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
