cytomegalovirus.
• Teratogenic: lead- valproic acid
Perpetuating Factors Prognostic Factors
• Lack of support- psychosocial deprivation • Presence of family support→ good
• Presence of comorbidity (medical- mental - behavioral) • Early intensive behavioral intervention→ good
• Children è IQ > 70 & average adaptive skills→ good
• Presence of language disorder→ poor
• Severity
• Presence of comorbid conditions
Management:

Social Psychological pharmacological

❖ Social skill training
❖ ↑long term skills in independent living
❖ ↑socially acceptable behaviors
❖ Speech therapy if needed
❖ Psychoeducation & support to the family ❖ Irritability:
❖ ↓irritable & disturbed behaviors • Risperidone→ 0.5-1.5mg
❖ Behavioral therapy for repetitive behavior, self-injury • Aripiprazole→ 5-15mg
❖ Behavioral therapy for insomnia if present ❖ ADHD like syx:
❖ CBT for anxiety, depression, or OCD if present • stimulant→ methylphenidate
• non-stimulant→ atomoxetine
• clonidine
❖ insomnia: melatonin
❖ mood or OCD: SSRIs
Childhood Autism Rating Scale (CARS)
The Childhood Autism Rating Scale (CARS) is a 15-items behavioral rating scale developed to identify children with autism and to
categorize these behaviors from mild to moderate to severe. The total CARS score may range from a low of 15 (obtained when the child¹s
behavior is rated as falling within normal limits on all 15 scales) to a high of 60 (obtained when the child¹s behavior is rated as severely
abnormal on all 15 scales). The score represents placement on a continuum: the lower the score, the fewer autistic behaviors the child
exhibits; the higher the score, the more autistic behaviors the child exhibits.

School Rating Completed by …………. The scores were as follows:

Relating to People (1-2-3-4)

Emotional Response (1-2-3-4)

Imitation (1-2-3-4)

Body Use (1-2-3-4)

Object Use (1-2-3-4)

Adaptation to Change (1-2-3-4)

Listening Response (1-2-3-4)

Taste, Smell, Touch (1-2-3-4)

Visual Response (1-2-3-4)

Fear or Nervous (1-2-3-4)

Verbal Communication (1-2-3-4)

Activity Level (1-2-3-4)

Nonverbal Communication (1-2-3-4)

Level & Consistency of Intellectual Response (1-2-3-4)

General Impression (1-2-3-4)

Total Score XX