Autism - MH Flashcards

1
Q

Autism Spectrum Epidemiology

A
  • Current prevalence: 6 per 1000 or 1 in 166
  • Male : Female Ratio: 2:1 to 6.5:1, even higher in high-functioning ASD and Aspergers
  • If an older sibling has ASD, the recurrence risk is 5-6%
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2
Q

ASD Key Features

A
  • Qualitative impairment in reciprocal social interaction
  • Qualitative impairment in communication
  • Restricted, repetitive, and stereotyped patterns of behavior, interests, and other activities
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3
Q

ASD Etiology

A
  • Mainly genetic in origin, and genetic mechanisms are complex
  • Environmental factors may modulate phenotypic expression. Probably during fetal brain development.
  • Implicated genetic sites on chromosomes 2, 3, 6, 7, 13, 15, 16, 17, 22
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4
Q

ASD Subtypes

A

Idiopathic: meet criteria for ASD with no comorbid medical condition known to cause autism

  • Most ASD
  • Less likely to have GDD/MR or dysmorphic features

Secondary: have an identifiable syndrome or medical disorder known to be associated with autism
-Less than 10% of ASD

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5
Q

Secondary ASD

A
  • Fragile X
  • Tuberous Sclerosis
  • Phenylketonuria
  • Fetal Alcohol Syndrome
  • Angelman Syndrome
  • Rett Syndrome
  • Smith-Lemli-Opitz Syndrome
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6
Q

Myths about ASD

A

The child with autism…

  • Is not affectionate
  • Does not form attachments
  • Never makes eye contact
  • Does not communicate
  • Engages in self-stimulatory and repetitive behaviors all the time
  • All children with repetitive behaviors have autism
  • All children with poor social skills have Asperger syndrome
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7
Q

Role of Primary Care

A
  • ASD is presumably present at birth, with onset of symptoms before 36 months
  • Accurate diagnosis possible at 18-24 months, maybe earlier (Early Sibs studies)
  • Parents first voice concerns around 18 months, but diagnosis is typically not until 3 years or older
  • Huge potential benefits of early treatment
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8
Q

Surveillance

A

Surveillance factors

  • Sibling with ASD
  • Parent concern, inconsistent hearing, unusual responsiveness
  • Other caregiver concern
  • Pediatrician concern
  • If 2 or more, refer for EI, ASD Evaluation, and Audiology simultaneously
  • If 1 and child at least 18 mos old, use screening tool
  • When screen is positive, refer for EI, ASD Evaluation, and Audiology
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9
Q

Screening Tools

A
  • Modified Checklist for Autism in Toddlers (M-CHAT)
  • For 16-48 months
  • Sensitivity: 85% -Specificity: 93%
  • Questionnaire completed by parent
  • 5-10 minutes to complete (parent)
  • Simple Scoring
  • Download form and scoring
  • MCHAT Follow-up Interview: clarifying questions that can be used to increase positive predictive value of a positive screen
  • Translations of MCHAT in 14 languages
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10
Q

Diagnostic Tools

A
  • CARS (Childhood Autism Rating Scale): For > 2 yrs. old; 15-item, direct observation; 5-10 minutes
  • ADOS (Autism Diagnostic Observation Schedule): For toddlers to adults; direct observation, 30-45 minutes
  • ADI-R (Autism Diagnostic Interview): For mental age > 2 yrs.; structured interview; 1.5 – 2.5 hours
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11
Q

Treatment Goals

A

Minimize core features

Maximize functional independence

Maximize quality of life

Maximize family function

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12
Q

Comprehensive Treatment

A
  • Intervention as soon as diagnosis suspected; do not wait for definitive diagnosis
  • 25 hours per week, 12 months per year in “systematically planned, developmentally appropriate educational activities”
  • Low student:teacher ratio
  • Inclusive experience with typically developing peers
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13
Q

Educational Interventions

A
  • Applied Behavioral Analysis
  • Structured teaching – TEACCH
  • Developmental
  • Relationship focused
  • Speech and Language Therapy, including use of augmentative and alternative communication
  • Social Skills Instruction – joint attention
  • OT (Sensory Integration) Therapy – evidence base not yet established
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14
Q

Common Behavioral Issues

A
  • Disruption/aggression 15-64%
  • Self-injurious 8-38%
  • Eating 25-52%
  • Sleeping 36%
  • Toileting 40%
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15
Q

Behavioral Treatment

A

Positive Behavioral Support

  • Proactive arrangement of the physical environment to prevent occurrence of problem behavior
  • Routine curriculum incorporates social skill development
  • Functional behavioral analysis used for individualized behavior management plans
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16
Q

Medical Management

A
  • Challenges in routine health care due to difficulties with social interaction, communication, and negotiating a new and unfamiliar environment
  • Average visit requires twice as much time as for a child without an ASD
  • Strategies in the office to promote familiarity
17
Q

Associated Medical Conditions

A
  • Gastrointestinal: chronic constipation/diarrhea, recurrent abdominal pain. Studies inconsistent, with rates of 9% to 70%
  • Seizures: 11 – 39%. More likely with co-morbid severe global delays and motor deficits.
  • Sleep problems
18
Q

Psychopharmacology

A
  • Goal is to minimize core symptoms and associated behaviors, and facilitate interventions.
  • Be sure environmental and behavioral strategies are in place
  • Pharmacotherapy is not the primary treatment
19
Q

Complementary & Alternative Medicine

A
  • 52 – 92 % of parents of children with autism report using CAM for their children
  • NIH budget for CAM research - $120M
  • PCP needs to: be knowledgeable, provide balanced information, maintain communication, help families know how to evaluate information, evaluate CAM studies by clinical research standards