Autism Spectrum Disorder

Question 1

What conditions does autism spectrum disorder encompass?

Answer 1

Asperger’s syndrome, Rett’s syndrome, childhood autism, pervasive developmental disorder, pervasive developmental disorder NQS

Question 2

What is the triad of impairments in autism?

Answer 2

Social communication, social interaction and imagination, repetitive behaviours

Question 3

What are some features of social communication in people with autism?

Answer 3

Generally good language skills but find it hard to grasp underlying meaning of conversation
Difficulties understanding jokes, idiom and sarcasm
Voices often sound monotonous
Language can be pedantic and idiosyncratic
Narrow interests which dominate their conversations
Difficulty showing thoughts and feelings

Question 4

What are some features of social interaction in people with autism?

Answer 4

Difficulties picking up non-verbal cues
Appear self-focused and lacking in empathy
Continually struggle to make and sustain relationships

Question 5

What are some features of social imagination in autistic patients?

Answer 5

Difficulties thinking flexibly and in abstract ways
Inability to understand other points of view
Difficulties applying knowledge and skills across settings with different people
Difficulties projecting themselves into future or planning goals sensibly

Question 6

What are some examples of ritualistic behaviours?

Answer 6

Stereotyped or repetitive movements or speech
Insistence on sameness, inflexible adherence to routine or ritualistic behaviour
Hyper/hyporeactivity

Question 7

How common is autism?

Answer 7

Occurs in about 1-2% = 5 times more common in boys

Question 8

What are SHBG levels like in girls with Asperger’s syndrome?

Answer 8

Reduced levels = points to higher levels of free testosterone

Question 9

What is the link between autism and gender identity?

Answer 9

8-10% of children seen at GID clinics meet criteria for autism
Between 2011-13, >50% of young people referred to London NHS GID clinic had autistic traits

Question 10

What is the link between congenital adrenal hyperplasia and autism?

Answer 10

Girls with CAH showed more traits of autism spectrum disorder and higher levels of gender dysphoria

Question 11

What are some conditions that autism is linked to?

Answer 11

Maternal rubella, tuberous sclerosis, fragile X syndrome, encephalitis, untreated phenylketonuria

Question 12

What is the heritability of autism?

Answer 12

35-90% heritability
30% of siblings will have broader autism phenotype
Around 5% of siblings meet diagnostic criteria

Question 13

What chromosomal abnormalities are linked with autism?

Answer 13

Deletions, duplications and inversions

Question 14

When do all known teratogens act on the foetus?

Answer 14

During the first 8 weeks from conception

Question 15

What are some perinatal factors that are linked to autism development?

Answer 15

Umbilical cord complications, foetal distress, birth injury/trauma, multiple births, maternal haemorrhage, low birth weight, congenital malformations, meconium aspiration, neonatal anaemia

Question 16

What parts of the brain are pathological in autism?

Answer 16

Frontal lobes, amygdala and cerebellum

Question 17

How does the amygdala appear in autistic boys?

Answer 17

Appears 13-16% larger = associated with more severe anxiety and worse social/communication skills

Question 18

What neurotrasmitters are implicated in autism?

Answer 18

Glutamate receptors, GABA and serotonin

Question 19

What are some speech and language difficulties seen in children with autism?

Answer 19

Don’t babble or use other vocal sounds
Can repeat words/phrases spoken by others without formulating their own language
Older children have problems using non-verbal behaviours to interact with others

Question 20

How do children with autism interact with others?

Answer 20

Lack awareness of and interest in other children
Struggle to initiate/sustain friendships
Often gravitate to older/younger children

Question 21

How do autistic children tend to play?

Answer 21

Tend to play alone

Some don’t demonstrate imaginative play while others will continually repeat the same pretend play

Question 22

How do autistic children use routines?

Answer 22

Prefer to stick to same routine and little changes may trigger tantrums
Some may engage in repetitive play

Question 23

How do some autistic children display their emotions?

Answer 23

Some may flap their hand or twist/flick their fingers when excited or upset

Question 24

Why do autistic children tend to have restricted diets?

Answer 24

Certain textures cause discomfort

Some flavours and foods too strong because of sensitive taste buds

Question 25

What can finding smells intense and overpowering make difficult for autistic children?

Answer 25

Toileting

Question 26

What difficulties can autistic children have with noise?

Answer 26

May be magnified | Sounds become distorted and muddled

Question 27

How can autistic children react to touch?

Answer 27

May be painful and uncomfortable Dislike having anything on hands/feet Only tolerate certain textures Difficulties washing or brushing hair

Question 28

What are some sensory processing difficulties present in autistic children?

Answer 28

Poor depth perception, clumsiness, easier to focus on detail rather than whole object, difficulty getting to sleep due to light sensitivity

Question 29

What are some communication difficulties seen in adults with autism?

Answer 29

Difficulties seeing other perspectives , picking up on cues and making eye contact Show compassion but may be confused by social signals Often repeat same phrase/expression over and over Problems starting and continuing conversation

Question 30

What are some social difficulties experience by adults with autism?

Answer 30

Appear shy or avoid initiating social contact Difficulty fitting in with other people Very few friendships and have difficulty keeping them May appear rude or unaware of bluntness Trouble processing certain thoughts and expressing needs to others Take things very literally

Question 31

What are some other features of autism in adults?

Answer 31

Many rituals, obsessive interests, unusual body movements, clumsiness, lack of co-ordination, sensory issues

Question 32

What are some diagnostic tools used for autism?

Answer 32

Developmental history and collateral history Screening questionnaire and semi-structured interviews Autism Diagnostic Observation Schedule

Question 33

What is the essential criteria for autism?

Answer 33

Symptoms must be present in early developmental period Symptoms cause clinically significant impairment in social, occupational and other areas Disturbances not better explained by other condition

Question 34

What are some common comorbidities of autism?

Answer 34

Depression and anxiety = 40-60% Eating disorders = 20% Learning disability = 70% have non-verbal IQ <70, 35% have non-verbal IQ <50

Question 35

What are some comorbid neurodevelopmental disorders seen in autism?

Answer 35

Tourette's syndrome = 7% Dyslexia = 70% Language impairment = 76%

Question 36

What are some less common comorbid conditions seen with autism?

Answer 36

Fragile x syndrome, tuberous sclerosis, epilepsy, hearing and visual impairments

Question 37

What is the aim of non-pharmacological treatment?

Answer 37

To loosen associated deficits and family distress | To increase quality of life and functional independence

Question 38

What are some non-pharmacological treatment options for autism?

Answer 38

Self and family psychoeducation is helpful Applied behaviour analysis, speech and language therapy and social skills training Diet = focus on role of additives, refined sugar and allergies

Question 39

Is there a medication available that treats the core symptoms of autism?

Answer 39

No

Question 40

What is risperidone licensed for treating in autism?

Answer 40

Management of severe aggression and significant self injury

Question 41

What are some treatments for autism comorbidities?

Answer 41

Antiepileptics for seizures Stimulants or non-stimulants for ADHD Antipsychotics for Tourette's syndrome Melatonin for chronic insomnia

Question 42

What can be used to treat severe autism with learning difficulties?

Answer 42

Mood stabilisers

Question 43

What can SSRIs or SNRIs be used to treat in autism?

Answer 43

Decrease social anxiety, OCD and to treat mood