ASD Flashcards
Is Asperger’s syndrome considered a high or low functioning variation of Autism Spectrum Disorder?
High functioning
What disorders now all come under the heading of ASD?
Asperger’s Syndrome
Rett’s Syndrome (learning disability)
Childhood Autism
Pervasive Developmental Disorder
What is included in the triad of ASD symptoms?
Impaired social interaction
Impaired communication
Restricted Interests
What symptom of ASD is common but NOT included in diagnostic criteria?
Repetitive behaviours
How do repetitive behaviours in ASD differ from compulsions in OCD?
Repetitive behaviours are to provide comfort and safety
Whereas compulsions are distressing to patient, and must be completed to minimise distress
Describe the difficulties that patients with ASD have with social communication?
- Good language skills but find it hard to grasp meaning of conversation
- Difficulty understanding jokes/sarcasm
- Voices often monotonous or English/American accent
- Language = pedantic
- Narrow interests dominate their conversations
- Difficulty sharing thoughts/feelings/emotions
Why do patients with ASD struggle with social interaction?
- Difficulty picking up non-verbal cues
- self-focused/lacking in empathy
- struggle to make/sustain relationships
What difficulties do ASD patients have with social imagination?
- Difficulties thinking in abstract ways
- Take things literally
- Difficulty transferring knowledge across different settings
- Difficulties projecting themselves into the future
What repetitive behaviours do patients with ASD often display?
- Insistence on sameness, inflexible routine
- Highly restricted/fixated interests
- Hyper- or hypo- reactivity to various sensory inputs
How many people are now thought to have autism, and why is it thought to have increased?
1 in 60
more people being diagnosed, and spectrum is widening => lower threshold for diagnosis
What is the gender ratio in ASD and why?
Boys:Girls
5/4:1
(this may be because girls are usually not diagnosed, as in younger age they possess better social skills than boys)
Why is testosterone thought to play a role in ASD?
- Sex hormones play important role in the organisation of brain circuits during early development
- higher rates of ASD in gender identity clinics
- Girls with Congenital Adrenal Hyperplasia have been exposed to high levels of testosterone and showed more traits of ASD than controls
What other physical medical conditions can predispose to the development of ASD?
- Rubella in the pregnant mother
- Tuberous sclerosis
- Fragile X syndrome
- Encephalitis (brain inflammation)
- Untreated phenylketonuria (PKU)
Does ASD have a genetic component?
Yes - it is strongly heritable
BUT genetic testing is not performed routinely as gene mutations do not need to be identified for diagnosis
What environmental factors during pregnancy may predispose to development of ASD?
- Any teratogens the baby is exposed to in first 8 weeks from conception
- heavy metals toxicity
What biological perinatal causes can predispose to ASD?
- Hypoxia
- Foetal distress
- Birth injury/trauma
- Multiple birth
- Maternal haemorrhage
- Low birth weight
- Congenital malformation
What areas of the brain appear pathological in ASD?
Frontal lobes
amygdala
cerebellum
The amygdala is larger in boys, why is this thought to cause some ASD symptoms?
- associated with more severe anxiety
AND worse social and communication skills
What neurotransmitters are involved in ASD?
Glutamate receptors, GABA, Serotonin
What speech and language difficulties may be noticed in children with suspected ASD?
- Don’t babble or use other vocal sounds
- Can repeat words or phrases spoken by others
- Older children have problems using non-verbal behaviours
How would patients with ASD be identified in social situations such as school?
- often either gravitate to older or younger children as they struggle to make relationships
- tend to play alone
- Difficulties starting conversations
- Some children don’t demonstrate imaginative or pretend play
- stick to the same routine
What sensory processing difficulties do children with ASD experience?
Taste: - Finds flavours too strong - restricted diet - Certain textures cause discomfort Smell: - some overpowering => can cause toileting problems Sound: - Inability to cut out background noise Touch: - painful and uncomfortable - Only tolerates certain types of clothing or textures Sight: - problems with throwing and catching/ clumsiness - problems with bright lights
How do adults with ASD display poor communication?
- Difficulty seeing other person’s perspective
- Difficulty making eye contact during conversations
- confused by social signals/ body language
- repeat the same phrase
- Problems starting a conversation
- hard time understanding humour/ sarcasm
How do adults with ASD appear in social situations?
- shy
- difficulty fitting in
- Very few friendships
- May appear rude or unaware of bluntness
- Trouble processing certain thoughts
- Take things very literally
What diagnostic tools are often used in ASD?
Screening questionnaires and Semi-structured interviews (3di, DISCO - longer questionnaire)
Standardised assessment tools (Autism Diagnostic Observation Schedule - ADOS)
What are the essential criteria for and ASD diagnosis?
- Symptoms present in early developmental period
- Symptoms cause clinically significant functional impairment
- Disturbances not better explained by other mental health problems
Many children with ASD have a comorbid learning disability which impairs their IQ. TRUE/FALSE?
TRUE
70% of children have a non-verbal IQ<70
About 35% have a non-verbal IQ<50
What physical conditions does ASD often co-exist with?
fragile X syndrome
tuberous sclerosis
seizure disorders (epilepsy)
hearing and visual impairment
What non-pharmacological management is used in ASD?
- Self and family psychoeducation
- social skills training may be useful
- Family and school based supports
What pharmacological management can be used in ASD?
Treat comorbidities:
- Antiepileptics if seizure disorder
- Stimulants/non-stimulants for ADHD symptoms
- Antipsychotics for tics disorders
- SSRIs/SNRIs prescribed to decrease social anxiety, treat mood and/or OCD
- In severe autism with LD mood stabilisers generally used*
- Melatonin for chronic insomnia
