Week 4 - Autism, ADHD, Personality disorders Flashcards
What is in the triad of autism symptoms?
- Communication (cannot sustain conversation)
- Social Interaction (e.g. avoids eye contact)
- Activities / Interests (narrow interests, preoccupied by one)
What is a rare genetic condition that may look like autism when in the regressive stage of disease?
Rett Syndrome
What are some direct observational tests that can be done on children with suspected ASD?
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Direct:
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ADOS 2 - Autism Diagnostic Observational Schedule – 2
- semi-structured, standardised assessment tool that uses play and interview to examine communication, social interaction, imagination and restricted and repetitive behaviours.
- Sally-Anne test
- Evaluates theory of mind
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ADOS 2 - Autism Diagnostic Observational Schedule – 2
What are some tests that can be done with the primary caregiver by an experienced clinician to assess i) existence of ASD and ii) needs of individual
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Autism Diagnostic Interview Revised – ADI-R
- an experienced clinical interviewer questions a parent or caregiver who is familiar with the developmental history and current behaviour of the individual being evaluated.
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Diagnostic Interview for Social and Communication Disorders (DISCO)
- is a semi structured interview schedule used with the parent or carer of an individual to elicit a broad picture of the individual’s behaviours and needs.
What are 3 medical treatments of ASD?
Medication – Used as adjuncts to psychological interventions
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Second generation antipsychotics – first line pharmacological treatment for children and adolescents with ASD and associated irritability.
- Risperidone is the only licensed medication in the UK and it can be used for aggressive, challenging behaviour in autistic children.
- SSRIs – mainstay of treatment of restricted repetitive behaviours, but evidence limited. Require lower doses than needed for antidepressant effects.
- Melatonin can help to reduce sleep latency (time it takes to fall asleep).
What are some forms of psychotherapy available for patients with ASD and families?
Psychotherapy
for both parents and the autistic patient
- CBT
- Behaviour management programmes
- Applied Behavioural Analysis program: an intense program [40 hours a week for 3 years] based on operant conditioning, imitation and reinforcement
- TEACCH – Treatment and Education for Autistic and related Communication Handicapped Children program – based on the belief that children are motivated to learn language, this has been successful in reducing self injurious behaviour, and enhancing life skills.
- Educational psychology
OSCE
explain autism in a few sentences
- “as if your child’s brain has been wired up in a different way to usual”
- “autism is not a shell around them – it is part of them”
- makes them experience the world differently; this leads to certain behaviours such as…
OSCE
What are the behaviours at home and at school?
- Make friends?
- Do they understand emotions?
- Do they like to make eye contact? Abnormal body postures e.g. tiptoe walking
- No clear social cues? Will they wait their turn?
- Special narrowed interests? E.g. jigsaws. Cannot talk details about other topic apart from their interest (won’t let you talk about you your interest)
OSCE
Do they have flexibility of thought? Or theory of mind?
Flexibility of thought
- Imaginative or repetitive play?
- Mannerisms – e.g. flapping
- How do they cope with change? Environment – crowds?
- Any routines or obsessions or rituals? Eg around food – certain way
Theory of mind - Sally-Anne test
OSCE
How is their language and communication?
Language and communication
- Can they have a 2 way conversation
- Pitch, tone, content
- Gestures while communicating
- Echolalia (repeating last few words – could be understanding)
OSCE
What are the sensory features you would ask for?
Sensory features
- Problems with loud noises, textures, water
- Sensory seeking or avoiding behaviours
OSCE
What is relevent in their behavioural history?
Behavioural History
- Temper problems? Meltdowns? Problems having to wait
- Obsessions, fears and phobias
OSCE
What common comorbidities should be looked for?
Co-morbidities
- ADHD
- Dyspraxia
- Intellectual disability
- Tics
- Dyslexia, dyscalculia
- Seizures
OSCE
What should be asked in Birth and development history?
Birth history
- Antenatal – alcohol, drugs, smoking, illness
- Perinatal
- Delivery
- LBW
- Postnatal problems
Developmental history
- Gross motor or fine motor
- Hearing, speech and language
- Regression of speech is a red flag!!
- Social interaction and play
OSCE
What should be asked for in FH?
Family history
- Consanguinity
- Developmental / learning problems
- Epilepsy and fits
- Alcohol, drugs, DV, parents were in care
- Attachment difficulties can be confused with ASD
- Skewed view of relationships from lack of close relationship with caregiver
