Autism Flashcards
Etiiology
Unknown Genetic: 35-40%3 such as Fragile-X or Rett’s syndrome Prenatal, perinatal, postnatal factors: 60-65%3 Prenatal advanced maternal or paternal age white or Asian male Asian female gestational hypertension or gestational diabetes Exposure to heavy metals and some maternal medications (eg. valproic acid for seizures)
Etiology continued
Perinatal C-section GA<36 weeks Breech Pre-eclampsia Post-natal Low birth weight Brain anomaly Vaccines – unfounded Symptoms appear after a period of “normal” dev’t
how is it characterized?
Developmental Disability
DSM-V category “Autism Spectrum Disorder”1
Categorized in severity from Level 1 (least involved) to Level III (most severe) 1
Combined with Asperger, CDO, and PDD-NOS
1 in 68 kids 1
Males>females (except for Rett’s syndrome)
Characteristics
Group of disorders including impairments in:
Communication
Social interaction
Stereotypical behaviors/repetitive behaviors
Arm flapping
Jumping
Rocking
Inflexible behavior
Sensory integration dysfunction
Hyper or hypoactive to sensory experiences
Signs and Symptoms
Generally apparent by 18-24 months of age
(if you know what you are looking for-may be 4yo)
One early sign is child’s inability to respond when his or her name is called
Poor eye contact
Parents may report infant “does not like them,” as child may not like being held
Developmental delay (e.g., walking)
Delayed or absent language
Sleep disorders, seizures, GI issue
RED FLAGS for autism in 12-18 month old children
Social communication
Social communication: reduced or atypical
Eye gaze and shared or joint attention
Sharing of emotion (positive or negative)
Social or reciprocal smiling
Social interest and shared enjoyment
Orienting when name is called
Regression or loss of social-emotional connectedness
RED FLAGS for autism in 12-18 month old children
Language
Language: delayed or atypical
Babbling, particularly back-and-forth with others
Language comprehension and production (eg delayed or odd first words, usually repetitive)
Unusual tone of voice
Development of gestures (eg pointing or waving)
Regression or loss of communication skills (including words)
“Red flags” for autism in 12- to 18-month-old children7
Play
Play: reduced or atypical Imitation of actions Functional and imaginative play Excessive or unusual manipulation or visual exploration of toys and other objects Repetitive actions with toys and other objects Intense attachment to a toy or object Lining up toys More interested in how it works
“Red flags” for autism in 12- to 18-month-old children7
Visual or other sensory and motor skills
Atypical visual tracking, visual fixation (eg on lights)
Under or over-reaction to sounds or other forms of sensory stimulation
Delayed fine and gross motor skills, atypical motor control (eg reduced muscle tone, reduced postural control for age)
Repetitive motor behaviors, atypical posturing of limbs or digits
Medications
Antidepressants, SSRIs for repetitive behavior (Zoloft or Prozac) – questionable effectiveness
Anticonvulsants to control seizures (Tegretol, Lamicalt, Depakote, Topamax)
Atypical antipsychotics (Risperidone, aripiprazole7)
Stimulants for hyperactivity/impulsivity (Ritalin)
Sleep disturbances (melatonin7)
PT impairment
May include:
Gross motor delay
Hypotonia
Decreased coordination/postural control/clumsy
Difficulty with motor planning
Toe walking
Self injurious behavior (head banging/biting)
PT intervention
Facilitate motor milestones
Gait training
Recommend adaptive equipment or orthotics
SI rx – OT essential
Behavior modification
Patient/family education
Ensure appropriate MDs involved for dx and rx prn: psychiatry, neurology, genetics
Guiding principles of effective intervention
Early Intervention Family Involvement Individualized Programming Systematic Intervention Structured/Predictable Environments Functional Approach to Behavior
Early signs in a nutshell
Hand flapping Does not respond to name or voice No eye contact Toe walking Repetitive head banging Fussy/screaming in public and/or crying for no apparent reason in any setting Pouring drinks back and forth Biting or aggressiveness Repetitive behaviors lasting minutes/hours (jumping/spinning, etc) Constant dark circles under eyes
