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1. Child and Adolescent Psychiatry > Autism Deck 2 (CAP resources) > Flashcards

Autism Deck 2 (CAP resources) Flashcards

1
Q

list most common comorbidities with autism

A

anxiety (40%)

ADHD
other NDD
trauma/stressor related
OCD and related
Mood
Psychotic

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2
Q

ddx to consider in autism dx

A

trauma/maltreatment
catatonia
review psychoed/cognitive testing
consider medical problems, especially in lower functioning kids

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3
Q

why should you be cautious in prescribing. meds in autism

A

often lower effect sizes and higher SEs for those with autism

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4
Q

first choice meds for treating anxiety in ASD

A

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

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5
Q

what are some non-pharm options for treating anxiety in ASD

A

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

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6
Q

why is it hard to assess OCD in ASD

A

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

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7
Q

how do you treat OCD in ASD

A

CBT–> emphasis on the B

meds per usual for OCD

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8
Q

what is first line for treatment for ADHD in kids wtih ASD

A

stimulants are still first line but may be harder to tolerate in younger kids, ID, high anxiety

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9
Q

what med should you consider in a kid with both ADHD and ASD who is more inattentive and has comorbid anxiety

A

atomoxetine

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10
Q

when to consider catatonia in ASD

A

in any autistic patient but particularly in adolescent with decline in functioning

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11
Q

what are the Wing-Shah Autistic Catatonia Criteria

A
  1. increased slowness affecting movements and verbal responses
  2. difficulty in initiating and completing actions
  3. increased reliance on physical or verbal prompting by others
  4. increased passivity and apparent lack of motivation
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12
Q

what are the consequences of lack of intervention for girls with autism

A

higher risk of anxiety, low self esteem, mood problems

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13
Q

how does psychiatric treatment change for the “PDA” variation of ASD presentation

A

psychiatric treatment is the same as otherwise

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14
Q

how to address aggression in ASD pharmacologically? (first line and alternatives)

A
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15
Q

what % of those with ASD have ID

A

25% or less

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16
Q

what areas of ASD tend to improve over time

A

first of all, most people with ASD improve over time

mostly in areas of social function and communication, and in irritability/agitation

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17
Q

what areas of ASD tend to NOT improve over time

A

ritualistic, repetitive behaviours

also adaptive functioning tends to remain poor

18
Q

name two predictors of good outcomes in ASD

A

language skills (particularly functional language before/at age 5) and IQ above 70

19
Q

what % of kids with ASD can be diagnosed with a particular single gene disorder?

A

about 10%–> i.e fragile X, TS, prader willi, NF

20
Q

what % of those with ASD have a known genetic syndrome, define mutation, do novo CNV

A

about 20% (other sources say 15%)

21
Q

how does concordance for ASD vary between MZ vs DZ twins

A

NZ–90%
DZ–20%

22
Q

what is the recurrence rate for ASD within families

A

20% for dx of ASD
20% for ASD traits in siblings

23
Q

list risk factors for ASD

A

advanced parental age (esp paternal over 40)

maternal anticonvulsants (esp. tegretol, also valproate)

low birth weight

hypoxia

pesticides

*vaccines not a risk factor

24
Q

what two genetic tests should all kids dx with ASD get

A

chromosomal microarray analysis

molecular DNA test for fragile X

25
Q

list 3 screening questionnaires for ASD

A

M-CHAT (modified checklist for autism in toddlers

SCQ (social communication questionnaire)

ABC (autism behaviour checklist)

26
Q

list 4 autism specific diagnostic tools

A

ADI-R (autism diagnostic interview-revised)

ADOS (autism diagnostic observation schedule)

CARS (childhood autism rating scale)

DISCO (diagnostic interview for social and communication disorders)

27
Q

what is IBI

A

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

28
Q

under what parameters does IBI show the most gains in a child with ASD

A
  1. high level of intervention (30-40 hours per week)
  2. 1:1 (therapist or parent)
  3. more than 2 years
  4. start before age 5
29
Q

other than IBI, list 3 other ABA based models of more developmental interventions for ASD

A

Early Start Denver model

Pivotal Response Training

Developmental Individual Difference Relationship based approach (DIR or Floortime)

30
Q

name a classroom based intervention for ASD

A

TEACCH

goal is to modify environment and improve skills

31
Q

what are the principles of TEACCH

A

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

32
Q

list 3 other non pharm interventions for ASD

A

sensory integration therapy

picture exchange communication system (PCES)–> promotes early symbolic communication usuing visual symbols

social skills training

33
Q

what is sensory integration therapy

A

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

34
Q

list common medical issues in ASD

A
  1. seizures
    –> two peaks–> early childhood and adolescence
  2. GI complaints
    –> constipation/encopresis = COMMON TRIGGER
    –> GERD
  3. dental caries
  4. allergies
    –> increased rate of food allergies
  5. minor injuries
  6. ear infections
  7. headaches
35
Q

are there any pharm treatments for the core symptoms of social and relationship problems of autism

A

no

36
Q

other than irritability/aggression, list some potential target symptom domains for pharmacotherapy in those with ASD

A

hyperactivity and inattention

repetitive behaviours

37
Q

based on studies, which helped more for ADHD in autism, MPH or atomoxetine

A

MPH (but more people also d/c it due to SEs)–> another study suggests the effects are actually similar

38
Q

describe a possible medication pathway for ADHD in ASD

A
  1. guanfacine/clonidine (lower risk lower reward)
  2. MPH (risk irritability, anxiety)
  3. atomoxetine (better tolerated)
  4. mixed amphetamine salts
  5. omega 3 fatty acids
  6. mixed receptor antagonists for severe impulsivity conferring risk of injury, elopement
39
Q

meds for treatment of repetitiev behaviours in kids and teens

A

risperidone has a positive study

citalopram and fluoxetine have negative studies

(in adults, both fluoxetine and fluvoxamine have positive studies)

40
Q

in treating irribability in autism with aripiprazole, was there a difference in effect between doses of 5, 10 or 15mg?

A

no difference between doses

weight gain was about 1.5 kg

41
Q

brain structure differences in ASD

A
  1. 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

  1. elevated serotonin levels in whole blood and platelets

–

  1. abnormalities in glutamate (excitatory) and GABA (inhibitory) balance

1. Child and Adolescent Psychiatry (32 decks)

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