Chapter 2 Index

A. Evaluation by system:

1. General

2. HEENT

3. Cardiopulmonary

4. GI

5. GU

6. Orthopedics

7. Neurological
--Breath-Holding Spells
--Benign Febrile Seizures
--Treating Children with Seizures
--ADHD
--Occupational Therapy
--Pediatric Physiatry
--Developmental Delay: When to Refer

Autism

Leslie Rubin, MD - Developmental Pediatricians

Introduction: Autism is diagnosed much more frequently now than in the past.  It may be that the incidence of autism has really increased, or it could be that physicians are now more aware of the diagnosis or both.  Autism is seen primarily in males, and diagnosed between 18-24 months.

Etiology:  Abnormal cells have been identified in the limbic system of the brain (the emotional regulatory system of the brain).  These cells are increased in number, are smaller than normal in size, and are not in the right places. When first described, autism (auto=self) was thought to be a result of poor and improper parenting.  This has not been found to be the case.

Clinical Characteristics of Autism:

1. Speech delay with abnormal patterns of speech such as echolalia.  The classic case is a child who acts normally for the first year of life, then possibly develops several words by 15 months of age who then is noted to regress by 18 months of age.

2. Unusual socialization and communication.  Often autistic children are noted to be playing on their own, noncommunicative, and does not show affection in the expected manner. 

There are a number of senses which act quite differently in autistic children:

1. Autistic children are “tactile-defensive”.  They do not respond to touch or to other stimuli in a normal fashion.
2. Hyperacusis. Autistic children often cover their ears when loud noises occur. Occasionally this is such a problem that they need to have ear plugs in their ears.
3. Vision.  Autistic children do make eye contact, but only briefly and never in a sustained fashion. 

3. Stereoptypic Behavior.  Autistic children usually enjoy doing ritualistic, repetitive behaviors.  This can take the form on insisting socks be put on in a certain way, want to repeat certain activities over and over.  If their routine is interrupted, they can panic quite easily.

Other repetitive behaviors include hand-flapping, spinning of plates, etc.

Differential Diagnosis:

1. Pervasive developmental disorder (PDD) of childhood.
2. Fragile X Syndrome.  Chromosomes should be drawn on anyone being considered autistic
3. Rett Syndrome.  Seen in mentally retarded girls (can have normal development at first), who engage in hand wringing and regress in their motor development as well.
4. Asperger’s Syndrome. Act like true autistic children, but at age 2-3 start talking and improve These children tend to have LD but are good at math.

Treatment of Autism:
It is not enough to just diagnose autism.  Diagnosis must be made early so that aggressive, intensive language-based socialization can begin by trained teachers.   If not sure of where to refer in your community, refer to “Babies Can’t Wait” program.

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Department of Pediatrics  |  Medical College of Georgia
Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004