Post-diagnostic management and f/u for ASD Flashcards
What to arrange or screen for after a diagnosis of ASD?
- Dental - may need sedated exam
- Nutrition - may need community dietician, SLP, behavioural interventionist
- GI - specifically constipation, GERD, celiac disease
- Sleep - 50-80% have sleep issues. Avoid screens, consider melatonin, sleep hygeiine
- Anxiety - in HALF of kids with ASD. Can contribute to self injury and aggression. CBT can be useful in those who are verbal and have a cognitive ability of >/=8 y.
- ADHD - 30-50%. Treat same as other ADHD.
- Depression - not as common, more so in older kids who are more self-aware
What referrals to consider?
- SLP - to improve communication and provide communication aids
- Psychologist - psychoeducational testing, help with comorbid diagnoses such as ADHD
- Psychiatry - if major psych comorbidity
- Occupational therapy - can help with sensory and fine motor impairments
- Physiotherapy - can help improve gross motor milestones and strength
Behavioural interventions that are useful?
- Early intensive behavioural therapy- ages 2-5, some evidence of improvement in adaptive skills, IQ, and receptive and expressive language
- Parent mediated interventions - Good for keeping parents engaged, educating them, and reducing symptom severity
- Social skills training - useful in 7-12 yo with average or above intelligence
- CBT- if you have anxiety
Examples of maladaptive behaviours?
- Aggression
- Self-injury
Factors that can increase the risk for having challenging behaviours?
- Communication deficits, making it difficult for a child to understand or express needs and wants
- Coexisting medical disorders, which can cause pain or discomfort
- Coexisting mental health problems or neurodevelopmental conditions
- Physical (e.g., lighting or noise levels) and social environments (e.g., home, child care, school)
- Changes in daily routines or personal circumstances
- Developmental changes (e.g., puberty)
- Bullying and other forms of maltreatment
First line management strategies for maladaptive behaviours?
- Anticipatory guidance on safety issues (e.g. wandering, bolting, vulnerability to bullying or abuse)
- Education and support for behavioural strategies for families. Recommend evidence-based parenting programs or classes, there are also helpful online toolkits
- Ongoing medical treatment for co-occurring physical disorder and psychotherapeutic intervention for coexisting mental health problems
- Counsel families on strategies and interventions that can positively impact a child’s physical environment (e.g. structured, predictable routines) and social life (e.g. consistent caregivers and approaches to behaviour management)
- Augmentative and alternative communication systems, devices or software to help minimally verbal children communicate
When to consider medication for maladaptive behaviour?
When nonpharmacological strategies have been exhausted, and should always be in combination with behavioural interventions
Pharmacotherapy for irritability and aggression for children with ASD who are 5 years and older? What adverse effects to monitor for?
- Risperidone or aripiprazole
- Weight gain, metabolic syndrome, extrapyramidal symptoms (e.g. muscle stiffness, tremors), drowsiness
Pharmacotherapy for anxiety?
SSRI, e.g. fluoxetine or sertraline
Pharmacotherapy for ADHD?
Methylphenidate or other stimulant
-Alternatives: atomoxetine and alpha-2 adrenergic receptor agonists (e.g. clonidine or long-acting guanfacine)
+parent training in ADHD behavioural management
Pharmacotherapy for depression?
SSRIs
Pharmacotherapy for sleep disturbances? Side effects?
- Melatonin + sleep hygiene and behavioural modification strategies
- SEs: difficult waking, daytime sleepiness, enuresis
CAM therapies considered to be risky and ineffective?
- Hyperbaric O2 theray
- Chelation
- Secretin
- Herbal products
- Antibiotics, antifungals and facilitated communication strategies considered ineffective
What about cannabiidiol oil?
Insufficient efficacy or safety data at the present time to support the use of medical cannabis to treat any condition in children
-Considerable ethical implications for pediatric care providers regarding its use in children with ASD
CAM therapies that are considered safe with appropriate monitoring, but lack supporting evidence?
- Supplementing diet with vitamins B6, C, D, Mg, or omega-3 fatty acids
- Dietary interventionos such as gluten- or casein-free diets
- Massage therapy, music and expressive therapies, therapeutic touch, therapeutic horse-back riding, other animal or pet therapy, yoga, energy therapies (healing touch, Reiki)
