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Autism autism spectrum disorder (ASD)

Feb 25, 2016




Autism autism spectrum disorder (ASD). Dr. Anne Zbaracki Parental presentation April 9,2014. Autism. Definition Epidemiology Diagnosis Screening S pectrum Treatment Local help Potential causes (or not). Definition. - PowerPoint PPT Presentation


Autismautism spectrum disorder (ASD)Dr. Anne ZbarackiParental presentationApril 9,2014AutismDefinitionEpidemiologyDiagnosisScreening SpectrumTreatmentLocal helpPotential causes (or not) DSM V- biologically based neurodevelopment disorder characterized by impairments in two major domains1 deficits in social communication and social interaction2 restrictive repetitive patterns of behavior, interests, activitiesMust be present in early developmentCause clinically significant impairment in social, occupational, or other important areas of current functioningSeverity 3 levels- requiring support, substantial support , very substantial supportDefinitionASD coversClassic autismChildhood disintegrative disorderPervasive developmental disordernosAsperger

EpidemiologyPrevalence4 times more in males than femalesIncreased since 70s, up to 1:50Sibling of ASD child, 7% if affected is female, 4% if male, >30% if 2 or more affectedEpidemiologyAssociated conditionsIntellectual disabilitySeizuresGenetic disordersTuberous sclerosisFragile XSmith-Lemli-Opitz

DiagnosisLike anything else needComplete historyPENeurological examThen, direct assessment of social, language, and cognitive developmentParent interviews for concerns and behavior hxStructured observation of social and communicative behavior and playDiagnosisHx- Family hx, 3 generation since can be genetic milestones, play skills, behavior, regressionParental concerns, hearing, vision, speech/languageCommunication behaviors, pointing, eye contact , response to nameHx of repetitive, ritualized behaviors- hand flappingNot tolerating change or transitionSelf injurySeizuresEating (pica), sleepDiagnosisLanguage delay, mental retardation, fragile x, Rett, Angelman, Prader-Willi, Smith-Lemli-Opitz, Tuberous sclerosis, anxiety, OCD, extreme shyness, social phobia, mutism, mood disorders, schizophrenia, seizures, tic disordersDiagnosisExam- will need extra time Growth patterns, esp head circumference, early acceleration then stabilizationHt/wt- low, highSkin with Woods lamp- hypopigmented, tuberous sclerosisDysmorphic as in Fragile X, long face, large ears & testes or Angelman, ataxic gait, broad mouthMuscle tone and reflexesDiagnosisPCP responsibility: listen to parents concerns and take them seriously Refer for comprehensive specialty evalEarly interventionDept. of educationBut dont wait for the formal dx before doing somethingEarly diagnosisThings the PCP can do while waiting for a formal dxTemperaments, discuss what that is, how its a scale and determine where the child is. Resources at The Center for Parenting Education, Carey Temperament ScalesSocialization, supervised community play groups, development servicesLanguage, picture books, ongoing descriptionScreeningCDC and AAPALARMAutism is prevalent1:50Listen to parentsEarly as 18mo, parents are concernedAct earlyConcerns, screen at 18 and 24 moReferDont delayMonitor Ongoing support and medical managementScreeningEarly indicatorsReduced response to nameReduced frequency looking at facesRed flagsNo babbling by 9 monthsNo pointing or gestures or lack of orientation to name by 12 monthsNo single words by 16 monthsLack of pretend or symbolic play by 18 monthsNo spontaneous or meaningful 2 word phrases by 24 monthsAny loss of language or social skillsScreeningIndicationsDelayed language/ communication, regression of social or language skills, parental concern1st stage screeningId ASD from general populationEx: CHAT, M-CHAT, social communication questionnaire2nd stage screeningASD from other development disordersEx: PDD screening test II , screening tools for autism in 2yr oldsDifferential DiagnosisGlobal development delay/intellectual disabilitySocial communication disorderno restrictive repetitive behaviorsDevelopmental language disorderNormal socializationLanguage-based learning disabilityNormal socialization, intent to communicateHearing impairmentNormal reciprocal social interactionsLandau-Kleffner syndromeNormal until 3-6RettFemales, >18monthsSevere early deprivation/ reactive attachment Caregiver neglect, improve with appropriate careAnxietySymptoms distressingOCDSymptoms distressingspectrumClassic autismChildhood disintegrative disorderPervasive developmental disorderAspergerSpectrumImpaired social communication and interactionSocial reciprocityUnaware of other children, lack empathy, lack imitationJoint attentionSeeking to share enjoyment, undemanding of attentionNonverbalBaby resists cuddling, avoid eye contactSocial relationshipsLack of friendshipsSpectrum Restricted and repetitive behaviors, interests , and activitiesStereotypedHand flapping, swaying, toe walking, self injurious SamenessDaily routines, routesRestricted interestsPreoccupations, sensory

TreatmentManagementBehavioral and education interventionsMedicationsComplementary and alternative therapiesTreatmentManagementChronic condition, no cure, need to be individualizedGoalsImprove social functioning and play skillsImprove communication, functional and spontaneousImprove adaptive skillsDecrease negative, nonfunctional behaviorsPromote academic function and cognitionTreatmentTreatment teamYouDevelopmental pediatrician, child neurologist, child psychiatristneuropsychologistGeneticist, genetic counselorSpeech language pathologistOccupational therapistAudiologistSocial workerTreatmentProven aspects of education programsHigh staff to student ration 1:1 or 1:2IndividualizedSpecial expertise teachers25 hours a week of servicesFluid treatmentCurriculum based on attention, imitation, communication, play, social interactionPredictable, structuredTransition planningFamily involvementTreatmentEarly intervention programSchool based special educationIDEA, individuals w/ disabilities education act, guarantees free and appropriate public educationPrivate Practice therapists

TreatmentYour jobLonger time for appointmentsRoutine care, preventative and screeningAssess nutrition, physical activity, screen time, alternative therapiesSafety Surveillance for comorbiditiesSeizures, lead poisoning, anxiety, depression, hyperactivity, sleep problems, GISupport the family, educate on proven treatmentsTreatmentPrognosisFactors that have better outcomesPresence of joint attention, functional play skills, cognitive, decreased severity, early ID, involvement, move to inclusionFactors with worse outcomesLack of joint attention by 4, lack of functional speech by 5, IQ