Autism spectrum disorder Flashcards

1
Q

Define autism spectrum disorder.

A

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

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2
Q

What is included within autism spectrum disorder?

A

Childhood autism
Atypical autism
Rett syndrome
Other childhood disintergrative disorder
Asperger’s syndrome
Other pervasive developmental disorders
Pervasive developmental disorder, unspecified

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3
Q

What is childhood autism?

A

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.

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4
Q

What is atypical autism?

A

Differs from childhood autism either in age of onset or in failing to fulfil all three sets of diagnostic criteria.

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5
Q

What is Rett syndrome?

A

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
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6
Q

What is Asperger’s syndrome?

A

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.

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7
Q

What are risk factors for autism spectrum disorder?

A
  • 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
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8
Q

What is the aetiology of autism spectrum disorder?

A

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.

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9
Q

What is autism associated with?

A

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

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10
Q

What is the triad associated with autism spectrum disorder?

A

Communication abnormalities

Reciprocal social interaction difficulties

Restricted, repetitive and stereotypic patterns of behaviour

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11
Q

What are the presenting features of communication abnormalities?

A

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
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12
Q

What are the presenting features of reciprocal social interaction impairment?

A
  • 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’
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13
Q

What are the presenting features of restricted, repetitive and stereotypic patterns of behaviour?

A
  • 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
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14
Q

What are other signs and symptoms of autism spectrum disorder?

A

75% have significant learning disabilities

25% suffer from seizures

Fear and phobias

ADHD, aggression, self-injury

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15
Q

What are psychosocial interventions for autism spectrum disorder?

A

Play-based strategies with parents and teachers to increase attention, engagement and reciprocal communication

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16
Q

What is the management for challenging behaviour in autism spectrum disorder?

A

Applied behavioural analysis (ABA): A behavioural programme for treating young children (aged 2/3 years at start of intervention). Use of a reward system to lessen impact of either repetitive behaviours or overactivity
Early Start Denver Model (ESDM)
More Than Words (Hanen programme):
For children < 6 years with difficulties in social interaction and communication.

Pharmacological intervention: Second-line. Consider antipsychotic when psychosocial interventions are insufficient/severe behavioural challenges.
Start at low dose; review at 3-4 weeks. If no response at 6 weeks, stop treatment.

17
Q

What is the prognosis for autism?

A

Only 1-2% adults gain full independence, with most needing lifelong support and care.

Good prognostic indicators: IQ > 70, acquisition of some useful language.