ASD in adults Flashcards
- Which of the following is TRUE regarding the symptoms of autism?
a) Narrowed interests is one of the main symptoms.
b) They are always associated with a delay in developmental milestones.
c) They are identical in boys and girls.
d) They typically appear in adolescence or early adulthood.
e) They usually improve with age.
a
- Which of the following is TRUE regarding comorbid disorders with autism?
a) ADHD is a common comorbid disorder with autism.
b) Autism is rarely associated with comorbid conditions.
c) Learning disability is rarely associated with autism.
d) Psychotic disorders are indistinguishable from autism.
e) Treatment of comorbid disorders is less important in autism.
a
- Which of the following is TRUE regarding the core features of autism?
a) Core symptoms of autism vary according to multiple factors.
b) Hypersensitivity to external stimuli is one of the core features of autism.
c) Presence of learning disability does not affect the severity of symptoms.
d) Treatment has limited effect on these symptoms.
e) None of the above.
a
- Which of the following is TRUE regarding the diagnosis of autism in adults?
a) Due to lack of specific treatment, early diagnosis does not change the outcome of this condition.
b) Formal assessment tools are always needed to confirm the diagnosis.
c) Most adult patients are diagnosed early in life.
d) The Adult Asperger Assessment (AAA) is used in patients with learning disability.
e) The Diagnostic Interview for Social and Communication Disorders (DISCO) can be used at any age.
e
- Which of the following treatments is recommended for the routine management of autism?
a) Anticonvulsants for challenging behaviour (when the benefits outweigh the risks).
b) Antidepressants.
c) Antipsychotics for challenging behaviour (when the benefits outweigh the risks).
d) Exclusion diet.
e) Oxytocin.
c
- Which of the following is TRUE regarding comorbid epilepsy and autism?
a) Adults with epilepsy have fewer autistic traits.
b) Antiepileptic medication can improve core symptoms of autism.
c) Control of seizures results in worsening of the core symptoms of autism.
d) Prevalence of epilepsy in autism is generally low.
e) Psychotic symptoms can appear with epileptic seizures.
e
- Which of the following is TRUE? Adults with autism may present with the following:
a) A forensic history.
b) Difficulties in education or employment.
c) The presence of anxiety or depression.
d) The presence of substance misuse.
e) All of the above.
e
- Which of these diagnostic tools does NICE recommend for people with learning disability?
a) ADOS-G and ADI-R.
b) ADOS-G and AAA.
c) ASDI and ADI-R.
d) ASDI and RAADS-R.
e) RAADS-R and AAA.
a
- Which of the following is NOT a common criminal behaviour committed by people with autism in forensic services?
a) Arson.
b) Criminal damage.
c) Drug- and alcohol-related offences.
d) Homicide.
e) Sexual offences.
d
Definition
Autism spectrum disorder (ASD) is defined as:
“a neurodevelopmental disorder characterised by impairments in communication and social interaction, as well as restricted, stereotyped behaviour and interests.”
Onset of symptoms
Early life- 1mo
Difficulties social interaction, communication, social imaginatioin
Preoccupation with topic/interest
+/- language delay
Origin of autism in history
Until recently, the first description of autism was credited to two clinicians who were working separately on two different continents:
In 1943, Leo Kanner (a psychiatrist who was working in Baltimore) published his article entitled ‘Autistic Disturbances of Affective Contact’ in the American Journal Nervous Child (Kanner, 1943).
Also in 1943, Hans Asperger, a Viennese paediatrician who was working in the Lazar clinic in Austria, published his thesis ‘Die ‘autistischen Psychopathen’ im Kindesalter’ (translation: ‘The ‘autistic psychopaths’ in childhood’) in Archiv für Psychiatrie und Nervenkrankheiten (Asperger, 1943).
A great deal of attention was drawn by this due to the narrow gap between the two publications and the similarities in their descriptions despite the authors working in seemingly different settings. Some believed this to be pure coincidence, but the publications also prompted various conspiracy theories. It later emerged that this was not a result of coincidence or conspiracy; two recently published books reveal that a third person named George Frankl was the missing link between the two clinicians (Robison, 2016).
George Frankl worked with Asperger in the Lazar clinic in Vienna. Being a Jew, Frankl left Austria in 1937 and joined his fiancée in the US. He later worked for Kanner, and it
was evident that he used his prior knowledge and experience of working with autistic
Leo Kanner
Wikimedia Commons
children to enrich Kanner’s work.
Two recent books (Silberman, 2015 and Donvan & Zucker, 2016) shed more light on this. Donvan and Zucker were able to meet Kanner’s first autism case study, Donald Triplett, and obtained access to previously unpublished records from the Johns Hopkins clinic. The patients described in the two original works of Kanner and Asperger were different in their degree of functioning. Asperger’s patients had better language abilities and good cognitive and intellectual skills, while several patients described in Kanner’s work were unable to speak at all, and many had intellectual impairment.
The delay in translating Asperger’s paper from German to English (Uta Frith’s translation appeared in 1991; Frith, 1991) and the position of Kanner as Editor of the first journal on autism (Journal of Autism and Childhood Schizophrenia) meant that Kanner’s descriptions dominated the English-speaking world.
Hans Asperger
Wikimedia Commons
Furthermore, Frankl and Asperger were working for the Viennese doctor Erwin Lazar, a student of the Swiss psychiatrist Eugen Bleuler, who used the term autism to describe the detachment seen in schizophrenia patients.
It is worth noting that many clinicians in Europe described cases of patients with features of autism without using the term. For example, a 1926 paper by Grunya Sukhareva described six boys with features of what we now call autism (Manouilenko & Bejerot, 2015).
Core features of autism
The presentation of autism is varied across a spectrum that ranges from the most severe forms, associated with a prominent intellectual disability, to the more highly functioning subtypes. However, there are ‘core features’ that are present in most patients with autism to varying degrees. These include:
difficulties with social communication and interaction
rigid and repetitive behaviours
resistance to change or narrowed interests.
How do adults with ASD present
Adults with autism may present with the following:
- difficulties in education or employment
- problems with social relationships
- presence of comorbid disorders such as anxiety, depression and other mental health problems
The presence of substance misuse and/or forensic history are other features of autism in adulthood.
People with autism find it difficult to build relationships with others, and this has a long-term effect on their personal and social life. Additionally, some features in childhood autism assessment do not apply for adults (e.g. lack of imaginative play).
People with autism may also present with hyperactive symptoms characteristic of ADHD. According to Hofvander et al (2009), nearly 40% of patients with autism also display symptoms of ADHD. The co-diagnosis of autism and ADHD was acknowledged when the DSM was last updated, and has been included in DSM-5, but it has not been included in ICD-10. Clinicians using the ICD-10 system are advised to choose one code rather than using multiple codes for individual patients.
Theories of deficits in ASD
Theories
There are many theories regarding the deficits in autism. The following are just examples, and this is not an exhaustive list:
‘Theory of mind deficit’ (Baron-Cohen, 2000) describes poor comprehension of social interactions.
‘Social motivation deficit’ (Chevallier et al, 2012) describes the lack of motivation to interact with others.
‘Atypical perception of social stimuli’ (Yang et al, 2015) attributes the social difficulties in autism to poor understanding of social cues.
‘Atypical pattern of executive functions’ (review by Wilson et al, 2014) and ‘Perception’ (Mottron et al, 2006) connect higher cognitive functions to autism symptoms.
