ASD Flashcards
ASD refers to which 5 disorders?
asperger's syndrome rett's syndrome childhood autism pervasive developmental disorder pervasive developmental disorder NOS (Non-otherwise specified)
what is the triad of impairment in ASD?
impaired social interaction
restricted interests
impaired communication
what 4 behaviours are affected in ASD?
social communication
social interaction
social imagination
repetitive behaviours
how is social communicaiton affected in ASD?
generally good language skills but can struggle to grasp underlying meaning of conversation
difficulties understanding abstract parts of language (i.e that take 2-3 steps to understanding) such as jokes, idioms, metaphors and sarcasm
often have monotomous voices or strange accents
language can be pedantic and idiosynchratic
narrow interests which dominate conversations (lack of reciprocity)
difficulty sharing thoughts and feelings - can present with anger
how is social interaction affected in ASD?
difficulties in picking up non-verbal cues
appear self focused and lacking in empathy when in fact they are simply trying to figure out social situations, cant really put themselves in other’s shoes
continually struggle to make and sustain personal and social relationships
how is social imagination affected in ASD?
difficulties thinking flexibly and in abstract ways (taking others opinions on board and using it to change their own opinon)
cant understand abstract thinking
inability to understand other points of view
difficulty applying knowledge and skills across settings with different people
difficulties projecting themselves into the future and planning goals sensibly (even if they do have a goal, cant really think of the steps in how to get there, live in the day to day)
how are repetitive behaviours affected in ASD?
stereotyped or repetitive motor movements, use of objects or speech
insistence on sameness, inflexible adherence to routines or ritualised patterns of verbal or non-verbal behaviour
highly restricted, fixated interests that are abnormal in intensity of focus (e.g people might like marine life but people with ASD will know everything about sharks specifically)
hyper/hypo reactivity to sensory input or unusual interest in sensory aspects of environment
which gender is ASD more common in?
boys 4:1
- girls are generally socially better from an early age so can struggle on for longer
theories behind gender differences?
sex hormones play role in organisation of brain circuits during early development
receptors for sex hormones widely distributed in brain and influence neural signalling
could just be due to under-diagnosing in females
how is brain different in ASD in females?
sex hormone binding globulin (SHBG) levels are reduced in females with aspergers pointing to higher levels of of free testosterone
link between autism and gender identity?
gender identity struggles are 3X more common in ASD
50% of young people referred to gender identity clinics have ASD traits
girls exposed to high levels of testosterone (e.g congenital adrenal hyperplasia) show more traits of ASD and higher rates of gender dysphoria
what is thought to cause ASD?
no clear mechanism environmental, biological and genetic factors in some cases, autistic behaviour can be caused by - rubella in pregnant mother - tuberous sclerosis - fragile X syndrome - encephalitis - untreated phenylketonuria
genetics in ASD?
strongly heritable of around 35-90%
90% in MZ twins
involves deletion, duplication and inversion in chromosomes
environmental factors in ASD?
action of teratogens in first 8 wees of pregnancy
evidence for heavy metals,
toxicity or exposure to particular diets is anecdotal and not reliable
biological/perinatal factors in ASD?
umbilical cord complications fetal distress birth injury/trauma multiple birth and haemaorrhage low birth weight/small for age congenital malformation meconium aspiration neonatal anaemia, hyperbilirubinaemia
where are the difficulties seen in the ASD brain?
frontal lobes, amygdala and cerebellum appear pathological in autism
amygdala = main organism responsible for emotional regulation, larger in ASD causing anxiety
specific areas of pathology relating to impairment?
no clear and consistent pathology for autism, but certain areas can be different causing different impairment
how is neurochemistry different in ASD?
glutamate receptors, GABA and serotonin seem impaired
glutamate = essential excitatory neurotransmitter, dysregulation = neuronal damage
GABA = regulation of early developmental stages of cell migration, neuronal differentiation and stages of maturation
serotonin = regulation of crucial steps of neuronal development
diagnosis of ASD in children?
speech and language
- dont babble or use other vocal sounds
- cant repeat words or phrases spoken by others without formulating their own language or in parallel to developing language skills
- older children have problems using non-verbal behaviours to interact
often lack awareness of and interest in other children
struggle to initiate and sustain friendships
often gravitate to older or younger children
many many more
sensory difficulties in ASD?
any sense can be under/over sensitive
taste = some flavours too strong/overpowering, restricted diet, some textures cause discomfort
smell = smells intense and overpowering, can cause toilet issues
sound = noise is magnified and sometimes distorted/muddled, cant cut out sounds
touch = can be painful and uncomfortable, dislike anything on hands/feet, difficulties washing/brushing hair, only tolerate certain clothes/fabrics
sight = poor depth perception (throwing/catching difficulties), easier to focus on detail rather than whole object, sensitive to light
communication difficulties used for diagnosis of ASD in adults?
difficulties seeing other peoples point of view
difficulties picking up on body and facial language cues
difficulty making eye contact
shows compassion but confused by social signals and body language
often repeat same phrase or expression over and over
problems starting and continuing a conversation (small talk is hard)
difficulty making out people’s intention
social difficulties used in diagnosis of ASD in adults?
appear shy or avoid initiating social contect
difficulty fitting in with others die to not following social norms or ways of dressing
very few friendships and difficulty maintaining ones they have
may appear rude or unaware of bluntness
trouble processing certain thoughts and expressing needs to others
take things literally
other features in adult ASD?
...things have to be in a certain way, many rituals obsessive interests unusual body movements clumsiness, lack of coordination sensory issues
diagnostic tools in ASD?
developmental history and collateral history from parents/relatives/schools etc
screening questionnaires and semi-constructed interviews (3di, DISCO)
standardised assessment tools (autism diagnostic observation schedule - ADOS - not as good for girls)
other disciplines (SLT, OT etc)
ultimately it is a subjective clinical judgement
essential criteria in ASD?
symptoms must be present in early developmental period
symptoms cause clinically significant impairment in social/occupational or other areas of functioning
disturbances are not better explained by other mental health problems, intellectual disability or global developmental delay
co-morbidity in ASD?
emotional disorders (depression/anxiety, eating disorders) neurodevelopmental disorders (ADHD, dyslexia, dyspraxia and sensory processing problems, language impairment)
learning disability in ASD?
70% have non-verbal IQ<70 35% have non-verbal IQ <50 also co-occurs with variety of medical disorders - fragile X - tuberous sclerosis - seizures - hearing/visual impairments
non pharmacological management in ASD?
lessen associated defecits and family distress and increase QoL self and family psychoeducation applied behaviour analysis speech an language therapy social skills training family and school based support diet (limited research supporting)
pharmacological management?
no medication to treat core symptoms
risperidone can help with severe agression and self injury
treat any co-morbidities (seizures, mood stabilisers, antipsychotics for tics, SSRIs for anxiety/depression etc, melatonin for insomnia)
how is oxytocin involved in ASD?
emerging evidence suggests that oxytocin may be a blood based biomarker of social functioning
potential basis for ASD treatment
