Autistic spectrum disorders (ASDs) are characterised by a spectrum of social, language and behavioural deficits.

The autistic spectrum has a significant range. On one end patients have normal intelligence and ability to function in everyday life but displaying difficulties with reading emotions and responding to others. This was previously known as Asperger syndrome. On the other end, patients can be severely affected and unable to function in normal environments.

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.

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

Suspected autism in primary care

• immediate referral to an autism team if available (if not, a paediatrician, or a child psychiatrist), if there is a high probability due to:

  • child <3yrs: regression of language/social milestones
  • children/young people: persistent and significant limitations to daily living caused by features suggestive of ASD

• consider immediate referral to an autism team:

  • For children with modest limitations to daily lviing caused by features suggestive of ASD if there are significant concerns of the parents/carers about development or functioning

• if insufficient to prompt a referral:

  • watchful waiting (gather more information to help clarify need for referral

• Management of autistic spectrum disorders is complex, with the need for multidisciplinary team management and extra support for the family.

  • Child psychology and child and adolescent psychiatry (CAMHS)
  • Speech and language specialists
  • Dietician
  • Paediatrician
  • Social workers
  • Specially trained educators and special school environments
  • Charities such as the national autistic society

• Applied behavioural analysis is one technique that can be of benefit, whereby positive behaviours are encouraged and negative behaviours are ignored.

• 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.