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 is Rett syndrome
X-linked disorder; MECP2 gene
Girls > boys)
<0.2 per 1,000
S/S: develop normally to ~2yo - sudden deterioration + less social interaction + struggle to feed, etc.
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
What are the symptoms of autism spectrum disorder in pre-school aged children
Language: delayed language development, regression/loss, echolalia, reference to self by name or others by you, stereotypical phrases
Response: reduced, absent, or delayed response to their name being called, reduced social smiling and facial expressions, rejection of cuddles initiated by others
Interaction: lack of awareness of personal space, specific social interests, imitation, preference to play alone, does not share enjoyment
Behaviour and gestures: atypical eye contact (too much or too little), poor attention, no pointing to share an interest
Play: reduced or absent imaginative play
Unusual or restricted interests/rigid repetitive behaviours: stereotypical movements (hand flapping, body rocking, finger flicking), repetitive play, overly-focused unusual interests
What are the symptoms of autism spectrum disorder in primary school aged children
Language: limited use of speech, monotonous tone, repetitive speech, stereotypical speech, responses that seem rude or inappropriate, talking ‘at’ rather than ‘with’
Response: reduced, absent, or delayed response to their name being called, reduced social smiling and facial expressions, rejection of cuddles initiated by others
Interaction: lack of awareness of personal space, specific social interests, imitation, preference to play alone, does not share enjoyment
Behaviour and gestures: atypical eye contact (too much or too little), poor attention, no pointing to share an interest
Play: reduced or absent imaginative play
Unusual or restricted interests/rigid repetitive behaviours: stereotypical movements (hand flapping, body rocking, finger flicking), repetitive play, overly-focused unusual interests
Over or under reaction to sensory stimuli, for example, sounds, smells, taste, and textures.
What are the symptoms of autism spectrum disorder in secondary school aged children
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
Over or under reaction to sensory stimuli, for example, sounds, smells, taste, and textures.
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 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 is the management for autism spectrum disorder
- 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)
