Autism Flashcards
Name 3 non-psychiatric co-occurring disorders with ASD
Epilepsy 21.5% if also ID and 8% in normal IQ
Bowel concerns - constipation
Sleep concerns
Other:
ID
Psychological - ADHD, anxiety, mood
Which modules should be chosen for ADOS based on age and speech level
Toddler module with score 20, what is the category?
Reasons for high score (false positive) in ADOS other than ASD?
what aspects of ADOS would a blind child score high on unrelated to ASD?
what aspects of ADOS would deafness child score high on unrelated to ASD?
What is the definition of GDD by the DSM-V
3 other criteria for ASD other than A and B
6 reason for high score on ADOS mod 4 other than ASD
ADHD
Anxiety (selective mutism)
Language disroder
Intellectual Developmental Disorder
Visual imapirment
Movement disorder (tics, etc)
Visual impairmet and ASD
what are 4 overlapping symptoms other than reduced eye contact
Sensory exploring (visual exploring)
Reduced sharing or showing
Lack of joint attention
Reduced gestures
Reduced social smile
Reduce response to name
link of non-verba with verbal
Name the psychological framework on which evidence-based interventions in ASD are based
Applied behavioral analysis
Or behavioral modification
2 genetic tests for ASD if symptoms in girl other than microarray or fragile X
MECP-2: Rett (developmental regression)
Whole Exome Sequencing
Karyotype: Turner syndrome (if short stature, dysmorphic features, history of 2+ miscarriages in mom)
PTEN if macrocephaly
NF1 if cafe au lait macules, etc - signs of NF
Features of social communication disorder (pragmatic)
- Communication for social purposes
- Difficulties changing language to match the social situation
- Difficulties following rules of conversation or storytelling (e.g. taking turns)
- Difficulties understanding humour, not taking things literally
Evidence based treatment for ASD?
Common comorbidities in ASD in adolescence?
IDD
Language Disorder
SLD
DCD
ADHD
Depression
Anxiety
ARFID
Constipation
Epilepsy
Gender dysphoria
What does ABC stand for in context of challenging behaviors?
Antecedent, Behaviour, Consequence
Indication for MRI in ASD ? (6)
Regression
Seizures
Focal neurological findings
Microcephaly
Dysmorphism
Neurocutaneous skin lesions
2 ASD screening test in gen peds?
MCHAT
CAST
RITA
STAT
Infant Toddler Checklist
SRS
SCQ
ASD + melatonin
4 counselling points
Unregulated, irregular dose
Helps with initiation
Does not replace sleep hygiene strategies
Increase nightmares / Vivid dreams
30 minutes before bedtime
Start low dose
No addictive propertlies
Difference in DSM 5 criteria from DSM IV
reasons to diagnose ASD in ID?
- Approach to managing behavioural interventions is different - helps to guide the behavioural management approach
- helps caregivers understand origin of difficulties
- helps to frame their difficulties in the context of their overall clinical picture
- extra access to supports/helps for future planning - i.e. supports as an adult based on adaptive abilities
- School supports/classroom placement - helps to advocate for what the child’s specific needs are
blood test for gluten free diet / casein free diet & really restricted diet
Vitamin D
Calcium
Iron studies
CBC
Electrolytes
Albumin and total protein
27 month old with ASD. (a) Indications for doing metabolic testing. (b) Components of a metabolic screen (10). (c) 3 additional genetic tests to CMA and one indication for each.
(a) Regression, seizures, dysmorphic features, multisystem dysfunction
(b) Amino acids, urine organic acids, urine pyrimadines, creatine kinase, all tier 1…
(c) Fragile X – family history of features (ataxia, POF), characteristic facial features; Rett – regression, midline hand stereotypies; karyotype; PTEN
reasons not to use hyperbaric oxygen in treatment of ASD?
Adverse effects of HBOT include barotrauma to the middle ear, sinuses, or lungs; reversible myopia; pulmonary oxygen toxicity; and seizures. (See “Hyperbaric oxygen therapy”, section on ‘Complications’.)
5 triggers for behavior (functions of behaviors)
gaining access
escaping demand
attention
communication
sensory
Treatable causes of behavior
hunger
pain
fatigue
cavities
constipation
overstimulation
absence of routine
Principles and components of childhood intervention for children with ASD?
Principle - functional goals that are driven by the family
Components -
OT: behaviour/emotional regulation, increasing adaptive functioning and working on sensory needs
SLP: social + pragmatic communication
BIT: participation
first 2 investigations in newly diagnosed ASD
Hearing
Vision
then CMA
You have recently made the diagnosis of ASD in a young boy. His history and clinical evaluation is remarkable for language and intellectual deficits, seizures, hypermotoric and ataxic movements, paroxysms of laughter, and happy disposition. List one genetic syndrome you would consider in this patient. What is the associated gene? What testing would you consider for this patient.
Angelman syndrome (C15q11-13 maternal deletion) – DNA methylation analysis
5 characteristics that may lead to underdiagnosis of ASD?
Counselling re gluten free diet in ASD?
Evidence does not support this method of treatment for symptoms of ASD
Risks likely outweigh the benefits – malnutrition
Will recommend consultation with dietician
At risk of nutritional deficits, may need regular bloodwork to ensure that the child is getting enough protein, calcium and vit D
Important to only try 1 alternative medical treatment at a time and carefully monitor for outcomes, side effects etc.
10 factors or diagnosis which are associated with increase risk of ASD
Family history
higher maternal age at pregnancy (and close spacing of pregnancies)
preterm, low birth weight
male
CP
Epilepsy
NF1
T21
Klinefelter, Angelman, Rett, COrnelia de Lange, De George
Infection - rubella
Name 8 factors that can increase the risk for challenging behaviours in children with ASD.
Poor language abilities
Comorbid ADHD
Comorbid IDD
Social environment
Poor community supports/resources
Higher level of symptoms
Pain
Developmental changes in demands
Sleep issues
2 contraindications to do ADI-R?
- cognitive level < 2 years old
- unreliable caregiver for history
4 core features of social pragmatic communication disorder (SPCD) dsm V
1) Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context.
2) Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding use of overly formal language.
3) Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
4) Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).
4 evidence based treatments for ASD?
1) early intensive behavioural (2-5 years)
2) parent-mediated interventions
3) social skills training
4) CBT for anxiety in verbal kids
** CPS Statement ASD III (Treatment)
4 screening tools for ASD in the community
-MCHAT - Modified Checklist for Autism in Toddlers
-Infant Toddler Checklist (8 months to 2 years)
-RITA-T
-SRS - social responsiveness scale
3 non-A or B criteria for ASD diagnosis
- Onset in early developmental period
- Not better explained by alternative diagnosis, specifically GDD/IDD
- Interfering with daily functioning
6 reasons for ADOS high score other than ASD dx in teen
Anxiety
ADHD
IDD
Substance use
SLD
wrong module
visual or hearing impairment
Vision impairment and ASD - 4 overlapping symptoms from the ADOS scoring module (aside from reduced eye contact).
reduced communicative gestures
reduced showing
sensory seeking behaviors increased (example visual inspection)
stereotypic movements and speech increase
Reduced use of visual coordination (ie joint attention)
4 positive factors that influence success after cochlear implant
bilateral implants
family support and engagement in rehab
younger child
no other developmental delays
Define benficence, non-malificence, justice, and autonomy
4 indications to start antipyschotic in ASD with aggression
Aggression causing self-injury
Aggression casuing distruction of property
Limiting function at home or school
Failure of behavioral interventions
Autism and macrocephaly
what genetic diagnosis should you test for other than fragile X, microarray
PTEN (macrocephaly >3SD)
2 types of augmented communication devices
PECS (picture board)
two choice buttons (Big Mack)
2 English based diagnostic interviews for use in ASD diagnosis and research.
ADI-R
SCQ
DISCO
3DI
4 blood tests to assess nutritional status of a child on a gluten casein free diet.
other nutritional: Albumin, total protein
Bone health: 25-OH-vitD, cal, phosphorous, alk phos,
creatine, lytes
Bloodwork for Failure to thrive:
serum albumin
total protein
calcium
vitamin D levels
Others:
Ferritin
ALK phos
Albumin
phosphate
weight, height, HC
Bone density Z score
12-year-old diagnosed with ASD. What are the 4 most common comorbidities that should have been addressed in this assessment?
Intellectual disability (50%)
· Epilepsy (30%)
· ADHD (2/3rd)
· Anxiety (1/3rd)
Constipation
Sleep disturbaces
2 meds for aggression ASD other than antipsychotics
· Alpha agonists (Intuniv, Clonidine)
Mood stabilisers (valproate)
ADOS module 1 - 3 adjustment you can make for administration in adolescent (ADOS, doing a module 1 on a teenager, name 3 modifications the manual says you can make)
pg 25:
For “Anticipation of a Social Routine” replace with a back-and-forth hand game (ex. Gimme 5, up high, down low, too slow)
Pg 14 says you can also omit this activity when doing Module 1 in older individuals
Page 14:
Having a birthday party for an action figure (instead of baby)
In “Free Play” adding action figures and “break” materials from Module 3 to the “Free play” materials
In “Bubble Play” introduce 2 toys so the the examiner and patient can have a bubble fight
In “Snack” use 2 plates and cups, so snack can be shared together
Adjustments to Module 2
Page 14:
In “Free Play” the family of dolls can be replaced with action figures from Module 3
“Telling a Story from a Book” materials can be replaced with book from Module 3
Male 3 years old with ASD normal growth parameters, HC +2SD, macrocephaly and frontal bossing, flat nasal bridge. Normal microarray and normal fragile X. Normal MRI.
genetic test?
other tests?
PTEN gene testing
TIDE
EEG
Write one thing that differentiates spcd and asd on social, behaviours, routines, play
Specifiers in ASD diagnosis? (3)
a) Level of severity for impairment in social interaction and communication
b) Level of severity for abnormal and repetitive/restricted behaviours
c) With or without language impairment
d) With or without intellectual impairment
e) With or without genetic disorder
f) With or without catatonia
g) Associated with another neurodevelopmental, mental, or behavioral disorder
1 year old with SNHL – 3 tests to determine cause
Genetics
urinalysis
MRI
CMV
Optho assessment
ASD and picking eater, first step, 3 medical reasons for feeding problems in ASD
rule out medical problems
- GERD
- Constipation
- Dental problems
- Sensory sensitivities
List 5 criteria that parents should look for when looking for interventions/therapy for children with ASD
Teachers and therapists are trained and experienced, and work in supportive environments (e.g., classes with appropriate child-to-educator ratios).
Teachers and therapists are supervised by professionals with extensive ASD expertise.
Interventions support ongoing child development, including social communication, language, emotional and behavioural regulation, cognitive, and adaptive skills.
The child’s progress is monitored and evaluated regularly, and adjustments are made accordingly.
Evidence-based protocols are followed closely, to ensure overall program effectiveness.
Parents are actively involved, and learning opportunities are incorporated into daily experiences.
4 first line treatments for behavior outbursts in ASD?
- Rule out comorbid medical and psychiatric (ex. Seizures, sleep disturbances, OSA, pain) and provide treatment
- Evidence-based parent training programs
- Target-specific behavioural interventions
- Environmental modifications
- AAC devices for minimally verbal children
