Definition:
Characterised by qualitative deficits in reciprocal social interaction and communication skills
and restricted patterns of behaviour
DSM-IV:
A. A total of 6 or more from:
(1) Qualitative impairment in social interaction, manifested by 2 of:
a. Marked impairment in use of nonverbal behaviours e.g. eye-to-eye gaze, facial
expression, body postures and gestures
b. Failure to develop peer relationships appropriate to developmental level
c. A lack of spontaneous seeking to share enjoyment, interests, or achievements
with other people
d. Lack of social / emotional reciprocity
(2) Qualitative impairments in communication, manifested by 1 of:
a. Delay in, or total lack of, the development of spoken language
b. In patients with adequate speech, impairment in the ability to initiate or sustain
conversation with others
c. Stereotyped and repetitive use of language or idiosyncratic ideas
d. Lack of varied, spontaneous, make-believe play or social imitative play
appropriate to developmental level
(3) Restricted repetitive and stereotyped patters of behaviour, interests and activities,
manifested by one of:
a. Preoccupation with stereotyped and restricted patterns of interest that is
abnormal either in intensity or focus
b. Apparently inflexible adherencec to specific, non-functional routines or rituals
c. Stereotyped and repeptitive motor mannerisms e.g. hand or finger flapping or
twisting
d. Persistent preoccupation with parts of objects
B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3
years:
(1) Social interaction
(2) Language as used in social communication
(3) Symbolic / imaginative play
Diagnosis:
Deficits in language development and difficulty using language to communicate
Minor physical abnormalities e.g. ear malformations
Do not demonstrate special attention to important people in their lives
Impaired eye contact and attachment behaviour to family members
Activities and play often repetitive, rigid and monotonous
Common behaviour problems = hyperkinesis, aggression, head banging, scratching, hair
pulling and resistance to change in routine
Epidemiology:
Occurs in 0.05% of children
More common in males (4:1)
Onset before 3 years of age
DDx:
Schizophrenia with childhood onset
Mental retardation with behavioural symptoms
Acquired aphasia with convulsion
Congenital deafness / severe hearing impairment
Psychosocial deprivation
Course and Prognosis:
Generally a lifelong disorder with a guarded prognosis
2/3rds remain severely handicapped and dependent
Management:
Remediation:
o Structured classroom training with behavioural methods
o Language and academic remediation
Psychotherapy:
o Parents are often distraught and need support and counselling
Pharmacotherapy:
o Administration of antipsychotic medications reduces aggressive / self-injurious
behaviour
o E.g. risperidone, olanzapine, quetiapine
Definition:
Impairment in social interaction and restricted repetitive patters of behaviour
No significant delays in language, cognitive development or age-appropriate self-help skills
Diagnosis:
Features include at least 2 of the following:
o Markedly abnormal nonverbal communicative gestures
o Failure to develop peer relationships
o Lack of social / emotional reciprocity
o Impaired ability to express pleasure in other people’s happiness
Restricted interests and patterns of behaviour are always present
Epidemiology and Aetiology:
Prevalence greater than that of autistic disorder
Cause is unknown
DDx:
Autistic disorder – will have language delay as core feature
Course and Prognosis:
Variable
Good prognosis relies on normal IQ and high-level social skills
Treatment:
Depends on patient’s level of adaptive functioning
Similar techniques used with autistic disorder for patients with severe social impairment
Definition:
A persistent pattern of inattention and / or hyperactivity and impulsive behaviour that is more
severe that expected of children of similar age and level of development
Symptoms must be present before 7 years of age, must be present in at least 2 settings and
must interfere with the appropriate social, academic and extracurricular functioning
Diagnosis:
Principle signs are based on history of child’s developmental patterns and direct observation in
situations requiring attention
Typical signs = talking excessively, persevering, fidgeting, frequent interruptions, impatience,
difficulty organising and finishing tasks, distractibility and forgetfulness
Epidemiology:
Occurs in 3 – 7% of primary school children
Males > females 3 : 1
Symptoms often present by 3 years
Aetiology:
Possible causes include perinatal trauma and genetic and psychosocial factors
Evidence of NA and dopaminergic dysfunction in neurotransmitter systems
Soft neurological signs are found in higher rates amongst children with ADHD
DDx:
Bipolar I disorder
Mania
Learning disorders
Depressive disorder
Anxiety disorder
Course and Prognosis:
Course is variable
Most patients undergo partial remission
Inattention is frequently the last remitting symptom
Patients are vulnerable to antisocial behaviour, substance use disorders and mood disorders
Management:
Psychotherapy:
o