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Neuropsychiatric Disorders > Autism Spectrum Disorders > Flashcards

Autism Spectrum Disorders Flashcards

1
Q

How was ASD originally described by Kanner (1943)?

A

Autistic disturbances of affective contact

▪️ Shortly after birth
▪️ Profound lack of social engagement
▪️ Echolalia, literalness, pronominal reversal
▪️ Unusual responses to inanimate environment
▪️ Difficulties with change

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2
Q

How did Asperger describe autistic psychopathy (1944)?

A

▪️ Males only
▪️ Strong language and cognitive skills
▪️ Runs in families
▪️ Interest in acquiring unusual knowledge

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3
Q

How did Wing and Happe describe autism?

A

Problems with communications, socialisation, and imagination

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4
Q

What are the three main ICD10 criteria for childhood autism?

A
  1. Impairments in reciprocal social interaction
  2. Impairments in communication
  3. Restricted/stereotypes patterns of behaviours, interests, and activities
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5
Q

What might be seen as abnormalities in reciprocal social interaction?

A

▪️ Problems orientating to name
▪️ Difficulties with eye contact, gesture, expression, posture
▪️ Insensitivity to others’ emotions and social context
▪️ Lack of interest in other children/few friends
▪️ Difficulties sharing excitement
▪️ Not seeking or giving comfort

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6
Q

What might be seen as abnormalities in communication in autism?

A

▪️ Language delay without non-verbal compensation
▪️ Limited social /two-way chat
▪️ Stereotyped, repetitive use of language
▪️ Reduced social-imitative and imaginative play

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7
Q

What are examples of restricted and repetitive behaviours, interests, and activities commonly seen in ASD?

A

▪️ Circumscribed interests
▪️ Unusual preoccupations
▪️ Rituals/compulsions
▪️ Motor stereotypies
▪️ Difficulties with change
▪️ Sensory interests or sensitivities

Onset before 36 months!

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8
Q

What is the difference between high-functioning autism (HFA) and Asperger’s?

A

Children with Apsergers don’t typically show language delay before age 3

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9
Q

How does IQ differ between autism, high-functioning autism, and Asperger’s?

A

▪️ All those with autism will have a learning disability
▪️ Those with HFA will have borderline/low average IQ
▪️ Those with Asperger’s tend to have average or high IQ

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10
Q

What are the two domains used to classify ASD in the DSMV?

A
  1. Persistent deficits in ability to initiate and sustain reciprocal social interaction and communication
  2. Restricted, repetitive, and inflexible patterns of behaviours, interests, or activities, including differences in sensory sensitivities and interests
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11
Q

What other criteria are necessary for a diagnosis of ASD?

A

▪️ Social impairments across contexts and not accounted for by general developmental delays
▪️ Symptoms present in early childhood, but may not fully manifest until social demands increase
▪️ Symptoms limit and impair everyday functioning

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12
Q

What neurodevelopmental disorders occur more commonly in children with ASD than the general population?

A

▪️ ADHD (30%)
▪️ Tics (10%)
▪️ Developmental coordination disorder (70%)
▪️ Epilepsy (5%)

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13
Q

How does comorbidity of other neurodevelopmental disorders in ASD change in adulthood?

A

▪️ Most improve
▪️ ADHD still seen in 30-45%
▪️ Epilepsy in 5% of those without ID

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14
Q

What are the two main tools used for ASD diagnosis?

A
  1. Autism Diagnostic Interview (ADI)
  2. Autism Diagnostic Observation Schedule (ADOS)
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15
Q

What is the Autism Diagnostic Interview?

A

▪️ Clinician administered interview
▪️ Parents/caregivers asked about social interaction, communications, and restricted behaviours in first 5 years of life
▪️ Less reliable with adults (memory!)

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16
Q

What percentage of individuals with ASD have an IQ within the LD range (<70)?

A

50%

(has decreased with increasing recognition of ASD in children with normal IQ)

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17
Q

How does prevalence of ASD differ across genders?

A

▪️ 4x higher in males
▪️ This excess increases with IQ
▪️ Asperger’s = 10:1

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18
Q

What are some of the positive attributes of ASD?

A

▪️ Strong interests
▪️ Attention to detail
▪️ Unusual memory
▪️ Ability to concentrate for long periods conducive to creativity
▪️ Heightened visual functioning or musical processing

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19
Q

What have rare genetic variants identified in ASD samples been associated with?

A

Growth and development of the synapse

(i.e., neuroligands, neurexin, contactin-associated proteins)

20
Q

What have neuroimaging studies found in those with ASD?

A

Aberrant structural and functional brain connectivity

21
Q

What is the main biological causal model of ASD?

A

Genetically mediated abnormalities of synaptic maturation and connectivity (both micro and macro)

22
Q

ASDs are caused by abnormalities in…..

A

▪️ Multiple brain regions and networks
▪️ NOT single structures

23
Q

How does amygdala volume correlate with ASD symptoms?

A

▪️ Not well with verbal or repetitive behaviours
▪️ Predicted ~53% of variance in nonverbal social impairment

24
Q

What brain regions have been implicated in mentalising?

A

▪️ Dorsal mPFC (I, you, it relations)
▪️ Posterior superior temporal sulcus (detecting goal-directed actions)
▪️ Temporal-parietal junction (perspective taking)

25
Q

What brain regions have been implicated in emotional empathy and learning?

A

▪️ ACC/right anterior insula (pain, disgust of self/others)
▪️ Amygdala (distress cues)
▪️ Ventral mPFC

26
Q

What brain regions have been implicated in mirroring/action observation and execution?

A

▪️ Inferior frontal gyrus (IFG)
▪️ Intraparietal sulcus (IPS)

27
Q

What cognitive domains show underconnectivity in ASD?

A

▪️ Working memory for faces
▪️ Inhibitory control
▪️ Resting-state network
▪️ Sentence comprehension
▪️ Planning ability (Tower of London task)

28
Q

Which intrinsic brain networks show great hypoconnectivity in autism?

A

▪️ Cortico-cortical
▪️ Interhemispheric

29
Q

Which intrinsic brain networks show hyperconnectivity in autism?

A

Sub-cortical

30
Q

What evidence suggests the importance of common genetic variation in disease risk for ASD?

A

Independent heritability of distinct ASD core domains

31
Q

What evidence suggests the importance of identifying rare variants in ASD?

A

Functional disruption of single molecules seems to be sufficient to cause ASD

▪️ Growing list of single genetic lesions which each appear to be sufficient to cause ASD
▪️ Significant proportion may be a result of de novo mutations

32
Q

How might the genetic underpinning of ASD explain the difference in prevalence across males and females?

A

Identified de novo mutations appear to have reduced penetrance in females

33
Q

What might be useful as a biomarker for later ASD onset?

A

Patterns of functional activity or changes in anatomy during development in first year of life

34
Q

What is multivariate pattern classification?

A

▪️ Phase 1 = Training; feed computer scans from two different groups (e.g., ASD and HC) to train it to distinguish the two
▪️ Phase 2 = Testing; give unknown scan and see what group it puts it in

35
Q

What psychiatric comorbidities are most commonly seen in ASD?

A

▪️ ADHD (30-45%)
▪️ Intellectual disability
▪️ Depression
▪️ Anxiety disorder
▪️ OCD
▪️ Schizophreniform disorders
▪️ Bipolar affective disorder
▪️ Catatonia/movement disorders
▪️ Specific reading/writing difficulties

36
Q

What features of ASD might predispose someone to psychotic symptoms?

A

▪️ Problems with perspective-taking
▪️ Insensitivity to social norms - monitoring responses
▪️ Pragmatic speech problems - omission of logical connections between topics
▪️ One-sided communication and salient preoccupations
▪️ High social anxiety and default assumption that people are hostile following bullying

37
Q

How might ASD overlap with avoidant/restrictive food intake disorder (ARFID)?

A

▪️ Sensory sensitivities
▪️ Resistance to dietary change
▪️ Intense interest in a specific diet
▪️ Too literal response to dietary advice
▪️ Restricted, bizarre diet and pattern of eating

38
Q

What is the association between ASD and anorexia nervosa?

A

▪️ May be difficult to identify ASD in adult women in presence of other psychiatric disorders such as AN
▪️ Being underweight might lead to reversible autistic symptomology or unmask previously unrecognised autism

39
Q

What are the main symptoms of catatonia?

A

▪️ Stereotypies
▪️ Complex mannerisms
▪️ Echolalia
▪️ Difficulty initiating complex actions
▪️ Unusual slowness
▪️ Mutism
▪️ Passivity and freezing

40
Q

What is the relationship between ASD and gender dysphoria/incongruence and what does this mean for clinical practice?

A

▪️ Autistic traits appear over-represented in gender identity clinics - possible association?
▪️ Neurodevelopmental state may be relevant but should not hinder access

41
Q

What are the main principles for management of ASD?

A

▪️ Psychoeducation
▪️ Adapted CBT
▪️ Social interventions/support
▪️ Assess co-existent conditions
▪️ Same medications for comorbidities but start low and slow (e.g., antipsychotics for anxiety and irritability)

42
Q

What is empathy?

A

An affective response more appropriate to someone else’s situation that one’s own

43
Q

What are the three main types of empathy?

A

▪️ Cognitive (theory of mind)
▪️ Emotional (affective response)
▪️ Motor (tendency to automatically mimic and synchronise signals and movements)

44
Q

Why might empathy be impaired in ASD?

A

▪️ Difficulties representing mental state of others
▪️ Alexithymia
▪️ Literal interpretation of speech
▪️ Pragmatic speech problems
▪️ Processing social-emotional cues
▪️ Problems with prior social learning and schema formation
▪️ Restricted interests
▪️ Sensory processing
▪️ Attention allocation

45
Q

How might empathy problems differ between ASD and personality disorder/psychopathy?

A

▪️ ASD = impaired perspective taking
▪️ Psychopathy = impaired emotional empathy

Neuropsychiatric Disorders (30 decks)

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