Autism Spectrum Disorders

Question 1

What are the 3 main features in ASD?

Answer 1

CSS

1. Communication
   - impairment or delay in language skills
   - impairment in non-verbal communication (restricted range of facial expressions, poor eye contact, difficulty interpreting the facial expressions or gestures of others)
2. Social
   - lack of social reciprocity, and the ability to have a two way back and forth conversation
   - difficulty developing peer relationships
   - lack of interest in interacting with others
3. Stereotypies
   - repetitive rituals and behaviours that are quote inflexible
   - restricted interests
   - physical behaviours such as hand flapping, spinning

Question 2

What causes ASDs?

Answer 2

• Atypical brain development
• Appears to be highly heritable but not linked to any specific genetic syndromes
• Risk factors: higher age of mother and father, complications during pregnancy (pre-eclampsia, gestational diabetes), medications during pregnancy (valproate), infections (rubella)
• Likely an interplay between genetics and the environment
• Studies have not been conclusive about the environmental factors

Question 3

What is the gender ratio for ASD?

Answer 3

Male:female 4:1

Question 4

How would you screen for ASD?

Answer 4

1. Parental concerns about child’s development and behaviour
2. Family history of ASD
3. Questionnaires (M-CHAT, CAST)

Refer for comprehensive evaluation if any of the above.

Question 5

What is the M-CHAT?

Answer 5

Modified Checklist for Autism in Toddlers
16-30 months
High sensitivity and specificity

Question 6

What is the CAST?

Answer 6

Childhood Asperger Syndrome Test

Question 7

How is ASD diagnosed?

Answer 7

• Diagnosis usually made by a specialist developmental paediatrician or child psychiatrist
• Direct observation and rating scales (CARS2, ASRS, ADI-R)
• MDT may be useful: cognitive skills (neuropsychologist), language skills (speech therapist), behavioural and other skills (psychologist, OT)

Question 8

What is the ADI-R?

Answer 8

Autism Diagnostic Interview Revised

Question 9

Management of ASDs?

Answer 9

• Early intervention critical
• Treatment involves a co-ordinated MDT approach: speech and language therapy, social skills therapy, applied behavioural analysis, occupational therapy, sensory integration therapy
• Involve the family, psycho-education
• Medications in some situations as an adjunct to behavioural interventions (SSRIs, atypical antipsychotics) however there are significant risks and limited research

Question 10

When are signs of autism first observed?

Answer 10

1.5-3yrs

Question 11

What myths that are not true about the cause of autism?

Answer 11

• Vaccines
• Diet
• Upbringing

Question 12

Which medications are shown to have some effect in children with autism?

Answer 12

Risperidone, SSRIs, stimulants and anticonvulsants