bubble_chart Overview

Childhood autism, previously known as infantile autism, is currently classified under the category of psychological developmental disorders, referred to as pervasive developmental disorder. According to Western reports, its prevalence is approximately 4 to 10 per 10,000 children. In China, reports were very rare in the past but have gradually increased in recent years. It is more common in boys (male-to-female ratio about 5:1). The cause of this disease is unknown. Twin studies indicate a higher concordance rate in monozygotic twins compared to dizygotic twins. Both EEG and brain imaging show high rates of abnormalities, though these are not specific. Neurological soft signs are also more frequent. Certain conditions, such as fragile X syndrome, are more commonly associated with autistic symptoms.

bubble_chart Clinical Manifestations

The main manifestations are significant impairment or underdevelopment in social interaction abilities, and markedly narrow interests and range of activities. The degree of these symptoms is closely related to age.

Such children show a lack of contact with others from a very young age, such as avoiding eye contact when looked at and lacking the reaction to reach out when being held. After learning to speak, they rarely initiate conversation, making it difficult to establish peer relationships. When encountering setbacks (e.g., falling), they do not seek sympathy or comfort from others, nor do they show sympathy or comfort when others (e.g., their mother) are in distress. If they attend school, they struggle to fit in with peers, and even when participating in group activities, they can only take on more mechanical roles. These children not only struggle with verbal communication but may also exhibit abnormal language development, such as inability to correctly understand others' questions, express themselves properly, or having unusual pronunciation. They often display stereotyped behaviors or actions, such as repeatedly imitating a specific action of a TV actor, or being unable to change established habits, such as insisting on sitting in the same seat during meals. Their interests are narrow, sometimes fixating on a single fragment of a game, repeating it endlessly, even mastering it. Occasionally, they may focus solely on a particular toy or part of a toy, or even a piece of string.

Symptoms generally appear in early childhood, but in some patients, they may not be prominent or noticed at this stage. By the age of three, however, few cases go undetected. Although the condition is now referred to as childhood autism, most cases actually manifest in infancy.

Most affected children exhibit some degree (mild to grade II) of intellectual disability, and without detailed medical history inquiries, they may be misdiagnosed with intellectual developmental disorder. The cognitive impairments in autistic children are typically uneven, with some areas showing no significant deficits. Autistic children may also exhibit hyperactivity, inattention, impulsivity, aggression, self-injury, or fits of rage. Sensory abnormalities may also be present, such as increased pain thresholds (insensitivity to pain) or heightened sensitivity to sound and light. Some children exhibit extreme picky eating, even to the point of pica. Others may have sleep disturbances (waking multiple times at night). Some display unusual fears, being afraid of things that are not typically frightening while showing no fear of genuinely dangerous objects. As they grow older, milder cases may develop feelings of inferiority or depression due to awareness of their condition.

Laboratory tests are generally negative, and even if positive findings occur, the influence of comorbid physical illnesses should be ruled out. Epilepsy is relatively common in autism, often accompanied by abnormal EEG results, though many without clinical seizures also show nonspecific EEG abnormalities. In recent years, brain imaging abnormalities (CT, MRI, etc.) have frequently been reported in autistic children, though these are generally nonspecific. However, some reports highlight cerebellar midline hypoplasia. Additionally, it has been reported that individuals with fragile X syndrome often exhibit autistic symptoms.

Autistic children may undergo significant changes during adolescence, with some showing marked improvement and others deteriorating. Generally, those with better language development have a more favorable prognosis, while the opposite is true for those with poorer language skills. According to U.S. data, about one-third of patients can live independently as adults.

bubble_chart Diagnosis

The diagnosis is primarily based on medical history and clinical manifestations, with particular emphasis on impairments in social interaction, verbal and nonverbal communication, as well as restricted interests and repetitive behaviors. Various autism rating scales have been developed abroad and are also being used in China. Differential diagnosis mainly involves distinguishing it from intellectual disability and schizophrenia. Pure schizophrenia typically manifests after the age of 10, and cases occurring in early childhood are rare and difficult to diagnose as schizophrenia.

bubble_chart Treatment Measures

There is currently no specific treatment for autism, with the primary focus being on educational training to address behavioral deficits, especially in learning to interact with others. This type of education should be conducted gradually and over the long term, requiring the cooperation of the child's parents. When symptoms such as hyperactivity, excitement, or depression are present, appropriate psychiatric medications may be used. If other conditions accompany the disorder, corresponding treatments should be administered.