Autistic spectrum disorders (ASDs) are characterised by a spectrum of social, language and behavioural deficits. Socially, children with autism do not enjoy or seek comfort from the company of other people. They lack 'theory of mind'; they are not able to imagine the perspective of other people.

Most austism spectrum disorders are labelled PDD-NOS (pervasive developmental disorder - not otherwise specified

Presentation

• As the name suggests children with autism can present with a spectrum of severities. In its most severe form:
  • Children with autism are not able to understand that other people have thoughts and feelings, prefer to play alone and avoid eye contact.
  • Children with autism have speech and language delay, monotonous tones of voice with limited expression and problems using pronouns (confuse 'I', 'you', 'she' etc.). They also interpret speech literally, and so have problems with the use of idiom (e.g. 'it's raining cats and dogs').
  • In terms of behaviour, children with ASD commonly have narrow interests (e.g. trains), ritualistic behaviours that rely heavily on routine, and stereotyped movements (e.g. rocking, flapping hand movements).
• Autistic spectrum disorders are commonly associated with learning difficulties.
• About 25% of children with autism may also have seizures.

Management

• Management of autistic spectrum disorders is complex, with the need for multidisciplinary team management and extra support for the family.
• Applied behavioural analysis is one technique that can be of benefit, whereby positive behaviours are encouraged and negative behaviours are ignored.

Prognosis

• Autistic spectrum disorders require a huge amount of support, as less than 10% of children with ASD will be able to live independently as adults.