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Autism Spectrum Disorder

With DSM-5 considered a continuum model Specifiers


Deficits in social communication & restricted and repetitive Intellectual impairment
behaviors Language impairment
Formerly 5 separate disorders Medical or genetic condition or environmental factor
Autistic disorder Other neurodevelopmental, mental, or behavioral disorder
Aspergers disorder Catatonia
Childhood disintegrative disorder DDx:
Rhett syndrome Social communication disorder
Pervasive developmental disorder NOS Childhood onset Schizophrenia
Epidemiology: Intellectual Disability with Behavioral Symptoms
Prevalence 1% in US Language Disorder
Onset: Early developmental period 2-3yo Congenital Deafness or Hearing Impairment
Diagnosed 4X Males > Females Psychosocial Deprivation
Girls with ASD more likely to have intellectual disability Tx:
Etiology: Psychosocial Interventions
Heritable contribution Early intensive behavioral & developmental
15% associated with a known gene mutation Social Skills
rates (up to 50%) when siblings with diagnosis of autism Specific behavioral interventions & CBT for petitive
Biomarkers influence: 5-HT (serotonin) in platelets behaviors
Immunologic factors: Maternal ABs Interventions addressing comorbid symptoms
Prenatal & Perinatal factors Educational interventions
Adv maternal & paternal age, maternal gestational Pharmacological Interventions
bleeding, gestational DM, 1st born baby Course & Prognosis:
Umbilical cord complications, birth trauma, fetal Lifelong disorder
distress, small gestational age, low birth weight, low 5 Highly variable severity & prognosis
min Apgar score Best prognosis with
Comorbidities: IQ > 70
EEG abnormalities and grand mal seizures more common in Average adaptive skills
patients with autism spectrum disorder Develop communicative language by age 5-7yo
No specific EEG finding consistent with autism spectrum disorder
Possible failed cerebral lateralization DSM-5 & ICD-10
Dx: Rett Syndrome
A. Persistent deficits in social communication and social interaction Nl development 6 months, then developmental
across multiple contexts deterioration
1. Deficits in social-emotional reciprocity Exclusive to female diagnosis
2. Deficits in nonverbal communicative behaviors used Childhood Disintegrative Disorder
for social interaction Nl development for 2 years, then regression in several
3. Deficits in developing, maintaining, and understanding areas which ends up similar to autism
relationships Aspergers Disorder
B. Restricted, repetitive patterns of behavior, interests or activities as Impairment and oddity of social interaction and
manifested by at least two of the following restricted interest and behavior
1. Stereotyped or repetitive motor movements, use of Pervasive Developmental Disorder NOS
objects, or speech Condition with severe pervasive impairment in
2. Insistence on sameness, inflexible adherence to communication skills or the presence of restricted and
routines, or ritualized patters of verbal or nonverbal repetitive activities and associated impairment in social
behavior interactions
3. Highly restricted, fixated interests that are abnormal in
intensity or focus
4. Hyper- or hyporeactivity to sensory input or unusual
interest in sensory aspects of the environment
C. Symptoms must be present in the early developmental period
D. Symptoms cause clinically significant impairment in social,
occupational, or other important areas of current functioning
E. These disturbances are not better explained by intellectual
disability or global developmental delay