Neurodevelopmental Disorders: Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a lifelong developmental disorder characterized by deficits in social communication and social interaction as well as restricted, repetitive patterns of behavior, activities, or interests. Symptoms must begin during the developmental period, but may not become evident until social demands exceed the individual’s capabilities. Alternatively, learned social skills may help improve social functioning in later life. The incidence of ASD has increased, with the most recent prevalence estimated as 1 in 36. While hundreds of candidate genes have been identified, in the majority of cases, a genetic etiology cannot be determined. Associated features of ASD include several medical (gastrointestinal issues, seizures, sleep disturbance) and psychiatric symptoms (anxiety, irritability, repetitive behaviors, inattention, hyperactivity, impulsivity, and anxiety). Comprehensive treatment approaches to individuals with ASD include careful evaluation and treatment of medical illness, supporting functional communication, and developing appropriate educational and vocational goals. Many individuals will require special education services and benefit from adjunctive treatments such as speech therapy, occupational therapy, physical therapy, and social skills instruction. The most evidence-based psychotherapies are applied behavioral analysis-based treatments, and these should be implemented early and intensively. Psychiatric medications are sometimes indicated to address interfering symptoms. However, the evidence base remains limited, and individuals with ASD often exhibit poorer response and tolerability to medications than neurotypical populations.