Community: Autism Spectrum Disorder Flashcards
What percentage are male?
75%
Before what age does it usually develop?
3 years old
What are the 3 main features?
1) Impairment of language and communication
2) impairment of social relationships
3) restrictive or repetitive behaviour/ interests/ activities
What should you look for with regards to social communication and interaction?
Social reciprocity (how child responds to others) Joint attention - does the child want to share an interest? Non verbal communication - can this be interpreted and used themselves? Social relationships - is there trouble developing these or maintaining them?
What are some examples of restrictive or repetitive behaviours?
Lining up toys Flapping hands Imitating words or phrases and repeating them Fixed routine Restrictive thinking, specific knowledge
What behaviours can be observed?
Poor eye contact Not responding to their name Not smiling when you smile at them Head banging Teeth grinding Rocking
Does each child have a unique spectrum of symptoms?
Yes - variance in severity of deficits
What causes ASD?
Genetic - affects brain development in specific areas related to social interactions and communication (the specific affected genes unknown)
No clear environmental risk factors identified
Is there a cure?
No
What treatment is there?
Education programmes Behaviour therapy Psychological therapy Support networks - child, parents, siblings Acknowledge strengths
Treatment should be tailored to each child - true or false?
True
Do most children with ASD have a decreased IQ?
Yes
What differentials are there?
Expressive and receptive language disorders Rett syndrome (females) Fragile X CNS development abnormalities Tuberous sclerosis
Autism may be missed in…
Those with learning disability
Those who are verbally able
Under diagnosed in girls
Looked after children or those in criminal justice system - important information about early development may not be readily available
ASD affects approximately what percentage of children?
1%
What comorbid comditions is it associated with?
Neurodevelopmental conditions: ADHD, epilepsy, learning difficulties Anxiety Sleep problems OCD Dyspraxia - problems with coordination Eating disorders Oppositional defiant disorder Tics / Tourette’s
The symptoms need to occur in more than one environment. True of false?
True
What does sensory processing difficulties mean?
Can get very upset if they do not like certain taste, smell or sounds
Can lead to problems with self care e.g may refused to have hair cut of brushed or only eat certain foods - anaemia or obesity
Autism can be different in girls and boys. How may autistic girls present?
Quieter
Hide feelings
Appear to cope better with social situations
Children with ASD can have difficulties with social imagination. What does this mean?
Unable to act out stories e.g with a toy
How can the family be impacted?
Stressful looking after challenging behaviour
Financial - may have to give up work to look after child
Social restriction
Why can someone with ASD be at risk of abuse?
Difficulties with social interaction can mean they are easily manipulated or bullied by others
Difficulty interpreting intentions of others
Communicating experiences difficult
What questionnaire can be used as a screening tool for autism?
Gilliam Autism Rating Scale (GARS)
Usually sought from more than one source e.g home, nursery or school to show evidence that the core problems are truly pervasive
Also: the Autism Diagnostic Observation Schedule (ADOS) - used in diagnosis (tasks and observations focused on the social and communication behaviours)
What type of assessment is considered best practice when giving a diagnosis of autism?
Multi professional assessment
What additional information would be helpful before considering a potential diagnosis?
Educational psychologist assessment Family history of autism Parental view about diagnosis School report SALT assessment
Why is an educational psychology assessment important?
Build a picture of child’s difficulties
Give opinion about any early life difficulties or developmental trauma contributing to child’s current social/ behavioural presentation
Carry out assessment of cognitive abilities to identify comorbid learning difficulties
Having a full sibling with a diagnosis of autism increases risk of ASD by how much?
10 fold (compared to background population) Having a cousin with autism increases risk 2x
Why is a SALT assessment vital?
Needed whenever there is concerns about a child’s understanding or use of language
Can give opinion about child’s functional and use of language to communicate
Does it affect all ethnicities equally?
Yes
When do the problems typically become most apparent?
Often when child joins a new nursery / school
Some may be easier to identify, while others may take longer for a clear diagnosis to be made
Can overall intelligence vary?
Yes from severe learning difficulties to gifted - often with special talents
Is the separation of Aspergers and autism still used?
No - separate diagnosis seen as less helpful and the term ASD generally used
Is there an absolute absence of social skills?
No - the difficulties are relative
Children with ASD often have difficulty engaging with those around them. Give an example..
They may not join in with group activities in school
What does a reduced sense of shared enjoyment mean?
E.g not laughing at the things other children of their age may find funny
Children with ASD may have reduced empathy towards emotions. True or false?
True e.g not understanding why another child cries when they fall over
What are some typical features associated with speech and communication problems?
Delay in development of expressive language - say few or no words
Less response when name called
Repetition of phrases - may answer question by repeating question
Difficulty using speech in socially accepted way e.g taking turns
Limited use of everyday gestures e.g pointing and facial expressions
Difficulty forming meaningful sentences e.g giving coherent account of ideas
Are restricted and repetitive behaviours unique to ASD?
No - many seen in most children at some stage in their development
Children with ASD tend to display these features with increased duration and rigidity
Give some examples of fixed, repetitive rituals
Preference for sameness - repeating activities e.g lining up toys
Fixed routines
Fixed rituals
Stereotypical behaviours e.g hand flapping, walking in circles
Unusual interests
What are some examples of sensory issues?
Hug from stranger
Scratchy label in clothing
A police siren
Hypersensitivity to sound and touch
What parts of the brain are affected?
Prefrontal cortex - role in controlling complex social behaviours
Temporal lobes - role in understanding language and sensory input
Cingulate cortex - role in emotional processing and subsequent behaviour
What conditions are associated with an increased prevalence of ASD?
Congenital insults to CNS e.g cerebral palsy, effects of extreme prematurity
Chromosomal disorders - Down syndrome, fragile X, tuberous sclerosis
Neonatal epileptic conditions
Muscular dystrophy
Neurofibromatosis
If a person has a sibling with ASD, what is there risk of having it?
15-30 x greater chance
Is it true that many children with ASD do not have any known FH of developmental problems?
Yes
Multiple genetic mutations can occur randomly to cause ASD and other changes are epigenetic - changes to way gene expressed, not change to gene itself
What factors could alter the way a gene is expressed?
Toxins
Developmental stressors - severe neglect, in utero exposure to AEDs, effect of migration
MDT assessment and management is important. Who is involved?
Paediatrician or child and adolescent psychiatrist
SALT
Educational/ clinical psychologist
Is it a pervasive disorder?
Yes for diagnosis to be made
Not uncommon for problems to be different in nature at home and school, but some difficulties need to be pervasive
Many children with underlying ASD come to attention because of other issues such as…
Difficult behaviour
Hyperactivity
Learning problems
Children with attachment difficulties including many in care can present with similar problems (can have both)
Some children with ASD are able to learn key skills to appear to function well in certain situations. When they have to adapt to complex or novel situations, their communication and behaviour difficulties often become noticeable again, for example…
Inability to understand subtext
Diminished sharing of two way conversation
Reduced responses to others
Poor understanding of personal space
Reduced awareness of social niceties or hierarchies
Apparent mature speech masking difficulties with comprehension and delay in language processing
Unable to adapt communication style to different social situations
Anxiety, anger, aggression when things do not go their way
Continuing support is as important as correct diagnosis. Ideally a key professional should be identified to coordinate care - true or false?
True
GP
School nurse
Social workers
All should liaise together
Do non identical twins have same chance as having ASD as identical twins?
No - chance higher for identical twins
What social skill training can be done?
How to start and end a conversation
Turn taking
Making friends
Identifying and expressing emotion
Those in mainstream education may have good speech and language, but what may function at a lower level?
Comprehension
Why may those with ASD take many seconds to process information?
They may only pick up on one or two words being said to them
What classroom management approaches could be taken?
Movement breaks
Use of headphones to decrease auditory stimulation
Object to hold or fidget with
Chew gum
Safe space should have: de cluttered area, dim lighting, reduced noise
What is first line therapy for anxiety in ASD?
CBT
What percentage of children with developmental disorders have sleep difficulties?
80%
What are the most common types of sleep problems?
Delayed sleep initiation
Anxiety about sleeping alone
Waking during night
What behavioural interventions can be done for sleep problems?
Establish relaxing night time routine
Avoid day naps
Avoid caffeine
Remove TV screens and computers from bedroom
What techniques can be used with regards to behaviour management?
Picture exchange communication system - if little or no communication
When learning to identify triggers, parents keep a diary
Distraction techniques
Introducing preparation for new experiences
For aggressive behaviour that does not respond to specialist behavioural and educational management, what can be done?
Emergency cases: risperidone is licensed for use in ASD
What are the 5 autism spectrum disorders?
Autism Asperger’s syndrome Rett syndrome Childhood disintegrative disorder Pervasive developmental disorder not otherwise specified (PDD-NOS)
