Transcript Autistic Spectrum Disorders - the Peninsula MRCPsych Course

Autistic Spectrum
Conditions
Soni Bhate
Content
Policies
 Diagnosis
 What next?
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‘it seems that for success in
science and art a dash of autism is
necessary’
Policies
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Autism Act 2009
Fulfilling and rewarding lives: the strategy for
adults with autism in England (March 2010)
Towards 'Fulfilling and rewarding lives': The first
year delivery plan for adults with autism in
England (April 2010)
Supporting People with Autism through
Adulthood (National Audit Office) 2009
The Governments (at the time)
Vision
‘All adults with autism are able to live
fulfilling and rewarding lives within a
society that accepts and understands
them. They can get a diagnosis and
access support if they need it, and they
can depend on mainstream public services
to treat them fairly as individuals, helping
them make the most of their talents.’
ASC - types
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Autism, also known as autistic disorder,
childhood autism, early infantile autism,
Kanner’s syndrome or infantile psychosis.
Asperger syndrome.
Childhood Disintegrative Disorder, also known
as CDD, dementia infantalis, disintegrative
psychosis or Heller’s syndrome.
Pervasive Developmental Disorder (Not
Otherwise Specified), also known atypical
autism.
ASC
Overall prevalence 1% (1.8% men, 0.2%
women) (Brugha et al,2009)
 Three times as common in boys
 Half have a LD
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Conditions that may be associated
with ASC
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Fragile X
ADHD
Dyspraxia/dyslexia
Downs syn----10% prev
Neurofibromatosis
Generalised LD
Tourettes syn
Tuberose Sclerosis
Phenylketonuria
ASC - genetics
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Twin studies show increased rate in
siblings
The Triad
Social interaction
 Social communication
 Social imagination
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Social interaction impairment;
different manifestations
Aloof, indifferent, passive
 Active but odd/bizzare
 Over-formal stilted
 Sociable with 1 person difficulties in a
group
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Social communication impairment;
different manifestations
No communication
 Communicates own needs
 Repetitive, one-sided
 Formal, long winded , literal
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Social imagination impairment;
different manifestations
Handles objects for simple sensations
 Handles objects for practical uses
 Copies pretend play of others
 Limited ‘pretend’ play; repetitive, isolated
 Invents own imaginary world but rigid and
stereotyped
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Childhood autism-ICD 10
‘ a pervasive developmental disorder
defined by the presence of abnormal
and/or impaired development that is
manifest before the age of 3 years and by
the characteristic type of abnormal
functioning in 3 areas’
Asperger Syndrome
Asperger Syndrome (or “high functioning
autism”) usually describes those people with an
ASD who have an average or above average IQ
and relatively good spoken language but who
also experience significant difficulties with social,
occupational and other areas of their life (Powell
2002).
Taking Responsibility, good practice guidelines for services for people with Asperger Syndrome. 2002 Andrew Powell. National
Autistic Society
Aspergers----ICD 10
No significant general delay
 Qualitative abnormalities in reciprocal
social interaction
 Stereotyped patterns
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Aspergers - the reality
"Reality to an autistic person is a confusing,
interacting mass of events, people, places,
sounds and sights. There seems to be no
clear boundaries, order or meaning to
anything. A large part of my life is spent
just trying to work out the pattern behind
everything."
Aspergers- additional symptoms
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Unusual responses to sensory stimuli. For example,
some people with Asperger syndrome may be
hypersensitive to specific sounds, textures or colours.
Others may be oblivious to discomfort or pain.
Behavioural disturbances. For example, some people
with Asperger syndrome may be hyperactive. Others
may be aggressive towards others or may harm
themselves.
Cognitive characteristics. People with Asperger
syndrome are of average or higher than average
intelligence but struggle to think abstractly or
symbolically.
Sensory processing disorders
‘Sensory integration is the ability to organise
sensory information for use’
Dr A Ayres-1971
Sensory processing disorder
Ordinary sensory experiences felt in
unusual way
 Impacts on arousal level
 Can cause sensory seeking or avoidance
behaviour
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Impact of SPD on daily functioning
Difficulty with social interaction
 Avoidance of situations
 Poor sleep patterns
 Self stimulation and self injurious
behaviours
 Etc etc
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Diagnosis of ASC
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Clinical (behaviourally defined) using
ICD/DSM
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Various structured interviews
Some structured tools
Adult diagnostic observation schedule
ADOS (Lord et al 2002)
 Diagnostic interview for social and
communication disorders DISCO (Wing et
al 2002)
 Adult diagnostic interview revised ADI-R
(Lord et al 1994)
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ASC comorbidity
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40% of people with ASC show signs of
psychiatric comorbidity (Ghaziuddin 2002)
Aspergers---comorbidity
Dyspraxia
 Epilepsy
 Depression
 Anxiety
 ADHD
 OCD
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ASC and offending
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Rate of law-breaking including offending is
low (woodbury-smith 2006, Langstrom 2009)
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When offences occur likely to be in 3 broad
categories; violent, sexual, criminal particularly
arson (Mullen 2004, Berney 2004)
Interventions
Self awareness
 Self advocacy
 Environment
 Therapy
 Acceptance – less self blame
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Psychosocial interventions
Individual psychotherapy to help the
individual to process the feelings aroused
by being socially handicapped
 Parent education and training
 Behavioral modification
 Social skills training
 Educational interventions
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Therapies
Perception, expression and regulation of
emotion is recognised as an area of
difficulty ( Attwood 2004) .
 Attwood has developed a tool for helping
people with ASC to have a greater
understanding ( CAT-KIT)
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Therapies
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CBT helpful (Gauss 2007)
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Social stories to correct dysfunctional
beliefs
Employment
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Only 15% of people with ASC are in
employment compared with 48% with
general disabilities ( NAO 2009)
Psychopharmacological
interventions
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For hyperactivity, inattention and impulsivity:
Psycho stimulants (methylphenidate),
atomoxetine
For irritability and aggression: Mood Stabilizers
(valproate, carbamazepine), Beta Blockers
(propranolol), anti-psychotics (risperidone,
olanzapine, quetiapine)
For preoccupations, rituals and compulsions:
SSRIs (fluoxetine, paroxetine), Tricyclic
Antidepressants (clomipramine)
For anxiety: SSRIs (sertraline, fluoxetine)