Care of the Patient With an Autism Spectrum Disorder
Care of the Patient With an Autism Spectrum Disorder
The common thread of ASD is impairment in socialisation and communication and repetitive or stereotyped behaviours. However, the five conditions that comprise ASD differ significantly in the degree to which each of these underlying categories present clinically. Classic autism manifests at a younger age, shows evidence of a genetic aetiology and commonly causes regression in communication and socialisation. It is associated with intellectual disability and seizures and has a poor prognosis of recovery of function despite intensive therapy. In contrast, Asperger syndrome manifests at a later age and is not commonly associated with intellectual disability or seizures. Outcomes with therapy are much better when compared with classic autism. Childhood disintegrative disorder is an extremely rare condition, almost exclusively seen in male subjects, where the patient shows a dramatic loss of communication and socialisation often with associated seizures and intellectual disability. Rett syndrome affects female subjects almost exclusively with the impairments in communication and socialisation and repetitive behaviours also associated with loss of muscle tone and inability to perform normal motor activities. PDD-NOS is a catch-all diagnosis for individuals manifesting a preponderance of ASD symptoms without a clear ability to classify into one of the above four conditions due to one or more missing characteristics required for that diagnosis. Table 1 describes in detail the clinical and epidemiological aspects of the five diagnoses that comprise ASD.
Characteristics of ASDs
The common thread of ASD is impairment in socialisation and communication and repetitive or stereotyped behaviours. However, the five conditions that comprise ASD differ significantly in the degree to which each of these underlying categories present clinically. Classic autism manifests at a younger age, shows evidence of a genetic aetiology and commonly causes regression in communication and socialisation. It is associated with intellectual disability and seizures and has a poor prognosis of recovery of function despite intensive therapy. In contrast, Asperger syndrome manifests at a later age and is not commonly associated with intellectual disability or seizures. Outcomes with therapy are much better when compared with classic autism. Childhood disintegrative disorder is an extremely rare condition, almost exclusively seen in male subjects, where the patient shows a dramatic loss of communication and socialisation often with associated seizures and intellectual disability. Rett syndrome affects female subjects almost exclusively with the impairments in communication and socialisation and repetitive behaviours also associated with loss of muscle tone and inability to perform normal motor activities. PDD-NOS is a catch-all diagnosis for individuals manifesting a preponderance of ASD symptoms without a clear ability to classify into one of the above four conditions due to one or more missing characteristics required for that diagnosis. Table 1 describes in detail the clinical and epidemiological aspects of the five diagnoses that comprise ASD.
