54 Chapter 4
autism but may sometimes improve associated symptoms when used for
specific indications and as part of an integrated package of psychological
and educational interventions. Selective serotonin reuptake inhibitors
(SSRIs) are sometimes effective treatments for severe anxiety, depression,
self-injury, and obsessional or repetitive behaviour. Stimulants may re-
duce associated ADHD, though this may be at the cost of an unaccept-
able increase in irritability or repetitive behaviours. Neuroleptics such
as haloperidol, risperidone and aripiprazole have been shown to reduce
irritability, hyperactivity, aggression and self-injurious behaviour, though
these potential advantages have to be set against the hazards of neuroleptic
medication (see Chapter 38).
Prognosis
As described earlier, classical studies showed that roughly 70% of children
with the full autistic syndrome acquired useful speech – which may be an
underestimate nowadays since autism is more broadly defined and mild
cases are more likely to be recognised. Children who have not acquired
useful speech by the age of 5 years are unlikely to do so subsequently.
Autistic aloofness improves in the majority of cases, being replaced by an
‘active but odd’ social interest.
Adolescence is associated with several changes:
The peak age for onset of seizures is 11–14 years.
Earlier over-activity may be replaced by marked under-activity and
inertia.
About 10% of individuals with autism go through a phase in ado-
lescence when they lose language skills, sometimes with intellectual
deterioration as well; this decline is not progressive, but the lost skills
are not generally regained.
Agitation seems more common, sometimes leading to serious aggressive
outbursts.
Inappropriate sexual behaviour can become troublesome.
By adult life, roughly 10% of individuals who initially had the full
autistic syndrome are working and able to look after themselves. Fewer
have good friends, marry, or become parents. The best predictors of long-
term social independence are IQ and whether speech was present by
5 years of age. Individuals with a non-verbal IQ of under 60 are very
likely to be severely socially impaired in adult life and unable to live
independently. Individuals with higher IQs are more likely to become
independent, particularly if they have acquired useful speech by the age of
- Even with IQ and speech on their side, however, people with classical
autism only have around a 50% chance of a good social outcome in
adult life. The prognosis is generally better for those milder variants of
autism that are now increasingly recognised. Though some individuals
with ASDs subsequently develop psychotic symptoms, this is a distinctly
unusual outcome.