Professional Documents
Culture Documents
Autism in Children: IAP UG Teaching Slides 2015-16
Autism in Children: IAP UG Teaching Slides 2015-16
developmentofsocialandcommunicationskills.
By:BrittanyAllen
LeoKanner,achildpsychiatrist,in1943firstcoined
thetermautism.
11childrendescribedwhodemonstrated:aprofound
lackofsocialengagement,failedtouselanguageto
communicate,hadanobsessiveneedforsameness.
But,faultypostulationthatautismoccursdueto
difficultiesintheparentchildrelationship.
Autismisnowrecognizedasaneurodevelopmental
disorder&neurobehavioraldisorder.
Autismoccursduetounderlyingdisorderofbrain
development.
Autismisacomplexneurodevelopmentaldisorder
characterizedby:
qualitativeimpairmentsinsocialinteraction,
qualitativeimpairmentsincommunication,and
restricted,repetitive,stereotypedpatternsofbehavior,
interestsandactivities.
AutismisNOTasingledisorder.
Autisticsymptomsoccuralongawidespectrum.
Sensoryhyposensitivitiesorhypersensitivitiestothe
environmentoftennoted.
Symptomsmayvaryinthesameautisticchildandchange
overtime.
Nospecificbiologicalmarkers.
Diagnosisbasedentirelyonclinicalfindings.
Ascertainwhetherthechildsspecificbehaviors
meettheDiagnosticandStatisticalManualofMental
DisordersVRevised(DSMV)criteria.
Observechildinseveralsettingsassymptomsmay
unfoldovertime.
Persistentdeficitsinsocialcommunicationandsocial
interactionacrosscontexts,notaccountedforbygeneral
developmentaldelays,manifestedbyallofthefollowing:
Deficitsinsocialemotionalreciprocity
Deficitsinnonverbalcommunicativebehaviors
Deficitsindevelopingandmaintainingrelationships
appropriatetothedevelopmentallevel
Restricted,repetitivepatternsofbehavior,interests,
oractivitiesasmanifestedbyatleast2ofthe
following:
Stereotypedorrepetitivespeech,motor
movements,oruseofobjects
Excessiveadherencetoroutines
Highlyrestricted,fixatedintereststhatare
abnormalinintensityorfocus
Hyperorhyporeactivitytosensoryinputor
unusualsensoryinterests
Symptomsmustbepresentinearlychildhood.
Symptomstogetherlimitandimpaireveryday
functioning.
A.Impairmentinsocialinteractions(4criteria)
1.Lackseyetoeyegaze,facialexpression,gestureswhile
interacting
2.Failstodeveloppeerrelationships
3.Doesnotshareinterestswithothers(e.g.,nobringing,or
pointingoutobjects)
4.Lackssocialoremotionalreciprocity
B.Impairmentincommunication(4criteria)
1.Hasdelayeddevelopmentofspeech
2.Doesnotinitiateorsustainconversation
3.Hasstereotypedandrepetitivelanguageor
idiosyncraticlanguage
4.Lacksmakebelieveplayorsocialimitativeplay
13 13
DSMIVRCRITERIAFORDIAGNOSINGAUTISM
C.Repetitivebehaviorsandstereotypedbehaviorpatterns(4criteria)
1.Hasstereotyped,restrictedpatternsofinterest,abnormalin
intensityorfocus
2.Hasinflexibleadherencetospecific,nonfunctionalroutinesor
rituals
3.Hasstereotypedandrepetitivemotormannerisms(e.g.,handor
fingerflapping)
4.Haspersistentpreoccupationwithpartsofobjects
14
PREVALENCEOFAUTISM
7.1per10,000inindividualsunder18yearsofage
(westerncountries).
Boysareaffectedmoreoftenthangirls.
Averagemale:femaleratiois3.8:1.
Currenthigherprevalenceratesreflectimproved
identificationofautism.
NoprevalencedataavailablefromIndia.
Diagnosisfrequentlymissed.
Lackofawarenessandknowledgeaboutthedisorder
amonghealthprofessionals.
ButrecentreportsfromNewDelhiandChandigarh
statethatautisminNOTuncommoninIndia.
Noonesingleunifiedtheorycanexplainetiologyofautism.
StructuralMRIbrainstudieshavedetected,thoughnot
consistently,increasedvolumeofthetotalbrainand
abnormalitiesinthecerebellum,frontallobe,andlimbic
system(amygdalaandhippocampus)inyoungchildrenwith
autism.
Infirstyearoflife:nocleardiscriminatingfeatures.
However,homevideosofinfantslaterdiagnosedto
haveautismhavedetectedfourautisticbehaviorsviz.
notpointing,notshowingobjects,notlookingat
others,andfailingtoorienttonamebeingcalled.
Abnormallyacceleratedrateofgrowthinheadsize
between614monthsofage:anearlywarningsignal
ofriskforautism.
Carefulattentiontoparents'concernsandspecific
inquiryintohowchildinteracts,communicates,and
playshelpsdetectautismearly.
Autismcanbereliablydiagnosedatbetween23yrs.
ofage.
Interventiontherapywheninitiatedatanearlyage
canimproveoutcome.
Needtogiveinformationregardingrecurrencerisks
toparents.
Repetitiveandstereotypedbehaviorpatterns
1.Showsextremereactionstoinvasionofpersonalspace(e.g.
tempertantrums)
2.Showsextremeresistancetobeing"hurried"
3.Wantstowatchthesameeducationalvideorepeatedly
4.Hasintenseinterestinaparticulartopic(e.g.,traintimetables,
dinosaurs)
5.Isunabletocopewithchangeorinunstructuredsituations
(e.g.,schoolpicnic)
6.Hasunusualresponsestosensoryvisual/olfactorystimuli(e.g.
startscryinginsunlight)
MCHAT(ModifiedChecklistforAutisminToddlers)
PDDBI(PervasiveDevelopmentalDisordersBehavior
Inventory)
ADIR(AutismDiagnosticInterviewRevised)
ADOS(AutismDiagnosticObservationSchedule)
CARS(ChildhoodAutismRatingScale)
TrivandrumAutismBehavioralChecklist
75%haveassociatedmentalretardation.
714%haveepilepsy.
Frequentlyhaveseriousbehavioraldisturbances,
suchasselfinjuriousbehavior,aggression,
hyperactivity,andtempertantrums.
In<10%,autismoccursinconjunctionwithknown
medicaldisorders:tuberoussclerosis,fragileX
syndrome,phenylketonuria,andcongenitalrubella
syndrome.
Amultidisciplinaryteamofprofessionalstrainedand
specializedinautismisnecessary.
Theteamshouldinclude:
Developmentalpediatrician,
Childpsychiatrist,
Occupational(behavioral)therapist,
Speechtherapist,
Psychologist,
Specialistteacherand
Socialworker.
Pharmacotherapy
SensoryIntegrationTherapy
AuditoryIntegrationTherapy
DietTherapy
MegaVitaminTherapy
LovaasBehavioralModification
AppliedBehaviorAnalysis
Noknowncureforautism.
But,earlyintensivebehavioralandeducational
interventiontherapycanhelpamelioratecore
behavioraldeficits.
1525hrs/weekassoonasdiagnosisofautismis
consideredanddefinitelybeforefouryearsofage
Interventionsshouldbecontinuedfor34yrstill
theyimprovetheirabilitytolearnandgeteducated.
Psychotropicmedicationsusedtoreduce(butnotnecessarily
eliminate)interferingbehaviorstomakethechildmore
amenabletointerventions.
Medicationsusuallyformanagementofcomorbidities
Atypicalantipsychotics(risperidone,olanzapine,clozapine)
fortempertantrums,aggression,orselfinjuriousbehavior;
Selectiveserotoninreuptakeinhibitors(sertraline,citalopram,
fluoxetine)foranxietyandrepetitivebehaviors;and
Psychostimulant(methylphenidate),opioidantagonist
(naltrexone)forhyperactivity.
Symptomaticepilepsyneedstobetreatedandappropriate
medicationprescribeddependingonseizuretype.
36