INTRODUCTION
Childhood autism, classified under the ICD-10
code F84, is a pervasive developmental disorder
that significantly impacts a child’s ability to
communicate, socialize and engage in flexible
thinking or behavior. Commonly referred to as
Autism Spectrum Disorder (ASD), childhood
autism typically manifests in the first 3 years of life
and affects boys more frequently than girls. The
term “spectrum” reflects the wide range and
variation in challenges and strengths experienced
by individuals with autism.
From a psychological perspective, childhood
autism is marked by impairments in three core
areas: social interaction, communication, and
behavior. Children with autism often struggle to
understand social cues, maintain eye contact, or
develop age-appropriate peer relationships.
Language development maybe delayed, unusual,
or absent, and communication- both verbal and
non-verbal can be limited or atypical. Here we can
also see repetitive behaviors, restricted interests
and a strong preference for routine are also key
characteristics of the disorder.
There is no specific cause of autism been found.
Experts haven’t found a single cause of autism. It’s
likely a combination of genetics and certain things
related to pregnancy, labor and delivery. You
might see these things described as
“environmental factors” or “prenatal events”.
There specific things that may make autism more
likely to be in a child include:
1.Becoming pregnant over age 35
2.Becoming pregnant within 12 months of having
another baby.
3.Reduced oxygen to the fetus during pregnancy
or delivery.
Diagnosing autism involves several steps. Often,
the process begins at a routine well-check. A
American Academy of Pediatrics recommends
autism screenings at the 18-month and 24-
month visits. A screening means your pediatrician
will ask some questions about your child,
including how they act, communicate, and
express emotions. There can be a standardized
assessment, like the Autism Diagnostic
Observation Schedule(ADOS).
BACKGROUND
Childhood autism, first formally identified in the
1940s, has evolved significantly in its understanding
and classification over time. The term “autism” was
initially introduced by psychiatrist Leo Kanner in
1943, who described a group of children with
profound difficulties in social interaction,
communication, and a tendency toward repetitive
behaviors. Around the same time, Hans Asperger in
Austria identified similar traits in children with higher
intellectual functioning, leading later to the
identification of Asperger’s Syndrome (now part of
Autism Spectrum Disorder).
Autism is categorized under ICD-10 (International
Classification of Diseases) as F84- Pervasive
Developmental Disorders, and in the DSM-5
(Diagnostic and Statistical Manual of Mental
Disorders), it is grouped under Autism Spectrum
Disorder (ASD).
The number of ASD cases reported per year varies
by country, but globally, autism diagnoses have
been increasing steadily.
GLOBAL Estimates
According to the World Health Organization(WHO) (2024
update)
1. 1 in 100 children worldwide is estimated to be on the
autism spectrum.
2. That translates to approx. 7-8 million new cases per year
globally.
UNITED STATES (CDC data, 2023):
1. 1 in 36 children is diagnosed with ASD.
2. Each year, over 100,000 new cases are diagnosed
among children in the U.S. alone.
INDIA (ICMR & WHO estimates):
1. Prevalence is estimated at around 1-1.5% of children.
2. With India’s high birth rate, this means around 200,000
to 250,000 new autism cases per year.
SIGNS OF ASD
Autism Spectrum Disorder(ASD) presents differently
in each child, but there are core signs related to it
1.SOCIAL COMMUNICATION & INTERACTION
DIFFICULTIES
Limited or no eye contact
Difficulty understanding facial expressions, tone
of voice, or social cues.
Prefers to play alone rather than with others.
Limited response to their name or difficulty
engaging in back-and-forth conversation.
Struggles to share interests (e.g., not pointing to
show objects).
May not enjoy or seek physical affection (e.g.,
hugging).
2. COMMUNICATION CHALLENGES
Delayed speech or language development.
Repetitive use of words or phrases (called
echolalia).
Speaking in a flat, robotic, or sing-song voice.
Difficulty understanding or using gestures like
waving, nodding, or pointing.
May talk a lot about a specific topic, ignoring
other topics or listener cues.
3. REPETITIVE BEHAVIORS
Repeating movements (e.g., hand-flapping,
rocking, or spinning)
Insistence on routines or sameness (distress at
small changes).
Intense focus on specific interests (e.g., trains,
numbers, maps)
Lining up toys or objects in a specific order.
Plays with toys in unusual ways.
4. SENSORY SENSITIVITIES
Over or under reacts to sounds, lights, textures, or
smells.
May cover ears to block sounds or avoid certain
fabrics or foods.
Seeks out sensory inputs.
CAUSES
Causes of Autism Spectrum Disorder (ASD)
ASD is a neurodevelopmental condition with a
complex and multifactorial origin. While there is
no single known cause, research indicates that
ASD results from a combination of genetic,
neurological, and environmental factors that
affect early brain development.
1. GENETIC FACTORS
Genetics play a major role in the development of
autism:
Heritability: studies show that ASD is highly
heritable. If one identical twin has autism, there’s
up to 90% chance the other does too.
Gene Mutations: certain spontaneous gene
mutations or inherited changes are associated with
ASD. These can affect brain development and
synaptic function.
Polygenic Risk: many small genetic changes, when
combined, may increase autism risk even without
a single “autism gene”.
2. ENVIRONMENTAL & PRENATAL FACTORS
While genetics lay foundation, environmental
exposures may interact with genes to increase ASD:
1. Prenatal & Perinatal Factors:
Advanced parental age (mother or father)
Maternal illness or infections during pregnancy
(e.g., rubella, fever)
Prenatal exposure to toxins (e.g., air pollution,
pesticides)
Medical exposure
Gestational diabetes or high blood pressure
Complications during birth.
Case Analysis – F84 Childhood
Autism: case of B.S
1.CASE HISTORY:
(Background)
The index child is 4 years and 10 months of age,
first born, to a 33 years old mother Mrs. S.S a
homemaker, and 37 years old father Mr. P.S. a
businessman from a middle class family, through
full term pregnancy, caesarean mode of delivery,
with birth of 2.7 kgs and immediate birth cry. As
reported by the parents, the index child achieved
his development milestones on time. By the age
of 1.5 years, the child could speak words like
‘mama’ and ‘papa’. The parents mentioned that
till 1.5 years to 2 years he spoke a lot of words and
telegraphic speech came, but after birth of
younger sister his words formation stopped.
Mother mentioned that they did not pay much
attention to the child’s condition earlier and
thought it will be fine as some children tend learn
late as told by elders in the house.
2. Signes Experienced:
B.S showed signs of autism, his signs included:
1. Sudden stop of words formation
2. Till age of 4 years, no proper speech
formation.
3.No sustained eye contact.
4. Engaged in isolated playing and sometimes
indulges in hitting younger sister.
5. Responds to his name with prompts.
3. Child Behaviour:
Adaptive Behaviour in following areas:
Self-help skills (Bathing, eating, dressing,
toilet etc.): The child is able to brush his
teeth and bathe himself with assistance. H is
able to eat food independently, drinks milk
from bottle but needs assistance to feed him.
He is able to unbutton and remove his
trouser but needs assistance with pulling up
the garments and buttoning. The child
signals for toilet.
Play behaviour: the child has a solitary play
style and does not initiate play with other
children of same age group; however, the
child has started to engage with his sister
named little from past few weeks but
reciprocates if the play has been initiated
with him. The child likes to play, colour and
has repetitive play patterns. At present, his
screen time on mobile and T.V is restricted by
the parents and is only used for learning
purpose.
Communication skills:
Repetitive language: the child is able to
respond to his name within 2-3 prompts,
maintains eye contact but has difficulty
sustaining it.
Expressive language: the expressive
language is present but only minimally. The
index child engages in telegraphic speech,
using up to 2 words. He mostly indicates his
needs using gestures or pulls the mother to
the place to make his need satisfied.
Awareness about environment: the
child is able to recognize his house, car,
teacher and games etc.
4. MEDICAL & FAMILY
HISTORY:
The index patient’s parent had consulted a Doc. A
Pediatrician in 2020, who had suggested Umeed
Rehabilitation centre.
Past History: nil contributory.
Family History:
The child is currently living in a nuclear family
with his mother, father, and younger sister.
Relationship within the family members is
cordial.
There is not history of mental illness and
intellectual disability in the family.
There is no history of consanguinity in family.
B.S.
Scholastic History
The child has never been to any school.
He is currently taking special education at UMEED
rehabilitation centre.
5. IDENTIFIED PROBLEM-
F84 CHILDHOOD AUTISM
According to behavioral observation and
temperament, the impression is as “ difficult
child”.
According to Vineland social maturity scale,
the impression is that the child primarily
needs intervention in the areas of self-help,
communication, and socialization.
According to developmental screening test
the impression indicates mild delay in
development functioning.
SUMMARY:
The test findings indicate mild autism like features, mild
delay in socio-adaptive functioning and Borderline
intellectual functioning. The child needs intervention in
the areas of self help skills, communication, occupation
and socialization. Case history and behavioural
observation suggest that the child’s communication skills
are poor, eye contact is partially made, attention cannot
be sustained for long and rapport was established with
difficulty. The child is partially dependent in self-help
skills. The child can comprehend simple instructions, but
with prompts, thus is unlikely to progress in academics
beyond certain level but he can be trained in social and
occupational skills.
PROVISIONAL DIAGONSIS-
F84 CHILDHOOD AUTISM.
PROGNOSTIC FACTORS
Good
Continuous psychological and
occupational intervention.
Improving receptive and expressive
communication skills.
Supportive family environment
Poor
Parental neglect after birth of second
child.
6. COUNSELLING
DIAGNOSTIC FORMULATION
Index child B.S , 4 years and 10 months of age, Hindu,
male, currently enrolled in UMEED Rehabilitation
Centre, belonging to middle socio economic status,
living in a joint family, of Lucknow , first born child, with
developmental delays in speech and language
milestones, was presented with an condition with
insidious onset, continuous course and improving
progress, chiefly characterized by reduced receptive
and expressive communication, lack of clarity in speech
articulation, difficulty in maintaining eye contact,
solitary play behaviour and excess of emotions when
not required . Behavioural observation revealed
general appearance as kempt and tidy, hygiene was
maintained, dressed age appropriately, eye contact was
partially made, with normal motor behaviour,
repetitive speech and increased reaction time,
command following with prompts, Attention could be
aroused but not sustained for long.
CONCLUSION
The boy was diagnosed with F84 childhood autism.
INDEX
1 Introduction
2 Background
3 Signs of ASD
4 Causes
5 Case analysis
6 Summary
7 Conclusion
ACKNOWLEDGEMENT
I would like to express my utmost gratitude to all
those who offered constructive suggestions and
support for improving various aspects of this case
study. In particular, I extend my heartfelt thanks to
Dr. Rachna Vyas for her constant encouragement
and expert guidance, which proved to be
invaluable throughout the completion of this
work.
psychology
Case profile
Topic : F84 Childhood Autism
Name: Kanan Gopalani
Class: XII H
School: M.G.D GIRLS’ SCHOOL, JAIPUR
ROLL NO.
