Autism spectrum disorder (ASD)

Question 1

What is a neurodevelopment disorder?

Answer 1

An impairment in the growth and development of the brain and/or CNS

Question 2

What is ASD?

Answer 2

Autistic spectrum disorder (ASD) is characterised by persistent deficits in the ability to initiate and to sustain reciprocal social interaction and social communication, and by a range of restricted, repetitive and inflexible patterns of behaviour, interests or activities that are clearly atypical or excessive for the individual’s age and sociocultural context

Question 3

What are some comorbidities that are common in ASD?

Answer 3

depression, anxiety, EDs, Tourettes, OCD, ADHD, learning disabilities

Question 4

Describe the aetiology of ASD

Answer 4

More common in males (4:1)
Suggested link to sex hormones
Possibly due to misdiagnosis of girls

Question 5

What are some conditions that can increase risk of ASD during pregnancy?

Answer 5

Rubella
Vitamin D deficiency (Neonate)
Valproate use
Tuberous sclerosis
Fragile X syndrome
Encephalitis
Untreated PKU (Neonate)

Question 6

What processes are controlled by genes which seem to be implicated in ASD?

Answer 6

• Protein synthesis in neuronal cells
• Activity and adhesion of neuronal cells
• Synapse formation and remodeling
• Excitatory to inhibitory neurotransmitter balance

Question 7

What are some main regions of the brain that seem to be pathological in ASD

Answer 7

Frontal lobes
Amygdala
Cerebellum

Question 8

What are some specific brain systems that seem to be pathological in ASD?

Answer 8

Fusiform face area on the inferior temporal cortex (Facial recognition)

Limbic system (Emotional and memory processing)

Question 9

What are some functional changes that occur in the brain in ASD?

Answer 9

Reduced connectivity between specialised regions of the brain, but increased global connectivity of the brain

Question 10

What is global connectivity of the brain involved in?

Answer 10

Integrating and processing complex sensory and cognitive inputs and comparing them their the brain’s model of the world

Question 11

What is regional connectivity of the brain involved in?

Answer 11

Detail processing and for adjusting the view of the world to more closely fit the incoming data

Question 12

What are some neurochemicals that seem to be involved in ASD?

Answer 12

Glutamate
GABA
Serotonin

Question 13

How does GABA relate to ASD neurochemistry

Answer 13

GABA has a key role in regulation of early developmental stages of cell migration, neuronal differentiation and stages of maturation

Question 14

How does glutamate relate to ASD neurochemistry

Answer 14

Glutamate is an essential exctitatory neurotransmitter which dysregulation can lead to neuronal damage

Question 15

How does serotonin relate to ASD neurochemistry

Answer 15

Serotonin neurotransmitter system has a critical role in the regulation of crucial steps of neuronal development

Question 16

What are some forms of presentation in ASD?

Answer 16

Social communication
Social interaction
Social imagination
Repetitive impairment

Question 17

What are some symptoms of ASD relating to social communication

Answer 17

• Generally good language skills but find it hard to grasp the underlying meaning of conversation
• Difficulties understanding jokes, idioms, metaphors and sarcasm
• Voices often sound monotonous
• Language can be pedantic and idiosyncratic
• Often have narrow interests which dominate their converations (lack of reciprocity)

Question 18

What are some symptoms of ASD relating to social interaction

Answer 18

• Difficulties picking up non-verbal cues
• Appear self-focused and lacking in empathy, when in fact they are simply trying to figure out social situations
• Continually struggle to make and sustain personal and social relationships

Question 19

What are some symptoms of ASD relating to social imagination

Answer 19

• Difficulties thinking flexibly and in abstract ways
• Inability to understand other people’s points of view, taking things literally
• Difficulties applying knowledge and skills across settings with different people
• Difficulties projecting themselves into the future or planning goals sensibly

Question 20

What are some symptoms of ASD relating to repetitive impairment

Answer 20

• Stereotyped or repetitive motor movements, use of objects or speech
• Insistance on sameness, inflexible adherence to routines, or ritualised patterns of behaviour or nonverbal behaviour
• Highly restricted, fixated interests that are abnormal in intensity of focus
• Hyper- or hypo- reactivity to sensory input or unsual interest in sensory aspects of the environment

Question 21

What are some screening questionnaires used in ASD?

Answer 21

Autism Quotient - AQ-10
M-CHAT for children

Question 22

What are the essential criteria for ASD diagnosis

Answer 22

• Symptoms must be present in the early developmental period
• Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning (regardless of age)
• Disturbances are not better explained by other mental health problems, intellectual disability, or global developmental delay

Question 23

How is ASD usually managed?

Answer 23

Treatment is mainly through education and social interventions

Question 24

What medication may be used in severe aggressive or self-injurious forms of ASD?

Answer 24

Risperidone

Question 25

What are some environmental changes that can be made to accomodate those with ASD

Answer 25

• Give personal space
• Use visual supports or easier labels or symbols
• Avoid patterns and high-arousal colours on walls, opting for pastel colours
• Reduce noise levels
• Reduce fluorescent lighting