Autism Spectrum Disorder Flashcards

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1
Q

DSM 5 diagnosis of ASD?

A

Deficits in social - emotional reciprocity
Deficits in nonverbal communicative behaviors used in social interactions
deficits in developing , maintaining, and understanding relationships appropriate to developmental level

Restricted, repetitive patterns of behaviour, interests,
or activities, as manifested by at least two of the
following:
• Stereotyped or repetitive motor movements, use of
objects, or speech.
• Insistence on sameness, inflexible adherence to
routines, or ritualized patterns of verbal or nonverbal
behaviour.
• Highly restricted, fixated interests that are abnormal in
intensity or focus
• Hyper- or hyporeactivity to sensory input or unusual
interest in sensory aspects of the environment

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2
Q

Screening instruments for ASD?

A
  • Social Communication Questionnaire (SCQ)

• Social Responsiveness Scale (SRS)

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3
Q

Tools for diagnostic assessment?

A

Autism Diagnostic Interview – Revised (ADI-R)
• Semistructured parent interview that probes for
symptoms of ASD
• Autism Diagnostic Observation Schedule (ADOS)
– Interactive assessment of ASD symptoms
– Four different modules, graded according to
language and developmental level

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4
Q

Epidemiology of ASD ?

A
Prevalence: 1.85% (1/59)
• Male:female ratio: 4.3:1
• 33% have Intellectual Disability
• 20% develop seizures, usually in early childhood or in
adolescence
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5
Q

Genetics of ASD

A

ibling recurrence rate is 5-10%
• Heritability of ASD is about 90%
• “Unaffected” relatives have increased rates of social,
language, and behavioural problems
• 5%-10% of patients have abnormalities detectable with
clinical microarray

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6
Q

Possible predictors of good outcome with Intensive Behavioral Intervention ?

A

Earlier age of initiation of therapy
– Higher level of intelligence
– Lower levels of ASD symptom severity

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7
Q

Target behaviors for pharmacotherapy in ASD?

A

Aggression
Inattention and hyperactivity
Anxiety / Repetitive Behaviour

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8
Q

Tx - Aggression

A

Haloperidol, risperidone, olanzapine, aripiprazole,
and lurasidone have been shown to be better than
placebo for aggression
Weaker evidence:
SSRI’s
– Numerous open label trials but very few placebo-
controlled RCT’s and none have shown efficacy in
reduction of aggression in children with ASD
– May be beneficial if aggression is associated with
anxiety or depression
• Stimulants
• Strattera
• Anticonvulsants
• Lithium

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9
Q

Co-morbid with ASD?

A

Common comorbid condition for ASD
– Studies suggest at least 50% of children with
ASD also meet criteria for ADHD

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10
Q

Tx of ADHD with ASD?

A

Stimulants
Atomoxetine
Antipsychotics

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11
Q

How can anxiety present when seen in ASD patients?

A

– repetitive and ritualistic behaviour
– phobias
– difficulty with unpredictability

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12
Q

Alternative therapies in ASD

A

Anti-fungal agents
• Homeopathic / naturopathic remedies
• Chelation
• Dietary interventions

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13
Q

Environmental Risk factors for autism?

A

Advanced paternal age
Maternal anticonvulsants - esp teretol
LBW, hypoxia, IVF

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14
Q

What does not improve over time in ASD?

A

No improvement in ritualistic, repetitive behaviors.

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15
Q

Predictors of good outcomes?

A

language skills and IQ>70

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16
Q

Early red flags in ASD?

A

Impaired joint attention

Speech delay cut off: spontaneous 2 word phrases with a verb by 24 months

17
Q

Medical evaluation in ASD?

A
Chromosomal microarray analysis
molecular DNA testing for fragile X
Genetic (PTEN, Rett, Karyotype)
Metabolic testing
EEG
MRI
18
Q

ASD Assessment Tools

A
Screening:
M-CHAT
Social communications questionnaire
ABC -Autism Behavior checklist
Diagnostic Tools:
ADOS-G - Autism Diagnostic Observation-Generic
19
Q

Common medical issues in ASD?

A

Seizures (25-30%)
GI complaints - constipation/encoporesis
GERD

20
Q

Co-morbidy in ASD?

A

ID (25-30%)
ADHD
Motor d/o - developmental coordination disorder

21
Q

What treatment has evidence for repetitive behaviors in children?

A

Risperidone*