Week 12- Autism

Question 1

What is the definition for Autism Spectrum Disorder?

Answer 1

Group of developmental disabilities that can cause significant social, communication and behavioural challenges.

Question 2

What is the Autism triad?

Answer 2

Social interaction
Activities and interests
Communication

Question 3

What is the stereotyped behaviour associated with Autism?

Answer 3

Repetitive or ritualistic movement, posture or utterance.

Rigidly following routines

Question 4

What are characteristic movements of Austism (6)?

Answer 4

Rocking/banging head
Finger/flicking near eyes
Hand flapping
Facial grimaces
Jumping
Toe walking

Question 5

What are features of Autism (13)?

Answer 5

Range in intelligence
Physically normal (may have difficulties)
Inability to relate to ppl (reduced social skills)
Unable to interpret language
May dislike physical contact
Lack of eye contact
Lack of response
Variable ability to form emotional relationships
Usually immersed in activity that interests them
Attuned to routine & lists
Abnormal facial perception
Selective attention
Altered sensory perception

Question 6

What do children with ASD need?

Answer 6

Specialised educational help with as much integration as possible.
Child needs to be recognised as having special needs.

Question 7

What is the possible aetiology of Autism?

Answer 7

Genetics (chromosome 15 & 17)
Neuro-pathology of the brain
Parental conditions (maternal nutritional deficiencies)
Systemic disorders
Oxidative stress
High testosterone levels
Metallic elements, esp mercury

Question 8

How is ASD diagnosed?

Answer 8

2 steps:

1. Developmental screening
2. Comprehensive diagnostic evaluation (if 1st test picks up any abnormality)

Question 9

What are early signs and symptoms?

Answer 9

No big smiles
No back and forth sharing of sounds or facial expressions by 9 months
No babbling by 12 months
No back and forth gestures (waving, pointing) by 12 months
No words by 16 months
Any loss of speech, babbling or social skills at any age.

Question 10

What are characteristics of ADHD?

Answer 10

Disorder of DOING- they know what to do but can’t manage to do it.

Impulsive
Hyperactive
Poor mood regulation
Easily distracted
Can't sort out what to attend to.

Question 11

How is ASD different from ADHD?

Answer 11

Not impulsive
Not hyperactive
Mood regulation
Able to focus on task if they like it. 
Can't sort out what to attend to if too many verbal instructions.

Question 12

What medication is prescribed for ADHD vs ASD

Answer 12

ADHD: Ritalin
ASD: only for certain aspects- difficulty sleeping. Last resort after behaviour intervention failed.

Question 13

How are ASD and ADHD similar?

Answer 13

Problems escalate with increased demand.

Question 14

Is ASD and ADHD more common in males or females?

Answer 14

Males

Question 15

What is theory of mind?

Answer 15

Ability to understand and predict behaviour or emotion of others.
People with ASD have difficulty predicting other people’s emotions.

Question 16

What other condition is ASD commonly associated with?

Answer 16

Epilepsy

Question 17

What are the 4 forms of ASD?

Answer 17

Autistic disorder
PDD-NOS
Childhood disintegrative disorder
Asperger’s syndrome

Question 18

How does Autistic Disorder differ from the other 3 ASD syndromes?

Answer 18

More social activity, higher empathy and greater interaction

Question 19

How does PDD-NOS compare to the other 3 ASD syndromes?

Answer 19

Moderate social activity, empathy and interaction

Question 20

How does Childhood Disintegrative Disorder compare to the other 3 ASD syndromes?

Answer 20

Late onset of developmental delays in language, social function & motor skills. More severe sensory processing disorder but less severe cognitive problems.

Question 21

How does Asperger’s Syndrome compare to the other 3 ASD syndromes?

Answer 21

Relatively normal language, skills and intelligence but having poor social skills and decreased ability to show empathy.

Question 22

What are some tips for managing ASD patients in a dental setting?

Answer 22

Avoid discussing anything fear related until child is old enough to realise it’s not going to hurt them.
Say things literally (don’t use analogies)

Question 23

What are some sensitivities and fears of ASD pts in the dental clinic?

Answer 23

Texture (cotton rolls, dam)
Scent (office, materials, gloves, you)
Noise (drill, phone)
Clothing (tags, seams)

Question 24

What 3 disorders can have similar symptoms to ASD?

Answer 24

Prader-Willi syndrome
Rett syndrome
Fragile X syndrome

Question 25

What is the main therapy for ASD pts?

Answer 25

Early psycho-social interventions geared towards: - social skills - speech - behaviour management Drugs only used for severe cases

Question 26

What pharmacological therapies can be used to treat ASD?

Answer 26

``` Antipsychotics Antidepressants Anticonvulsants Benzos Stimulants Antihypertensives ```

Question 27

Antipsychotics for ASD pts - example - indication - side effects

Answer 27

- Risperidone - indicated for pts with severe irritability, aggression and mood disorders. - side effects: weight gain, tardive dyskinesia, sialorrhea, inc sedation of other CNS depressants, thrombocytopenia, hypotension

Question 28

Antidepressants for ASD pts - example - indication - side effects

Answer 28

- SSRI - indicated for management of fear anxiety, depressions, desire for sameness, repetitive thoughts and behaviour. - Side effect: drowsiness, xerostomia, dysgeusia, anxiety, insomnia, dec appetite, tardive dyskinesia, diarrhea. Can potentiate benzos.

Question 29

Anticonvulsants for ASD pts - example - indication - side effects

Answer 29

- Carbamazepine, valproate, phenytoin - Primarily for aggression, mood swings and seizures - Risk or leukopenia, thrombocytopenia, excessive bleeding with Aspirin, inc clearance of drugs

Question 30

Antihypertensives for ASD pts - example - indication - side effects

Answer 30

- Clonidine - Control of inattention, impulsiveness, irritability and hyperacitivty. - Side effects: potentiate CNS depression of other CNS depressants used in dent.

Question 31

Stimulants for ASD pts - example - indication - side effects

Answer 31

- Ritalin - Dec hyperactivity and impulsivity, improve alertness and concentration. - Side effects: anorexia, rebound depression & anxiety, insomnia, tachycardia, risk of thrombocytopenia, leukopenia, aneamia. Also risk of hypertensive episode with IV injection of LA with vasoconstrictor.

Question 32

Benzodiazepine for ASD pts - indication - side effects

Answer 32

- Management of anxiety, insomnia and agitation. - Side effects: drowsiness, dizziness, GI upset, blurred vision, depression, impaired coordination, jaundice, trembling, dependence.

Question 33

What are adjunctive/alternative therapies for ASD?

Answer 33

``` Acupuncture Massage Electroconvulsive therapy Hyperbaric oxygen therapy Music ```

Question 34

What should you do prior to appt with ASD pt (5)?

Answer 34

``` Obtain med hx Discuss management strategies with carer Ask carer level of tolerance Who gives consent? Need for chemical restraints? ```

Question 35

What should be done at the dental appt with ASD pt?

Answer 35

``` Should not be kept waiting Short, regular appts Desensitising appts Keep instructions brief and simple Be consistent Minimise distractions Tell-show-do ```

Question 36

Is GA recommended for ASD pts?

Answer 36

Should be kept to minimum as sudden change in routine may be upsetting.

Question 37

What are oral issues of ASD (7)?

Answer 37

Epilepsy meds can cause gingival hyperplasia, delayed eruption. Trauma- head banging, falls, accidents, seizures assoc w/ epilepsy Oral habits- self mutilation, lip/cheek biting, pica. Bruxism GORD- erosion Dental caries- cariogenic foods as reward for behavioural managment Periodontal disease- poor OH, poor compliance.

Question 38

What are recommendations for dental care for pts with ASD?

Answer 38

Staged introduction of dental setting | Close coordination with carer regarding pts behavioural managment therapy

Question 39

What are some issues with managing more severe ASD pts?

Answer 39

Issue of consent if they have poor cognitive abilities. | Motor function may be impaired- OH maintenance issues.

Question 39

What are some issues with managing more severe ASD pts?

Answer 39

Issue of consent if they have poor cognitive abilities. | Motor function may be impaired- OH maintenance issues.

Question 40

What are the characteristics of Rett Syndome?

Answer 40

- Neurodevelopmental disorder - Females affected mostly (affected males don't survive) - Normal growth in first 6-30months, then retardation in rate of cranial growth, extreme aggitation, involuntary movements, loss of previously acquired skills. - Prominent feature: intense staring to obtain eye communication.

Question 41

What are oral issues of Rett Syndrome?

Answer 41

Severe bruxism during waking hours. Inadequate nutrition, GORD, irregular breathing Self-abusive behaviour Seizures

Question 42

What are characteristics of prader-willi syndrome

Answer 42

- Genetic disorder - Equal gender distribution - Inc appetite, intellectual disability, physical inactivity, dec pain sensitivity, disturbed thermal perception, speech difficulties. - Morbid obesity and issues associated with this. - Short stature, delayed sexual development - Definable psychiatric issues

Question 43

What are oral issues of Prader-Willi Syndrome

Answer 43

Rampant caries Reduced saliva flow Delayed tooth eruption They don't have same responses to pain so dental disease can go undetected.

Question 44

What are characteristics of Fragile X syndrome?

Answer 44

- Genetic disorder - Males affected more severely than females - Intellectual disability, behavioural deficits similar to autism - Dolichofacial, prominent ear & forehead, prognathic md, narrow palate, dec adult stature. - Mitral valve prolapse (50%)- may require AB prophylaxis. - Recurrent otitis media & sinusitis - GORD - Seizures (20%)