Autistic Spectrum Disorders Flashcards
Is autism spectrum more common in boys or girls?
4x more common in boys
What are the 2 most common comorbities with ASD?
ADHD and anxiety
What are the DSM V core features of ASD?
- Social Communications and Social Interaction Deficits, Persistent, Across Multiple Contexts
- Restricted Repetitive Patterns of Behavior, Interests or Activities
- Functional Impairment
- Not due to Intellectual Impairment or Global Developmental Delay
- Present from early development
A. when social demands exceed capacities
B. later in life may be masked by learned strategies
What social communication traits are present in ASD?
- Abnormal Social Emotional Reciprocity
A. Abnormal social approach
B. Failure of back-and-forth conversation
C. Reduced sharing of interests, emotions, affect
D. Failure to initiate or respond to social interactions
E. Deficits in Nonverbal Behaviors Used for Social Interaction
F. Deficits in Developing, Maintaining and Understanding Relationships
What are examples of the Deficits in Nonverbal Behaviors Used for Social Interaction?
- Eye contact and body language
- Gesture understanding and use
- Mismatch verbal and body language
- Lack of facial expression/nonverbal communication
What are examples of Deficits in Developing, Maintaining and Understanding Relationships?
- Adjusting behavior to suit social context
- Sharing imaginative play
- Making friends
- Absence of interest in peers
Define the Underdeveloped theory of mind?
- The ability to appreciate that another person, not the self, exists
- Appreciate that that other person might have thoughts, feelings and opinions different from the self
- Appreciate what those feelings might be based on nonverbal and verbal cues
- Feel Empathy
- Use other’s cues in deciding what to do or say next
- Think about and evaluate one’s own thoughts
What are the Restrictive or repetitive patterns of behavior, interests, or activities in ASD?
At least 2:
- Insistence on sameness
- Highly restricted fixed interests abnormal in intensity and/or focus
- Sensory issues
- Stereotyped or repetitive motor movements
true/false: non-eye contact in >6 month old babies is indicative of ASD
True
What information may make you suspicious of ASD in a baby on a prenatal visit?
- Family history of ASD
- In Utero Exposures
- Behavior of the parents towards each other; towards you
What information may make you suspicious of ASD in a baby on a neonatal, 2 and 4 wk visit?
- Lack of Eye contact
A. by history
B. on exam
What are normal checkmarks on a 2 and 4 month visit?
- Eye contact
- Smile
- Vocalization
- Sensory
What are normal checkpoints at 6-8 months?
- Stranger anxiety/interest in you/referencing caregiver’s reaction to you
- Language: babbling, cooing
- Sensory
What are normal checkpoints at 9, 12, and 15 months?
- Language: first words
- Shared attention
- Sensory
- Need for sameness: routine
What are checkpoints at 18 months that may indicate ASD?
Start using MCHAT
- Language
- Sensory
- Use of mother as extension of self to accomplish a task v. as a separate partner in the task
- Stable base to be returned to
- Sameness
- Solitary play
- Use of toys
What is the MCHAT?
Screening tool for ASD in young children
When should children display empathy/interest in others?
At least 24-30 months
What is screened at 30-36 months?
- Language Quality: tone assessment, abnormal flow of rhythm
- Loss of language/other milestones
- Sensory
- Sameness (with persistent tantrums)
- Solitary play
- Odd
- Stereotypies
- Social anxiety/ Other comorbidities
What is screened at 2 ys?
- Language
- Sensory
- Sameness
- Shared attention
- Empathy
- Solitary play
- Idiosyncratic use of toys
What is screened at 4-5 yrs?
- Language
- Little professor
- Solitary play, few friends, prefers adults
- Controlling in play with others
- Sameness, anxiety and tantrums
- Stereotypies, “stimming”
- Sensory issues
What is seen at school age?
- Few friends and bossy
- Routine-bound
- Sensory issues
- Bullied
- Comorbidities e.g. ADHD, Anxiety, Nonverbal learning disabilities
Who do you call when ASD is suspected and you need an evaluation?
- Under age 3: Early Intervention
- Age 3-5 : the local school district Committee on Preschool Education
- Over age 5: Psychologist who knows how to do one of the validated standardized tests for ASD, e.g. the ADOS, ADI-R, CARS-2
What are ASD look-alikes?
- Language delays
- Global developmental delay
- Cognitive delays
- Sensory impairments, especially deafness
- Reactive attachment disorders
- OCD
- Anxiety disorders
What is the medical work-up for suspected ASD?
- There is no definitive biologic test. That being said do:
A. Hearing Test
B. Dysmorphology Exam
C. Lead test
D. Chromosome microarray, with referral to genetics if positive
Who is involved in the treatment of ASD?
- parents,
- educators, speech, often OT,
- case manager
- often mental health
- natural support systems
What is the role of the PCP in treating ASD?
- Educator, trusted Resource
- Advocacy for evidence-based treatment
A. Ask about CAMS (complementary alternative medications); beware of those that might cause harm
B. early, intensive, long term
C. Applied Behavioral Analysis Variants: Improve mostly language skills and cognition
D. Social Skills Training
-Skillstreaming Manualized
-Peer Mediated/Group-based
E. Play-/Interaction-Focused Methods
-Joint Attention Interventions - Team player in contact with other players
- Be the medical home, continuity of care over the child’s life
- Screen for incipient mental health comorbidities
True/False: there are no drugs for the core deficits in ASD?
True, however oxytocin may be helpful
What are examples of applied behavioral analysis variants?
UCLA/Lovaas
ESDM/Denver
LEAP
Improvements mostly in language skills and cognition
What comorbidities may be present with ASD?
- Intellectual disability
- Seizure disorders and/or EEG abnormalities 25%
- ADHD
- ODD – “Pervasive Demand Avoidance Syndrome”
- Obsessive-compulsive phenomena
- Anxiety
- Aggressive Behavior
- Depression and other mood disorders
- Victims of abuse including bullying
What are the 4 big comorbidities to look for?
- ADHD
- Anxiety
- Aggression
- Depression
When is the dual diagnosis of ASD and intellectual disability?
The dual diagnosis of ASD with ID is made when the social skills are poorer and the perseverative behaviors are beyond what would be expected for the level of ID.
How are comorbidities treated?
- Therapy
- Medication management
- Strengthen the team around the family
How is the type of therapy used for comorbidities determined?
- Choose based on Developmental Age
- Outpatient Modalities
A. Parenting Skills
B. Behavioral interventions
C. CBT adapted to the individual child
D. Family Therapy
E. Social Skills Groups - Inpatient – often can benefit from the milieu
What are the general med guidelines?
- Generally with the same medications as in neurotypical children
- Often have more side effects at lower doses, so..
- Start low and go slow
- Use of screening tools for monitoring
What is the therapy of choice for ASD children with anxiety and depression?
CBT
How is the team built up around an ASD child?
- Case Management
- Natural Supports
- Referral to Subspecialists
- “Wrap –Around” Services: What does the family want?
A. Respite
B. Skill Builder
C. Transportation
