Autism Flashcards
Recognise the variable clinical features of childhood autism Recognise that there are different types of autism spectrum disorders Gain an understanding of the epidemiology and complex aetiology Gain familiarity with the assessment and management approaches of childhood autism
Define autism
A triad of impaired communication, impaired social interaction, and restricted, repetitive, stereotypic patterns of behaviour
What is the male to female ratio of autism?
4:1
Define autistic savant
An individual with autism and an above average IQ, typically with skills in a very isolated area
Describe the verbal impairments in autism
Speech delay, stereotyped and repetitive speech, lack of social usage of language (slang, colloquialisms)
Describe the non-verbal communication impairments in autism
Poor gesture, lack of creative play
Describe the impairments in social interaction in autism
Lack of reciprocity, missing of social-emotional cues, lack of theory of mind, literal and concrete understanding, failure to develop peer relationships, lack of shared enjoyment
Describe the behavioural abnormalities in autism
Unusual sensory interests, little imaginative play, stereotyped motor mannerisms (e.g. hand flapping, spinning), adherence to non-functional routines or rituals, unusual preoccupations or interests
Before what age must abnormalities be apparent for a diagnosis of childhood autism?
3
Describe some typical symptoms of childhood autism
Irrational fears or phobias, sleeping disturbances, eating disturbances, temper tantrums, aggression, self-injury
How is Asperger’s syndrome differentiated from childhood autism?
No general delay or retardation in language or cognition
What percentage of individuals with autism have an identifiable medical cause?
6-10%
What is the concordance rate of autism in monozygotic twins?
36-60% severe, 90% mild
State an implicated genetic site in autism
2q, 7q32, 6q21, 15q11-13, 16p
In which population groups are rates of autism higher?
Children of engineers and children of South-East Asian immigrant mothers
Name at least 5 medical conditions which can cause autism
Tuberous sclerosis, fragile X, maternal rubella, neurofibromatosis, Herpes simplex encephalitis, Turner’s syndrome, blindness, deafness, Down’s syndrome, untreated phenylketonuria
Name at least 3 speculative causative environmental factors
Diet, pollutants, antibiotics, allergies, severe deprivation
Name 2 mental health disorders associated with autism
Anorexia nervosa and ADHD
In which sub-group of autistic patients is schizo-affective disorder more common than in the general population?
Fragile X autism
What percentage of autistic individuals have epileptic seizures before age 3?
20%
What percentage of autistic individuals develop epileptic seizures in adolescence?
15-20%
Why can deafness confound an autism diagnosis?
Hearing impaired children talk later and are less socially skilled, symptoms shared with autism - but autism is also more common in the deaf population, hypothesised due to an underlying neurological disorder causing both
State at least 5 autism-suggestive behaviours in infants
Feeding problems, dislike of physical contact, content to be alone (angel baby), not lifting arms to be lifted, not snuggling down when held, not gripping when being carried piggy-back, fascinating with lights or spinning, lack of curiosity, lack of social pointing and eye contact, delayed motor milestones, limited babbling
How do the 2011 NICE guidelines suggest autism is identified early?
Regular health visitor checks, hearing and vision tests, training professionals to recognise signs and symptoms
What is the prevalence of autism spectrum disorder? (Chakbarti & Frombonne, 2006)
116 per 100,000
What is the prevalence of childhood autism?
25 per 100,000
What percentage of the adult population has autism?
1.1%
Give 3 reasons why autism appears to be on the increase
Changes in diagnostic criteria, increasing awareness, recognition of associations (e.g. with hearing impairment and Down’s syndrome), increased willingness to receive diagnosis (reduction in institutionalisation), increased benefits of diagnosis (development of specialist services)
Give some differentials for autism
Receptive language disorder, expressive language disorder, elective mutism, schizophrenia, disintegrative disorder
How can receptive-expressive language disorder patients be distinguished from autistic patients?
They exhibit reciprocal social behaviour and good eye contact
How can severe neglect mimic autism (as seen in the Romanian orphans?)
It produces language delay, abnormal social behaviour, and unusual habits and stereotypies - however once relationships are re-established, children start to show language comprehension and normal social reciprocity
Why are height, weight, and head circumference measurement important in suspected autism?
To exclude Rett’s syndrome
What percentage of children with autism have an IQ below 70?
75%
Which is higher in most autistic children - performance or verbal IQ?
Performance IQ
What is the most important intervention in childhood autism?
Appropriate educational placement (often the hardest thing to achieve)
State some negative prognostic factors in autism
Regression, low IQ, no speech by 7
What are the aims of behaviour management in autism?
Reinforcing desired behaviours and reducing unwanted behaviours, the impact of obsessional behaviours, and destructive and aggressive behaviours
