Autism spectrum disorder Flashcards
Define autism spectrum disorder.
Refers to someone who does not meet the full criteria for diagnosing autism but is similar.
A group of disorders characterised by qualitative abnormalities in reciprocal social interactions and in patterns of communication and by a restricted, stereotyped, repetitive repertoire of interests and activities. These abnormalities are a pervasive feature of the individual’s functioning in all situations
What is included within autism spectrum disorder?
Childhood autism
Atypical autism
Rett syndrome
Other childhood disintergrative disorder
Asperger’s syndrome
Other pervasive developmental disorders
Pervasive developmental disorder, unspecified
What is childhood autism?
Defined by abnormal/impaired development that is manifest before the age of 3 and characteristic type of abnormal functioning in all three areas of psychopathology (reciprocal social interaction, communication and restricted, stereotyped, repetitive behaviour).
In addition, a range of other nonspecific problems are common e.g. phobias, sleeping/eating disturbances, temper tantrums and (self-directed) aggression.
What is atypical autism?
Differs from childhood autism either in age of onset or in failing to fulfil all three sets of diagnostic criteria.
What is Rett syndrome?
A condition, so far only found in girls, in which apparently normal early development is followed by partial/complete loss of speech and of skills in locomotion and use of hands, plus deceleration in head growth, usually with onset between 7-24 months age.
- Loss of purposive hand movements, hand-writing stereotypes and hyperventilation are characteristic.
- Social and play development are arrested but social interest tends to be maintained
- Trunk ataxia and apraxia start to develop by age 4 yrs and choreoathetoid movements frequently follow
- Severe mental retardation almost always results
What is Asperger’s syndrome?
Similar features to autism with impaired communication and reciprocal interaction but no general delay in language or cognitive development. Often associated with marked clumsiness, but most have normal IQ.
What are risk factors for autism spectrum disorder?
- A sibling with autism
- Birth defects associated with CNS malformation and/or dysfunction including cerebral palsy
- Gestational age <35 weeks
- Parental schizophrenia-like psychosis or affective disorder
- Learning disability
- ADHD
- Neonatal encephalopathy or epileptic encephalopathy, including infantile spasms
- Chromosomal disorders e.g. Down’s
- Genetic disorders e.g. fragile X, phenylketonuria
- Muscular dystrophy
- Neurofibromatosis
- Tuberous sclerosis
What is the aetiology of autism spectrum disorder?
No single cause: genetic and environmental interaction
Twin studies: MZ twin concordance rate 36-60%
Psychological theories of autism: The thought that autism is linked with cognitive dysfunction.
What is autism associated with?
Increased rates of affective disorders in family members
Increased rates of anorexia nervosa
If ASD and Fragile X > higher rates of schizoaffective disorder
ADHD in 30%
High prevalence rates of epilepsy in ASD:
20% of ASD have non-febrile seizures under age 3; 15-20% develop seizures during adolescence
What is the triad associated with autism spectrum disorder?
Communication abnormalities
Reciprocal social interaction difficulties
Restricted, repetitive and stereotypic patterns of behaviour
What are the presenting features of communication abnormalities?
Verbal aspects
- Expressive speech and comprehension delayed/minimal
- Speech may consist of monologue, interminable questions and echolalia
- Stereotyped, repetitive speech e.g. stereotypes utterances, inappropriate questions
- Lack of chit-chat
Non-verbal
- Ideas taken literally (concrete thinking)
- Gestures usually absent e.g. pointing, waving goodbye
What are the presenting features of reciprocal social interaction impairment?
- Not interested in people
- Impaired reciprocal interaction i.e. not always thinking about other person in conversation
- Tend to play alone, failure to develop peer relationships
- Miss social emotional cues e.g. picking up on facial gestures
- Lack ability to read emotional states of others
- Attachments are impoverished
- Do not tend to turn to parents for comfort
- Eye contact may be odd (avoidant or looking ‘through’ you)
- Lack ‘theory of mind’ i.e. unable to accurately predict what others may be thinking
- Tested via ‘Sally Anne test’
What are the presenting features of restricted, repetitive and stereotypic patterns of behaviour?
- Tendency to not use objects in intended functional fashion
- Lack of imaginative play
- Unusual sensory interests
- Stereotyped motor mannerisms
- Adherence to non-functional routines/rituals; small changes in routine can result in intense tantrums
What are other signs and symptoms of autism spectrum disorder?
75% have significant learning disabilities
25% suffer from seizures
Fear and phobias
ADHD, aggression, self-injury
What are psychosocial interventions for autism spectrum disorder?
Play-based strategies with parents and teachers to increase attention, engagement and reciprocal communication
