Autism Flashcards
1
Q
What is the triad of autism?
A
- Social interaction
- Social communication
- Social Imagination
2
Q
How is social interaction seen in autism?
A
- Difficulty recognising emotions, in themselves and others
- Unwilling to make direct eye contact
- Unaware of appropriate social behaviour - failure to share toys or take turns in conversation, indifferent or adverse to physical affection
3
Q
How is social communication seen in autism?
A
- Some children are late to start talking or remain nonverbal - if speaking, often monotone and lack of gestures
- May not respond to own name
- Difficulty understanding non-verbal communication and they themselves may have absent facial expressions
4
Q
How is social imagination seen in autism?
A
- Children often have a limited range of interests
- They may favour one toy greatly or can’t talk about another topic apart from their interest
- Patterns of play can be repetitive
5
Q
What is autism linked to?
A
- Anxiety and poor stress management
- May have problems with loud noises, textures, water etc, consider seeking or avoiding behaviours
- Low mood and depression (may worsen in adolescence)
- OCD
- Sleep disturbance
- Gender dysmorphia
6
Q
What is the management for autism?
A
- No cure, just learning how to manage behaviour, become independent e.g. specialist teaching schools
- Educate family on how to manage
- 40% of autism patients having a learning disability
- Getting help - health visitor and specialist health visitor, parent groups and voluntary organisations, specialist teaching and schools (to help develop social skills)
- Education Health and Care Plan, Disability Living Allowance
7
Q
What is the psychotherapy for autistic patients and their parents?
A
- CBT
- Behaviour management programmes
- Applied Behavioural Analysis program - intense 40hrs/wk for 3yrs based on operant conditioning, imitation and reinforcement
- TEACCH - treatment and education for autistic and related communication handicapped children programme - successful in reducing self-injurious behaviour and enhancing life skills
- Educational psychology
8
Q
What medications can be used as an adjunct to psychological interventions in autism?
A
- SSRIs - main treatment for repetitive behaviours, anxiety, aggression. Require lower doses than needed for antidepressant effects.
- 2nd gen antipsychotics - 1st line pharmacological treatment for aggression, self-injury etc is risperidone
- Melatonin - help reduce sleep latency
9
Q
What are risk factors for autism?
A
- Male 4:1
- Congenital rubella infections - exposure in 1st trimester in early brain development
- Strong link between learning disabilities and seizure disorders
- 90% heritability rate and recurrence rate of 2-8% among siblings
10
Q
What social and emotional interaction questions do you want to ask in the history?
A
- Can they make and keep friends
- Do they understand emotions (their own and others)
- Do they like making eye contact? Abnormal body postures? e.g. walking on tiptoes
- Not clear of social cues (age appropriate
- Special narrowed interests e.g. trains, jigsaw, TV stars, star wars etc, cannot talk details about other topic apart from their interest
11
Q
What flexibility of thought questions do you want to ask in the history?
A
- Imaginative or repetitive play
- Mannerisms (tip toe walking/hand flapping)
- How they cope with change?
- Any obsessions? Routines? Rituals?
12
Q
What language and communication questions do you want to ask in the history?
A
- Can they have a two way conversation?
- Pitch, tone and content of speech
- Gestures while communicating
- Echolalia (understanding < expression)
13
Q
What questions do you ask about sensory features, sleep and diet?
A
- Any problems with loud noises, textures, water - consider sensory seeking or avoiding behaviours
- Consider co-morbidites: ADHD, developmental coordination disorder (dyspraxia), intellectual disability, tics, specific learning difficulties such as dyslexia, dyscalculia
14
Q
What questions do you want to ask in the history about behaviour and development?
A
- Temper problems? Meltdowns?
- Obsessions, fears and phobias
- How do they cope with being left alone/waiting?
- Gross motor or fine motor movement
- Hearing, speech and language - progression of speech, regression is a RED FLAG
- Social interaction and play development
15
Q
What do you want to know about the birth history?
A
- Antenatal hx of alcohol, drugs, smoking or illness
- Perinatal - delivery problems or LBW
- Postnatal problems e.g. infections, epilepsy, delays
- Congenital rubella and phenylketonuria are associated with autism
16
Q
What do you want to know about the family hx?
A
- Consanguinity
- Developmental and learning problems
- Epilepsy and fits
- Alcohol and drug abuse, domestic violence or parents are care leavers
- Consider attachment difficulties which can be confused with ASD
17
Q
What specific questions do you want to ask the parents?
A
- What are the parent/teacher/caregiver’s main concerns?
- Ask about all behaviours at home, school, day centre etc
- Ask about family circumstances; how is everything at home? Any other siblings, are they like this?
18
Q
How would you assess suspected autism?
A
- Interactive assessment/observation of communication skills and behaviours
- Schedule of growing skills or Oriffith Mental Developmental Scales
- ADOS2 (Autism Diagnostic Observation Schedule) - uses play and interview to examine communication, social interaction, imagination and restricted/repetitive behaviours
- DISCO (Diagnostic Interview for Social and Communication Disorders)
- ADI-R (Autism Diagnostic Interview-Revised)
19
Q
Describe ADOS2
A
- Toddler module: 12-30mths, don’t consistently use phrase speech
- Module 1: >/=31mths, don’t consistently use phrase speech
- Module 2: children of any age who use phrase speech but not verbally fluent
- Module 3: verbally fluent children + young adolescants
- Module 4: verbally fluent older adolescants and adults
- Score put in algorithm to give autism, autism spectrum, non-spectrum
20
Q
Describe the DISCO assessment tool
A
Interview with parent/carer of patient to gain holistic understanding of patient’s character/lifestyle.
21
Q
Describe the ADI-R assessment tool
A
Made up of 93 items: focuses on 3 functional domains: language + communication; reciprocal social interactions, restricted, repetitive and stereotyped behaviours and interests
22
Q
What physical exam would you want to do for autism?
A
- General physical exam
- Height, weight + head circumference
- Gait + coordination (look at heel/toe)
- Throwing/catching
- Fogs test (tests movement to assess for neurological issues)
- Skin stigmata and neurocutaneous markers
- Injuries (self-harm or maltreatment)
- Congenital anomalies or dysmorphic features - consider genetic testing
- MSE (secondary MH conditions)
23
Q
How is a diagnosis of autism made?
A
- Never diagnosed on 1st clinical appointment
- Psychiatrist/psychologist/SALT/paediatrician assessments
- Involve school
- Cambridge questionnaire, CAST questionnaire
- Map to DSM-V criteria/ICD-10
24
Q
What is a needs based management plan for autism?
A
- Take the family and educational context into account
- Communicate findings to parents and child if appropriate
- Provide a written report explaining findings and reasons for conclusions, copy report to GP, parents, school
25
What health professionals can help manage autism?
- Health visitor and specialist health visitor
- Parent groups and voluntary organisations
- National Autistic Society of action for ASD
- Portage (pre-school home visiting special educational needs support service)
- ECHP (Education Health and Care Plan), DLA (Disability Living Allowance)
- S+L therapists
26
What factors are indicative of a good prognosis?
- Communicative speech 6yrs old and above
- Higher IQ (>50)
- Skills that can be used to secure employment
27
How is aggression managed in children?
- Psychological interventions are tried and a physical cause for aggressive behaviour is ruled out or treated first.
- Risperidone is the only licensed pharmacological treatment.
