Autism Spectrum Disorder (ASD) / ADHD
When are children who meet DSM criteria for ASD often diagnosed?
- 2-3yo - if a subtler case, then not as noticeable until school-age, when social demands become greater
What are the 6 major attributes a medical home should have for a family dealing with Autism?
- Accessibility - Family-Centered Care - Continuous Care - Comprehensive and Coordinated Care - Compassionate Care - Culturally Sensitive Care
You perform an Infant and Toddler Checklist (ITC) aka Communication and Symbolic Behavior Scales and Development Profile (CSBS-DP) on your patient who is <18 months old. It consist of questions about developmental milestones and social communication. What are you screening for?
- Communication Delays +/- early ASD - unable to distinguish ASD from other communication delays
What are some common comorbid mental health issues of those with Autism that complicate the dx and require you to make sure to always take into account treating multiple underlying disorders?
- Depression - Anxiety - Phobia - Bipolar - Disruptive behavior - ADHD - Seizure
what are some overlapping sx's between ASD and ADHD?
- Fidgeting - Trouble settling down - Impulsive - Hyperfocus - Socially Awkward
What is the initial workup / diagnostic process/ screening tools for a child suspected of ASD?
- ITC / CSBS-DP (9-24mo) - M-CHAT (16-30 mo) - CAST (4-11 yo)
All children being assessed for ASD must undergo a complete PE looking for:
- Neuro abnormalities (macrocephaly, hypotonia) - oddities (toe walking) - dysmorphic features suggesting any syndromes - neurocutaneous skin findings (cafe au lait, ash leaf spots)
In addition to evidence-based ABA tx, what are some other common types of complementary and alternative medicine (CAM) therapies that help address issues like speech and language delays, and sensory problems?
- PRT - TEACCH - DIR / Floortime - Speech and Language Therapy (ST) - Occupational Therapy (OT)
When considering a ddx of a child with significant developmental delays, it is important to remember the harsh psychosocial conditions can elicit a response that may mimic autism such as:
- PTSD -Reactive Attachment Disorder (RAD) - Child Abuse
If a child appears to have developmental delays but they are 3+ yo who should you refer to ?
- Special education dept at the local school - Speech Therapist (ST), Occupational Therapist (OT), and Physical Therapist (PT)
What are some genetic Syndromes that are rarely associated with Autism ?
- Tuberous sclerosis - Neurofibromatosis - Angelman syndrome - Fragile X Syndrome - Rett Syndrome
Research has shown that ABA tx results in improvements of what 3 things?
- communication - social relatedness - decreasing repetitive behaviors
What are some common comorbid concerns of patients who have Autism Spectrum Disorder (ASD)?
- constipation, or other GI issues - sleep issues - weight issues - irritability - low self esteem
In the last 20 years, the dx of ASD as increased due to reasons of:
- diagnostic substitution - broadening of the definition of ASD - better screening and ascertainment
You perform a Modified Checklist for Autism in a Toddler (M-CHAT) patient, aged 16-30mo. While assessing, you notice the child's parent circles "no" for questions 2 (deaf?) , 5 (unusual finger moves?), 12 (upset at daily noises?) and everything else is a "yes". So therefore they scored way above a 8+. What is your next step?
- high suspicion/ probability for Autism - need additional formal testing if insurance requires or if child is 3+ years old to confirm dx
The most recent report from the CDC and Prevention indicates that the biggest increase in cases is among the ______ (high/low function) with less severe disease and in ________ (race) populations
- higher-functioning patients - African American and Hispanic
A pediatric patient is being brought in by their parent bc they think they may be deaf, have ASD, or possible ADHD. What are some key findings that would make you more suspicious of Autism (ASD)?
- unresponsive to name - inappropriate laughing/giggling - inappropriate attachment to objects (i.e. telephone, washing machine) - physical over- or under-activity - playing with toys in a way they're not intended - not as cuddly as their siblings - has an outburst every time they don't take the same interstate exit on their drive home
At what age are ALL children recommended to be screened for ASD by in order to provide the earliest dx and early intervention tx?
18-24 months (< 2 yo)
Many children with autism (ASD) are 1st recognized by their delay in what by 18-24 months?
1st. Language / communication 2nd. Learning difficulties
At what age should early intervention be ideally recommended/ started for a child that appears to have developmental delays, regardless if you're certain or not?
< 3 yo
What are the 5 criteria DSM5 has indicated that a child must meet in order to be diagnosed with ASD?
A. Deficit in social communication/ interaction B. Restricted, repetitive patterns of behior, movement, or speech C. Sx's present in early development D. Sx's cause impairment in social, occupational, or other areas E. Disturbances are not better explained by Intellectual disability disorder or global developmental delay
A pediatric patient is being brought in by they're parent for you assess why they their having difficulty interacting with others, not responding to their name, and they mostly repeat phases or questions that others ask them instead of answering the question. What is your probable dx?
ASD
What is the widely recognized evidenced based treatment previously known as behavioral modification that is designed to increase socially appropriate behavior and decrease the severity and/or emergence of challenging behaviors (i.e. co-occuring disruptive behaviors = aggression, tantrums, self injury).
Applied Behavioral Analysis (ABA)
What is one of the complementary and alternative medicine (CAM) therapies is an intensive program that requires pt's parents/caregiver to work directly and play 1v1 with their children 20min / session, incorporating lots of time on the floor?
Developmental, Individual-difference, Relationship-based model (DIR) / Floortime
You're assessing a child (with ASD) severity level, who only have noticeable impairments without supports in place with decreased interest in interaction - able to speak full sentences have to-and-fro convos but come across as "odd" with minimal success making friends. What severity level are they at?
Level 1 Severity for ASD - requires support
You're assessing a child (with ASD) severity level, and they have only marked deficits and impairments, even with supports in place - speaking simple sentences, w/ interaction limited on narrow special interests, with odd nonverbal communication and some inflexibility behavior and difficulty coping with change. What severity level are they at?
Level 2 Severity for ASD - requires substantial support
You're assessing a child (with ASD) severity level and they have severe deficits and impairments - having few words of intelligible speech who rarely initiates interaction, and only responds to very direct social approaches, with extreme difficulty coping with change, with inflexible behaviors. What severity level are they at?
Level 3 severity for ASD - requires VERY substantial support
What are the 3 severity levels of ASD in regards to social communication and restricted, repetitive behaviors?
Level 3: Requiring VERY substantial support Level 2: Requiring substantial support Level 1: Requiring support
If a child has ASD and ADHD should you still choose to treat with a stimulant?
NO; Atypical Antipsychotic / Neuroleptic: - Aripiprazole (Abilify) - Risperidone (Risperdal) - Quetiapine (Seroquel)
What is one of the complementary and alternative medicine (CAM) therapies is designed to improve fine motor deficits, and academic and self-care skills, while also integrating sensory of info?
Occupational Therapy (OT)
What is one of the complementary and alternative medicine (CAM) therapies that is a data-driven approach designed to improve language and social, behavioral, and play deficits common among children with ASD?
Pivotal Response Training (PRT)
Children with marked deficits in social communication, but has no other sx's defined by DSM criteria for ASD, should be evaluated for ___ disorder instead.
Social (pragmatic) Communication Disorder
ABA tx is catered to the individual's needs and requires support of the family, but generally focuses on identifying the function of problem behavior and building skills to improve such behaviors. This is done by:
Specific behaviors are taught in a systematic manner in the context of repeated trials (i.e. reward system)
What is one of the complementary and alternative medicine (CAM) therapies is focused on improving verbal and nonverbal communication via didactic and naturalistic behavior methods using techniques like Picture Exchange and Communication System (PECS)?
Speech and Language Therapy (ST)
You perform Childhood Autism Spectrum Test (CAST) on your patient who is between the age of 4-11yo (PreK to elementary) and parent and teacher are concerned for possible underlying diagnoses. Out of the 39 questions they score a 14. What is you next step?
Too low to qualify for a Autism Diagnosis (which requires a positive score of ~15-31)
What is one of the complementary and alternative medicine (CAM) therapies that is focused on comprehensive services across lifespan that are specific to the individual (i.e. environment, skill deficits, family situation), where parents/caregiver play a huge role in treatment, and education strategies are focused on learning abilities vs. deficits ?
Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH)
