Autism Spectrum Disorder

Question 1

DSM 5 diagnosis of ASD?

Answer 1

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

Question 2

Screening instruments for ASD?

Answer 2

• Social Communication Questionnaire (SCQ)

• Social Responsiveness Scale (SRS)

Question 3

Tools for diagnostic assessment?

Answer 3

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

Question 4

Epidemiology of ASD ?

Answer 4

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

Question 5

Genetics of ASD

Answer 5

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

Question 6

Possible predictors of good outcome with Intensive Behavioral Intervention ?

Answer 6

Earlier age of initiation of therapy
– Higher level of intelligence
– Lower levels of ASD symptom severity

Question 7

Target behaviors for pharmacotherapy in ASD?

Answer 7

Aggression
Inattention and hyperactivity
Anxiety / Repetitive Behaviour

Question 8

Tx - Aggression

Answer 8

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

Question 9

Co-morbid with ASD?

Answer 9

Common comorbid condition for ASD
– Studies suggest at least 50% of children with
ASD also meet criteria for ADHD

Question 10

Tx of ADHD with ASD?

Answer 10

Stimulants
Atomoxetine
Antipsychotics

Question 11

How can anxiety present when seen in ASD patients?

Answer 11

– repetitive and ritualistic behaviour
– phobias
– difficulty with unpredictability

Question 12

Alternative therapies in ASD

Answer 12

Anti-fungal agents
• Homeopathic / naturopathic remedies
• Chelation
• Dietary interventions

Question 13

Environmental Risk factors for autism?

Answer 13

Advanced paternal age
Maternal anticonvulsants - esp teretol
LBW, hypoxia, IVF

Question 14

What does not improve over time in ASD?

Answer 14

No improvement in ritualistic, repetitive behaviors.

Question 15

Predictors of good outcomes?

Answer 15

language skills and IQ>70

Question 16

Early red flags in ASD?

Answer 16

Impaired joint attention

Speech delay cut off: spontaneous 2 word phrases with a verb by 24 months

Question 17

Medical evaluation in ASD?

Answer 17

Chromosomal microarray analysis
molecular DNA testing for fragile X
Genetic (PTEN, Rett, Karyotype)
Metabolic testing
EEG
MRI

Question 18

ASD Assessment Tools

Answer 18

Screening:
M-CHAT
Social communications questionnaire
ABC -Autism Behavior checklist
Diagnostic Tools:
ADOS-G - Autism Diagnostic Observation-Generic

Question 19

Common medical issues in ASD?

Answer 19

Seizures (25-30%)
GI complaints - constipation/encoporesis
GERD

Question 20

Co-morbidy in ASD?

Answer 20

ID (25-30%)
ADHD
Motor d/o - developmental coordination disorder

Question 21

What treatment has evidence for repetitive behaviors in children?

Answer 21

Risperidone*