Autism physical examination

Physical examination of patients with autism is usually remarkable for repetitive behavior, dyspraxia, abnormal gait, and abnormality of motor functions. The signs of autism are present since birth but initial signs are visible by the age of 6-12 months. Most of the clinical signs of autism are identified by three years of age.

Clinical signs of autism are present since birth but are generally visible by three years of age. The earliest noticeable signs of autism are lack of social communication, language deficits and repetitive stereotyped behavior. However routine early screening helps in early identification of autism in infants and toddlers. Patients with autism should also undergo observational assessment studies such as Autism Diagnostic Observational Schedule (ADOS). This observational schedule involves specific social situations and the child’s response in these situations is noted. ADOS help determine patient’s social communication skills and behavioral skills.In addition, patients with autism should be evaluated with full physical examination, especially general appearance and neurological exam with focus on child’s affect in multiple settings (home, play group or school).^[1][2]

• Physical examination of patients with autism is usually remarkable for repetitive behavior, dyspraxia, abnormal gait, and abnormality of motor functions.

• Patients with autism usually appear anxious/irritated with repetitive behavior.

Skin examination of patients with autism may show signs of injury, if the patients depicts self mutilating behavior such as self biting, lip chewing, removal of hair or body punching. The signs include:

• Bruises
• Contusion
• Cuts

Cognition should be assessed via the following scales:

• Bayley Scales of Infant Development
• Mullen Scales of Early Learning
• Wechsler Preschool and Primary Test of Intelligence
• Wechsler Intelligence Scale for Children
• Stanford-Binet Intelligence Scales

• Preschool Language Scale
• MacArthur Communicative Development Inventory

• Peabody Developmental Motor Scales
• Gross Motor Scale

• Vineland Adaptive Behavior Scales

• Sensory profile

• Increased head circumference (may return to normal in adolescence)^[3][4]
• Evidence of trauma
• Lack of eye contact
• Extra-ocular movements may be abnormal with unable to fix gaze
• Ophthalmic exam may be abnormal with findings of retinal detachment
• Delayed verbal and non-verbal communication
• Lack of joint attention

• Neck examination of patients with autism is usually normal.

• Cardiovascular examination of patients with autism is usually normal.

Abdominal examination of patients with autism is usually normal.

• Motor tics
• Motor delay
• Mental retardation (uncommon)
• Atypical language with pronoun reversal, use of non-sense words, echolalia or stereotyped phrases^[5]
• Aprosody

Extremities examination of patients with autism may show stereotypies and hyperkinesia such as:

• Hand flapping with a flaccid wrist; it is generally seen when the child is excited.
• Other movements include bouncing up and down or rotating around an imaginary vertical axis.
• Abnormal palmar crease
• Unusual posture

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