Autistic Spectrum Disorder (ASD)

Question 1

Definition of ASD

Answer 1

• Starts before age 3
• Triad of core symptoms:
  
  • Abnormal reciprocal social interaction
  • Communication/language impairment
  • Restricted and repetitive interests/activities
• M:F is 4:1
• 80% have low IQ (learning disability)
• 20% have normal IQ (high functioning autism)

Question 2

Abnormal social interaction

Answer 2

• Indifference
• Minimal shared enjoyment
• Reciprocal interaction
• Functional friendships
• Only early life friends
• Attachment to objects
• Aloof or awkward
• Egocentric
• Limited empathy
• Social rules
• Insensitive
• Lack of intuition
• Emotional recognition

Question 3

Communication/Language impairment

Answer 3

• Delayed or lack of speech
• Prolonged or avoidant eye contact
• Awkward posture or body language
• Speech unusual volume
• Formal, stilted, pedantic
• Misinterpretation of literal/implied meanings
• Advanced vocabulary ; poor conversational skills
• Lack of prosody (monotonous)
• Talking at rather than to
• Few nonverbal gestures

Question 4

Restricted and repetitive interests/behaviours

Answer 4

• Obsessive fixed interests
• Motor mannerism (hand flapping, body rocking)
• Compulsive / repetitive behaviours
• Ritualistic daily activities
• Repetitive self injury
• Preference for sameness e.g. food
• Change unsettling
• Increased sensory responsiveness

Question 5

Other features

Answer 5

• Clumsiness
• Difficulty expressing emotion
• Increased pain threshold
• Lack of empathy

Question 6

Compensation

Answer 6

• Escape into imagination
• Social withdrawal / avoidance
• Self blame, low self esteem
• Imitation of others / adaptation

Question 7

Assessment

Answer 7

• Doctors, SALT, OT, Psychology
• Standardised tools
  
  • Autism Behaviour Checklist (ABC)
  • Childhood Autism Rating Scale (CARS)
  • Autism Diagnostic Observation Schedule (ADOS)
  • Diagnostic Interview for Social and Communication Disorders (DISCO)

Question 8

Management

Answer 8

• Information
• Adapting environment
• Communication aids
• Social skills training
• Family support – parenting programmes
• Medication – symptomatic (antipsychotics for stereotyped or aggressive behaviours, SSRI’s for compulsive behaviours, melatonin for insomnia), future research