A girl with normal milestones spend her time seeing her own hand, do not interact with others, what is the diagnosis
PERVASIVE DEVELOPMENTAL DISORDERS (AUTISM SPECTRUM DISORDER):- These are group of neurodevelopmental or neurobehavioral disorders, which are characterized by disturbance of social interaction, abnormalities of communication and restricted behaviors. Autism (Childhood autism, autistic disorder):- It is a neurodevelopmental disorder (neurobehavioral disorder) with a strong genetic basis. The onset is before the age of 3 years. Chromosome 7,2,4,15 and 19 have been found to contribute to the disorder. Fragile X syndrome, tuberous sclerosis, congenital rubella and phenylketonuria are associated with autism and are found with high frequency in children with autistic disorders. Around 70% of children with autism have comorbid mental retardation. The prevalence of perinatal insults like bih asphyxia has also been found to be higher in children with autism. symptoms:- * Impairment in social interaction: The patients with autism have impaired reciprocal social skills. As infants they have poor eye contact, lack social smile and anticipatory posture (the posture which the kid assumes when he wants to be picked up). They may have poor attachment to their parents and other impoant persons and may not acknowledge their presence (e.g. they won't come running to meet when the father returns to home after office). However, if the routine of these children is disturbed (e.g. if someone rearranges the furniture in their room), they may show excessive reaction. When they grow up, they may have difficulty in making friends and getting into a romantic relationship. * Impairment of communication and language: These children usually have significant delay in language milestones, whereas the motor milestones are usually normally achieved. The patients also have development of abnormal language such as difficulty in making sentences properly (aiculation difficulties) and pronoun reversals (using "me" instead of "you"). * Restricted, repetitive and stereotyped behavior: The activities and play of these children tend to be repetitive and boring. They may show stereotyped behaviors like hand wringing, spinning and banging. These children are quite resistant to changes and may become extremely upset if their routines are disturbed (e.g. bathing routine is changed or furnitures are rearranged in the room). These restrictive behaviors usually result from a lack of imagination and creativity. Apa from these three characteristic features, the patients with autism also have abnormal responses to stimuli. They may have a higher threshold for pain and may show intense interest in some sounds (like that of a ticking watch) and may totally ignore other sounds. They may also have self destructive behaviors like head banging, biting , scratching, etc. Precocious skills or islets of precocity: Some individuals with autism may have skills in ceain areas, which are much higher than their normal peers. For example, hyperlexia (early ability to ready very well), extremely good remote memory or calculating ability, etc. Treatment:- Educational interventions such as a structured classroom teaching along with use of behavioral therapy is the recommended treatment. The role of medications is limited. Atypical antipsychotics such as risperidone and aripiprazole have been used to reduce aggressive and self injurious behavior. Ref:- Psychiatry by Sandeep Govil; pg num:- 248
ADHD
Autism
Asperger's syndrome
Rett's disorder
Child psychiatry