Elective Preparation Flashcards
What are the core clinical characteristics of ASD?
Impairments in two areas of functioning (social communication and social interaction), as well as restricted, repetitive patterns of behaviour, interests or activities. Must be present from early childhood.
Where is ASD found in the DSM-5?
Under neurodevelopmental disorders
How do we determine ASD severity?
Three levels:
1: requires support
2: requires substantial support
3: requires very substantial support
How prevalent is ASD?
1% in the UK
Give three red flags of ASD in the second year of life.
Lack of showing Lack of coordination of nonverbal communication Lack of sharing interest or enjoyment Repetitive movements with objects Lack of appropriate gaze Lack of response to name lack of warm, joyful expressions Unusual prosody Repetitive movements or posturing of body
Should we screen for ASD?
There are screening tools with up to 70% specifities and sensitivities, however only if there’s a suitable treatment and the means to provide this treatment. Examples include the modified checklist for autism in toddlers (M-CHAT) and the childhood autism spectrum disorders test (CAST)
What was autism thought to be due to in the 1950s/60s?
The defective upbringing of children by cold and rejecting parents, thereby leaving the child with no alternative but to seek comfort in solitude
Give five risk factors for ASD
- Siblings with autism
- Being a twin (especially monozygotic)
- Valproate use during pregnancy
- Folic acid use reduces risk
- Epigenetics
- Parental history of schizophrenia-like psychosis
- Parental history of affective disorder
- Parental history of another mental or behavioural disorder
- P/Maternal age of over 40y
- Low birth weight
- Prematurity
- Presence of birth defects
- Male gender
- Threatened abortion at less than 20 weeks
How would a child with ASD react to a windup toy?
A typical child at 12m shifts his eye gaze from the windup toy to the clinician and then coordinates his eye gaze with smiling. A child with ASD becomes hyper-focused on the windup you and doesn’t look at or engage with adults.
What is stimulus overselectivity?
Children with ASD exhibit overly selective attention to some particular stimuli, not to the gestalt of what is being seen or heard (like making a puzzle not using the image to be built but paying attention only to the shape of the pieces). Also seen with intellectual disabilities.
Give examples of peer relation behaviours seen in ASD.
- Not looking into the eyes of approaching adults
- Failing to orient towards biological motion
- Using nonverbal behaviours less often than typically developing children (eye contact, gestures, body postures, facial expressions)
How can we quantify impairments in communication?
- Delay in, or total lack of development of spoken language, no accompanied by compensatory attempts
- Marked impairment in the ability to initiate or sustain conversations
- Stereotyped, repetitive or idiosyncratic language
- Lack of varied, spontaneous imitative or make-believe play
How might a child with ASD react to a popping balloon?
Over-reactive to sensory input, covers ears in anticipation of it making a loud noise, reach to mother for comfort
Name two disorders ASD is associated with.
Fragile X syndrome
Rett’s disorder
What are the differential diagnoses of ASD
- Severe psychosocial deprivation
- Intellectual disability
- Rett’s disorder
- Receptive-espressive language disorders
- Separation anxiety
- Childhood schizophrenia
- ADHD
- OCD
How do we treat ASD?
- Education, with special attention to social, communication, academic and behavioural development
- Accessible community support
- Psychological and medical treatments
How do we treat ASD pharmacologically?
Medication is justified only to treat co-morbid conditions e.g. ADHD, not for the core symptoms of ASD, and in the management of challenging behaviours e.g. aggression and self-harm that do not response to other approaches. There is good evidence that risperidone can be helpful for the latter.
What was the former name of ADHD and why was its name changed?
Used to be called minimal brain damage. Then changed to minimal brain dysfunction when realised not all children had brain lesions. Then changed to hyperkinetic disease characterised by restlessness and distractibility. Then changed to ADHD when the role of inattention was recognised.
