Autism

Headnote

Part 1 - Background to aetiology and diagnosis

In the first of a two-part series on autism and its clinical consequences, Dr Paul Constable takes a look at the background of the disease spectrum. Module C16181, one general CET point for optometrists and dispensing opticians

The originai description of autism, which from a psychiatric definition relates to an individual that is 'self absorptive', was used by Leo Kanner who studied a small group of children exhibiting obsessive/repetitive behaviours and lacked emotional contact.1 At a similar time Asperger described an 'autistic psychopathy' in children who had poor motor skills, obsessive behaviour and difficulties with communication. The observations of Kanner and Asperger have come to define the clinical picture of autism and Asperger syndrome. This compa rtmen tal approach to diagnosis along with aligned conditions such as pervasive developmental disorder not otherwise specified (PDD-NOS) has now shifted, and these conditions belong to what is termed an autistic spectrum disorder (ASD). This spectrum approach acknowledges that the clinical lines between each diagnostic condition may blur and overlap and that a range of abilities and disabilities may be present within die individual.

An individual with an ASD will exhibit deficits to a greater or lesser extent compared to a typically developing child in three core domains.

* A difficulty with language and communication

* Poor reciprocal social interactions

* Repetitive stereotyped behaviours and may lack creative play.

The triad of social impairment, poor language and a lack of imaginative play may be recognised in children at the age of two but owing to the differences in the severity of these signs may be overlooked and a child may not be diagnosed until later in life. The early detection of ASD in young children is important, because early intervention by speech and language therapists, occupational therapists, and the introduction of social stories to reinforce behaviour all help the child develop the areas where he/she may be lacking. The optometrist can play an imporram role in noticing possible behavioural differences in these young children.

ASD is a lifelong developmental condition whose prevalence is increasing owing to greater awareness of this condition rather than any single causative agent. One large study based on over 50,000 children born in the South...