Transcript AUTISTIC SPECTRUM DISORDERS

AUTISTIC SPECTRUM
DISORDERS
Kate Morton
“Usually people look at you when they’re
talking to you. I know that they’re working
out what I’m thinking, but I can’t tell what
they’re thinking. It is like being in a room
with a one-way mirror in a spy film.”
AUTISTIC SPECTRUM DISORDERS
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ASD – range of conditions including autism and
Asperger’s syndrome
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Describes a lifelong developmental disorder
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Impairments in 3 main areas:
 Social interaction
 Language and communication
 Thought and behaviour
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Spectrum – ranging from subtle problems with
understanding and social function to severe disabilities
EPIDEMIOLOGY
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Each GP likely to have up to 20 people with ASD
on their list (typical list size 2000)
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Boys > girls (4:1) (Asperger’s 9:1)
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Genetic aetiology – can be associated with
Fragile X, PKU and tuberous sclerosis
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No association with social class or ethnicity
DIAGNOSIS
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Autism – difficulties in all 3 main areas, must start before
the age of 3
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‘Atypical autism’ occurs when onset of symptoms is after
the age of 3
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Most parents aware something wrong when child around
18 months
 BUT diagnosis often takes a long time
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Asperger’s – difficulties with social interaction and
restricted behaviour and social interaction but no
significant general delay in language or cognition
POSSIBLE SIGNS
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Social interaction
 Not smiling socially
 Very independent
 Preferring to play alone
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Communication
 Not responding to name
 Delayed language
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Behavioural
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Red flags for autism
• No babbling by 12m
• No gesturing by 12m
• No single words by 16m
• No 2-word spontaneous
phrases by 24m
• Any loss of any language or
social skills at any age
Oversensitivity to sounds and textures eg clothing
Unusual attachments to toys
Hyperactivity
Stereotyped repetitive behaviours
THE ‘CHAT’
= CHecklist for Autism in Toddlers
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For use by GPs or health visitors at 18m check
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Series of questions and observations
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Available via the National Autistic Society website
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Note this does not meet the criteria for a population
screening test but can provide a useful structure for
assessing relevant clinical features
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If suspect, should be referred for diagnostic assessment
ROLE OF THE GP
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If suspect ASD, refer for diagnostic assessment
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Liaise with paediatricians, psychiatry and specialist
therapists
 Clinical psychologists
 Occupational therapists
 ASD trained teachers
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Management of intercurrent illnesses and associated
conditions
 Epilepsy
 Hearing and visual impairment
 Mental illness – depression, anxiety, ADHD
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Provide information and support to parents and carers
CONSULTATIONS
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Ideally see pt in first or last appt
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Ensure the consulting room is a suitable environment - keep sharps
out of the way, have toys to play with
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Use clear simple language – short sentences; avoid irony, metaphors
etc
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Ask questions directly, increased use of closed questions
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Explain exactly what you will do in the examination before doing it,
use pictures or toys to help explain
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Check pt’s understanding
A WORD ABOUT “DIAGNOSTIC
OVERSHADOWING”…
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Specifically mentioned in the curriculum!
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Refers to when a pt’s presenting symptoms are
put down to their learning disability, rather than
the doctor seeking another, potentially treatable
cause
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Eg – pt presents with a new behaviour –
consider:
 Physical cause – pain, deterioration in vision or hearing
 Psychiatric cause – depression, psychosis, dementia
 Social cause – change in carer, bereavement, abuse
RESOURCES
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InnovAiT Volume 2, Issue 11 (November
2009)
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National Autistic Society website
www.autism.org.uk
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The curious incident of the dog in the
night time (2003) by Mark Haddon