Autistic Spectrum Disorders 47(echolalia); pronominal reversal (for example, ‘you’ for ‘I’); idiosyncratic
use of words or phrases; invented words (neologisms); and reliance on
stock phrases or repetitive questioning. Instead of chatting in a to-and-fro
waywithother people, the individual with autism primarily talksatother
people. For example, some individuals with autism use speech mainly for
demanding things. Others talk at length about one of their current pre-
occupations, oblivious of the social cues indicating that their listener has
long since lost interest in the topic. Speech is often abnormal in intonation
or pitch, for example, sing-song or a monotonous drone. Gestures are
similarly reduced and poorly integrated (for example, abnormal pointing).
Restricted and repetitive activities and interests
These include: resistance to change so that, for example, a small rearrange-
ment of furniture provokes major tantrums; insistence on routines and
rituals; hand-flapping, twirling, or other stereotypies; ordering play (for
example, lining things up); attachment to unusual objects (for example, a
dustbin); fascination with unusual aspects of the world (for example, the
feel of zips or people’s hair); and intense preoccupations with restricted
subjects (for example, train timetables, car prices). Pretend play is typically
lacking, except in older higher-functioning individuals; when present,
pretend play is often limited to simple repetitive enactments, for example,
of just one or two incidents from a favourite story or TV programme.
Early onset
Though the disorder is rarely recognised in the first year of life, it is
clear retrospectively in around 70% of cases that development was never
entirely normal. For example, the child may never have liked being cud-
dled, even as a baby; or speech development may have been significantly
delayed. In around 30% of cases, however, there was a clear ‘setback’:
after a period of normal or near normal development, these children
went through a phase of regression (most often between 18 and 24
months) when they lost previously acquired skills in social interaction,
communication and play. Both ICD-10 and DSM-IV stipulate that at least
some symptoms must have been present by 36 months, but this is an
arbitrary cut-off and it is sometimes hard to date the onset precisely from
retrospective accounts, particularly when the disorder is relatively mild.
While some children meet all four of these criteria and warrant a
diagnosis of childhood autism, others meet only some of the criteria
and so may warrant a diagnosis of atypical autism (ICD-10) or pervasive
developmental disorder, not otherwise specified (DSM-IV).
Asperger syndrome
This differs from classical autism in several respects:
There is little or no delay in the development of vocabulary and gram-
mar, though other aspects of language are abnormal, as in autism. Thus,