12. ASD

Question 1

What is autism?

Answer 1

TRIAD = Social interaction difficulty, social communication diff, cognitive rigidity (non-functional)

• solitary play
• withdrawn in presence of other people
• indifferent to attempts at communication
• intense, absorbing interests
• ritualistic behaviour
• compulsive routines

Question 2

How is autism managed?

Answer 2

Early intensive behavioural intervention

Speech therapy

Special schooling

Parent training

Support = national autism society, key worker, self-help groups

Social skills/communication training

Meds = risperidone (aggression), melatonin (sleep), SSRIs (repetitive behaviour)

Ensure all physical/mental health and behavioural issues are addressed

Question 3

How is ASD diagnosed?

Answer 3

Observations = poor eye contact / gaze monitoring, head banging/teeth grinding, rocking, reduced response to pain, delayed speech, echolalia

Ix =

• GARS questionnaire
• SALT assessment
• School reports
• Organic causes = bloods (TFT, bone profile, LFT, U+E, anaemia screen, lipids), urine analysis
• Exam = neurocutaneous features, dimorphism, growth (height, weight, HC)

Clinical Dx = DSM IV or ICD 10

***can only be reliable >3y

Question 4

What is a DDx for autism?

Answer 4

Asperger’s syndrome

Rett’s syndromes

Children disintegrative disorder

Learning disability

Deafness

Childhood schizophrenia

Question 5

Outline the aetiology of autism

Answer 5

***all factors increase risk

Prenatal = fragile X syndrome, tuberous sclerosis, mother >40y, mother taking Na valproate, infection (rubella)

Antenatal = hypoxia, dec gestional age, very low birthweight

Postnatal = lead/mercury, pesticides

***no proven link to MMR vaccine!!