ASD

Question 1

ASD: DSM V Criteria

Answer 1

• Term used for a group of conditions e.g. austism, Asperger’s , pervasive developmental disorder (PDD), PDD-NOS

By age 3:

1. Persistent deficits in social interaction and communication
2. restricted, repetitive behaviours/interests/activities
3. Sx present in early developmental period
4. Sx cause significant impairment
5. Not better explained by ID/global developmental delay

Question 2

Associated disorders of ASD

Answer 2

• ID (75%)
• Epilepsy (20%)
• Tourette’s
• ADHD
• Anxiety, depression
• OCD
• Nutritional deficiencies
• Rare: tuberous sclerosis, fragile X, congenital rubella

Question 3

Epidemiology:

• prevalence
• M/F
• when

Answer 3

• Prevalence of 1%
• M > F (3:1)
• Typically appears during the first three years of life

Question 4

Clinically, how must a Dx be reached?

Answer 4

Clinical diagnosis, requiring presence of 3 core features by age of 3 years

At least 2 clinicians must agree on the Dx, with one being a paediatrician

Question 5

Briefly outline an OSCE history for an ASD patient (no answer)

Answer 5

(no answer)

Question 6

Outline a Mx plan for ASD

Answer 6

1. Early intervention
   - Action plan
   - Info resources
   • Autism Victoriawww.amaze.org.au
   • Irabina Childhood Autism Serviceshttp://www.irabina.com/
   - Parent training
   - Strategies for family support
2. Parental support and education
   ○ Explain diagnosis
   ○ Explain that there is a spectrum
   ○ Reassurance for parents
3. Environmental
   - Structured + predictable
   - Routine
   - Visual aids e.g. picture cards
4. Therapy
   - Speech pathology/therapy
   - Behaviour therapy
   - Sensorimotor programs (OT)
   - Social skills development - ABA therapist “learn how to learn”
5. Child’s education
   - Special education, school support
6. Rx
   Sometimes helpful:
   - atypical antipsychotics (for aggression, agitation, self-mutilation, tics)
   - SSRIs (for anxiety, depression)
   - stimulants (for associated inattention and hyperactivity)

Question 7

What abnormal social interaction and communication features might you find in autism?

Answer 7

1. Social interaction
   - Lack of socio-emotional reciprocity
   - Often only interact when needed or about special interests
   - Common descriptions: ‘aloof’, ‘passive’, ‘active but odd’, ‘overly formal and stilted’
2. Communication
   - Routine, abnormal communication (robotic)
   - Deficit in non-verbal communication
   - Focus communication towards objects not people
   - Severe ASD may not speak
   - May display ‘echolalia’: repetition of word

Question 8

What kind of restricted, repetitive patterns of behaviour, interests, or activities might an autistic child display? How many of these for a Dx (DSM V)?

Answer 8

1. repetitive movements, speech, objects (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Adherence to routine
3. Highly fixated interests
4. Hyper/hyporeactivity

Question 9

What other clinical features might you find with autism?

Answer 9

• lack of creative play
• Intellectual disability (separate DSM code)
  • Restricted eating patterns.
  • Sleeping problems.
  • Anxiety.
  • Emotional difficulties.
  • Attention difficulties.
  • Difficulties with planning and organising.