Perinatal factors. Autism

A number of studies have shown an increased frequency of prenatal, perinatal, and neonatal complications in autistic children. The most frequently reported complications include bleeding after the first trimester and meconium staining of the amniotic fluid, an indication of fetal distress. One study found that maternal use of medication during pregnancy significantly differentiated autistic children from their normal siblings. Most studies finding an increased incidence of obstetrical complications in autistic children did not include a control group matched for I.Q., making it difficult to determine whether the complications were associated with autism or with mental retardation. One recent study comparing autistic children with their normal siblings, with normal children, and with I.Q.-matched controls found that delayed cry, respiratory distress syndrome, and neonatal anemia differentiated the autistic group from the control groups. Total obstetrical optimality scores (a rating based on a 61-item scale of prenatal, perinatal, and neonatal risk factors) were significantly lower for the autistic children than for all control groups.

DIAGNOSIS AND CLINICAL FEATURES

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The diagnosis of autistic disorder requires that a certain number of criteria in three symptom areas of social interaction, verbal and nonverbal communication and play, and repertoire of activities and interests be met. However, children meeting criteria for autistic disorder may appear very different from one another owing to differences in intellectual and language ability: Both the mute, aloof child and the one who asks grammatically perfect but inappropriately personal questions of strangers may be diagnosed with autistic disorder. The variability in phenomenology may lead to diagnostic errors, especially when children are at the extremes of intellectual functioning. In addition, certain behaviors characteristic of autism diminish with age, so that diagnoses made after childhood are not as reliable as those made in the preschool period, when many behaviors characteristic of autistic disorder are seen. The evaluation of autistic children requires a detailed prenatal and perinatal developmental, psychiatric, and medical history and a comprehensive medical examination that includes hearing, speech, and neurological evaluations. Neuropsychological testing, including I.Q. testing, should be performed. Because autism is believed to be a syndrome with multiple etiologies, it is important to rule out medical-genetic conditions that may underlie the disorder in a particular child.

Age at onset

Onset characteristically occurs before age 3 years and is marked by failure to develop language and failure to develop relatedness to parents–the most frequent reasons parents of autistic children contact health professionals. In addition, some parents fear that their child may be deaf, as the child may not respond when spoken to. Rarely, parents report that their child had normal social and language development but subsequently lost language and withdrew from social interaction.

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