In this lecture, we will discuss
autism spectrum disorders.
So we often call this a spectrum
because this spectrum
described a variability
of severity of illness
in patients with autism.
So on one side, we can think of
very mild autistic behaviors
and these patients are sometimes
described as having Asperger’s syndrome.
They are very functional, they may
hold down very important jobs,
but they have certain behaviors
that are similar to patients
who have more severe disease.
Patients may have mild autism, where
they’re reasonable functionally.
Or they may have very severe autism
with pervasive developmental delay
and need assistance lifelong.
So this is how we think
of this spectrum.
I’d like to talk specifically
about the characteristics
of autism along that spectrum,
the similarities that exist.
In general, these patients experience
difficulties with reciprocal social interaction.
They may have difficulties
with communication with others
and they may exhibit repetitive
or restricted behaviors.
They have very focused interests
or certain activities that
they really have to do a lot
and at the neglect of other
activities that may be important.
So an example of difficulties
with social interaction include
things like impairment of
It turns out that our ability
to interact with people
relies in a lot of ways on
our own eye to eye contact,
our gestures, our
And these are all impaired in patients
with autism spectrum disorders.
This can result in poor peer relationships
and these patients tend to not want to
spontaneously seek to share enjoyment.
So if you look at this picture,
this is a child autism who is
being taught to point to things.
Think about that for a little bit.
Basically, these patients may not seek
to share an experience like others do.
So a young child,
we often pick this up because these
children don’t point to things.
If I’m interested in
something and I point to it,
what that means is a I want others
to share in that interesting aspect
of whatever it is
I’m pointing to.
And these children don’t
seek to share experiences.
They may lack social or
So they don’t want to have that
experience reinforced with others.
These patients may also have
difficulties with communication.
This can present as language delay,
an inability to sustain
they may have stereotype
or repetitive language.
In severe cases, they’ll say the same
thing over and over and over again.
And this may result in poor quality
of play with other children,
which can further make difficult the
social ostracization of these children.
So in addition, they may have stereotype
or repetitive pattern of interest.
They may like to line
things up perfectly or
have a certain activity, which is the
same thing over and over and over again.
They may be inflexible or need
to adhere to a certain ritual
or certain way they get
ready in the morning.
First, my shoes, then brush my teeth, and
they can’t do it the other way around.
They may exhibit repetitive
Certain almost tics, but not really,
just repetitive motor movements that they
need to do to keep themselves organized.
And they may become preoccupied
with parts of objects.
A child may be interested in a certain –
like the tag on a stuffed animal, but
not the stuffed animal themselves.
So we’re seeing a lot more of autism
and the epidemiology is
important to understand
because it’s not clear for just
making the diagnosis some more
or if there’s something
significant going on.
Right now, it seems to be affecting
about 1 in 110 children.
So this is a common problem.
It does affect boys more than
girls by about a 4:1 ratio.
And that ration is reduced
to 2:1 for severe autism.
And there is a high risk for siblings
so there’s some genetic predisposition.