ESSENTIALS OF DIAGNOSIS
Persistent issues with social communication and interactions.
Repetitive behaviors, interests, or activities.
Symptoms interfere with functioning.
May or may not have accompanying language or intellectual impairment.
Autism spectrum disorder is a neurodevelopmental disorder in which patients suffer from pervasive difficulties with social communication and have repetitive, restricted interests and behaviors. Autism spectrum disorder affects about 1% of the adult population with an estimated heritability of about 90%. Approximately 20–30% of individuals in whom autism is diagnosed also have a substance use problem as well as a higher risk of ADHD, mood, or obsessive-compulsive disorders. The National Institute of Health and Care Excellence (NICE) guidelines recommend that assessment of autism spectrum disorder should be a comprehensive and multidisciplinary approach that includes asking about core autism spectrum disorder difficulties, early development, medical and family history, behavior, education, employment, needs assessment, risks, physical examination with potential laboratory testing, and feedback to the individual.
No treatments for the core symptoms of autism spectrum disorder in adults have been validated. Two antipsychotics, risperidone and paliperidone, are approved for treating irritability in patients with autism spectrum disorders. These antipsychotics can help with some of the behavioral symptoms of autism but also carry a risk of metabolic side effects and extrapyramidal symptoms. There is some evidence for therapy, such as applied behavioral analysis, to address social cognitions and behaviors. Use of repetitive transcranial magnetic stimulation and vasopressin for the treatment of autism spectrum disorder are under investigation.
J. JAMA patient page. Screening for autism spectrum disorder. JAMA. 2016 Feb 16;315(7):718.
et al. Autism spectrum disorder: consensus guidelines on assessment, treatment and research from the British Association for Psychopharmacology. J Psychopharmacol. 2018 Jan;32(1):3–29.
et al. Autism spectrum disorder in adults: diagnosis, management, and health services development. Neuropsychiatr Dis Treat. 2016 Jul 7;12:1669–86.
et al. A single dose, randomized, controlled proof-of-mechanism study of a novel vasopressin 1a receptor antagonist (RG7713) in high-functioning adults with autism spectrum disorder. Neuropsychopharmacology. 2017 Aug;42(9):1914–23.