FFinalistSouthampton · 2027
Psychiatry
AKT · Psychiatry/Neurodevelopmental

Autism spectrum disorder (ASD)

Overview

A neurodevelopmental disorder of persistent deficits in social communication and interaction PLUS restricted, repetitive patterns of behaviour, interests or activities, present from early development.

Recognise

  • Social-communication: reduced reciprocity, poor non-verbal communication, difficulty with relationships
  • Restricted/repetitive: stereotypies, insistence on sameness, intense narrow interests, sensory sensitivities
  • Present from early childhood; varying severity/IQ

Red flags

  • Regression of skills, or coexisting epilepsy, ADHD, anxiety, self-injury

Differentials & how to tell them apart

ADHDinattention/impulsivity primary; social deficit secondary — often coexist
Social anxiety / selective mutismsocial skills intact when comfortable
Intellectual disability aloneno specific social-communication dyad
Hearing impairmentexclude in language delay

Investigations

Specialist multidisciplinary assessment (e.g. ADOS/ADI-R), developmental and collateral history. Consider genetic/hearing assessment.

Management

  1. 1Educational and social support, structured environment, family support; manage coexisting conditions (ADHD, anxiety, epilepsy).
  2. 2No pharmacotherapy for core features; treat comorbidities specifically.
No drug treats core ASD — manage comorbidities; risperidone may be used short-term for severe aggression/irritability under specialist care

Key points

High rates of coexisting epilepsy, ADHD, anxiety, sleep and GI problems.

Monitor & prognosis

Development, comorbidities, family support needs.

Lifelong; outcome varies widely with support and ability.

Source: NICE NG170/CG142; StatPearls