Sleeping and Eating Disturbances
SLEEPING AND EATING DISTURBANCES
Sleep disturbances, such as reversal of sleep pattern and recurrent awakening at night, and eating disturbances, such as an aversion to certain foods because of their texture or smell, an insistence on eating a limited choice of foods (food faddism), a refusal to try new foods, or pica, can be very trying on parents.
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MOOD AND AFFECT DISTURBANCES
Some autistic individuals show sudden mood changes and may laugh or cry for no apparent reason. It is not uncommon to see autistic children giggling to themselves. Some children are emotionally fragile. Excessive fears, sometimes of benign objects, and intense anxiety may characterize certain children. Separation anxiety may be intense. There are case reports of severe depression occurring in autistic adolescents.
SELF-INJURIOUS BEHAVIOR AND AGGRESSION AGAINST OTHERS
Autistic children may bite their hands or fingers, which may lead to bleeding and callous formation. Head banging may result in welts and frontal bossing. They may pick their skin, pull their hair, bang on their chests, or hit themselves. The lack of a sense of danger commonly seen in autistic children may unintentionally lead to injuries. Temper tantrums are not uncommon, some children being easily frustrated or annoyed when demands are placed on them. Unprovoked aggressive outbursts may occur in some children.
SEIZURE DISORDERS
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Epileptic seizures occur in approximately 10 to 25 percent of autistic persons. The development of a seizure disorder is highly correlated with the severity of mental retardation and the level of CNS dysfunction. In most cases the seizures are grand mal seizures. It has been believed that autistic persons who develop seizures are more likely to develop them in adolescence, unlike mentally retarded persons, in whom seizures develop in early childhood. A recent study of 192 autistic children, however, found that the majority of the 41 who developed seizures did so in early childhood, with a second peak occurring in early adolescence. One longitudinal study reported the association of adolescent seizure development with deterioration in language, intellectual functioning, and inertia in a small number of cases.
COURSE AND PROGNOSIS
Although most autistic children show improvement in social relatedness and language ability with increasing age, autistic disorder remains a lifelong disability, with the majority of persons so affected unable to live an independent existence and needing institutionalization or supervision.
