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▲▲
31.5 Autism Spectrum
Disorder
Autism spectrum disorder, previously known as the pervasive
developmental disorders, is a phenotypically heterogeneous
group of neurodevelopmental syndromes, with polygenic heri-
tability, characterized by a wide range of impairments in social
communication and restricted and repetitive behaviors. Prior to
the development of the Fifth Edition of the American Psychiatric
Association’s
Diagnostic and Statistical Manual of Mental Dis-
orders
(DSM-5), autism spectrum disorder was conceptualized
as five discrete disorders, including:
autistic disorder, Asperger’s
disorder, childhood disintegrative disorder, Rett syndrome,
and
pervasive developmental disorder not otherwise specified.
Autis-
tic disorder was characterized by impairments in three domains:
social communication, restricted and repetitive behaviors, and
aberrant language development and usage. A less extensive form
of autism spectrum disorder, Asperger’s disorder, did not include
language impairment as a diagnostic criterion. Recent clinical
consensus has shifted the conceptualization of autism spectrum
disorder toward a continuum model in which heterogeneity of
symptoms is recognized as inherent in the disorder, and core
diagnostic impairments are collapsed into two domains: deficits
in social communication, and restricted and repetitive behaviors.
Aberrant language development and usage is no longer consid-
ered a core feature of autism spectrum disorder. This diagnostic
change, is based, in part, on recent studies in siblings with diag-
noses of autistic disorder, suggesting that symptom domains may
be transmitted separately, and that aberrant language develop-
ment and usage is not a defining feature, but an associated fea-
ture in some individuals with autism spectrum disorder. Autism
spectrum disorder is typically evident during the second year
of life, and in severe cases, a lack of developmentally appropri-
ate interest in social interactions may be noted even in the first
year. Some studies suggest that a decline in social interaction
may ensue between the first and second years of life. However,
in milder cases, core impairments in autism spectrum disorder
may not be identified for several more years. Although language
impairment is not a core diagnostic criterion in autism spectrum
disorder, clinicians and parents share concerns about a child
who by 12 to 18 months has not developed any language, and
delayed language accompanied by diminished social behavior
are frequently the heralding symptoms in autism spectrum dis-
order. In up to 25 percent of cases of autism spectrum disorder,
some language develops and is subsequently lost. Autism spec-
trum disorder in children with normal intellectual function and
mild impairment in language function may not be identified until
middle childhood when both academic and social demands are
increased. Children with autism spectrum disorder often exhibit
idiosyncratic intense interest in a narrow range of activities,
resist change, and typically, do not respond to their social envi-
ronment in accordance with their peers.
According to the DSM-5, diagnostic criteria for autism
spectrum disorder include deficits in social communication and
restricted interests, which present in the early developmental
period, however, when subtle, may not be identified until sev-
eral years later. approximately one third of children meeting the
