Session Six (Autism) Flashcards
What is the triad of autistic impairments?
- Problems with social reciprocity (affecting the development and maintenance of relationships)
- Problems with language and communication (including difficulties with non-verbal aspects of communication)
- Poor behavioural flexibility
What are some classic presentations of autism?
- Child not speaking or communicating well
- Child not establishing relationships with peers
- Odd, repetitive behaviour and inability too break from a set routine (e.g. can only drink out of a specific cup)
Describe the behaviours linked to Repetition of behaviour displayed by autistic individuals
- Stereotyped or repetitive speech, motor movements or use of certain objects.
- Adherence to routines, ritualised behaviour
- Excessive resistance to change
- Restricted, fixated interests that are abnormal in intensity or focus
- Hyper or Hypo reactivity to sensory input or unusual sensory interest
Outside of the classic triad (repeated behaviours, social difficulties and language deficits), what are some other common features of ASD?
- Movement issues; Poor motor co-ordination including clumsiness, odd gait and posture.
- Sensory issues; Odd responses to sensory stimuli (can be tactile, auditory or visual). Senses either hyper-intense, hypo-intense. Patient may display sensation seeking behaviour. Very classically patients shun people for other forms of visual stimuli.
- Special skills; Some children with ASD have a special skill at a much higher level than the rest of their abilities (for example, art, music, calculations, jigsaw puzzles)
Briefly outline the DSM-5 criteria for an autism diagnosis?
Must meet all 4 criteria:
- Persistent deficits in social communication and social interactions across contexts (must affect reciprocity, maintenance of relationships, nonverbal communications)
- Restricted, repetitive patterns of behaviour/interests/activities (includes repeated speech and movements, adherence to routine, fixated interests, altered reactivity to sensory input)
- Symptoms must be present in early childhood
- Symptoms must limit and impair everyday function
What changes were made to the description of autism in DSM-5?
- Name; renamed as Autism Spectrum Disorders
- Asperger’s now dropped as indistinguishable from autism
- Three domains of disease have become two (communication and social interaction are considered so interlinked they may as well be treated as one)
- Symptoms before age 3 are no longer specified
What behaviour can be seen in small children that may be absent in those with autism?
- Looking at each other
- Mirroring behaviours
- Turn taking
- Emotional range
- Babbling with intonation
Essentially it is important to understand that speaking is not the start of communication development, more of an early milestone following from years of small steps, which may be missed in those with ASDs.
Why might autistic symptoms only present quite late in childhood, since we know communication development begins so young?
Symptoms may not manifest until social demand exceeds capacity.
What are the Specifiers included in the DSM 5 description of autism
Things to include in a diagnosis of autism, allow for the significant variation seen in patients. Include:
- Whether or not it is associated with a known medical or genetic condition
- Whether or not it was associated with an environmental factor
- Pattern of onset (e.g. regression)
- Verbal and general cognitive abilities
- Severity of symptoms in the two main domains
- Other mental, behavioural or neurodevelopment disorders
How do we think of autism in 2019?
- Relatively common condition
- Can be reliably diagnosed by age 2 in some cases
- Outcome is very variable and may depend on treatment
- Spectrum of conditions
- Heritable genetic underpinnings, perhaps with environmental factors influencing
What is meant by the Fractionation of the Triad?
Happe et all 2006:
- Genetics research
- Surprisingly low degree of correlation between social/communication wing of the diagnosis and the repeated behaviours wing.
- Both genetically linked, but little overlap between the genetic influences
What are the two Criteria of ASDs?
A way of describing people with the condition based on the two categories of symptoms, but not a total descriptor.
A = Issues with; Social-Emotional reciprocity, Non-verbal social communication, Reciprocal relationships
B = Issues more with; Repetitive speech and movements or Use of objects, Adherence to routines and rules, Restricted interests, Unusual sensory reactions
(N.B. this leaves out many many symptoms linked to ASDs, including intellectual disability, language level…)
What features are associated with autism?
- Language disability
- Mood disorders
- Hyper-reactivity
- Sleep deficits
- Attention disorders
- Irritability issues such as tantrums, self-injury, aggression..
- Physical symptoms such as GI disorders and immune dysfunction
What is the prevalence of autism in the UK?
About 1% of people in the UK have some sort of ASD
What can explain the apparent rise in autism diagnosis?
- Increased awareness among professionals and parents
- Broadening of the definition, from autism to ASDs.
- Increase in availability of diagnostic services
- Inclusion of children with average IQs
- Use of the diagnosis in previously excluded groups.
Outline some of the evidence linking genetics and autism?
Multiple complex genetic and environmental, as well as gene-environment factors may account for changes in brain development:
- Well established genetic components to ASDs (some inherited, some de novo mutations)
- Most genetic risk lies in common variations
- MZ twin concordance at least 50-60% but some studies suggest its as high as 90%
- 10% chance of developing the condition if you have a sibling with it
- 10-15% of conditions are associated with a known genetic issue (such as Fragile X syndrome, Tuberous sclerosis)
Outline some of the evidence linking environmental causes to autism?
- This body of evidence suggests someone CAN be born with a genetic vulnerability to autism, but the condition will actually only develop if that person is exposed to a specific trigger.
- Suggested environmental triggers include; mother having a viral or bacterial infection in pregnancy (notable rubella), air pollution and pesticides
- Women exposed to rubella have a 7% risk of giving birth to a child with an ASD
- New fathers who are older than 40 are 6 times more likely to father a child with autism
- Severe deprivation may cause autism; Romanian orphanage study.
