Community: Autism Spectrum Disorder

Question 1

What percentage are male?

Answer 1

75%

Question 2

Before what age does it usually develop?

Answer 2

3 years old

Question 3

What are the 3 main features?

Answer 3

1) Impairment of language and communication
2) impairment of social relationships
3) restrictive or repetitive behaviour/ interests/ activities

Question 4

What should you look for with regards to social communication and interaction?

Answer 4

Social reciprocity (how child responds to others)
Joint attention - does the child want to share an interest?
Non verbal communication - can this be interpreted and used themselves?
Social relationships - is there trouble developing these or maintaining them?

Question 5

What are some examples of restrictive or repetitive behaviours?

Answer 5

Lining up toys
Flapping hands
Imitating words or phrases and repeating them 
Fixed routine 
Restrictive thinking, specific knowledge

Question 6

What behaviours can be observed?

Answer 6

Poor eye contact
Not responding to their name 
Not smiling when you smile at them 
Head banging
Teeth grinding
Rocking

Question 7

Does each child have a unique spectrum of symptoms?

Answer 7

Yes - variance in severity of deficits

Question 8

What causes ASD?

Answer 8

Genetic - affects brain development in specific areas related to social interactions and communication (the specific affected genes unknown)
No clear environmental risk factors identified

Question 9

Is there a cure?

Answer 9

No

Question 10

What treatment is there?

Answer 10

Education programmes 
Behaviour therapy 
Psychological therapy 
Support networks - child, parents, siblings 
Acknowledge strengths

Question 11

Treatment should be tailored to each child - true or false?

Answer 11

True

Question 12

Do most children with ASD have a decreased IQ?

Answer 12

Yes

Question 13

What differentials are there?

Answer 13

Expressive and receptive language disorders
Rett syndrome (females)
Fragile X 
CNS development abnormalities 
Tuberous sclerosis

Question 14

Autism may be missed in…

Answer 14

Those with learning disability
Those who are verbally able
Under diagnosed in girls
Looked after children or those in criminal justice system - important information about early development may not be readily available

Question 15

ASD affects approximately what percentage of children?

Answer 15

1%

Question 16

What comorbid comditions is it associated with?

Answer 16

Neurodevelopmental conditions: ADHD, epilepsy, learning difficulties 
Anxiety
Sleep problems
OCD
Dyspraxia - problems with coordination
Eating disorders
Oppositional defiant disorder 
Tics / Tourette’s

Question 17

The symptoms need to occur in more than one environment. True of false?

Answer 17

True

Question 18

What does sensory processing difficulties mean?

Answer 18

Can get very upset if they do not like certain taste, smell or sounds
Can lead to problems with self care e.g may refused to have hair cut of brushed or only eat certain foods - anaemia or obesity

Question 19

Autism can be different in girls and boys. How may autistic girls present?

Answer 19

Quieter
Hide feelings
Appear to cope better with social situations

Question 20

Children with ASD can have difficulties with social imagination. What does this mean?

Answer 20

Unable to act out stories e.g with a toy

Question 21

How can the family be impacted?

Answer 21

Stressful looking after challenging behaviour
Financial - may have to give up work to look after child
Social restriction

Question 22

Why can someone with ASD be at risk of abuse?

Answer 22

Difficulties with social interaction can mean they are easily manipulated or bullied by others
Difficulty interpreting intentions of others
Communicating experiences difficult

Question 23

What questionnaire can be used as a screening tool for autism?

Answer 23

Gilliam Autism Rating Scale (GARS)
Usually sought from more than one source e.g home, nursery or school to show evidence that the core problems are truly pervasive

Also: the Autism Diagnostic Observation Schedule (ADOS) - used in diagnosis (tasks and observations focused on the social and communication behaviours)

Question 24

What type of assessment is considered best practice when giving a diagnosis of autism?

Answer 24

Multi professional assessment

Question 25

What additional information would be helpful before considering a potential diagnosis?

Answer 25

``` Educational psychologist assessment Family history of autism Parental view about diagnosis School report SALT assessment ```

Question 26

Why is an educational psychology assessment important?

Answer 26

Build a picture of child’s difficulties Give opinion about any early life difficulties or developmental trauma contributing to child’s current social/ behavioural presentation Carry out assessment of cognitive abilities to identify comorbid learning difficulties

Question 27

Having a full sibling with a diagnosis of autism increases risk of ASD by how much?

Answer 27

``` 10 fold (compared to background population) Having a cousin with autism increases risk 2x ```

Question 28

Why is a SALT assessment vital?

Answer 28

Needed whenever there is concerns about a child’s understanding or use of language Can give opinion about child’s functional and use of language to communicate

Question 29

Does it affect all ethnicities equally?

Answer 29

Yes

Question 30

When do the problems typically become most apparent?

Answer 30

Often when child joins a new nursery / school | Some may be easier to identify, while others may take longer for a clear diagnosis to be made

Question 31

Can overall intelligence vary?

Answer 31

Yes from severe learning difficulties to gifted - often with special talents

Question 32

Is the separation of Aspergers and autism still used?

Answer 32

No - separate diagnosis seen as less helpful and the term ASD generally used

Question 33

Is there an absolute absence of social skills?

Answer 33

No - the difficulties are relative

Question 34

Children with ASD often have difficulty engaging with those around them. Give an example..

Answer 34

They may not join in with group activities in school

Question 35

What does a reduced sense of shared enjoyment mean?

Answer 35

E.g not laughing at the things other children of their age may find funny

Question 36

Children with ASD may have reduced empathy towards emotions. True or false?

Answer 36

True e.g not understanding why another child cries when they fall over

Question 37

What are some typical features associated with speech and communication problems?

Answer 37

Delay in development of expressive language - say few or no words Less response when name called Repetition of phrases - may answer question by repeating question Difficulty using speech in socially accepted way e.g taking turns Limited use of everyday gestures e.g pointing and facial expressions Difficulty forming meaningful sentences e.g giving coherent account of ideas

Question 38

Are restricted and repetitive behaviours unique to ASD?

Answer 38

No - many seen in most children at some stage in their development Children with ASD tend to display these features with increased duration and rigidity

Question 39

Give some examples of fixed, repetitive rituals

Answer 39

Preference for sameness - repeating activities e.g lining up toys Fixed routines Fixed rituals Stereotypical behaviours e.g hand flapping, walking in circles Unusual interests

Question 40

What are some examples of sensory issues?

Answer 40

Hug from stranger Scratchy label in clothing A police siren Hypersensitivity to sound and touch

Question 41

What parts of the brain are affected?

Answer 41

Prefrontal cortex - role in controlling complex social behaviours Temporal lobes - role in understanding language and sensory input Cingulate cortex - role in emotional processing and subsequent behaviour

Question 42

What conditions are associated with an increased prevalence of ASD?

Answer 42

Congenital insults to CNS e.g cerebral palsy, effects of extreme prematurity Chromosomal disorders - Down syndrome, fragile X, tuberous sclerosis Neonatal epileptic conditions Muscular dystrophy Neurofibromatosis

Question 43

If a person has a sibling with ASD, what is there risk of having it?

Answer 43

15-30 x greater chance

Question 44

Is it true that many children with ASD do not have any known FH of developmental problems?

Answer 44

Yes Multiple genetic mutations can occur randomly to cause ASD and other changes are epigenetic - changes to way gene expressed, not change to gene itself

Question 45

What factors could alter the way a gene is expressed?

Answer 45

Toxins | Developmental stressors - severe neglect, in utero exposure to AEDs, effect of migration

Question 46

MDT assessment and management is important. Who is involved?

Answer 46

Paediatrician or child and adolescent psychiatrist SALT Educational/ clinical psychologist

Question 47

Is it a pervasive disorder?

Answer 47

Yes for diagnosis to be made | Not uncommon for problems to be different in nature at home and school, but some difficulties need to be pervasive

Question 48

Many children with underlying ASD come to attention because of other issues such as...

Answer 48

Difficult behaviour Hyperactivity Learning problems Children with attachment difficulties including many in care can present with similar problems (can have both)

Question 49

Some children with ASD are able to learn key skills to appear to function well in certain situations. When they have to adapt to complex or novel situations, their communication and behaviour difficulties often become noticeable again, for example...

Answer 49

Inability to understand subtext Diminished sharing of two way conversation Reduced responses to others Poor understanding of personal space Reduced awareness of social niceties or hierarchies Apparent mature speech masking difficulties with comprehension and delay in language processing Unable to adapt communication style to different social situations Anxiety, anger, aggression when things do not go their way

Question 50

Continuing support is as important as correct diagnosis. Ideally a key professional should be identified to coordinate care - true or false?

Answer 50

True GP School nurse Social workers All should liaise together

Question 51

Do non identical twins have same chance as having ASD as identical twins?

Answer 51

No - chance higher for identical twins

Question 52

What social skill training can be done?

Answer 52

How to start and end a conversation Turn taking Making friends Identifying and expressing emotion

Question 53

Those in mainstream education may have good speech and language, but what may function at a lower level?

Answer 53

Comprehension

Question 54

Why may those with ASD take many seconds to process information?

Answer 54

They may only pick up on one or two words being said to them

Question 55

What classroom management approaches could be taken?

Answer 55

Movement breaks Use of headphones to decrease auditory stimulation Object to hold or fidget with Chew gum Safe space should have: de cluttered area, dim lighting, reduced noise

Question 56

What is first line therapy for anxiety in ASD?

Answer 56

CBT

Question 57

What percentage of children with developmental disorders have sleep difficulties?

Answer 57

80%

Question 58

What are the most common types of sleep problems?

Answer 58

Delayed sleep initiation Anxiety about sleeping alone Waking during night

Question 59

What behavioural interventions can be done for sleep problems?

Answer 59

Establish relaxing night time routine Avoid day naps Avoid caffeine Remove TV screens and computers from bedroom

Question 60

What techniques can be used with regards to behaviour management?

Answer 60

Picture exchange communication system - if little or no communication When learning to identify triggers, parents keep a diary Distraction techniques Introducing preparation for new experiences

Question 61

For aggressive behaviour that does not respond to specialist behavioural and educational management, what can be done?

Answer 61

Emergency cases: risperidone is licensed for use in ASD

Question 62

What are the 5 autism spectrum disorders?

Answer 62

``` Autism Asperger’s syndrome Rett syndrome Childhood disintegrative disorder Pervasive developmental disorder not otherwise specified (PDD-NOS) ```