Autism Spectrum Disorder

Question 1

ESSENCE

Answer 1

Group of lifelong developmental disorders characterised by effect on social and communication skills, as well as by restricted/repetative interests

Question 2

CLINICAL FEATURES

Answer 2

• Difficulties with social relationships
• Problems in communication
• Absorbing and narrow interests

Question 3

How does difficulty with social relationships manifest

Answer 3

• Few or no sustained relationships
• Persistent aloofness or awkward interaction with peers
• Unusually egocentric with little concern for others
• Lack of awareness of social rules

Question 4

How does problems with communication manifest

Answer 4

• Odd voice, monotonous and maybe unusual volume
• Language superficially good but too formal, stilted or pedantic, difficulty catching non-literal meanings
• Impassive appearance with few gestures and abnormal gaze
• Awkward or odd posture and body language

Question 5

How does absorbing and narrow interests manifest

Answer 5

• Obsessively pursued interests
• Set approach to everyday life that may include unusual routines or rituals, change is often upsetting

Question 6

INVESTIGATIONS

1st to order

Answer 6

• ASD screening tests
• Childhood autism rating scale (CARS)
• Modified checklist for autism in toddlers (M-CHAT)
• Childhood autism screening test (CAST)

Question 7

INVESTIGATIONS

To consider

Answer 7

• Diagnostic questionaire
• Skin examination with wood light (tuberous sclerosis)
• Genetic testing
• EEG (only if indicated by history)
• Audiology (hearing loss)
• MRI brain

Question 8

MANAGEMENT

First line if aged 12 months to 5 years

Answer 8

• 1st - Behaviour and parent medicated intervention for core features of ASD
  
  • Plus inpute from early education service
  • Plus family support and education
  • Adjunct MDT therapies such as speech, occupational and physiotherap
  • Adjunct behaviour interventions for challenging behaviour
  • Adjunct management of ADHD
  • Adjunct management of eating and drinking difficulties
  • Adjunct management of sleep disturbance

Question 9

MANAGEMENT

First line for children aged 5 to 18

Answer 9

• 1st - behaviour and parent medicated interventions for core symptoms of ASD
  
  • Plus input from educational services
  • Plus family support and education
  • Adjunct management of co-morbidities

Question 10

MANAGEMENT

First line for adults

Answer 10

• 1st - non-pharmacological treatment for core symptoms (employment support, social skills programmes, social learning programmes, behaviour and life skill interventions
  
  • Plus family support and education
  • Adjunct management co-morbidities