Autism Spectrum Disorders

Question 1

What is autism?

Answer 1

A lifelong, pervasive developmental disorder on a spectrum of severity
It is characterised by 2 core symptoms: (1) persistent deficits in social communication and interaction across multiple contexts (2) restricted, repetitive patterns of behaviour, interests or activities
Must be present early in development and cause functional impairment later in life as well as not being attributed to another condition/intellectual disability/global developmental delay

Question 2

What is the cause of autism?

Answer 2

Unknown
Genes thought to play a part
Associated epilepsy in 30%

Question 3

How is the diagnosis of autism made?

Answer 3

Requires a specialist team including psychiatrist, paediatrician, SALT, psychologist.
Detailed history, collateral from school, observation in different settings
Formalised framework for diagnosis - ADOS/3di

Question 4

What broad 3 categories do the clinical features of autism fit into?

Answer 4

Impaired reciprocal social interaction
Impaired imagination
Poor range of interests and activities

Question 5

What are the clinical features of impaired reciprocal social interaction?

Answer 5

Unawareness if the existence and feelings of others
Abnormal response to being hurt
Impaired imitation
Repetitive play that tends to be solitary/uses others as mechanical aids
Bad at making friends if they even bother

Question 6

What are the clinical features of impaired imagination?

Answer 6

Little babbling, few facial expressions or gestures
Avoids mutual gaze, no smiles on approach, stiffens when being held, no greetings
No interest in stories or fantasy/pretend play
Odd speech
Difficulty initiating/sustaining reciprocal roles in conversations

Question 7

What are the clinical features that fall under ‘poor range of activities and interests’?

Answer 7

Stereotyped movements
Preoccupation with parts of an object/unusual attachments
Marked distress over minor or trivial changes
Insists on following routines in precise detail
Narrow fixations

Question 8

What is the management for autism?

Answer 8

Early intensive behavioural intervention +/- speech therapy
Special schooling
Social skills training
Risperidone (aggression), melatonin (sleep), SSRIs (repetitive behaviour)
Benefits - disability living allowance