Table of Contents
Overview – Autism Spectrum Disorder
Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterised by persistent difficulties in social interaction and communication, alongside restricted and repetitive behaviours or interests. Typically presenting in early childhood, ASD affects everyday functioning to varying degrees, ranging from mild social awkwardness to severe communication and cognitive impairment. Understanding the broad clinical features, diagnostic process, and multidisciplinary approach to management is essential for medical students preparing for both paediatric and psychiatric clinical contexts.
Clinical Features
ASD is defined by persistent deficits in three areas of social communication and interaction, along with restricted, repetitive behaviours, beginning in early developmental periods.
1. Social-Emotional Reciprocity
- Abnormal social approach; failure of normal back-and-forth conversation
- Reduced sharing of interests, emotions, or affect
- Failure to initiate or respond to social interactions
2. Nonverbal Communicative Behaviours
- Poorly integrated verbal and nonverbal communication
- Abnormal eye contact and body language
- Deficits in understanding or use of gestures
- Flat facial expressions and absent nonverbal cues
3. Developing and Understanding Relationships
- Difficulty adjusting behaviour to social contexts
- Challenges in making friends or sharing imaginative play
- Apparent disinterest in peer interactions
Restricted and Repetitive Behaviours (2 or more required)
- Stereotyped or repetitive motor movements (e.g., hand-flapping, lining up toys)
- Insistence on sameness, inflexible routines
- Highly restricted, fixated interests (e.g., preoccupation with objects or topics)
- Hyper- or hypo-reactivity to sensory stimuli (e.g., indifference to pain, adverse response to sounds)
Differential Diagnosis
- Developmental delay
- Attention Deficit Hyperactivity Disorder (ADHD)
- Communication disorders
- Childhood-onset schizophrenia
- Obsessive-Compulsive Disorder (OCD)
- Social anxiety disorder
- Hearing or visual impairments
- Abuse or neglect-related behavioural disturbance
Diagnosis
A thorough diagnostic workup is essential and includes:
- Hearing and vision testing – to exclude sensory impairment
- Psychological and cognitive assessment – evaluates IQ, learning difficulties
- Chromosomal analysis – to rule out genetic syndromes (e.g., Fragile X, Down syndrome)
- Psychiatric screening – for mood, psychotic, or anxiety disorders
- Social and family assessment – evaluates potential environmental contributors
Management
A multidisciplinary approach provides the best outcomes for individuals with ASD.
Multidisciplinary Team
- Paediatrician or psychiatrist
- Psychologist
- Speech and language therapist
- Occupational therapist
- Physiotherapist
- Educational specialists and social workers
Psychosocial Interventions
- Family education and support
- Specialised school programs and inclusive learning
- Behavioural therapy (e.g., Applied Behaviour Analysis)
- Social skills training and structured routines
Pharmacotherapy (Symptom-Based)
- Atypical antipsychotics – for aggression, self-injury, or severe irritability
- Selective serotonin reuptake inhibitors (SSRIs) – for anxiety or depression
- Stimulants (e.g., methylphenidate) – for comorbid inattention or hyperactivity
Summary – Autism Spectrum Disorder
Autism Spectrum Disorder is a developmental condition marked by core deficits in social communication and restrictive behaviours. Diagnosis involves exclusion of other causes and relies on multidisciplinary input. Management focuses on psychosocial support, behavioural intervention, and targeted pharmacotherapy. For a broader context, see our Psychiatry & Mental Health Overview page.