AUTISTIC DISORDER

Suryadi Susanto
Pediatric Department
Krida Wacana Christian University

Definition
Neurodevelopmental disorder of unknown
etiology, but with a strong genetic basis.
It develops and is typically diagnosed before 36
mo of age.
Characterized by a behavioral phenotype that
includes qualitative impairment in the areas of
language development or communication skills,
social interactions and reciprocity, and
imagination and play

Epidemiology
The prevalence rate of autism is 22/10,000

Etiology
The exact cause is unknown
Multifactorial, with a strong genetic influence.
Environmental factors
Many excellent epidemiologic studies have
established that there is no association
between the administration of the measlesmumps-rubella vaccine and the development of
autism.

Neuroanatomic Findings
Head circumference of children with autism is
normal or slightly smaller than normal at birth
until 2 mo of age
Abnormally rapid increase in head circumference
from 614 mo of age
MRI studies done at 24 yr of age: increased brain
volume (cerebellum, cerebrum, and amygdala)
Changes in the anterior cingulate gyrus
decision-making and the ascription of feelings
and thoughts.

Clinical Features
Vary with the severity of the impairment
No pathognomonic symptom or behavior
Most children have some impairment in joint
attention or pretend play.
Intellectual functioning can vary
Some children with autism show typical
development in certain skills
The autistic child is often withdrawn and spends
hours in solitary play.
Eye contact is typically minimal or absent.

Diagnosis
Hallmark is aberrant social skill development
Early social skill deficits (abnormal eye contact,
failure to orient to name, failure to use gestures
to point or show, a lack of interactive play, failure
to smile, lack of sharing, and lack of interest in
other children)
Important early red flags for ASD: combined
language and social delays and regression in
language or social milestones
Early signs include unusual use of language or

Diagnosic Criteria
A. Total of 6 or more
1. Qualitative impairment in social interaction:
Marked impairment multiple nonverbal behaviors
Failure to develop peer relationships
Lack of spontaneous seeking to share enjoyment,
interests, or achievements
Lack of social or emotional reciprocity

Diagnosic Criteria
2. Qualitative impairment in social interaction:
Delay in, or total lack of development of spoken
language
Marked impairment in ability to initiate or sustain
a conversation with others
Stereotyped and repetitive use of language or
idiosyncratic language
Lacked of varied, spontaneous make-believe play
or social imitative play appropiate to
developmental level

Diagnosic Criteria
3. Restricted, repetitive, and stereotyped patterns
of behavior, interests, and activities:
Encompassing preoccupation with 1
stereotyped and restricted pattern of interest
(abnormal intensity or focus)
Apparently inflexible adherence to specific, non
functional routines or rituals
Stereotyped and repetitive motor mannerisms
Persistent preoccupation with parts of objects

Diagnosic Criteria
B. Delay or abnormal functioning in 1 of the
following areas, with onset < 3 yo (social
interaction, language, and symbolic or imaginative
play)
C. The disturbance is not better accounted for by
Rett disorder or childhood disintegrative disorder

Diagnosis
Several screening tools:
CHAT (The Checklist for Autism in
Toddlers)
M-CHAT (The Modified Checklist for
Autism in Toddlers)
PDDST (The Pervasive Developmental
Disorders Screening)

https://www.youtube.com/watch?v=8YJ9OMQcoPk
https://www.youtube.com/watch?v=9g5XeNBWm90
https://www.youtube.com/watch?v=sMn9G5d1wr8

Treatment
Behavioral therapy
Older children and adolescents : psychotherapy,
behavioral or cognitive behavioral therapy, and
pharmacotherapy.
Pharmacotherapy:
Risperidone
Olanzapine.
Naltrexone
Clomipramine

Prognosis
Grow up to live self-sufficient, employed, albeit isolated,
lives in the community, dependent on their family.
Early and intensive therapy may improve language and
social function, delayed diagnosis may lead to a poor
outcome.
No increased risk of schizophrenia in adulthood.
A better prognosis is associated with higher
intelligence, functional speech, and less bizarre
symptoms and behavior.