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Autistic Spectrum Disorder/Autism

ASD is almost always a neurologically based


developmental disorder. Probable multiple
pathophysiology being combination of genetic and
environmental factors.

Diagnosis depends on recognition of observable


behaviours which occur as a result of the basic
abnormality.
Autism Diagnostic Observation Schedule-2
(ADOS-2)

Strong genetic component (twin studies) and siblings


of an autistic child are have increased risk of a range
of other neuropsychiatric conditions.

(1) DSM V Criteria

(2) Clinical features of autism


Parents often notice developmental delay before 2yo.
50% have intellectual impairment.
Social Problems

Impaired reciprocal-social interaction

Difficulty with gaining "joint attention" for an


activity

General personality lacks social spontaneity

Relate to objects with difficulty in understanding


and relating to people

Diminished awareness for the feelings of others

Failure to seek the usual comfort when distressed

Reduced or abnormal socially responsive eye


contact

Reduced symbolic and imaginative and social


play
Communication Problems

Impaired spoken language and communication


o 20% have regression or stagnation of
language/social development at 18 to 24
months
o May stop saying words but do progress in
other developmental domains

May have abrupt progress of language/social


development around 4 years

Semantic pragmatic difficulties (contextual and


social use of language) always present

Other features of language disorder variable

One sided conversations with abnormal form and


content eg. echolalia, confused pronouns

Abnormal social use of language eg, literal


interpretation

Impaired non-verbal communication


Repetitive, stereotyped patterns of interest
and activity

Repetitive behavior

Obsessional interests

Restricted range of interest and dislike of novelty

Obsessive desire to maintain ritual and constancy


Insistence on sameness
Sensory sensitivities eg, to noise or touch
(3) Diagnostic Studies

Instrument for diagnosing and assessing autism


using a series of structured and semi-structured
tasks that involve social interaction between the
examiner and the subject
Conducted by pediatricians, child psychologists
or child psychiatrist.
Organized by Autism Spectrum Australia (Aspect)

Studies to rule out organic pathology

Metabolic studies if symptoms of metabolic


disease, several system involved, or lack of
neonatal screen.

EEG studies if history of seizures, regression or


sleep related epilepsy

Imaging studies for specific indications, mainly


MRI

Genetic studies

CPK if muscle weakness or other signs of


Duchenne muscular dystrophy
(4) Management
Social support

early intensive intervention programs with


educational focus

Improving social, communication and play skills


o Speech and language therapy programs

Psychological interventions in more competent


older child eg cognitive behaviour therapy

Special education

Family involvement, education and training

Parental counselling: Address any parental


concerns or feelings of guilt
Autism Pharmacotherapy
No pharmacological treatment for core impairment.
Medications provide an opportunity for interaction
and learning, improved adaptive (daily) functioning
and independence.
Need for Medications Qn: How much interference
is there to daily activities?
General monitoring: BP, BMI, PR, sleep disorders
Treatment of target symptoms
1. Aggression

Aggression responds to first and second


generation antipsychotics e.g.
Risperidone
2. Attention deficit disorder (ADHD occurs in 50%)

Stimulant methylphenidate e.g. Ritalin

Non-stimulant Atomoxetine e.g.


Strattera
3. Obsessive or repetitive behaviours
Repetitive behaviours may have a self-calming
purpose in autism and should only be medicated
if they are causing self-injury.
SSRIs helpful in reducing aggression. Rmb to
warn parents that it may take 6 weeks for effects
to begin showing.

SSRI Fluoxetine e.g. Prozac, Lovan

SSRI Sertraline e.g. Zoloft

4.
5.

6.

SSRI Fluvoxamine e.g. Luvox


Excessive anxiety

TCA e.g. Imipramine


Tic disorders

2-agonist e.g. Clonidine, guanfacine


also shows some reduction in impulsivity
and aggressive outbursts. Clonidine
short-acting, guanfacine longer-acting.
Sleep disorder
Many children with autism have interrupted sleep
patterns. Autistic children may have low levels of
melatonin.

Melatonin supplement