CAMHS - Autism Flashcards
Define autism spectrum disorder (incl. Asperger’s syndrome) (ICD-10/DSM-5)
Autism spectrum disorder (ASD) is a group of conditions that affects social interaction, communication, interests and behaviour.
doesn’t meet the full diagnostic criteria, but similar to autism
Asperger’s, is a neurodevelopmental disorder characterized by significant difficulties in social interaction and non-verbal communication, along with restricted and repetitive patterns of behavior and interests
-Normal language and IQ
Aetiology of ASD?
obstetric complications - i.e. gestational dm
sodium valproate use in womb
perinatal infection (e.g. maternalrubella),
Genetic;
- Large 90% inheritable! Similar traits in families but no specific gene
- genetic disorders such as TUBEROUS SCLEROSIS
Down syndrome, and fragile X are all risk factors.
epidemiology
0.25% autism 1% ASD
lecture:
- Executive dysfunction theory
- Theory of mind - unable to put themselves in other people’s shoes - failure of theory of mind
What is the presentation of autism?
- Autistic children are not interested in people; they tend to play alone, and lack the ability to ‘read’ emotional
states in others. Attachments are impoverished, without
mutuality or warmth; these children do not turn
to parents for comfort. EYE CONTACT may be odd, either
avoidant or ‘looking through’ you. - Communication abnormalities
Expressive speech and comprehension are delayed or minimal.
speech delay
Ideas are taken literally (concrete thinking).
Difficulty using Gestures - may not be able to use them at all (e.g. pointing, waving goodbye), some gestures may be odd.
All in all - difficulties with non-verbal communication
Later, speech may consist of;
monologues - going on about themselves, won’t ask you questions about eg how are you doing
interminable questions,
or echolalia (repeating what has been said), but there is no exchange. or mimicking
stock phrases - learned phrases they use to get themselves through conversations, because sometimes difficulty in spontaneous speech
Classically ‘I’ and ‘me’ are confused
with ‘you’, ‘he’, and ‘she’ (pronominal reversal).
- Restricted behaviours and routine
repetitive, stereotyped behaviours and
restricted interests—rather than imaginative play.
small changes in routine (e.g. the wrong spoon) can
result in intense tantrums.
Additionally, 75% of children have significant learning
disabilities and 25% suffer from seizures. Overactive
behaviour is common.
OTHERS;
Toe walking - walking on tiptoe can be associated with ASD among other conditions.
Identify appropriate investigations for autism spectrum disorder (incl. Asperger’s syndrome) and interpret the results
- Hearing tests.
- Speech and language assessment and therapy
- Assess IQ
- ASSQ/Gilbergs (autism spectrum screening)
- for normal IQ, espech Aspergers or mild impairment
- screening not diagnostic
- sent to parents & teachers to complete
- scores >19/ 22 - ADOS: Autism Diagnostic Observation Schedule.
lecture:
Sally anne test - perform poorly (because unable to put themselves in other people’s shoes - failure of theory of mind) -> autism
Refer them to CAMHS
ddx for asd?
1.Deafness causes poor language acquisition.
2. Asperger’s syndrome (Box 19.2).
3. Specific language disorder: delayed speech but
normal IQ and social ability.
- Learning disability: IQ problems but relatively intact
social skills. - Rare disorders, e.g. childhood schizophrenia, Rett’s
syndrome. - Neglect can lead to language delay and poor
socialization—reversible unless severe.
How is autism managed?
- Support and advice for families, e.g. the National
Autistic Society. - Behaviour therapy —reinforce positive
behaviours!!!!! ABA - applied behavioural analysis - Speech and language therapy SALT.
- Special education. need an EHPC from psych team; educational health & care plan to allow access to appropriate education.
- Treat comorbid problems (e.g. epilepsy -1/3rd have this).
- Antipsychotics or mood stabilizers are occasionally
used for extreme aggression or hyperactivity.
prognosis of autism?
positive prognostic indicators?
Only 10% of gain full independence, with most
needing lifelong support and care.
Good prognostic
indicators are an IQ over 70 and acquisition of some
useful language.
asperrgers has much better prognosis
how is aspergers managed?
advice
support
ROUTINE
Social skills training
complications of autism?
70% have at least 1 mental or behavioural disorder eg:
anxiety
ADHD
oppositional defiant disorder
self harm and harm to environment
functional problems;
sleeping, eating, GI problems
characterise normal onset of speech and give example of speech delay
by age 1 kids should be saying isolated words on their own
by age 2 they should be able to put sentences together
1 case i saw of ASD language delay:
words by age 3, sentences by age 5/6
what is an Education, Health and Care Plan - EHPC?
It outlines any special educational needs a child has, and the provision a local authority must put in place to help them.
what is one major thing you REALLY have to remeber about autism?
speech delay is a MAJOR component and huge giveaway hence why many of the differentials are based on speech delay eg:
speech delay or learning disability or neglect
when screening for autism it is important to screen for Sensory sensitivity. why?
they can have increased sensitivity to sensory stimuli eg;
Intense sensitivity to sound : loud noises can be painful so crowds can be an issue
bright lights
dont like to wear jeans but prefer jogging bottoms
this can extend to foods: find textures distressing etc
Paradox of pain in autism -
high pain threshold; some can tolerate extreme heat, cold or pressure others low pain htreshold.
list some coping mechanisms that autistic kids may adopt?
“Stimming” - Short for self-stimulatory behaviors, this includes all sorts of things: flapping hands, echoing phrases, making noises, and walking in circles. Sometimes, these autism symptoms can be self-injurious, like head banging.
Compulsive organization
Intellectual obsessions - an exhaustive and staggering knowledge of a particular subject.
what is the triad of autism?
lecture
recipricating repetitive restrictive behaviours
social interaction difficulties
communication difficulties
2+3 often go together
