Autism Spectrum Disorder

Question 1

DSM Diagnosis of Autism:

DSM:
• A: difficulties in social communication and social interaction. Requires all 3 of…

• o Deficits in social-emotional ___
• o Deficits in nonverbal communicative behaviours used for social ___
• o Deficits in developing, maintaining and understanding ___

• B: restricted and repetitive behaviours, interests or activities. Requires 2 of…

• o ___, repetitive pattern of behaviour, interests or activities
• o Insistence on ___, inflexible adherence to routines or __ patterns of verbal and
• nonverbal behaviour
• o Highly restricted, ___ interests that are abnormal in intensity or focus
• o Hyper- or hypo- reactivity to sensory input or unusual interest in sensory aspects of the
• environment
• C: symptoms must be present in the ___ developmental period
• D: symptoms cause clinically significant ___ in social or other areas of current functioning
• E: not better explained by __ disability or __ __ __
• Severity: levels ___(least support required) to ___ (most support required)

Answer 1

DSM Diagnosis of Autism:

DSM:
• A: difficulties in social communication and social interaction. Requires all 3 of…

• o Deficits in social-emotional reciprocity
• o Deficits in nonverbal communicative behaviours used for social interactions
• o Deficits in developing, maintaining and understanding relationships

• B: restricted and repetitive behaviours, interests or activities. Requires 2 of…

• o Stereotyped, repetitive pattern of behaviour, interests or activities
• o Insistence on sameness, inflexible adherence to routines or ritualized patterns of verbal and
• nonverbal behaviour
• o Highly restricted, fixated interests that are abnormal in intensity or focus
• o Hyper- or hypo- reactivity to sensory input or unusual interest in sensory aspects of the
• environment
• C: symptoms must be present in the early developmental period
• D: symptoms cause clinically significant impairment in social or other areas of current functioning
• E: not better explained by intellectual disability or global developmental delay
• Severity: levels I (least support required) to III (most support required)

Question 2

Early signs of autism

Answer 2

lack of response to name at 1 yo, atypical social behaviour (gaze avoidance), lack of pointing for itnerest at 1 yo, no pretend play

Question 3

red flags

Answer 3

language delay/atypical, language without intent to communciate, unusal behaviours, atypical play, resistance to change, difficulties with reciprocal interactions, peer issues.

Question 4

developmental, mental health and medical conditions comorbid with autism

Answer 4

o Developmental: intellectual disability, loss of previously acquired skills, language
deficits/delay, ADHD, Tic disorders, motor abnormalities

o Mental health: anxiety, depression, OCD, psychotic disorder, substance use disorders, ODD,
eating disorders

o Medical: epilepsy, GI problems, sleep disorders, restrictive diet/pica, dental problems

Question 5

note about differential diagnosis of autism

Question 6

risks that may lead to a later diagnosis

Answer 6

milder symptoms, higher IQ/preserved language, lower SES, cultural factors, geographic factors, female gender

Question 7

screening tool for autism

Answer 7

MCHAT– highest sensitivity at 24 months of age.

Question 8

investigations for autism

Answer 8

MCHAT, check vision and hearing

• medical investigations: may or may not be indicated but can include genetic testing, thyroid tests, tests for inborn errors of metabolism, iron studies, neuromaging and EEG

Question 9

management of autism

Answer 9

Medications can reduce co-occurring or aggravating symptoms, but do not directly improve social communication

Target specific aggravating symptoms– constipation, sleep

Target co-occurring conditions– ADHD, anxiety.

Respiradone and Aripiprazole: FDA approved medication with ASD indication (for irritability)

• need a lot of behavioural therapy to enhance communication skills, social and play skills, independence and self-care, behaviour.

Question 10

prognosis of ASD

Answer 10

outcome is better if high IQ and early language

Do worse with no intervention– goal is to initiate interventions at 2-4 years of age

Before early intervention: 50-78% of adults with ASD have poor or very poor outcomes in terms of independent living, educational attainment, employment and peer relationships.