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Atypical autism — Clinical Guidelines

Overview

Atypical autism encompasses presentations that align with core autism spectrum disorder (ASD) features but may exhibit unique symptom profiles or developmental trajectories, often including pronounced echolalia and varying communication abilities. 1 12 26

Diagnosis

Key Diagnostic Criteria: Persistent deficits in social communication and interaction, restricted and repetitive behaviors, significant echolalia 1 12.

Recommended Tests: Auditory processing evaluations (TEOAE, ABR) to assess hearing abilities 18.

Grading: Diagnostic criteria based on DSM-5 or ICD-10, with clinical judgment informed by standardized assessments 1 18.

Management

First-Line Treatments:

- Applied Behavior Analysis (ABA): Intensive, structured behavioral interventions shown to improve core symptoms 13 16. - Augmentative and Alternative Communication (AAC): Interventions like aided language modeling and voice output communication aids to support language development 5 15 21.

Adjunctive Treatments:

- Speech Therapy: Focused on enhancing functional communication and reducing echolalic speech 1 22. - Social-Interaction-Based Therapies: Such as MEHRIT, aiming to improve social interaction and language function 10.

Special Populations

Pediatrics: Early intervention programs, including parent-led approaches, significantly reduce symptom severity 9 22.

Comorbidities: Consideration of obstructive sleep apnea risk assessment in children with ASD 6.

Pregnancy: Prenatal antidepressant use warrants cautious consideration due to potential links with autism risk 8.

Key Recommendations

Implement intensive Applied Behavior Analysis (ABA) interventions as a first-line treatment for core symptoms of atypical autism (Evidence: Strong 13).

Utilize augmentative and alternative communication strategies, including aided language modeling, to support language development in children with atypical autism (Evidence: Moderate 5 15).

Early intervention programs led by parents can effectively reduce symptom severity in young children with atypical autism (Evidence: Moderate 9).

Evaluate auditory processing through TEOAE and ABR to rule out hearing impairments impacting communication in individuals with atypical autism (Evidence: Moderate 18).

Monitor for signs of obstructive sleep apnea in children with atypical autism due to potential increased risk (Evidence: Moderate 6).

Exercise caution with prenatal antidepressant use given emerging associations with autism risk (Evidence: Weak 8).

References

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Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 2019. link 7 Akhter M, Ashraf M, Ali A, Rizwan I, Rehman R. Integration of therapies in autistic children; a survey based in Karachi, Pakistan. JPMA. The Journal of the Pakistan Medical Association 2018. link 8 Schendel DE. Prenatal antidepressant use and risk of autism. BMJ (Clinical research ed.) 2017. link 9 . Parent-led early intervention can reduce symptom severity. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2016. link 10 Casenhiser DM, Binns A, McGill F, Morderer O, Shanker SG. Measuring and supporting language function for children with autism: evidence from a randomized control trial of a social-interaction-based therapy. Journal of autism and developmental disorders 2015. link 11 Sandiford GA, Mainess KJ, Daher NS. A pilot study on the efficacy of melodic based communication therapy for eliciting speech in nonverbal children with autism. Journal of autism and developmental disorders 2013. link 12 Thomke H, Boser K. "Language construction in an autistic child: thoughts regarding language acquisition and language therapy": translation, update, and commentary on a 1977 case report. Cognitive and behavioral neurology : official journal of the Society for Behavioral and Cognitive Neurology 2011. link 13 Virués-Ortega J. Applied behavior analytic intervention for autism in early childhood: meta-analysis, meta-regression and dose-response meta-analysis of multiple outcomes. Clinical psychology review 2010. link 14 Pickett E, Pullara O, O'Grady J, Gordon B. Speech acquisition in older nonverbal individuals with autism: a review of features, methods, and prognosis. Cognitive and behavioral neurology : official journal of the Society for Behavioral and Cognitive Neurology 2009. link 15 Schlosser RW, Wendt O. Effects of augmentative and alternative communication intervention on speech production in children with autism: a systematic review. American journal of speech-language pathology 2008. link) 16 Paul R. Interventions to improve communication in autism. Child and adolescent psychiatric clinics of North America 2008. link 17 Brachlow AE, Ness KK, McPheeters ML, Gurney JG. Comparison of indicators for a primary care medical home between children with autism or asthma and other special health care needs: National Survey of Children's Health. Archives of pediatrics & adolescent medicine 2007. link 18 Tas A, Yagiz R, Tas M, Esme M, Uzun C, Karasalihoglu AR. Evaluation of hearing in children with autism by using TEOAE and ABR. Autism : the international journal of research and practice 2007. link 19 Hilton JC, Seal BC. Brief report: comparative ABA and DIR trials in twin brothers with autism. Journal of autism and developmental disorders 2007. link 20 Thomas KC, Morrissey JP, McLaurin C. Use of autism-related services by families and children. Journal of autism and developmental disorders 2007. link 21 Drager KD, Postal VJ, Carrolus L, Castellano M, Gagliano C, Glynn J. The effect of aided language modeling on symbol comprehension and production in 2 preschoolers with autism. American journal of speech-language pathology 2006. link) 22 Yoder P, McDuffie A. Teaching young children with autism to talk. Seminars in speech and language 2006. link 23 Aman MG, Arnold LE, McDougle CJ, Vitiello B, Scahill L, Davies M et al.. Acute and long-term safety and tolerability of risperidone in children with autism. Journal of child and adolescent psychopharmacology 2005. link 24 Bodfish JW. Treating the core features of autism: are we there yet?. Mental retardation and developmental disabilities research reviews 2004. link 25 Woo EJ, Ball R, Bostrom A, Shadomy SV, Ball LK, Evans G et al.. 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Effects of high and low constraint utterances on the production of immediate and delayed echolalia in young children with autism. Journal of autism and developmental disorders 1994. link 36 Windsor J, Doyle SS, Siegel GM. Language acquisition after mutism: a longitudinal case study of autism. Journal of speech and hearing research 1994. link 37 Nalitz NG. Consultation and collaboration programs for individuals with autism. Clinics in communication disorders 1993. link 38 Duchan JF. Issues raised by facilitated communication for theorizing and research on autism. Journal of speech and hearing research 1993. link 39 McMullen T. The savant syndrome and extrasensory perception. Psychological reports 1991. link 40 Burd L, Martsolf JT, Kerbeshian J, Jalal SM. Partial 6p trisomy associated with infantile autism. Clinical genetics 1988. link 41 Eshkevari HS. Early infantile autism in monozygotic twins. Journal of autism and developmental disorders 1979. link

Atypical autism