Autistic disorder and Asperger’s syndrome are just two components of ASD. Patients who suffer with ASD present with difficulties in language and socialization. The challenge inherent to the diagnosis of ASD is the significant variability in the severity of dysfunction observed in individual patients. Given that language is the basis for human socialization, one wonders whether ASD is indeed a social disability with associated comorbidities.
Clinical presentations of ASD
Parents of very young infants severely affected by ASD often notice that their child does not seem to interact with or respond to the environment around him. (It is important to note that the male-to-female ratio of ASD is 4:1, so we are not displaying a gender bias in our use of the masculine pronoun. Clinicians are more likely to see a larger number of boys than girls with ASD). The parents may be aware that the child exhibits poor eye contact, a lack of demonstrated affection, or language delay; he may also seem slow to reach developmental milestones. These are the children first identified by Austrian physician Leo Kanner in 1943 as having “early infantile autism.” Historically, these are the youngsters one might think of as having the severe impairment more typical of one end of the autistic spectrum. While a diagnosis of more severe forms of ASD can seem clear-cut, the correct diagnosis of the less severe forms requires a high level of suspicion on the part of the clinician.
In 1944, Austrian physician Hans Asperger described a group of boys whose behavior seemed to represent a higher-functioning form of autism.5 Children with Asperger’s syndrome, which occurs in males five times more commonly than in females,1 often develop quite well in the first several years of life in that they learn to care for themselves and often meet appropriate physical developmental milestones.
Like patients with other forms of ASD, those with Asperger’s syndrome have an emotional disconnect from their surroundings, but they do not uniformly exhibit speech delays. Indeed, Asperger’s patients can be precociously verbal, often sounding like small adults in their ability to speak before their first birthday. These children can, and often do, speak in a professorial way about topics of their interest and choosing. The verbal skills of Asperger’s patients can seem quite advanced to the adults around them, as the children tend to focus on one topic and learn everything they can about it. This would be considered a savant quality. To their parents and teachers, these youngsters might just seem a little quirky. The diagnosis of Asperger’s syndrome requires a high level of suspi-cion on the part of the clinician because this disorder is defined by dramatically less impairment than a diagnosis of autistic disorder.
As Asperger’s patients get older, their social impairment becomes painfully clear in their interactions with peers. Asperger’s patients tend to display an inability to read social cues and respond appropriately; this often isolates them from their peer group and leads to concomitant anxiety disorders and depression.
Popular media and parent groups have focused a great deal of attention on the immunizations administered in infancy and early childhood as possible causative factors of ASD. Children get immunizations every few months during a period when they are maturing and developing various social interactive skills. The simultaneous occurrence of those events has led to the targeting of immunizations as a cause of ASD. Despite the public media frenzy that has erupted, the medical and scientific literature has found no correlation between immunizations and ASD. As clinicians, we must be both sensitive and aware of the intense emotionality of the vaccine/autism debate, but we must also remember that no data exist to support an association.