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
