Autism Spectrum Disorder Flashcards
DSM 5 diagnosis of ASD?
Deficits in social - emotional reciprocity
Deficits in nonverbal communicative behaviors used in social interactions
deficits in developing , maintaining, and understanding relationships appropriate to developmental level
Restricted, repetitive patterns of behaviour, interests,
or activities, as manifested by at least two of the
following:
• Stereotyped or repetitive motor movements, use of
objects, or speech.
• Insistence on sameness, inflexible adherence to
routines, or ritualized patterns of verbal or nonverbal
behaviour.
• Highly restricted, fixated interests that are abnormal in
intensity or focus
• Hyper- or hyporeactivity to sensory input or unusual
interest in sensory aspects of the environment
Screening instruments for ASD?
- Social Communication Questionnaire (SCQ)
• Social Responsiveness Scale (SRS)
Tools for diagnostic assessment?
Autism Diagnostic Interview – Revised (ADI-R)
• Semistructured parent interview that probes for
symptoms of ASD
• Autism Diagnostic Observation Schedule (ADOS)
– Interactive assessment of ASD symptoms
– Four different modules, graded according to
language and developmental level
Epidemiology of ASD ?
Prevalence: 1.85% (1/59) • Male:female ratio: 4.3:1 • 33% have Intellectual Disability • 20% develop seizures, usually in early childhood or in adolescence
Genetics of ASD
ibling recurrence rate is 5-10%
• Heritability of ASD is about 90%
• “Unaffected” relatives have increased rates of social,
language, and behavioural problems
• 5%-10% of patients have abnormalities detectable with
clinical microarray
Possible predictors of good outcome with Intensive Behavioral Intervention ?
Earlier age of initiation of therapy
– Higher level of intelligence
– Lower levels of ASD symptom severity
Target behaviors for pharmacotherapy in ASD?
Aggression
Inattention and hyperactivity
Anxiety / Repetitive Behaviour
Tx - Aggression
Haloperidol, risperidone, olanzapine, aripiprazole,
and lurasidone have been shown to be better than
placebo for aggression
Weaker evidence:
SSRI’s
– Numerous open label trials but very few placebo-
controlled RCT’s and none have shown efficacy in
reduction of aggression in children with ASD
– May be beneficial if aggression is associated with
anxiety or depression
• Stimulants
• Strattera
• Anticonvulsants
• Lithium
Co-morbid with ASD?
Common comorbid condition for ASD
– Studies suggest at least 50% of children with
ASD also meet criteria for ADHD
Tx of ADHD with ASD?
Stimulants
Atomoxetine
Antipsychotics
How can anxiety present when seen in ASD patients?
– repetitive and ritualistic behaviour
– phobias
– difficulty with unpredictability
Alternative therapies in ASD
Anti-fungal agents
• Homeopathic / naturopathic remedies
• Chelation
• Dietary interventions
Environmental Risk factors for autism?
Advanced paternal age
Maternal anticonvulsants - esp teretol
LBW, hypoxia, IVF
What does not improve over time in ASD?
No improvement in ritualistic, repetitive behaviors.
Predictors of good outcomes?
language skills and IQ>70
Early red flags in ASD?
Impaired joint attention
Speech delay cut off: spontaneous 2 word phrases with a verb by 24 months
Medical evaluation in ASD?
Chromosomal microarray analysis molecular DNA testing for fragile X Genetic (PTEN, Rett, Karyotype) Metabolic testing EEG MRI
ASD Assessment Tools
Screening: M-CHAT Social communications questionnaire ABC -Autism Behavior checklist Diagnostic Tools: ADOS-G - Autism Diagnostic Observation-Generic
Common medical issues in ASD?
Seizures (25-30%)
GI complaints - constipation/encoporesis
GERD
Co-morbidy in ASD?
ID (25-30%)
ADHD
Motor d/o - developmental coordination disorder
What treatment has evidence for repetitive behaviors in children?
Risperidone*
