US Editor: Stas Fridland, 4th Year Medical Student, Northwestern University School of Medicine, Chicago, Illinois
Brief overview
Early childhood autism
Synonyms: Kanner syndrome, infantile autism, early childhood psychosis, autistic disorder, pervasive developmental disorder (PDD)
The traditional clinical picture of early childhood autism develops before the age of 3 and is characterized by marked contact disorder, lack of empathy, slowed language development, stereotyped patterns of behavior, interests, and activities, and usually a reduced intelligence quotient.
Boys are affected more often than girls.
In terms of differential diagnosis, early childhood autism should primarily be distinguished from other forms of profound developmental disorders. However, the presence of attachment disorders in childhood and a reduction in intelligence with emotional behavioral disorders should also be considered.
A cure for early childhood autism has not yet been developed. However, the earlier the diagnosis is made, the better the affected child can be supported and existing deficits strengthened.
The DSM-5 and ICD-11 classify autism as a spectrum of disorders known as autism spectrum disorder. This includes early childhood autism and Asperger’s syndrome.
Definition
Early childhood autism
Early childhood autism is a profound developmental disorder occurring before the age of 3. Its leading symptoms are a marked social contact disorder, impaired language development, stereotyped patterns of behaviors, interests, and activities, and impulsive behaviors.
Research results of the last decades have not been able to confirm the classification of early childhood autism and Asperger syndrome according to the ICD-11[1] as two separate disease entities. Accordingly, the continuum of symptoms with an overall heterogeneous etiology is currently assumed, which is reflected in the DSM-5[2] and in the ICD-11 in the diagnostic group of autism spectrum disorders.
Epidemiology
The prevalence of autism spectrum disorders (ASD) is currently estimated at 1.5% in the US with a 4:1 male predominance.
Etiology
A heterogeneous etiopathogenesis is assumed: there is a strong underlining genetic predisposition that is likely polygenic. A variety of cerebral abnormalities have also been described. Neurochemical findings show elevated serotonin and dopamine levels. Additionally, environmental factors such as toxin exposure and prenatal infections may increase the risk of ASD.
Signs and symptoms
The symptoms of early childhood autism begin before the age of 3. Classically, a pronounced contact disorder (isolation, fellow human beings as “non-existent,” no smile, no eye contact), a lack of empathy, aslowed speech development, presence of stereotyped patterns of behaviors, interests, and activities, and repetitive motions are observed.
Peculiarities in speech behavior can manifest as follows:
Echolalia: repetition of spoken words
Iterations: repetition of certain sentences without situation reference
Pronominal reversal: pronouns are reversed; the child addresses his/her interlocutor as “I,” for example
Intelligence is usually reduced, yet special talents (e.g., arithmetic, memory) with marked attention to detail may sometimes be present.
Those affected are usually severely limited in their imagination, creativity, and play repertoire. They are often aggressive toward others and themselves (self-injurious behavior in approximately 50% of children) and exhibit pronounced impulsive behavior. Affected persons classically react to changes in their environment with pronounced anxiety and disturbance. Often there are additional motor disorders (ritualized, stereotyped movements, disturbed fine motor skills), and co-occurring sleep and eating disorders as well as epilepsy.
