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Autism

The major significance of autism is that it impairs social functioning as well as language functioning autism, autistic, idiot savant. These are the two major issues related to normal functioning in children who have autism. Based upon the original criteria, we were finding fewer children in that criteria of autism. Now the criteria has expanded and we are looking at autism as being along a spectrum rather than just really narrow boundaries, and we are seeing that more children actually have autism. The more expanded criteria includes more socially related factors. You see that it continues to be more boys than there are girls, but the unfortunate thing is that the affected females have a tendency to be more severe. And I can truthfully say that over the past two years I have not seen actually a single, solitary referral for a girl for a suspicion of autism. They've all 

In terms of the etiology; we still don’t know the exact etiology but we do know that there is a central nervous system problem going on here and 25% of these children will develop seizures at puberty. So that can be a problem later on down the line. You have to take a really good history, in terms of the family history. You’ll find many times that it has a tendency to run in families,

In terms of impaired social functioning, these are children who have a tendency to play alone. If they are in preschool then they have a tendency to be in the corner by themselves, and not really paying attention or noticing other children and not initiating any sort of interactive play with other children. They have a tendency to show less affection, in other words manifest less affection. They are not likely to go to their parents and ask for a hug and sit in the laps and that. They have a tendency to be less empathetic or show less empathy. And they have a tendency to treat people as objects. So if a child with autism wants something done they may take a person’s hand and put that person’s hand on that object rather than using communication skills, language, signals, in order to let the person know what they’d like to do.

In terms of the impaired communication; you may have some children who don’t talk by 18-months-of-age or have some children who actually talk and by 18-months-of-age they stop talking. So there are probably varying entries into the diagnosis of autism. That’s something that we will have to iron out somewhere later on down the line, but these are children who at 18-months-of-age, and a lot of times beyond, who don’t have much speech and language and don’t understand terms of much speech and language, so they don’t orient to their names, they don’t understand the contextual situations of language and they

No dramatic play and cannot pretend. These are not the kind of kids who will engage in pretending they are a famous basketball player and doing the commentary on the side and that kind of thing. They do not have a conceptual understanding of those kinds of things and they can’t do that. These are children who, in preschool, are not going to be able to pretend that, "Okay, I’m the

These are children who many times will engage in repetitive activities, a lot of rituals, and they have a hard time in terms of changing. Now the repetitive activities may not be what you characteristically think of like rocking and banging and that sort of 

Intolerant of change. In a testing situation - say if you are doing a Bailey, or a Denver - these are children who, when you change the test items, have a tendency to fall apart. You give them some blocks and then you kind of want to transition to a puzzle and

In terms of making the diagnosis; important to do a complete history with looking at the onset of symptoms, and the severity of difficulties. Then you look for the physical exam, kind of ruling out any kind of genetic abnormalities. You have to look at something like a fragile-X; consider fragile-X in the child who does have autistic-type behaviors or autistic features. And then if

Again, complete history in terms of language communication difficulties, how the language is progressing. Generally what happens with children with autism is they have a tendency to take maybe two steps forward and one step back and that kind of thing. So the parents may give you that kind of history. Aberrant social interactions, especially when you get into the more subtle cases.

In terms of management; management is lifelong. Parents who have a child with autism, this is going to be a very stressful thing in terms of dealing with them on a day-to-day basis and just a lifelong thing. So it’s real important to get a sense of what is the goal. Sometimes it’s helping the parents to grieve what the child’s not going to be able to do later on down the line, but you want to

That’s basically what the major goal is. And it’s multi-modal. It’s not just the parents; it’s the home, it’s the school, It’s the community, a lot of times the neighbors are really helpful related to this, but you want to engage as many people as possible who are surrounding or involved in this child’s life. In terms of the parents; short-term and long-term goals are really very important. Parental education as well as parental support. There are parent support groups for children who have a diagnosis of autism so that they can talk about some of the grief and loss issues that they are suffering at this point in time, and then later on to begin to plan what to do with this child as they move into adulthood and the parents are no longer able to

Then they may have specific interventions in terms of speech and language therapy, behavior therapy, sometimes occupational therapy. Children with autism a number of times have difficulty with respect to oral-motor control and eating, so these are children who may benefit from some occupational therapy as well as some speech therapy. Those have a tendency to overlap sometimes. Then behavior therapy which will usually entail social skills training. This is real interesting because you will see

In terms of prognosis; a child who speaks before the age of five-years-of-age, that’s a better prognosis than the child who doesn’t. Performance IQ of over 70. Unfortunately there are a number of children who you have a hard time getting an IQ on

More overt brain dysfunction; like someone who has a brain disorder associated with autism, someone who has some of the other sensorineural … hearing impaired, visually impaired. I have seen children who are blind and have autism, I have seen

Attention deficit disorder has really changed over time. Minimal brain dysfunction and attention deficit. All kinds of different names. So now it’s attention deficit hyperactivity disorder. And that’s what we’ve settled on now, maybe a decade later we will settle on something else but in terms of prevalence; 5% of the school-age population is thought to have this and it’s estimated that 50% of children who have ADHD will have it as adults, and that’s real important to remember because it may be a lifelong thing, in terms of the pediatric practice. So if you have a child who presents at seven or eight or nine-years-of-age, this is a child who