Infantile autism is characterized by general and profound failure to develop social relationships, language retardation and ritualistic and compulsive behavior.

Approximate incidence is 4:10,000. More boys than girls are affected and clinical finding manifest before the age of 30 months.

Etiology :

Although the cause of autism remains unknown CNS dysfunction is suggested by the increased incidence of autism in populations affected by prenatal problems. Monozygotic twins are more vulnerable to develop autism than dizygotic one.

Clinical Feature (Sings and symptoms) :

a. Impaired social relationship :

Delayed or absent social smile, failure to use eye to eye gaze and facial expression for social interaction, a lack of empathy (the ability to understand how others feel and think) and of co-operative play. The children are aloof and indifferent to people.

b. Language abnormality :

Language acquisition is delayed and deviant. Many autistic children never develop language (approx.50%). When present, language abnormalities are many and varied, including immediate and delayed echolalia, pronominal reversal and abnormalities in intonation, rhythm and pitch.

c. Ritualistic and compulsive behavior :

Common abnormalities are rigid and restricted patterns of play, intense attachment to unusual objects and marked resistance to any change in the environment or daily routine. Tantrums and explosive outbursts often occur when any change is attempted.

d. Other features :

Autistic children often exhibit a variety of stereotypes including rocking, finger twirling, spinning and tip toe walking. 70% are in the retarded range of intelligence with only 5% having an IQ above 100. 25% will develop mild to moderate epilepsy during adolescence.

e. Association with other conditions :

Autistic behavior occurs in some patients with a diverge group of conditions including rubella, phenylketonuria, tuberose sclerosis, neurolipoidosis and infantile spasm.

The goal of the treatment is to normalize the child behavior and adaptive social skills :

1. Behaviorally oriented special education or day treatment program are vital in helping the autistic child acquire more appropriate social, linguistic, self care and cognitive skills.
2. Neuroleptics have shown promise in reducing self injurious behavior, outwardly directed aggression, stereotypic behavior and social withdrawal.
3. Potent opiate antagonists have recently been shown to alter behavioral problems, withdrawal and stereotypes.
4. Parents and families need strong support as well as education in coping with the disorder.