SM_103b: Autism Spectrum Disorders

Question 1

Autism spectrum disorder is a disorder of ____

Answer 1

Autism spectrum disorder is a disorder of social development

• Lack of interaction with caregivers
• Lack of eye contact
• Lack of social gestures
• Lack of mentalization and theory of mind
• Lack of social reciprocity in conversation

Question 2

Describe DSM-5 criteria for autism spectrum disorder

Answer 2

Autism spectrum disorder DSM-5

• Persistent deficits in social communication and social interactions across multiple contexts: deficits in social-emotional reciprocity, non-verbal communication, relationships
• Symptoms of restricted and repetitive behaviors and/or stereotypes patterns of interest that are abnormal in their intensity or focus (2)
• Symptoms must be present in early developmental period
• Symptoms cause clinically significant impairment in social, occupational, or other important areas of functioning
• These disturbances are not better explained by intellectual disability (intellectual development disorder) or global developmental delay

Question 3

Describe DSM-5 specifiers for autism spectrum disorder

Answer 3

Autism spectrum disorder DSM-5 specifiers

• Current severity levels (levels 1-3): based on social communication impairments and restricted repetitive patterns of behavior
• With or without accompanying intellectual impairment
• With or without accompanying language impairment
• Associated with known medical / genetic condition or environmental factor: Rett syndrome, Fragile X syndrome, Down syndrome, epilepsy, valproate exposure, Fetal Alcohol Syndrome, very low birth weight
• Associated with other neurodevelopmental, mental, or behavioral disorder
• With catatonia

Question 4

Describe commonly associated symptoms of autism spectrum disorder

Answer 4

Autism spectrum disorder commonly associated symptoms

• Hyperactivity
• Obsessive and compulsive symptoms
• Tics
• Self-injury
• Aggression
• Mood symptoms (anxiety, depression, affective instability)
• Emotional over-reactivity
• Low frustration tolerance
• Intellectual disability (IQ<70) in 40%
• Speech / language disorders
• Gross or fine motor deficits
• Seizure disorders
• Sensory hypersensitivity (avoidant restrictive food intake disorder)

Question 5

Avoidant Restrictive Food Intake Disorder is associated with ____

Answer 5

Avoidant Restrictive Food Intake Disorder is associated with sensory hypersensitivity

Question 6

Screening for autism spectrum disorder involves ____, which assesses ____, ____, and ____

Answer 6

Screening for autism spectrum disorder involves Modified Checklist for Autism in Toddlers, which assesses proto-declarative pointing, proto-imperative pointing, and gaze monitoring

(immediate referral if score>7)

Question 7

____, ____, ____, and ____ are diagnostic tools for uatism spectrum disorder

Answer 7

Autism Diagnostic Interview, Autism Diagnostic Observation Schedule, Childhood Autism Rating Scale, and Social Responsiveness Scale are diagnostic tools for uatism spectrum disorder

Question 8

Describe approach to evaluating autism spectrum disorder

Answer 8

Approach to evaluating autism spectrum disorder

• Parent interview
• Direct observation / interview
• Physical examination
• Speech and language evaluation
• Occupational therapy evaluation
• Psychological testing: cognitive skills, language skills, adaptive functioning, and academic performance
• Additional testing

Question 9

Describe genetic conditions associated with autism

Answer 9

Genetic conditions associated with autism

• Fragile X syndrome
• Tuberous sclerosis
• Down syndrome
• Rett syndrome

Question 10

Describe differential diagnosis for autism spectrum disorder

Answer 10

Differential diagnosis for autism spectrum disorder

• Attention Deficit Hyperactivity Disorder
• Expressive and receptive language disorders
• Very early onset schizophrenia
• Intellectual disability
• Selective mutism
• Social phobia
• Reactive attachment disorder
• Social pragmatic communication disorder

Question 11

Social (pragmatic) communication disorder involves ____ WITHOUT ____

Answer 11

Social (pragmatic) communication disorder involves persistent deficits in social communication and interaction across multiple contexts WITHOUT restricted, repetitive patterns of behavior, interests, or activities

Question 12

Describe comorbidities of autism spectrum disorder

Answer 12

Comorbidities of autism spectrum disorder

• Specific phobia
• OCD
• ADHD
• Separation anxiety disorder
• Major depressive disorder
• Other

Question 13

Describe approach to treatment of autism spectrum disorder

Answer 13

Autism spectrum disorder approach to treatment

• Behavior modification
• Social skills
• Speech therapy
• Occupational therapy
• School interventions: 504 plan / IEP, educational placement, vocational skills training, Prioritization of Urgency for Need for Services
• Treatment for agitation
• Pharmacotherapy for aggression or comorbidities

Question 15

Prognosis of ADHD is ____

Answer 15

Prognosis of ADHD is highly variable

Question 16

Rsik factors for autism spectrum disorder are ____, ____, ____, ____, and ____

Answer 16

Rsik factors for autism spectrum disorder are genetics, maternal and paternal age, grandfathers’ age, extreme prematurity, and close spacing of pregnancies

Question 17

Positive prognostic factors for autism spectrum disorders include ____, ____, ____, and ____

Answer 17

Positive prognostic factors for autism spectrum disorders include normal IQ, mild social disability, involved caregivers, and better language skills