A 20-Year-Old Man Who Stopped Speaking

James Robert Brasic, MD, MPH

Disclosures

July 31, 2017

ASD is a broad group of developmental disabilities characterized by the presence of impaired social interactions, atypical communication, and a limited range of interests and activities.[6]

The social impairments of people with ASD may include failure to acknowledge the presence of others. Additionally, individuals with ASD may fail to demonstrate the behaviors commonly displayed by people in the general population when interacting with others. Abnormalities in social interactions may take the form of markedly inhibited behaviors with others despite the desire for social interactions. On the other hand, people with ASD may display actions that are generally considered to be inappropriate due to the lack of closeness between the individuals. For example, a child with ASD may hug and kiss a complete stranger. Persons with ASD have difficulty reading other people's emotions and often respond inappropriately in social situations. Additionally, a man with ASD may propose marriage to a woman whom he just met without going through the usual sequence of dating and courtship. People with ASD may be amazed that the general population displays concerns when behaviors generally considered inappropriate are exhibited. For example, a man with ASD began dating and eventually married the adopted daughter of his former wife. He was surprised that the general community was shocked by his behavior.

The communication abnormalities of ASD may be idiosyncratic. Pronominal reversal (eg, substitution of "you" for "me") is common. People with ASD may have their own unique definitions of commonly used words. Additionally, people with ASD may develop neologisms (new words). Unlike other subgroups of ASD, people with Asperger syndrome, which is high-functioning autism that has recently been reclassified as fitting into the ASD spectrum, typically lack the communication abnormalities characteristic of ASD.[7,8,9]

The restricted range of activities and interests that are characteristic of ASD can encompass a broad spectrum. People with ASD may exhibit stereotypies and repetitive movements.[10] Rocking back and forth, hand flapping (shaking hands up and down with loose wrists), and other ordinary movements may be repeatedly performed. Waving the fingers back and forth before the eyes may simulate the actions of Venetian blinds. Additionally, people with ASD may engage in self-injurious behaviors.[11,12] These repeated behaviors may represent the efforts of people with ASD to provide self-stimulation in a barren environment.

Early diagnosis of ASD is desirable in order to institute treatment as soon as possible. The diagnostic instruments require considerable training and skill to administer and score. Intensive behavioral interventions at home and at school facilitate optimal outcomes.[13] Although imaging is useful for research purposes,[14,15] it may also be useful to rule out treatable structural lesions.

Catatonia is a distinctive condition that occurs in the course of many medical, surgical, and other disorders.[16] Catatonia typically manifests as an immobile occurrence. During this state, a patient may demonstrate mutism (the absence of speech), negativism (the refusal to follow commands of others), echolalia (the repetition of the speech of others), echopraxia (the repetition of the movements of others), waxy flexibility (odd postures occurring when others move the limbs of the patient), and withdrawal (marked inactivity and lack of participation in the ongoing activities of others). People with catatonia may alternatively exhibit an excited state, characterized by impulsivity, combativeness, and autonomic instability. In the excited state, people may collapse from exhaustion. This condition may be fatal.

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