8: Autism Spectrum Disorder

Question 1

DSM-V criteria for diagnosis (4).

Answer 1

1. Persistent deficit in social communication and interaction in several different contexts (lack of reciprocity in interaction, failure to initiate or respond to social interaction).
   A. Deficits in nonverbal communication (eye contact, understanding gestures).
   B. Deficits in developing and understanding relationships, absence of interest in peers.
2. Restricted, repetitive patterns of behavior, interests, or activities (stereotyped movements, fixated interests, hyper- or hyoreactivity to sensory input).
3. Symptoms must be present in early developmental period (may not be fully evident until social demands exceed capacity).
4. Symptoms cause clinically significant impairment in social, occupational, or educational areas.

Question 2

Among identical twins, if one has ASD the other is affected _____% of the time

Answer 2

30-95%

Question 3

What is the standard intervention?

Answer 3

Applied Behavior Analysis (ABA). Early intervention and educational settings.

Question 4

T/F ASD does not improve, but can be managed.

Answer 4

False. Some children do improve. Related to the recent intense services and programming.

Question 5

Are identical or fraternal twins more likely to both have ASD?

Answer 5

Identical

Question 6

On average, parents first become concerned at about _____ months of age but do not seek care until a mean age of _____ months.

Answer 6

19 months

24 months

Question 7

How early can ASD be diagnosed?

Answer 7

12 months if parents and providers are alert or if the symptoms are severe. Difficult to diagnose before 9 months because symbolic language skills (i.e., pointing) are just developing. Also difficult because some children experience a regression following normal early development.

Question 8

T/F There is a racial disparity in diagnosis of ASD.

Answer 8

True. Diagnosis age averages 6 for whites and 7 for AAs.

Question 9

Parents with one child with ASD, have a _____% risk of having a second affected child.

Answer 9

2-18%

Question 10

T/F Diagnosis is made by clinical observation.

Answer 10

True. Based on behaviors.

Question 11

What are red flags for ASD (5)?

Answer 11

1. No babbling by 12 months.
2. No pointing/gestures by 12 months.
3. No single words by 16 months.
4. No 2-word spontaneous utterances by 24 months.
5. Loss of any language or social skills at any age.

Question 12

T/F There is a delay of about 1 year from presentation of first concern to receiving a diagnosis.

Answer 12

True. Parents are often told to wait and see and not to worry.

Question 13

Prognosis is much more favorable if diagnosed before age _____.

Answer 13

5

Question 14

T/F ASD is an emotional disorder.

Answer 14

False. It is a brain disorder.

Question 15

T/F Early intervention, diagnosis, and management are critical.

Answer 15

True

Question 16

T/F Children with ASD also have IDD.

Answer 16

Not necessarily true. Originally thought that 70% of children with autism had IDD.

Question 17

Is ASD more common in males or females?

Answer 17

Males (5x)

Question 18

In nonidentical twins, the other is affected _____% of the time.

Answer 18

0-31%

Question 19

What testing might you order to r/o other issues before diagnosing ASD (7)?

Answer 19

1. Sensory (eyes/ears)
2. Lead
3. Chromosomal/DNA
4. FISH
5. Metabolic (amino acids, mitochondrial metabolism)
6. EEG (seizures)
7. MRIs/other imaging (focal neurological findings)

Question 20

What is the standardized screening tool for ASD and when should it be done?

Answer 20

M-Chat at 16 and 30 months, but do developmental screenings during all well child checks.

Question 21

T/F Immunizations can contribute to ASD.

Answer 21

False. Etiology is unknown, but likely multifactorial. Genetics, viral infections, environmental factors, and allergies are considered.

Question 22

Which country has a high prevalence of ASD?

Answer 22

South Korea (2.6% compared to global average of 1%).