Autism natural history, complications and prognosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Autism}} | {{Autism}} | ||
{{CMG}} | {{CMG}}; {{AE}}{{HK}} | ||
==Overview== | == Overview == | ||
ASD is a chronic illness with core features persisting throughout life, although presentation may vary according to the age, level of maturity, environment. [[Infants]] are affected most severely. There is developmental delay and [[Regression (medicine)|regression]] of language. Indifference and lack of interest (which is commonly found in ASD) may also seem like a delay in behavior. Some individuals may have a higher level of functioning despite social awkwardness (called savants). Autism patients may develop many syndromes and exhibit signs and [[symptoms]] of the respective syndrome, leading to complications. Higher [[Socio-economic status|socioeconomic status]], acquisition of language skill at an early age, higher IQ and absence of underlying [[Genetics|genetic]] or [[metabolic disorder]] are all associated with better outcomes in patients suffering from autism. | |||
== Natural History == | |||
ASD is a chronic illness with core features persisting throughout life, although presentation may vary according to the age, level of maturity, environment. [[Infants]] are affected most severely. There is developmental delay and [[Regression (medicine)|regression]] of language. Indifference and lack of interest (which is commonly found in ASD) may also seem like a delay in behavior. Some individuals may have a higher level of functioning despite social awkwardness (called savants). These children usually present later as they appear otherwise intelligent. Frustration, [[anxiety]] and [[depression]] affect future relationships even if the child becomes willing to socially interact. During [[adolescence]] hyperactivity may improve and ritualistic behaviors decrease, but the patient may be affected by other [[comorbidities]]. | |||
==Complications== | |||
*Autism can be associated with other disorders that affect the brain, such as: | |||
:*[[Fragile X syndrome (patient information)|Fragile X syndrome]] | |||
:*[[Mental retardation (patient information)|Mental retardation]] | |||
:*[[Tuberous sclerosis (patient information)|Tuberous sclerosis]] | |||
*Some people with autism will develop [[Seizure (patient information)|seizures]]. | |||
*The stresses of dealing with autism can lead to social and emotional complications for family and caregivers, as well as the person with autism. | |||
==Prognosis== | ==Prognosis== | ||
There is no cure. | * There is no cure for autism. Appropriate and timely intervention may lead to better outcomes and return to normal or near normal social functioning. | ||
* Most children with autism lack social support, meaningful relationships, future employment opportunities or [[Self-determination theory|self-determination]].<ref name="Burgess">{{cite journal |author= Burgess AF, Gutstein SE |date=2007 |title= Quality of life for people with autism: raising the standard for evaluating successful outcomes |journal= Child Adolesc Ment Health |volume=12 |issue=2 |pages=80–6 |doi=10.1111/j.1475-3588.2006.00432.x}}</ref> | |||
* [[Symptoms]] associated with autism may gradually improve with age.<ref name="Howlin06">{{cite journal |author= Howlin P |title= Autism spectrum disorders |journal=Psychiatry |volume=5 |issue=9 |date=2006 |pages=320–4 |doi=10.1053/j.mppsy.2006.06.007}}</ref> | |||
* Few high-quality studies address long-term [[prognosis]].<ref>{{cite journal |journal= Ment Retard Dev Disabil Res Rev |volume=10 |issue=4 |pages=234–47 |date=2004 |title= Trajectory of development in adolescents and adults with autism |author= Seltzer MM, Shattuck P, Abbeduto L, Greenberg JS |doi=10.1002/mrdd.20038 |pmid=15666341 |url=http://waisman.wisc.edu/family/pdf/seltzer_trajectory.pdf |format=PDF |accessdate=2008-04-17}}</ref> | |||
* Early acquisition of language skills (by age 6 years), IQ > 50, and having a socially acceptable skill all predict better outcomes; independent living is unlikely with severe autism.<ref>{{cite journal |author= Tidmarsh L, Volkmar FR |title= Diagnosis and epidemiology of autism spectrum disorders |journal= Can J Psychiatry |volume=48 |issue=8 |pages=517–25 |date=2003 |pmid=14574827 |url=http://ww1.cpa-apc.org:8080/Publications/Archives/CJP/2003/september/tidmarsh.asp}}</ref> | |||
* A 2004 British study of 68 adults who were diagnosed before 1980 as autistic children with IQ above 50 found that 12% achieved a high level of independence as adults, 10% had some friends and were generally in work but required some support, 19% had some independence but were generally living at home and needed considerable support and supervision in daily living, 46% needed specialist residential provision from facilities specializing in ASD with a high level of support and very limited autonomy, and 12% needed high-level hospital care.<ref name="Howlin">{{cite journal |author= Howlin P, Goode S, Hutton J, Rutter M |title= Adult outcome for children with autism |journal= J Child Psychol Psychiatry |date=2004 |volume=45 |issue=2 |pages=212–29 |pmid=14982237 |doi=10.1111/j.1469-7610.2004.00215.x}}</ref> | |||
* A 2005 Swedish study of 78 adults pointed out that patients having a lower IQ, had a lower rate of achieving independence.<ref>{{cite journal |journal= J Autism Dev Disord |year=2005 |volume=35 |issue=3 |pages=351–60 |title= Autism after adolescence: population-based 13- to 22-year follow-up study of 120 individuals with autism diagnosed in childhood |author= Billstedt E, Gillberg C, Gillberg C |doi=10.1007/s10803-005-3302-5 |pmid=16119476}}</ref> | |||
* A 2008 Canadian study of 48 young adults diagnosed with ASD as preschoolers found outcomes ranging through poor (46%), fair (32%), good (17%), and very good (4%); only 56% had ever been employed, most in volunteer, sheltered or part time work.<ref>{{cite journal |journal= J Autism Dev Disord |date=2008 |volume=38 |issue=4 |pages=739–47 |title= Young adult outcome of autism spectrum disorders |author= Eaves LC, Ho HH |doi=10.1007/s10803-007-0441-x |pmid=17764027}}</ref> | |||
* Patients harboring the 22q13 deletion have absent or severely delayed speech. They exhibit only minor facial [[dysmorphism]]; thin, flaky toenails (78%); large, fleshy hands (68%); large feet; prominent, poorly formed ears (65%); and other characteristics which are not visually apparent: [[hypotonia]] (97%); normal to accelerated [[growth]] (95%); increased tolerance to [[pain]] (86%); [[seizures]] (unknown percentage); [[strabismus]]; anomalies of the [[spine]]; poor central [[vision]].<ref>[http://www.22q13.org]</ref> | |||
=== Good prognosis factors === | |||
The following features and characteristics are associated with a better [[prognosis]] in patients affected with autism:<ref name="pmid23459124">{{cite journal |vauthors=Fernell E, Eriksson MA, Gillberg C |title=Early diagnosis of autism and impact on prognosis: a narrative review |journal=Clin Epidemiol |volume=5 |issue= |pages=33–43 |date=2013 |pmid=23459124 |pmc=3583438 |doi=10.2147/CLEP.S41714 |url=}}</ref> | |||
* Absence of [[cognitive impairment]] | |||
* No underlying [[genetic]] or [[metabolic disorder]] | |||
* Early [[diagnosis]] and optimum intervention | |||
* Upper [[Socio-economic status|socio-economic]] class | |||
* Higher levels of parental education | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Mature chapter]] | |||
[[Category:Disease]] | |||
[[Category:Psychiatry]] | |||
[[Category:Pediatrics]] | |||
[[Category:Neurology]] | |||
[[Category:Communication disorders]] | |||
[[Category:Neurological disorders]] | |||
[[Category:Autism]] | |||
[[Category:Needs overview]] | |||
{{WH}} | |||
{{WS}} | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [3]
Overview
ASD is a chronic illness with core features persisting throughout life, although presentation may vary according to the age, level of maturity, environment. Infants are affected most severely. There is developmental delay and regression of language. Indifference and lack of interest (which is commonly found in ASD) may also seem like a delay in behavior. Some individuals may have a higher level of functioning despite social awkwardness (called savants). Autism patients may develop many syndromes and exhibit signs and symptoms of the respective syndrome, leading to complications. Higher socioeconomic status, acquisition of language skill at an early age, higher IQ and absence of underlying genetic or metabolic disorder are all associated with better outcomes in patients suffering from autism.
Natural History
ASD is a chronic illness with core features persisting throughout life, although presentation may vary according to the age, level of maturity, environment. Infants are affected most severely. There is developmental delay and regression of language. Indifference and lack of interest (which is commonly found in ASD) may also seem like a delay in behavior. Some individuals may have a higher level of functioning despite social awkwardness (called savants). These children usually present later as they appear otherwise intelligent. Frustration, anxiety and depression affect future relationships even if the child becomes willing to socially interact. During adolescence hyperactivity may improve and ritualistic behaviors decrease, but the patient may be affected by other comorbidities.
Complications
- Autism can be associated with other disorders that affect the brain, such as:
- Some people with autism will develop seizures.
- The stresses of dealing with autism can lead to social and emotional complications for family and caregivers, as well as the person with autism.
Prognosis
- There is no cure for autism. Appropriate and timely intervention may lead to better outcomes and return to normal or near normal social functioning.
- Most children with autism lack social support, meaningful relationships, future employment opportunities or self-determination.[1]
- Symptoms associated with autism may gradually improve with age.[2]
- Few high-quality studies address long-term prognosis.[3]
- Early acquisition of language skills (by age 6 years), IQ > 50, and having a socially acceptable skill all predict better outcomes; independent living is unlikely with severe autism.[4]
- A 2004 British study of 68 adults who were diagnosed before 1980 as autistic children with IQ above 50 found that 12% achieved a high level of independence as adults, 10% had some friends and were generally in work but required some support, 19% had some independence but were generally living at home and needed considerable support and supervision in daily living, 46% needed specialist residential provision from facilities specializing in ASD with a high level of support and very limited autonomy, and 12% needed high-level hospital care.[5]
- A 2005 Swedish study of 78 adults pointed out that patients having a lower IQ, had a lower rate of achieving independence.[6]
- A 2008 Canadian study of 48 young adults diagnosed with ASD as preschoolers found outcomes ranging through poor (46%), fair (32%), good (17%), and very good (4%); only 56% had ever been employed, most in volunteer, sheltered or part time work.[7]
- Patients harboring the 22q13 deletion have absent or severely delayed speech. They exhibit only minor facial dysmorphism; thin, flaky toenails (78%); large, fleshy hands (68%); large feet; prominent, poorly formed ears (65%); and other characteristics which are not visually apparent: hypotonia (97%); normal to accelerated growth (95%); increased tolerance to pain (86%); seizures (unknown percentage); strabismus; anomalies of the spine; poor central vision.[8]
Good prognosis factors
The following features and characteristics are associated with a better prognosis in patients affected with autism:[9]
- Absence of cognitive impairment
- No underlying genetic or metabolic disorder
- Early diagnosis and optimum intervention
- Upper socio-economic class
- Higher levels of parental education
References
- ↑ Burgess AF, Gutstein SE (2007). "Quality of life for people with autism: raising the standard for evaluating successful outcomes". Child Adolesc Ment Health. 12 (2): 80–6. doi:10.1111/j.1475-3588.2006.00432.x.
- ↑ Howlin P (2006). "Autism spectrum disorders". Psychiatry. 5 (9): 320–4. doi:10.1053/j.mppsy.2006.06.007.
- ↑ Seltzer MM, Shattuck P, Abbeduto L, Greenberg JS (2004). "Trajectory of development in adolescents and adults with autism" (PDF). Ment Retard Dev Disabil Res Rev. 10 (4): 234–47. doi:10.1002/mrdd.20038. PMID 15666341. Retrieved 2008-04-17.
- ↑ Tidmarsh L, Volkmar FR (2003). "Diagnosis and epidemiology of autism spectrum disorders". Can J Psychiatry. 48 (8): 517–25. PMID 14574827.
- ↑ Howlin P, Goode S, Hutton J, Rutter M (2004). "Adult outcome for children with autism". J Child Psychol Psychiatry. 45 (2): 212–29. doi:10.1111/j.1469-7610.2004.00215.x. PMID 14982237.
- ↑ Billstedt E, Gillberg C, Gillberg C (2005). "Autism after adolescence: population-based 13- to 22-year follow-up study of 120 individuals with autism diagnosed in childhood". J Autism Dev Disord. 35 (3): 351–60. doi:10.1007/s10803-005-3302-5. PMID 16119476.
- ↑ Eaves LC, Ho HH (2008). "Young adult outcome of autism spectrum disorders". J Autism Dev Disord. 38 (4): 739–47. doi:10.1007/s10803-007-0441-x. PMID 17764027.
- ↑ [1]
- ↑ Fernell E, Eriksson MA, Gillberg C (2013). "Early diagnosis of autism and impact on prognosis: a narrative review". Clin Epidemiol. 5: 33–43. doi:10.2147/CLEP.S41714. PMC 3583438. PMID 23459124.