Autism Deck 2 (CAP resources) Flashcards
list most common comorbidities with autism
anxiety (40%)
ADHD
other NDD
trauma/stressor related
OCD and related
Mood
Psychotic
ddx to consider in autism dx
trauma/maltreatment
catatonia
review psychoed/cognitive testing
consider medical problems, especially in lower functioning kids
why should you be cautious in prescribing. meds in autism
often lower effect sizes and higher SEs for those with autism
first choice meds for treating anxiety in ASD
SSRIs = first choice
–> try lower doses and slower titrations (fluoxetine is good for this; can use compounding pharmacies for other SSRIs to make a slower titration)
–> careful with mood related SEs, activation/disinhibition
*careful with benzos (higher rates of paradoxical reaction in kids with ASD)
other med options: alpha agonists, pregabalin, SNRI, atomoxetine, hydroxyzine
what are some non-pharm options for treating anxiety in ASD
environment/expectations are extremely important
can do therapy–> ie FACING YOUR FEARS program which is modified CBT
*emphasis on the B in CBT
*skill development is essential
*more need for external motivators, parent involvement
why is it hard to assess OCD in ASD
repetitive behaviours/movements are part of ASD
kids with ASD may use repetitive behaivours to regulate
often is can be hard for ASD kids to articulate obsessions/worries
THEMES can be UNUSUAL (may seem psychotic)
insight can be poor
social awareness and motivation to change may be lacking
how do you treat OCD in ASD
CBT–> emphasis on the B
meds per usual for OCD
what is first line for treatment for ADHD in kids wtih ASD
stimulants are still first line but may be harder to tolerate in younger kids, ID, high anxiety
what med should you consider in a kid with both ADHD and ASD who is more inattentive and has comorbid anxiety
atomoxetine
when to consider catatonia in ASD
in any autistic patient but particularly in adolescent with decline in functioning
what are the Wing-Shah Autistic Catatonia Criteria
- increased slowness affecting movements and verbal responses
- difficulty in initiating and completing actions
- increased reliance on physical or verbal prompting by others
- increased passivity and apparent lack of motivation
what are the consequences of lack of intervention for girls with autism
higher risk of anxiety, low self esteem, mood problems
how does psychiatric treatment change for the “PDA” variation of ASD presentation
psychiatric treatment is the same as otherwise
how to address aggression in ASD pharmacologically? (first line and alternatives)
what % of those with ASD have ID
25% or less
what areas of ASD tend to improve over time
first of all, most people with ASD improve over time
mostly in areas of social function and communication, and in irritability/agitation
what areas of ASD tend to NOT improve over time
ritualistic, repetitive behaviours
also adaptive functioning tends to remain poor
name two predictors of good outcomes in ASD
language skills (particularly functional language before/at age 5) and IQ above 70
what % of kids with ASD can be diagnosed with a particular single gene disorder?
about 10%–> i.e fragile X, TS, prader willi, NF
what % of those with ASD have a known genetic syndrome, define mutation, do novo CNV
about 20% (other sources say 15%)
how does concordance for ASD vary between MZ vs DZ twins
NZ–90%
DZ–20%
what is the recurrence rate for ASD within families
20% for dx of ASD
20% for ASD traits in siblings
list risk factors for ASD
advanced parental age (esp paternal over 40)
maternal anticonvulsants (esp. tegretol, also valproate)
low birth weight
hypoxia
pesticides
*vaccines not a risk factor
what two genetic tests should all kids dx with ASD get
chromosomal microarray analysis
molecular DNA test for fragile X
list 3 screening questionnaires for ASD
M-CHAT (modified checklist for autism in toddlers
SCQ (social communication questionnaire)
ABC (autism behaviour checklist)
list 4 autism specific diagnostic tools
ADI-R (autism diagnostic interview-revised)
ADOS (autism diagnostic observation schedule)
CARS (childhood autism rating scale)
DISCO (diagnostic interview for social and communication disorders)
what is IBI
intensive behaviour intervention–> more intense form of ABA
has the most evidence
is more than 25 hours per week
is adult directed
is 1:1
under what parameters does IBI show the most gains in a child with ASD
- high level of intervention (30-40 hours per week)
- 1:1 (therapist or parent)
- more than 2 years
- start before age 5
other than IBI, list 3 other ABA based models of more developmental interventions for ASD
Early Start Denver model
Pivotal Response Training
Developmental Individual Difference Relationship based approach (DIR or Floortime)
name a classroom based intervention for ASD
TEACCH
goal is to modify environment and improve skills
what are the principles of TEACCH
understanding the culture of autism
using an individualized person and family centered plan (rather than standard curriculum)
structuring the physical environment
using visual supports to make the sequence of daily activities predictable and understandable
parental involvement crucial
not enough evidence yet
list 3 other non pharm interventions for ASD
sensory integration therapy
picture exchange communication system (PCES)–> promotes early symbolic communication usuing visual symbols
social skills training
what is sensory integration therapy
techniques such as “brushing” of the skin, “swinging” to stimulate vestibular responses and pressure massage applied in an effort to calm the child
no strong research but is clinically useful
list common medical issues in ASD
- seizures
–> two peaks–> early childhood and adolescence - GI complaints
–> constipation/encopresis = COMMON TRIGGER
–> GERD - dental caries
- allergies
–> increased rate of food allergies - minor injuries
- ear infections
- headaches
are there any pharm treatments for the core symptoms of social and relationship problems of autism
no
other than irritability/aggression, list some potential target symptom domains for pharmacotherapy in those with ASD
hyperactivity and inattention
repetitive behaviours
based on studies, which helped more for ADHD in autism, MPH or atomoxetine
MPH (but more people also d/c it due to SEs)–> another study suggests the effects are actually similar
describe a possible medication pathway for ADHD in ASD
- guanfacine/clonidine (lower risk lower reward)
- MPH (risk irritability, anxiety)
- atomoxetine (better tolerated)
- mixed amphetamine salts
- omega 3 fatty acids
- mixed receptor antagonists for severe impulsivity conferring risk of injury, elopement
meds for treatment of repetitiev behaviours in kids and teens
risperidone has a positive study
citalopram and fluoxetine have negative studies
(in adults, both fluoxetine and fluvoxamine have positive studies)
in treating irribability in autism with aripiprazole, was there a difference in effect between doses of 5, 10 or 15mg?
no difference between doses
weight gain was about 1.5 kg
brain structure differences in ASD
- greater volume of both grey and white matter especially in frontal and temporal cortex
increase in corticla thickness in ASD at age 3-4, followed by accelerated cortical thinning
- elevated serotonin levels in whole blood and platelets
–
- abnormalities in glutamate (excitatory) and GABA (inhibitory) balance
