An 8-Year-Old Boy With Autism

DR PARKER: AUSTIN IS AN 8-YEAR-OLD BOY DIAGNOSED AS HAVing autism at age 21⁄2 years. He has improved substantially in cognition and speech but still struggles with social interactions. This is his first year in a public school with his peers, and his parents wonder what the future holds. They live in a suburb of Boston, and Austin’s medical care is covered by managed care insurance. Austin weighed 8 lb 10 oz at birth, after a normal pregnancy and delivery. He appeared alert and normal in all respects. The parents noted normal early development, but at 12 months Austin began to box his ears at loud noises and cry for no apparent reason. Friends and family told the parents not to worry. At 18 months, Austin spoke only a few words (eg, “Mama, Daddy, juice”), yet these few words soon disappeared from his speech. The pediatrician reassured the concerned parents and advised them not to compare Austin with his older sibling. A day care program teacher noted Austin’s paucity of speech, lack of napping, and biting of children and staff when frustrated. Consequently, at age 21⁄2 years, Austin participated in a full-day evaluation at Children’s Hospital and his speech and language were noted to be at the 8to 15month level. Psychological assessment revealed diminished attention, preference for solitary play, perseveration, and limited social interacting. Physical examination findings were normal, and the diagnosis of autism was made. Austin received interventional services focusing on speech development and sensory integration. He showed improvement in both receptive and expressive language abilities, but still echoed other people’s language. Hitting, kicking, and biting behaviors diminished as his speech improved. Eye contact improved, and Austin liked being with other children but did not play with them reciprocally. At a second evaluation at age 3 years 4 months, his language skills remained at the 8to 15-month developmental range. The psychologist described him as quiet and even-tempered with a generally sunny affect. His attention was highly distractible and wandering. He talked gibberish to himself in the mirror and produced humming, grunting, screeching, and beeping noises. At age 31⁄2 years Austin received methylphenidate hydrochloride, which worsened his aggressive behaviors. Consequently, the medication was discontinued. At age 5 years, Austin participated in a school program for children with pervasive developmental disorder (PDD). He showed steady improvement and, in the fall of his seventh year, entered a public school classroom with an adult aide. He also received speech therapy and consultation from a behavioral specialist. Austin now can read, write, and speak in sentences, and he interacts more with children. A recent videotape reveals intermittent rhythmic, repetitive movements of the head and entire body, and his parents wonder about the significance of that behavior. He currently takes fluvoxamine maleate, 25 mg twice daily, which seems to help with social skills. The addition of trazodone hydrochloride, 50 mg at bedtime, seemed to improve his sleeping and general focus. Chromosomal analysis was normal, fragile X testing was negative, and electroencephalography (EEG) following sleep deprivation was normal. By age 8 years, many behaviors continued to improve. Austin seems happy and smiles often. He enjoys riding his bicycle, bowling with his father, and playing with his mother. His parents wonder if there are any new effective medications for symptoms of autism and if there will ever be a cure.