Autism (DONE) Flashcards
Autism spectrum disorders
Autistic disorder Asperger's disorder Childhood disintegrative disorder Rett's disorder Pervasive developmental disorder
Symptoms defined in DMS-V and ICD10
Difficulties in social communication and social interaction- deficits in non verbal communication skills, deficits in peer relationships
Restricted stereotyped and repetitive patterns of behaviour that impair or restrict every day function- restricted/fixated interests, insistence on sameness, inflexible adherence to routines, hyper reactivity or hypo reactivity to sensory input or sensory aspects of the environment
Associated features
Atypical language development
Motor abnormalities
Excellent attention to detail
Core autism symptoms
Social deficits
Language impairment
Repetitive behaviours
Associated neurological issues
Sleep deficits Mood Anxiety Hyperactivity Attention Seizures
Do not rule out autism because of:
Good eye contact, smiling and showing affection to family members
Reported pretend play or normal language milestones
Difficulties appearing to resolve after a needs-based intervention
A previous assessment that concluded there was no autism
Factors associated with increased risk of autism
Sibling with autism CNS birth defects Born before 35 weeks Maternal use of sodium valproate in pregnancy Learning disability ADHD Muscular dystrophy Chromosomal or genetic disorders Neonatal/epileptic encephalopathy
Severity levels
Level 1- requiring support, noticeable impairments in communication, difficulty switching activities
Level 2- requiring substantial support
Level 3- severe deficits in verbal and nonverbal communication, difficulty in coping with change
Epidemiology
Male to female ratio 2:1
4 per 10,000 people in UK
Early intervention and diagnosis important for long term outcome
45% of individuals with autism have intellectual disability
Causes of autism
Consistent link to advanced parental age
Highly genetic- twins
Genetic studies have not identified common genes
Possible link to maternal infection- immune response
No link to vaccination or thiomersal
Genetics of autism
Copy number variants associated with intellectual impairment
SNPs- no one causal identified but may have additive effects
Cadherins may be implicated- important in cell adhesion
Evidence for other synaptic connectivity dysfunction
Neurobiology
Neurodevelopmental disorder of pre- and post-natal development
Evidence for abnormal brain growth, impaired connectivity, disrupted cortical and subcortical development, abnormal serotonin function, less robust hypothesis of dopamine and glutamate impairments
Treatments
Need early diagnosis and defined biomarkers
Currently behavioural intervention through family and educational support
Only some specific programmes have an evidence base
Aim is to improve the functional status through skill acquisition in core areas
Dietary and CAMS
No robust evidence to support
Gluten free diets, omega 3s, hyperbaric oxygen therapy, chemical chelation, craniosacral massage
Anti-psychotic drugs
Risperidone/aripiprazole
To reduce challenging an repetitive behaviours, adverse effects include weight gain, sedation, extrapyramidal symptoms and hyperprolactinaemia
