Autism Spectrum Disorder Flashcards
Define Autism Spectrum Disorder
Neurodevelopmental condition that is characterised by:
1. Persistent impairments in social communication and interaction
2. Restricted, repetitive, and stereotyped patterns of behaviours, interests, or activities
What are the risk factors for autism spectrum disorder
Male
Siblings with ASD (50x risk)
Neurodevelopmental conditions: Cerebral palsy, Learning difficulties, ADHD
Pregnancy/birth: Prematurity (<35w), maternal valproate use, neonatal encephalopathy
Chromosomal disorders: Down’s syndrome, Fragile X syndrome
Muscular dystrophies
Neurofibromatosis
Tuberous sclerosis
DiGeorge syndrome
What is Atypical ASD
Abnormal or impaired development present > 3 years
Lack of sufficient demonstratable abnormalities in 1-2 of the areas of psychopathology required for diagnosis
What is Asperger’s syndrome
ASD features with no delay in language/cognitive development
Develops >5yo
Associated with a high verbal IQ, intense sophisticated interests
Associated with adult psychosis
What are the psychological theories of autism spectrum disorder
Executive dysfunction: poor flexibility of behaviours
Theory of mind: difficulty to conceive of others as having thoughts or feelings that are different
Epidemiology for ASD
One of the most common childhood neurodevelopmental disorders
Estimated prevalence 1%
At least one associated mental health or behavioural disorder occurs in 70% of children and young people with ASD
Heritability 90%, Monozygotic:dyzgotic = 60:5
Affects boys 3-4x more than girls
What are the symptoms of autism spectrum disorder
Language: limited use of speech, monotonous tone, repetitive speech, stereotypical speech, responses that seem rude or inappropriate, talking ‘at’ rather than ‘with’
Interaction: lack of awareness of personal space, specific social interests, imitation, preference to play alone, does not share enjoyment, long-standing difficulties in communicating and interacting, reduced/absent understanding of friendship, lack of awareness or interest in usual interest, limited ability for adaptive communication, difficulty in understanding jokes, sarcasm, metaphors
Behaviour and gestures: atypical eye contact (too much or too little), poor attention
Unusual or restricted interests/rigid repetitive behaviours: stereotypical movements (hand flapping, body rocking, finger flicking), repetitive play, overly-focused unusual interests, adherence to routines/ritiuals
Over or under reaction to sensory stimuli, for example, sounds, smells, taste, and textures.
What functional problems may autism spectrum disorder cause
Sleep problems
Eating problems
GI disturbance: diarrhoea, abdo pain, constipation
Sensory issues
General learning and attention difficulties
Seizures
Affective disorders e.g. anxiety
Behaviours that challenge
What are the differentials for autism spectrum disorder
Neurodevelopmental: Specific language delay or disorder, learning/intellectual disability, global development delay
Mental health: ADHD, mood disorder, anxiety, OCD, attachment disorder, oppositional defiant disorder
What investigations should be done for autism spectrum disorder
Cognitive assessment e.g. WISC, WPPSI
Autism diagnosis and assessment
- AQ-10 (Autism-Spectrum Quotient)
- ADI-R (Autism Diagnostic inventory - revised)
- ADOS (Autism Diagnostic Observatory Schedule)
Hearing and SALT assessment
What is the management for autism spectrum disorder in children
- Refer to autism team/paediatrician/paediatric neurologist (regression of language or social milestones or persistent impairments to ADLs)
→ MDT-led care
First line: psychosocial intervention
+ Applied behaviour analysis (ABA) from behaviour nurses
+ adjust the social and physical environment for the child (lighting, noise levels, visual support, personal space)
+ family and carer support (future plans, insurance, transition to adult services, extra education, social support)
+ identify a key worker/case manager
+ Education care plan (EHC)
What psychosocial interventions can be used for autism spectrum disorder
- Increase the parents’ understanding of and sensitivity and responsiveness to the child’s pattern of communication and interaction
- Techniques of therapist modelling and video-interaction feedback
- Techniques to expand the child’s communication, interactive play and social routines
Psychosocial play-based interactions
Increase attention, engagement (play specialists) and reciprocal communciation (SALT)
Increased carers’ and teachers’ understanding of patient’s communication/interaction pattern
E.g. EarlyBird (<5yo) or EarlyBird Plus (4-8yo)
What is the management for behaviour that challenges in autism spectrum disorder
First line: Psychosocial assessment
- Reduce impairment in communication (consider visual aids)
- Address Co-existing physical disorders (i.e. otitis media) and mental health problems (i.e. GAD, ADHD)
- Physical environment (i.e. lighting, noise)
- Reduce unintentional reinforcement of behaviour that reinforces
Second line: Pharmacological intervention:
- Antipsychotics → review in 3-4 weeks → stop at 6 weeks if there is no clinical indication
What pharmacological interventions can be used for the following in ASD: sleep difficulties, attention difficulties, and obsessional behaviours
- Melatonin for sleep difficulties
- Methylphenidate for attention difficulties
- SSRIs for obsessional behaviours
What is the management for autism spectrum disorder in adults
Psychosocial Interventions
- Social learning programmes (Group or individual structured leisure activity programme, Focus on interests and abilities, facilitator helps integrate participants)
- Anger management interventions (Analysis of anger and anger-provoked situations, Coping-skills training and behaviour rehearsal, Relaxation training, Development of problem-solving skills)
- Individual supported employment programmes
- Focused on life skills
