Autism (Novotny) - 10/18/16

Question 1

Three core components of Autism Spectrum Disorder

Answer 1

• Communication Impairment
  
  • Verbal and nonverbal
    
    • Delays in language acquisition
    • Repeitive vocalizations
• Social Deficits
  
  • Difficulty picking up on cues
• Repetitive Behaviors and Restricted Interests
  
  • Not just OCD
    
    • Rigidity (set to schedule)
    • Intense, unusual interests
    • Preoccupation with parts (i.e. knows every thing about a subway system, every part)

Question 2

Narrow or Classical Autism

vs

Broad Spectrum Autism

Answer 2

Narrow or Classical Autism (low functioning ASD)

• Relatively rare
• Increased cognitive impairment

Broad Autism Spectrum

• More common
• More likely to have average/superior intelligence
• Includes higher functioning subtypes

Question 3

Associated features

Answer 3

• Difficulty regulating emotion
  
  • Intense reactions to even mild situations
  • Includes anxiety, frustration, anxiety
• Sensory integration difficulty
  
  • Over or under react to environmental stimuli (light flicker, sounds)
    
    • Carly’s Cafe
  • Can make physical exam difficult
• Cognitive disabilities
  
  • Can have any IQ
  • May have significant mismatch b/w strengths and weaknesses
    
    • Can be math genius but poor reading comprehension
• Neurological/physical difficulties
  
  • Difficulties w/ gross or fine motor skills
  • Seizure disorders

Question 4

Neurobiology of Autism

• Anatomy
• Functional Anatomy

Answer 4

• Anatomy
  
  • Large head size as toddlers
    
    • B/c of poor pruning of neurons; Increased gray to white matter
  • Abnormalities in cerebellum
  • Micro abnormalities
    
    • Brain isn’t well connected
• Functional Anatomy
  
  • Abnormal circuitry
  • Abnormal resting state
  • Poor global connectivity
  • Better local connectivity

Question 5

Biochemical abnormalities

Answer 5

• Serotonin (abnormal)
• Oxytocin (decreased)
• GABA
• Acetylcholine
• Glutamate (abnormal)
• Omega 3 fatty acids

Question 6

Rating Scales

Answer 6

• M-CHAT
  
  • Modified Checklist for Autism in Toddlers
  • Sensitive to abnormalities in toddlerhood but not specific to autism
  • CARS I (higher functioning individuals) and CARS II
    
    • Childhood Autism Rating Scale
    • Specific for picking up autism
• GARS
  
  • Gilbert Autism Rating Scale
  • 3 hours testing - difficult time length
• ADI
  
  • Autism Diagnostic Interview
  • More with parents
• ADOS** (preferred)
  
  • Autism Diagnostic Observation Scale
  • Looking at child and scoring child’s behavior

Question 7

Etiology

Answer 7

• Genetic
• 90% monozygotic twins concordant for traits
• 60% monozygotic concordant for autism

Question 8

Environmental Factors interacting with genes

Answer 8

• Toxins (insecticides)
• Parental age at birth

Question 9

Treatment

• Behavioral
• Educational
• Therapies
• Alternative Therapies
• Medication

Answer 9

• Behavioral
  
  • Early intervention!
    
    • The earlier, the better!​
  • Applied Behavioral Analysis
    
    • The more intensive the better!__​
    • Practice skills - like going to the supermarket
  • _​_Floortime
    
    • Connecting with your child wherever your child is…. so if they are at the level of playing peek-a-boo, then play peek-a-boo

Question 10

Treatment

• Behavioral
• Educational
• Therapies
• Alternative Therapies
• Medication

Answer 10

• TEACCH (1:1)
  
  • Focus on communication
• Rapid Prompting
  
  • Labor intensive
  • Ask child to answer rapidly, intensely
    ​
• Facilitated Communication
  
  • Hold child while typing on keyboard

Question 11

Treatment

• Behavioral
• Educational
• Therapies
• Alternative Therapies
• Medication

Answer 11

Supplements

• Vitamins
• Diet therapy (gluten casein free)
• Secretin
• Chelation

Question 12

Treatment

• Behavioral
• Educational
• Therapies
• Alternative Therapies
• Medication

Answer 12

• Symptom driven
• Atypical Antipsychotics
• Stimulants
• SSRIs
• Anticonvulsants