ATYPICAL AUTISM: SYMPTOMS, CAUSES AND TREATMENT - NEUROPSYCHOLOGY - 2024

The atypical autism was a diagnostic category created to include those cases that had some symptoms of autism, but not enough. In this way, they do not meet the necessary diagnostic categories to consider autism, Asperger's syndrome or another similar condition.

They are cases very similar to autism, but that start later than normal, with infrequent or subliminal symptoms of autism. This condition has also been called pervasive developmental disorder, unspecified. In current diagnostic manuals it does not exist, although several people received this diagnosis when they were young.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) included this diagnostic category in its fourth edition. In the fifth, which is the current one, there is only one category to classify autism: "Autism spectrum disorder." In this category the full range of presentations and symptoms that characterizes autism is accepted.

In each of the editions, mental disorders, some symptoms or categories have been changed. Disorders are generally added or eliminated according to current social norms.

Atypical Autism according to ICD-10

The tenth version of the International Classification of Diseases is a diagnostic manual created by the World Health Organization (WHO). This includes atypical autism within the category "pervasive developmental disorders."

He describes it as a pervasive developmental disorder that differs from autism in that the pathologies begin to appear after 3 years of age.

It could also be that there are not sufficiently proven abnormalities in 1 or 2 of the 3 psychopathological aspects necessary to diagnose autism. These are: impairment in social interaction, communication disorders, and restrictive, stereotyped, and repetitive behavior.

In this way, the child only has clear deficits in 1 or 2 of the areas described. In the ICD-10 they also explain that atypical autism is common in profoundly retarded people with autistic traits, with a very low level of performance.

In addition, individuals with severe developmental disorders of language comprehension meet the criteria for atypical autism. According to this manual, atypical childhood psychosis is also included in the diagnosis of atypical autism.

Causes

The causes of atypical autism, like the causes of autism, are currently being investigated and there is still much to know.

A wide variety of different causes and a high number of genes have been found. Probably the appearance of autism depends on a set of factors rather than a specific cause.

Thus, brain development processes associated with excessive myelination or alteration in certain proteins seem to influence, generating incorrect neuronal wiring (such as Cux1 and Kv1), or affecting the neuronal migration process (MDGA1 protein), among others.

There are few studies that speak specifically about the causes of atypical autism, (although they can also cause classic autism):

Tuberous sclerosis

It appears that the risk of classic or atypical autism is between 200 and 1000 times higher in patients with this disease than in the general population.

In a study published in 1997, an association was found between tuberous sclerosis of the temporal lobes and atypical autism. Tuberous sclerosis is a rare genetic disease that causes tumors in the brain and widespread lesions of the skin, heart, kidneys, and eyes.

Specifically, the number of brain tumors was significantly higher in patients with autism or atypical autism than in those without these diagnoses. Furthermore, in almost all patients these were located in the temporal lobes.

Genetic alterations

Several studies highlight the connection between chromosome 15 alterations and classic, atypical autism and mental retardation.

Specifically, with a duplication of the 15q11-q13 region. Furthermore, it appears that this alteration is inherited from the mother and not from the father (Cook et al., 1997).

Symptoms

The symptoms of atypical autism are similar to those of autism, but appear later in life, present only a few (less than 6), or may be more unusual. Some of the symptoms listed in the diagnostic manuals are:

- Alteration of social interaction. That is, they barely maintain eye contact or feel interested in people. This has nothing to do with shyness, this behavior being present even with close relatives on a continuous basis.

- They have problems in non-verbal communication. This is manifested in that they are unable to adopt adequate facial, gestural and body expressions.

- Difficulties in establishing relationships with other colleagues.

- They do not have the normal spontaneous tendency to try to share their interests, enjoyments and objectives with others. One sign is that they do not show or point to the objects that interest them.

- There is no social or emotional reciprocity. This means that they do not emit responses, nor do they seem to understand the emotions of others.

- Delay or total absence in language. If speech is preserved, they have a very significant impairment in the ability to start or maintain a conversation with others. You can use language in a stereotyped and repetitive way.

- Does not practice spontaneous, symbolic or imitative play typical of other children.

- It has very rigid and inflexible behavior patterns. They cannot stand the change of routine.

- They may show a persistent and absorbing concern for certain parts of objects or some subjects. For example, they may be staring at an object for hours. If another tries to interrupt your activity, you may react with complaints and tantrums.

- Repetitive and stereotyped movements such as shaking the hands or fingers, or turning them continuously. It is very common to "flap" hands and swing.

Autism and atypical autism: differences and similarities

Atypical autism does not mean that the symptoms are milder or less disabling. Rather, it means that they do not fully fit the diagnostic criteria for other related conditions.

Thus, atypical autism generates serious consequences for the patient, significantly affecting their quality of life.

In a study by Walker et al. (2004) compared the level of functioning of 216 children with autism, 33 with Asperger syndrome and 21 with atypical autism. They found that, with respect to daily life, communication skills, social skills and IQ, the scores of children with atypical autism were between those with autism and those with Asperger syndrome.

On the other hand, these children had fewer autistic symptoms than the other two groups. Mainly stereotyped and repetitive behaviors. Furthermore, the authors differentiated three subgroups of children with atypical autism:

- High functioning group: covered 24% of children with this condition. The symptoms were very similar to those of Asperger's syndrome. However, these showed language delay or mild cognitive impairment.

- Group similar to autism: another 24% fell into this group, presenting symptoms similar to autism. They did not meet the exact criteria for a later age of onset, severe cognitive delays, or they were still too young.

- In the third group, 52% of the cases were found. They did not meet the criteria for autism, as they had fewer stereotyped and repetitive behaviors.

Therefore, the main criterion that patients with autism and those with atypical autism have in common is severe impairment in communication and social life.

Diagnostic problems of atypical autism

It is important to note that the diagnosis must be made by a mental health professional, and it is convenient that cases are not “overdiagnosed”.

It may be completely normal for some of the symptoms mentioned below to appear in healthy children. This would not necessarily imply the existence of atypical autism or other pathologies. Each person is different, and it is normal for development patterns to vary greatly from one child to another.

Currently, atypical autism is not usually diagnosed as such. DSM-IV types of autism were removed precisely because this diagnosis was being abused unnecessarily.

For those who have been diagnosed with atypical autism in the past, a new evaluation of their condition is recommended. They may not currently fit any classification associated with autism.

On the other hand, it may also happen that if the symptoms of atypical autism have been milder, they have been ignored in childhood. Thus, when they are adults they continue to manifest and have not been treated.

In a study published in 2007, it was found that patients diagnosed with typical autism before the age of 5 years continue to present significant differences in the social plane when they are adults. (Billstedt, Gillberg, & Gillberg, 2007).

The best thing to do to get a good quality of life is that these cases are diagnosed and treated as soon as possible.

Treatment

Apparently, the diagnostic category is not so important in the forms of autism to establish a treatment. This is because the forms of presentation of autism can be very varied in each child, being preferable to make a totally personalized intervention.

This intervention should be carried out by a team of several different professionals: psychologists, neuropsychologists, occupational therapists, neurologists, speech therapists, educators, etc. To do this, once atypical autism has been detected, the ideal is to examine the symptoms that the specific patient presents to establish a list of objectives.

The objectives should be based on the behaviors that you want to improve, such as ensuring that you say hello every time you arrive from school. Once the goals have been established, the psychologist will establish together with the family the most appropriate way to reward the desired behaviors and extinguish the unwanted ones.

This is a summary of what would be done in behavioral therapy, which is very effective for these children.

On the other hand, it is also important to attend to the development of communication, language and social relationships. Activities in the pool with other children, therapy with animals or music therapy can greatly help.

As the patient grows, it may be appropriate to start therapy to help them work on social skills.

References

1. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders: DSM-IV. 4th ed. Washington (DC).
2. Atypical Autism Symptoms: ICD Diagnostic Critera for Atypical Autism. (sf). Retrieved on December 31, 2016, from mhreference: mhreference.org.
3. Billstedt, E., Gillberg, IC, & Gillberg, C. (2007). Autism in adults: symptom patterns and early childhood predictors. Use of the DISCO in a community sample followed from childhood. Journal of Child Psychology and Psychiatry, 48 (11), 1102-1110.
4. Bolton, PF, & Griffiths, PD (1997). Association of tuberous sclerosis of temporal lobes with autism and atypical autism. The Lancet, 349 (9049), 392-395. New advances in the origin and causes of autism. (January 24, 2016). Obtained from Autism Diary: autismodiario.org.
5. Disorders of psychological development according to ICD-10. (sf). Retrieved on December 31, 2016, from Psicomed: psicomed.net.
6. Walker, DR, Thompson, A., Zwaigenbaum, L., Goldberg, J., Bryson, SE, Mahoney, WJ,… & Szatmari, P. (2004). Specifying PDD-NOS: a comparison of PDD-NOS, Asperger syndrome, and autism. Journal of the American Academy of Child & Adolescent Psychiatry, 43 (2), 172-180.
7. What Is Atypical Autism? (sf). Retrieved on December 31, 2016, from Lovetoknow: autism.lovetoknow.com.
8. What Was PDD-NOS, Also Known as Atypical Autism? (November 21, 2016). Obtained from Verywell: verywell.com.