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%
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
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
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
5
Q
Secondary ASD
A
- Fragile X
- Tuberous Sclerosis
- Phenylketonuria
- Fetal Alcohol Syndrome
- Angelman Syndrome
- Rett Syndrome
- Smith-Lemli-Opitz Syndrome
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
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
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
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
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
11
Q
Treatment Goals
A
Minimize core features
Maximize functional independence
Maximize quality of life
Maximize family function
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
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
14
Q
Common Behavioral Issues
A
- Disruption/aggression 15-64%
- Self-injurious 8-38%
- Eating 25-52%
- Sleeping 36%
- Toileting 40%
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