Autism Spectrum Disorders (ASD)

00:01 In this lecture, we will discuss autism spectrum disorders.

00:05 So we often call this a spectrum because this spectrum described a variability of severity of illness in patients with autism.

00:16 So on one side, we can think of very mild autistic behaviors and these patients are sometimes described as having Asperger’s syndrome.

00:25 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.

00:35 Patients may have mild autism, where they’re reasonable functionally.

00:38 Or they may have very severe autism with pervasive developmental delay and need assistance lifelong.

00:46 So this is how we think of this spectrum.

00:51 I’d like to talk specifically about the characteristics of autism along that spectrum, the similarities that exist.

00:58 In general, these patients experience difficulties with reciprocal social interaction.

01:05 They may have difficulties with communication with others and they may exhibit repetitive or restricted behaviors.

01:12 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.

01:23 So an example of difficulties with social interaction include things like impairment of nonverbal communication.

01:31 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 facial expressions.

01:42 And these are all impaired in patients with autism spectrum disorders.

01:48 This can result in poor peer relationships and these patients tend to not want to spontaneously seek to share enjoyment.

01:58 So if you look at this picture, this is a child autism who is being taught to point to things.

02:05 Think about that for a little bit.

02:07 Basically, these patients may not seek to share an experience like others do.

02:13 So a young child, we often pick this up because these children don’t point to things.

02:19 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.

02:27 And these children don’t seek to share experiences.

02:31 They may lack social or emotion reciprocity.

02:35 So they don’t want to have that experience reinforced with others.

02:40 These patients may also have difficulties with communication.

02:43 This can present as language delay, an inability to sustain a conversation, they may have stereotype or repetitive language.

02:52 In severe cases, they’ll say the same thing over and over and over again.

02:56 And this may result in poor quality of play with other children, which can further make difficult the social ostracization of these children.

03:06 So in addition, they may have stereotype or repetitive pattern of interest.

03:12 They may like to line things up perfectly or have a certain activity, which is the same thing over and over and over again.

03:19 They may be inflexible or need to adhere to a certain ritual or certain way they get ready in the morning.

03:26 First, my shoes, then brush my teeth, and they can’t do it the other way around.

03:31 They may exhibit repetitive motor mannerisms.

03:34 Certain almost tics, but not really, just repetitive motor movements that they need to do to keep themselves organized.

03:44 And they may become preoccupied with parts of objects.

03:48 A child may be interested in a certain – like the tag on a stuffed animal, but not the stuffed animal themselves.

03:56 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.

04:07 Right now, it seems to be affecting about 1 in 110 children.

04:11 So this is a common problem.

04:13 It does affect boys more than girls by about a 4:1 ratio.

04:17 And that ration is reduced to 2:1 for severe autism.

04:21 And there is a high risk for siblings so there’s some genetic predisposition.