Children with autism have higher rates of epilepsy than in the general population and children with epilepsy are at high risk of developing autism.1,2 When epilepsy and autism coexist, the quality of life in these individuals is severely impacted.3 Recognizing and diagnosing autism in children with epilepsy and understanding the treatment options is important for the comprehensive management of children with epilepsy. This chapter will focus on how to go about making the diagnosis of autism in children with epilepsy and on the treatment approach to children with epilepsy and autism.
DIAGNOSING AUTISM IN CHILDREN WITH EPILEPSY
Autism-like epilepsy is a heterogeneous developmental disorder associated with many diverse etiologies and pathologies (FIG. 43–1). The labels of autism spectrum disorders (ASD) or pervasive developmental disorders (PDD) are commonly used to describe individuals who have varying deficits in verbal and nonverbal communication, social skills, and a restricted repertoire of interests or repetitive behaviors (Table 43–1). Throughout this chapter, the term autism will be used to discuss this heterogeneous group of children.
Diagnostic issues in children with epilepsy and autism.
TABLE 43–1.AUTISM SPECTRUM DISORDER CRITERIA ||Download (.pdf) TABLE 43–1. AUTISM SPECTRUM DISORDER CRITERIA
|Behavioral Domain ||More Likely in Lower Functioning Child with Autism ||More Likely in Higher Functioning Child with Autism |
|Social || |
Failure to respond when called
Failure to participate within groups
Lack of awareness of others indifference to affection
Lack of social or emotional empathy
Impaired ability to make peer friendships
Poverty of social skills
Tend to be loners
|Language || |
Failure to develop both expressive and receptive language skills
Language is immature and characterized by echolalia, pronoun reversals, unintelligible jargon
Inability to initiate or sustain an appropriate conversation
|Repetitive behaviors || |
Resistance to change
Insistence on certain routines
Attachments to objects
Fascination with parts and movement of objects
Lining up or manipulating the toys
Flapping, humming, rocking, running around in circles
Lack of symbolic play
Repetition of certain words, phrases, or songs
Focus on narrow topics such as train schedules, maps, or historical facts
The DSM-IV and ICD-10 systems provide a framework for the clinical diagnosis of autism and evidence-based guidelines have been established for the diagnosis of autism and related disorders.4 From a research perspective the "gold-standard" for the diagnosis of autism are the Autism Diagnostic Observation System and the Autism Diagnostic Interview, which together provide both a structured detailed interview and an observation method to assess an individual's social ability, communication skills, and behavior objectively. A list of resources and references regarding the diagnosis and treatment for autism is available in Box 43–1.