Autism Flashcards
What is Autism?
ICD 10 groups autism under pervasive developmental disorders: a group of disorders
characterised by qualitative abnormalities in reciprocal social interactions and in
patterns of communication and by a restricted, stereotyped, repetitive repertoire of
interests and activities. These abnormalities are a pervasive feature of the
individual’s functioning in all situations
How common is autism?
Affects 1 in 1000 children
Male: female ratio is 4:1
What is Childhood autism?
defined by abnormal/impaired development that is
manifest before the age of 3 and characteristic type of abnormal functioning in
all three areas of psychopathology (reciprocal social interaction,
communication and restricted, stereotyped, repetitive behaviour). In addition,
a range of other nonspecific problems are common e.g. phobias,
sleeping/eating disturbances, temper tantrums and (self-directed) aggression
What is atypical autism?
differs from childhood autism either in age of onset or in
failing to fulfil all three sets of diagnostic criteria
What is Rett syndrome?
a condition, so far only found in girls, in which apparently
normal early development is followed by partial/complete loss of speech and
of skills in locomotion and use of hands, plus deceleration in head growth,
usually with onset between 7-24 months age.
Loss of purposive hand movements, hand-writing stereotypes and
hyperventilation are characteristic
Social and play development are arrested but social interest tends to be
maintained
Trunk ataxia and apraxia start to develop by age 4 yrs and
choreoathetoid movements frequently follow
Severe mental retardation almost always results
What is Asperger’s syndrome?
similar features to autism with impaired communication
and reciprocal interaction but no general delay in language or cognitive
development. Often associated with marked clumsiness, but most have normal
IQ
o Oth
What are the RFs of Autism?
o A sibling with autism
o Birth defects associated with CNS malformation and/or dysfunction including
cerebral palsy
o Gestational age < 35 weeks
o Parental schizophrenia-like psychosis or affective disorder
o Learning disability
o ADHD
o Neonatal encephalopathy or epileptic encephalopathy, including infantile
spasms
o Chromosomal disorders e.g. Down’s
o Genetic disorders e.g. fragile X, phenylketonuria
o Muscular dystrophy
o Neurofibromatosis
o Tuberous sclerosis
What is the aetiology of autism?
o No single cause: genetic and environmental interaction
o Twin studies: MZ twin concordance rate 36-60%
o Psychological theories of autism -> the thought that autism is linked with
cognitive dysfunction
Autism associations
o Increased rates of affective disorders in family members
o Increased rates of anorexia nervosa
o If ASD and Fragile X -> higher rates of schizoaffective disorder
o ADHD in 30%
o High prevalence rates of epilepsy in ASD
20% of ASD have non-febrile seizures under age 3
15-20% develop seizures during adolescence
What is the autism triad?
o Communication abnormalities
o Reciprocal social interaction difficulties
o Restricted, repetitive and stereotypic patterns of behaviour
What communication abnormalities occur in autism?
o Verbal aspects
Expressive speech and comprehension delayed/minimal
Speech may consist of monologue, interminable questions and
echolalia
Stereotyped, repetitive speech e.g. stereotypes utterances, inappropriate
questions
Lack of chit-chat
o Non-verbal
Ideas taken literally (concrete thinking)
Gestures usually absent e.g. pointing, waving goodbye
What are the Reciprocal social interaction impairments in autism?
o Not interested in people impaired reciprocal interaction i.e. not always
thinking about other person in conversation
o Tend to play alone, failure to develop peer relationships
o Miss social emotional cues e.g. picking up on facial gestures
o Lack ability to read emotional states of others
o Attachments are impoverished
o Do not tend to turn to parents for comfort
o Eye contact may be odd (avoidant or looking ‘through’ you)
o Lack ‘theory of mind’ i.e. unable to accurately predict what others may be
thinking
Tested via ‘Sally Anne
test
What are the stereotypic behaviours?
o Tendency to not use objects in intended functional fashion
o Lack of imaginative play
o Unusual sensory interests
o Stereotyped motor mannerisms
o Adherence to non-functional routines/rituals -> small changes in routine can result in intense tantrums
How do you diagnose and assess autism?
Early Identification
Clinical assessment
Referral to autism team for assessment
Autism diagnostic assessment
Diagnostic tools for autism:
o Autism diagnosis observation schedule (ADOS-2)
o Autism diagnostic interview-revised (ADI-R)
o Diagnostic interview for social and communication disorders (DISCO)
o The developmental, dimensional and diagnostic interview (3di)
o Checklist for Autism in toddlers (CHAT)
What is the management of autism?
MDT biopsychosocial approach Interventions for challenging behaviour (incl. psychosocial) Pharmacological Life skills intervention Sleep problem support Social support
What are the psychosocial interventions in autism?
First-line for challenging behaviour
Specific programmes include:
Applied behavioural analysis (ABA): a behavioural
programme for treating young children (aged 2/3 years at start
of intervention). Use of a reward system to lessen impact of
either repetitive behaviours or overactivity
Early Start Denver Model (ESDM)
More Than Words (Hanen programme): for children < 6
years with difficulties in social interaction and communication
