AUTISTIC SPECTRUM AUTISTIC SPECTRUM DISORDERSDISORDERS

Kate MortonKate Morton

“ “Usually people look at you when Usually people look at you when they’re talking to you. I know that they’re talking to you. I know that

they’re working out what I’m they’re working out what I’m thinking, but I can’t tell what they’re thinking, but I can’t tell what they’re

thinking. It is like being in a room thinking. It is like being in a room with a one-way mirror in a spy film.”with a one-way mirror in a spy film.”

AUTISTIC SPECTRUM AUTISTIC SPECTRUM DISORDERSDISORDERS

ASD – range of conditions including autism and ASD – range of conditions including autism and Asperger’s syndromeAsperger’s syndrome

Describes a lifelong developmental disorderDescribes a lifelong developmental disorder

Impairments in 3 main areas:Impairments in 3 main areas: Social interactionSocial interaction Language and communicationLanguage and communication Thought and behaviourThought and behaviour

Spectrum – ranging from subtle problems with Spectrum – ranging from subtle problems with understanding and social function to severe understanding and social function to severe disabilitiesdisabilities

EPIDEMIOLOGYEPIDEMIOLOGY

Each GP likely to have up to 20 people with Each GP likely to have up to 20 people with ASD on their list (typical list size 2000)ASD on their list (typical list size 2000)

Boys > girls (4:1) (Asperger’s 9:1)Boys > girls (4:1) (Asperger’s 9:1)

Genetic aetiology – can be associated with Genetic aetiology – can be associated with Fragile X, PKU and tuberous sclerosisFragile X, PKU and tuberous sclerosis

No association with social class or ethnicityNo association with social class or ethnicity

DIAGNOSISDIAGNOSIS Autism – difficulties in all 3 main areas, must start Autism – difficulties in all 3 main areas, must start

before the age of 3before the age of 3

‘‘Atypical autism’ occurs when onset of symptoms Atypical autism’ occurs when onset of symptoms is after the age of 3is after the age of 3

Most parents aware something wrong when child Most parents aware something wrong when child around 18 monthsaround 18 months

BUT diagnosis often takes a long timeBUT diagnosis often takes a long time

Asperger’s – difficulties with social interaction and Asperger’s – difficulties with social interaction and restricted behaviour and social interaction but no restricted behaviour and social interaction but no significant general delay in language or cognitionsignificant general delay in language or cognition

POSSIBLE SIGNSPOSSIBLE SIGNS

Social interactionSocial interaction Not smiling sociallyNot smiling socially Very independentVery independent Preferring to play alonePreferring to play alone

CommunicationCommunication Not responding to nameNot responding to name Delayed languageDelayed language

BehaviouralBehavioural Oversensitivity to sounds and textures eg clothingOversensitivity to sounds and textures eg clothing Unusual attachments to toysUnusual attachments to toys HyperactivityHyperactivity Stereotyped repetitive behavioursStereotyped repetitive behaviours

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

THE ‘CHAT’THE ‘CHAT’

= = CHCHecklist for ecklist for AAutism in utism in TToddlersoddlers

For use by GPs or health visitors at 18m checkFor use by GPs or health visitors at 18m check

Series of questions and observationsSeries of questions and observations

Available via the National Autistic Society websiteAvailable via the National Autistic Society website

Note this does not meet the criteria for a Note this does not meet the criteria for a population screening test but can provide a useful population screening test but can provide a useful structure for assessing relevant clinical featuresstructure for assessing relevant clinical features

If suspect, should be referred for diagnostic If suspect, should be referred for diagnostic assessmentassessment

ROLE OF THE GPROLE OF THE GP If suspect ASD, refer for diagnostic assessmentIf suspect ASD, refer for diagnostic assessment

Liaise with paediatricians, psychiatry and Liaise with paediatricians, psychiatry and specialist therapistsspecialist therapists

Clinical psychologistsClinical psychologists Occupational therapistsOccupational therapists ASD trained teachersASD trained teachers

Management of intercurrent illnesses and Management of intercurrent illnesses and associated conditionsassociated conditions

EpilepsyEpilepsy Hearing and visual impairmentHearing and visual impairment Mental illness – depression, anxiety, ADHDMental illness – depression, anxiety, ADHD

Provide information and support to parents and Provide information and support to parents and carerscarers

CONSULTATIONSCONSULTATIONS Ideally see pt in first or last apptIdeally see pt in first or last appt

Ensure the consulting room is a suitable environment - Ensure the consulting room is a suitable environment - keep sharps out of the way, have toys to play withkeep sharps out of the way, have toys to play with

Use clear simple language – short sentences; avoid irony, Use clear simple language – short sentences; avoid irony, metaphors etcmetaphors etc

Ask questions directly, increased use of closed questionsAsk questions directly, increased use of closed questions

Explain exactly what you will do in the examination before Explain exactly what you will do in the examination before doing it, use pictures or toys to help explaindoing it, use pictures or toys to help explain

Check pt’s understandingCheck pt’s understanding

A WORD ABOUT “DIAGNOSTIC A WORD ABOUT “DIAGNOSTIC OVERSHADOWING”…OVERSHADOWING”…

Specifically mentioned in the curriculum!Specifically mentioned in the curriculum!

Refers to when a pt’s presenting Refers to when a pt’s presenting symptoms are put down to their learning symptoms are put down to their learning disability, rather than the doctor seeking disability, rather than the doctor seeking another, potentially treatable causeanother, potentially treatable cause

Eg – pt presents with a new behaviour – Eg – pt presents with a new behaviour – consider:consider:

Physical cause – pain, deterioration in vision or Physical cause – pain, deterioration in vision or hearinghearing

Psychiatric cause – depression, psychosis, dementiaPsychiatric cause – depression, psychosis, dementia Social cause – change in carer, bereavement, abuseSocial cause – change in carer, bereavement, abuse

RESOURCESRESOURCES

InnovAiT Volume 2, Issue 11 InnovAiT Volume 2, Issue 11 (November 2009)(November 2009)

National Autistic Society website National Autistic Society website www.autism.org.ukwww.autism.org.uk

The curious incident of the dog in the The curious incident of the dog in the night time (2003) by Mark Haddonnight time (2003) by Mark Haddon