Week 12- Autism Flashcards
What is the definition for Autism Spectrum Disorder?
Group of developmental disabilities that can cause significant social, communication and behavioural challenges.
What is the Autism triad?
Social interaction
Activities and interests
Communication
What is the stereotyped behaviour associated with Autism?
Repetitive or ritualistic movement, posture or utterance.
Rigidly following routines
What are characteristic movements of Austism (6)?
Rocking/banging head Finger/flicking near eyes Hand flapping Facial grimaces Jumping Toe walking
What are features of Autism (13)?
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
What do children with ASD need?
Specialised educational help with as much integration as possible.
Child needs to be recognised as having special needs.
What is the possible aetiology of Autism?
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
How is ASD diagnosed?
2 steps:
- Developmental screening
- Comprehensive diagnostic evaluation (if 1st test picks up any abnormality)
What are early signs and symptoms?
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.
What are characteristics of ADHD?
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.
How is ASD different from ADHD?
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.
What medication is prescribed for ADHD vs ASD
ADHD: Ritalin
ASD: only for certain aspects- difficulty sleeping. Last resort after behaviour intervention failed.
How are ASD and ADHD similar?
Problems escalate with increased demand.
Is ASD and ADHD more common in males or females?
Males
What is theory of mind?
Ability to understand and predict behaviour or emotion of others.
People with ASD have difficulty predicting other people’s emotions.
What other condition is ASD commonly associated with?
Epilepsy
What are the 4 forms of ASD?
Autistic disorder
PDD-NOS
Childhood disintegrative disorder
Asperger’s syndrome
How does Autistic Disorder differ from the other 3 ASD syndromes?
More social activity, higher empathy and greater interaction
How does PDD-NOS compare to the other 3 ASD syndromes?
Moderate social activity, empathy and interaction
How does Childhood Disintegrative Disorder compare to the other 3 ASD syndromes?
Late onset of developmental delays in language, social function & motor skills. More severe sensory processing disorder but less severe cognitive problems.
How does Asperger’s Syndrome compare to the other 3 ASD syndromes?
Relatively normal language, skills and intelligence but having poor social skills and decreased ability to show empathy.
What are some tips for managing ASD patients in a dental setting?
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)
What are some sensitivities and fears of ASD pts in the dental clinic?
Texture (cotton rolls, dam)
Scent (office, materials, gloves, you)
Noise (drill, phone)
Clothing (tags, seams)
What 3 disorders can have similar symptoms to ASD?
Prader-Willi syndrome
Rett syndrome
Fragile X syndrome
What is the main therapy for ASD pts?
Early psycho-social interventions geared towards:
- social skills
- speech
- behaviour management
Drugs only used for severe cases
What pharmacological therapies can be used to treat ASD?
Antipsychotics Antidepressants Anticonvulsants Benzos Stimulants Antihypertensives
Antipsychotics for ASD pts
- example
- indication
- side effects
- 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
Antidepressants for ASD pts
- example
- indication
- side effects
- 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.
Anticonvulsants for ASD pts
- example
- indication
- side effects
- Carbamazepine, valproate, phenytoin
- Primarily for aggression, mood swings and seizures
- Risk or leukopenia, thrombocytopenia, excessive bleeding with Aspirin, inc clearance of drugs
Antihypertensives for ASD pts
- example
- indication
- side effects
- Clonidine
- Control of inattention, impulsiveness, irritability and hyperacitivty.
- Side effects: potentiate CNS depression of other CNS depressants used in dent.
Stimulants for ASD pts
- example
- indication
- side effects
- 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.
Benzodiazepine for ASD pts
- indication
- side effects
- Management of anxiety, insomnia and agitation.
- Side effects: drowsiness, dizziness, GI upset, blurred vision, depression, impaired coordination, jaundice, trembling, dependence.
What are adjunctive/alternative therapies for ASD?
Acupuncture Massage Electroconvulsive therapy Hyperbaric oxygen therapy Music
What should you do prior to appt with ASD pt (5)?
Obtain med hx Discuss management strategies with carer Ask carer level of tolerance Who gives consent? Need for chemical restraints?
What should be done at the dental appt with ASD pt?
Should not be kept waiting Short, regular appts Desensitising appts Keep instructions brief and simple Be consistent Minimise distractions Tell-show-do
Is GA recommended for ASD pts?
Should be kept to minimum as sudden change in routine may be upsetting.
What are oral issues of ASD (7)?
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.
What are recommendations for dental care for pts with ASD?
Staged introduction of dental setting
Close coordination with carer regarding pts behavioural managment therapy
What are some issues with managing more severe ASD pts?
Issue of consent if they have poor cognitive abilities.
Motor function may be impaired- OH maintenance issues.
What are some issues with managing more severe ASD pts?
Issue of consent if they have poor cognitive abilities.
Motor function may be impaired- OH maintenance issues.
What are the characteristics of Rett Syndome?
- 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.
What are oral issues of Rett Syndrome?
Severe bruxism during waking hours.
Inadequate nutrition, GORD, irregular breathing
Self-abusive behaviour
Seizures
What are characteristics of prader-willi syndrome
- 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
What are oral issues of Prader-Willi Syndrome
Rampant caries
Reduced saliva flow
Delayed tooth eruption
They don’t have same responses to pain so dental disease can go undetected.
What are characteristics of Fragile X syndrome?
- 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%)
