Autism Spectrum Disorder Flashcards
What conditions does autism spectrum disorder encompass?
Asperger’s syndrome, Rett’s syndrome, childhood autism, pervasive developmental disorder, pervasive developmental disorder NQS
What is the triad of impairments in autism?
Social communication, social interaction and imagination, repetitive behaviours
What are some features of social communication in people with autism?
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
What are some features of social interaction in people with autism?
Difficulties picking up non-verbal cues
Appear self-focused and lacking in empathy
Continually struggle to make and sustain relationships
What are some features of social imagination in autistic patients?
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
What are some examples of ritualistic behaviours?
Stereotyped or repetitive movements or speech
Insistence on sameness, inflexible adherence to routine or ritualistic behaviour
Hyper/hyporeactivity
How common is autism?
Occurs in about 1-2% = 5 times more common in boys
What are SHBG levels like in girls with Asperger’s syndrome?
Reduced levels = points to higher levels of free testosterone
What is the link between autism and gender identity?
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
What is the link between congenital adrenal hyperplasia and autism?
Girls with CAH showed more traits of autism spectrum disorder and higher levels of gender dysphoria
What are some conditions that autism is linked to?
Maternal rubella, tuberous sclerosis, fragile X syndrome, encephalitis, untreated phenylketonuria
What is the heritability of autism?
35-90% heritability
30% of siblings will have broader autism phenotype
Around 5% of siblings meet diagnostic criteria
What chromosomal abnormalities are linked with autism?
Deletions, duplications and inversions
When do all known teratogens act on the foetus?
During the first 8 weeks from conception
What are some perinatal factors that are linked to autism development?
Umbilical cord complications, foetal distress, birth injury/trauma, multiple births, maternal haemorrhage, low birth weight, congenital malformations, meconium aspiration, neonatal anaemia
What parts of the brain are pathological in autism?
Frontal lobes, amygdala and cerebellum
How does the amygdala appear in autistic boys?
Appears 13-16% larger = associated with more severe anxiety and worse social/communication skills
What neurotrasmitters are implicated in autism?
Glutamate receptors, GABA and serotonin
What are some speech and language difficulties seen in children with autism?
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
How do children with autism interact with others?
Lack awareness of and interest in other children
Struggle to initiate/sustain friendships
Often gravitate to older/younger children
How do autistic children tend to play?
Tend to play alone
Some don’t demonstrate imaginative play while others will continually repeat the same pretend play
How do autistic children use routines?
Prefer to stick to same routine and little changes may trigger tantrums
Some may engage in repetitive play
How do some autistic children display their emotions?
Some may flap their hand or twist/flick their fingers when excited or upset
Why do autistic children tend to have restricted diets?
Certain textures cause discomfort
Some flavours and foods too strong because of sensitive taste buds
What can finding smells intense and overpowering make difficult for autistic children?
Toileting
What difficulties can autistic children have with noise?
May be magnified
Sounds become distorted and muddled
How can autistic children react to touch?
May be painful and uncomfortable
Dislike having anything on hands/feet
Only tolerate certain textures
Difficulties washing or brushing hair
What are some sensory processing difficulties present in autistic children?
Poor depth perception, clumsiness, easier to focus on detail rather than whole object, difficulty getting to sleep due to light sensitivity
What are some communication difficulties seen in adults with autism?
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
What are some social difficulties experience by adults with autism?
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
What are some other features of autism in adults?
Many rituals, obsessive interests, unusual body movements, clumsiness, lack of co-ordination, sensory issues
What are some diagnostic tools used for autism?
Developmental history and collateral history
Screening questionnaire and semi-structured interviews
Autism Diagnostic Observation Schedule
What is the essential criteria for autism?
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
What are some common comorbidities of autism?
Depression and anxiety = 40-60%
Eating disorders = 20%
Learning disability = 70% have non-verbal IQ <70, 35% have non-verbal IQ <50
What are some comorbid neurodevelopmental disorders seen in autism?
Tourette’s syndrome = 7%
Dyslexia = 70%
Language impairment = 76%
What are some less common comorbid conditions seen with autism?
Fragile x syndrome, tuberous sclerosis, epilepsy, hearing and visual impairments
What is the aim of non-pharmacological treatment?
To loosen associated deficits and family distress
To increase quality of life and functional independence
What are some non-pharmacological treatment options for autism?
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
Is there a medication available that treats the core symptoms of autism?
No
What is risperidone licensed for treating in autism?
Management of severe aggression and significant self injury
What are some treatments for autism comorbidities?
Antiepileptics for seizures
Stimulants or non-stimulants for ADHD
Antipsychotics for Tourette’s syndrome
Melatonin for chronic insomnia
What can be used to treat severe autism with learning difficulties?
Mood stabilisers
What can SSRIs or SNRIs be used to treat in autism?
Decrease social anxiety, OCD and to treat mood
