Autism Spectrum disorder (ASD)

What are associated pediatric conditions of ASD?

*Anxiety is most common* OCD, depression I also occur

What are the components of diagnosing and assessment of ASD?

*Early Screening* - standardized screening @ *18- and 24- month* we-child visits *Evaluation of child* - developmental history & interview with caregivers and direct observation of child behavior - *multidisciplinary assessment* is recommended - diagnostic measures include questionnaires, standardized interviews, structure play-based observations, and developmental testing - *physical examination* - routine *genetic testing*

What are the outcomes of ASD?

*IQ scores that fall in the average range* and *presence of language* in early years predict *best outcomes* At least *70% diagnosed with autism acquire language* that can be used for *communication* (5 yr level) *OPTIMAL OUTCOME* -up to 10% of individuals *diagnosed early* will *no longer meet diagnostic criteria* by school-age - associated with intensive early treatment, hire a verbal IQ, and improvements in ASD symptoms during ages 2 to 3 Adulthood - *lower rates of employment, independent living, and social relationships*, even for those with average to above average IQ -higher rates of *Co-occuring psychiatric conditions*; higher mortality rate -significant *reduction in services* and supports available relative to childhood

What are associated Neurodevelopmental conditions of ASD?

*Intellectual disability* (31%) *ADHD* (16-50%) *Tic Disorders* (22%)

What are the sociodemographic factors of ASD?

*More boys than girls*, gender ratios range from 2:1 to 6:1 with greater difference in gender ratios @ higher IQs - *females* may be *misdiagnosed or diagnosed late* - *ethnic minorities* are more likely to be *misdiagnosed or diagnosed late* - *low-income children* are more likely to be *misdiagnosed or diagnosed late*

How does brain development & neural circuitry cause autism?

*early overgrowth theory* (association w/microcephaly) *key brain areas* - fronto-temporal & frontal parietal regions - limbic brain regions -fronto-striatal circuitry - cerebellum (movement, balance, & gait patterns) *differences in brain connectivity and functioning* (as opposed to brain structure)

What are the deficits in social communication of ASD?

*nonverbal communication impairments* -no eye contact -facial expressions -gestures -vocal intonation & prosody (patterns of speech)

What are the environmental causes of ASD?

- *obstetric complications* - *Neurodevelopmental insults* (CP, hydrocephalus) - *intrauterine exposure* (meds, chemicals, substance abuse) -*prenatal infections* -no association w/ toxic environmental exposures OR vaccines

What are the disruptions in social- emotional reciprocity of ASD?

- reduced joint attention - problems w/ reciprocal conversion - deficits in theory of mind (understandinf info)

What are the treatment approaches for ASD

-Applied behavioral analysis -speech language therapy -social skills training -occupational therapy -medication -school-based services -complementary and alternative therapies

What is ASD marked by?

-Defecits in social communication -restricted/repetitive behaviors and/or intereste

What are the social relationships challenges of ASD?

-Deficits in *play skills, particularly imaginative play* -difficulty initiating & maintaining friendships

What are some complementary and alternative therapies for ASD?

-Dietary manipulation, vitamin supplements, and non-FDA approved use of prescription medication most common - provide parents with supportive information, particularly about potentially dangerous therapies

What are specific programs of applied behavior analysis?

-Early start Denver model -pivotal response treatment -early social interaction -project JASPER intervention

What are school-based services as a treatment for ASD

-Individuals with disabilities & education act (IDEA) provide services for birth - 3 yrs AND 3yrs-21 - must provide free and appropriate public education in the least restrictive environment -Transition supports for adulthood are required

What are the restricted/ repetitive patterns of behavior and/ or interest of ASD?

-Repetitive, preservative, and stereotypical *behaviors* -repetitive, stereotyped, and idiosyncratic *language* (immediate and/ or delayed echolalia) -strict adherence to *routines* -*restricted interests* -young children may have *attachments to unusual things* -*stereotyped movements* (pacing, spinning, running in circles, drumming, rocking, arm flapping, toe walking) -*unusual responses to sensory input* (overreaction to environmental noises, touch, or odors)

The prevalence of ASD due to what?

-better ascertainment -higher awareness -diagnostic substitution

What are the diagnostic features of ASD?

-deficits in social communication -disruption in social-emotional reciprocity -social relationship challenges

What is the prevalence of ASD?

1 in 58 children

What are the different severity levels of ASD?

1,2,3

What are some genetic associated conditions of ASD?

10% have a non-genetic condition manifestation of ASD may differ from idiopathic ASD most common conditions include: - Rhett syndrome -Cohen syndrome -Cornelia delaying syndrome -tuber sclerosis complex -Angelmine charge syndrome -fragile X syndrome -neurofibromatosis type 1 -down syndrome -Noonan syndrome -William syndrome -22qll .2 deletion syndrome

What are the gender ratios for ASD?

2:1 to 6:1

What percentage of people with ASD have a co-occuring intellectual disability

31%

What is the prevalence of epilepsy in ASD cases?

8%- 30%

Dolprolic acid is an _______ medication and can be associated with Autism

Anti seizure

What is the strongest evidence-based treatment for ASD?

Applied behavioral therapy

Speech language therapy for ASD involves

Augmentative /alternative communication (AAC)

What are the range of targets for Applied Behvaioral Analysis?

Broad communication, play, dental skills, disruptive behavior

______ is an associated condition of ASD

Epilepsy

Medication for ASD includes

FDA-approved for irritability in ASD: *risperidone* (brand name: Risperdal) and Apriprozazole (brand name: Abilify) -similar and non-stimulant medications for co-occuring ADHD

_____ studies are conducted

Family

There is an association between genetic disorders and ASD. What are the disorders?

Fragile X, Prader-willi, tuberous sclerosis complex

What is GERD

Gastrointestinal reflux disease (food comes back up)

There is ______ research on stability of levels of ASD

Minimal

Autism Spectrum disorder (ASD) is a ______ disorder

Neurodevelopmental

Social skills training for ASD includes

PEERS (Program for the Education & Enrichment of Relational Skills)

What are associated impairments of ASD regarding Feeding?

Picky eaters with texture, smell, color, presentation, brand

How are pediatric conditions of ASD treated?

Psychotherapy particularly cognitive behavioral therapy psychotropic medications

What is echolalia?

Repeats other's words or phrases

What are associated impairments of ASD regarding sleep?

Restless cannot fall in not much sleep leading to; - irritability, crabbiness

What are associated impairments of ASD?

Sleep feeding toileting G.I. symptoms

People with ASD notice what types of things?

Small sounds, can't focus on anything but, get overwhelmed

What are associated impairments of ASD regarding toileting?

Struggle with sound of toilet flushing, bedwetting, diarrhea, constipation, GERD

What are the specifiers of ASD?

With or without: - intellectual impairment - language impairment - catatonia (unresponsive/ out of it) secondary to: - known medical, genetic, or environmental factors -another Neurodevelopmental, mental health, or behavioral condition

Epilepsy prevalence in ASD cases is more common in _____ with a co-occuring intellectual disability.

females

Gene-environment ______ also plays a roll in ASD

interaction

there is a genetic ______ to ASD

predisposition