Autism Spectrum Disorder

Question 1

ASD Etiology

Answer 1

• Unknown
• Genetic: 35-40%3
  
  • such as Fragile-X or Rett’s syndrome
• Prenatal, perinatal, postnatal factors: 60-65%
• Prenatal
  
  • advanced maternal or paternal age
  • white or Asian male
  • Asian female
  • gestational hypertension or gestational diabetes
  • Exposure to heavy metals and some maternal medications (eg. valproic acid for seizures
• Perinatal
  • C-section
  • GA<36 weeks
  • Breech
  • Pre-eclampsia
• Post-natal
  
  • Low birth weight
  • Brain anomaly
• Vaccines – unfounded
• Symptoms appear after a period

Question 2

Characteristics

Answer 2

• Developmental Disability
• DSM-V category “Autism Spectrum Disorder”
• Categorized in severity from Level 1 (least involved) to Level III (most severe)
  
  • Combined with Asperger, CDO, and PDD-NOS
• 1 in 68 kids
• Males>females (except for Rett
• Group of disorders including impairments in:
  • Communication
  • Social interaction
  • Stereotypical behaviors/repetitive behaviors
    
    • Arm flapping
    • Jumping
    • Rocking
  • Inflexible behavior
  • Sensory integration dysfunction
    
    • Hyper or hypoactive to sensory experiences

Question 3

S/S

Answer 3

• Generally apparent by 18-24 months of age
  
  • (if you know what you are looking for-may be 4yo)
• One early sign is child’s inability to respond when his or her name is called
• Poor eye contact
• Parents may report infant “does not like them,” as child may not like being held
• Developmental delay (e.g., walking)
• Delayed or absent language
• Sleep disorders, seizures, GI issues

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Question 4

“Red flags” for autism in 12- to 18-month-old children: Social communication

Answer 4

• Social communication: reduced or atypical
  
  • Eye gaze and shared or joint attention
  • Sharing of emotion (positive or negative)
  • Social or reciprocal smiling
  • Social interest and shared enjoyment
  • Orienting when name is called
• Regression or loss of social-emotional connectedness

Question 5

“Red flags” for autism in 12- to 18-month-old children: Language

Answer 5

• Language: delayed or atypical
  
  • Babbling, particularly back-and-forth with others
  • Language comprehension and production (eg delayed or odd first words, usually repetitive)
  • Unusual tone of voice
  • Development of gestures (eg pointing or waving
• Regression or loss of communication skills (including words)

Question 6

“Red flags” for autism in 12- to 18-month-old children: Play

Answer 6

• Play: reduced or atypical
  
  • Imitation of actions
  • Functional and imaginative play
  • Excessive or unusual manipulation or visual exploration of toys and other objects
  • Repetitive actions with toys and other objects
  • Intense attachment to a toy or object
  • Lining up toys
  • More interested in how it works

Question 7

“Red flags” for autism in 12- to 18-month-old children: Visual or other sensory and motor skills

Answer 7

• Visual or other sensory and motor skills
• Atypical visual tracking, visual fixation (eg on lights)
• Under or over-reaction to sounds or other forms of sensory stimulation
• Delayed fine and gross motor skills, atypical motor control (eg reduced muscle tone, reduced postural control for age)
• Repetitive motor behaviors, atypical posturing of limbs or digits

Question 8

Pathways to diagnosis and treatment of autism spectrum disorder (ASD).

Answer 8

Question 9

Medications

Answer 9

• Antidepressants, SSRIs for repetitive behavior (Zoloft or Prozac) – questionable effectiveness
• Anticonvulsants to control seizures (Tegretol, Lamicalt, Depakote, Topamax)
• Atypical antipsychotics (Risperidone, aripiprazole)
• Stimulants for hyperactivity/impulsivity (Ritalin)
• Sleep disturbances (melatonin)

Question 10

Medical Management

Answer 10

• Gluten-free, casein-free diet (Defeat Autism Now)
• Applied behavior analysis (ABA)
• Psychological services
• Rehab services and Sensory Integration
• Routine/picture schedules
• Communication (AAC)
  
  • Pictures, symbols, speech generating devices
• Initiate Services ASAP

Question 11

PT Impairments

Answer 11

• May include:
  
  • Gross motor delay
  • Hypotonia
  • Decreased coordination/postural control/clumsy
  • Difficulty with motor planning
  • Toe walking
  • Self injurious behavior (head banging/biting)

Question 12

PT Intervention

Answer 12

• Facilitate motor milestones
• Gait training
• Recommend adaptive equipment or orthotics
• SI rx – OT essential
• Behavior modification
• Patient/family education
• Ensure appropriate MDs involved for dx and rx prn: psychiatry, neurology, genetics

Question 13

Guiding Principles of Effective Intervention

Answer 13

• Early Intervention
• Family Involvement
• Individualized Programming
• Systematic Intervention
• Structured/Predictable Environments
• Functional Approach to Behavior

Question 14

Early Signs (in a nut shell)

Answer 14

• Hand flapping
• Does not respond to name or voice
• No eye contact
• Toe walking
• Repetitive head banging
• Fussy/screaming in public and/or crying for no apparent reason in any setting
• Pouring drinks back and forth
• Biting or aggressiveness
• Repetitive behaviors lasting minutes/hours (jumping/spinning, etc)
• Constant dark circles under eyes