ASD

Question 1

What is the incidence of ASD

Males :females ratio

Answer 1

Incidence in Australia 1/60-68 males :females 4:1. Twins mono 60% increase dia 3-10% increased risk 7.6/1000 1/132
If you have fragile X 30% high rate and tuberous sclerosis 40%
ASD is a lifelong neurological condition that effects individuals in 2 main ares communication
And social interaction
They can have repetitive behaviors
Restricted repetitive pattern of behavior interests and activities
Persistent defects in social communication and social interaction
In peceiprocosity
Non verbal communication
Development and maintain and understanding relationships

Question 2

Symptoms present in early childhood or show up later with the extra social remains but the history needs to show it was present <12 years of age

Answer 2

True

Question 3

Investigations

Answer 3

History
Need Chromonsomes fragile x and Tubersous sclerosis’s
EEG children 7-14% ASD have epilepsy and 20-35% adults have Epilepsy
Need to test hearing and vision to exclude other causes of poor comminucations

Question 4

Common presentations for ASD are

Answer 4

Delayed speech
Behavioral problems eg tantrums
You should initate referrals before make a diagnosis
Early intervention makes a difference

Question 5

Red flags in communications ?? ASD

Answer 5

No words by 16/12. Delayed speech
Appears deaf
Lost words regression
No spontaneous phrases by 24/12 no echolasia
No babbling pointing gestireing by 12/12
In older children

Poor comprehension
Difficulty reading between the lines
Literal pedantic
Difficulties with to and fro communication

Question 6

Red flags for social

Answer 6

Younger children
Does not smile socially
Restricted eye contact

Isolated / solitary play/ in his own world tunes out
Unaware /no interest in other children ( 2 years)
Prefers own play to social play (3 years )

Older children
Interest in but unable to sustain relationships
Misses social cues
Unusual quality of eye gaze
Unable to understand others feelings
Differences in factual experession/ body postures gestures

Question 7

DSM 5 definition of ASD

Answer 7

1 persistent deceit is in social communication /interactions across contexts
2 restricted rpt patterns of behavior /interests/and activities

Symptoms limit and impair everyday functioning

+/- intellectual impairment

Question 8

Social joint attention

Answer 8

Initially share enjoyment in an object looking back and foreword to the person who is with you ( in ASD more attention on the toy)
Later gestures and /or speech can be used to engage and response
Necessary for functional language development

Question 9

DD of ASD

Answer 9

Sensory impairment eg vision /hearing 
Developmental delay ID
Epilesy
ADHD ( may be comorbid in 60%)
Neurological/ regressive disorder 
Social communication disorder

Question 10

Medical investigations

Answer 10

Bloods FBC/Vit b12 /elfts lead Leadville
TFT lead level urine metabolic screen CGH array
Fragile sr and lead level CK

2 Neuro imaging if head size large or focal neurological signs

3 EEG. If seizures /speech regression /neuro degenerative disorder

4 refer genetics/ neurology dysmorphic family history consanguinity
Development regression

Question 11

ASD co morbidities

Answer 11

DD/ID 
Social anxiety
ADHD
Tic disorders 
Learning difficulties 
Language impairment 
Soldier sleep diet and mental health 
Medication can be used to target co morbidities eg SSRI for social anxiety 
Stimulants for ADHD 
Discussed Complimentary meds as a lot fo people use them 
Consider support for family and siblings

Question 12

Interventions

Answer 12

The earlier the better the more the better
Early intervention about 20hours per week
Multidisciplinary approaches
In collaboration with the family
Aiming to produce generalized skills
Develop function communication and spontaneous communication
Reduce the maladaptive behaviors
Teach functional adaptive skills