AUTISM IN THE GP’S WORLD
Objectives
1. Be aware of how autism presents in both young people and adults
2. Recognise the potential difficulties faced by patients, parents or carers in normal daily activities, including GPs surgeries
3. Learn how diagnosis is made and where to find support
Curriculum Statements
Curriculum Statement: Care of People with Learning DisabilityPromoting Equality & Valuing DiversityEthics and Values Based Medicine
Competency:Community orientationData Gathering and Interpretation
Autism- Your checklist
What do I know ?
Why do I need to know ?
Where can I get more information ?
Where is the restroom ?
CASE 1
Autism Spectrum Disorder
A spectrum of psychological characterized by widespread abnormalities of social interactions and communication, as well as restricted interests and repetitive behaviour
Autism Spectrum Disorder
Males > females A life long disability Usually evident during the first three
years of life. A condition that can co-occur with
other conditions, for example Attention Deficit Hyperactivity Disorder, Obsessive-Compulsive Disorder, Learning Disability, Down Syndrome, Hyperlexia, etc.
Autism Spectrum Disorder
Knows no racial or socioeconomic differences
A developmental disability that can be improved and intervened upon, but currently there is no cure.
Triad of Autistic Impairment
Impairment of social interaction
Impairment of language and communication
Impairment of flexibility of thought and behaviour
CHAT
Check list for Autism in Toddlers Series of questions filled in by
parents and primary health workers at 18 month development check.
2 sections: one for the parents and the second are observations by the primary health care worker
If child fails, gets rescreened one month later
CHAT
Currently, autism is rarely detected before the age of three and for the other social-communication disorders, age of detection can be even later. The CHAT, however, is administered when the child is 18 months old. The earlier a diagnosis can be made, the earlier intervention methods can be implemented and family stress reduced.
CASE 2
Autism: Clinical Indicators to Refer
Absolute indications
No babbling by 12 months No gesturing (pointing, waving, bye-bye, etc) by
12 months No single words by 16 months No two-word spontaneous (not just echolalic)
phrases by 24 months ANY loss of ANY language or social skills at ANY
age.
Other Clinical Indicators
Communication Concerns
Does not respond to his/her name
Cannot tell me what s/he wants
Language is delayed Doesn't follow directions Appears deaf at times Seems to hear sometimes but
not at others Doesn't point or wave
goodbye Used to say a few words, but
now doesn't
Behavioural Concerns
Tantrums Is hyperactive/unco-
operative/oppositional Doesn't know how to play with
toys Gets stuck on things regularly Toe walks Has unusual attachments to
toys Lines things up Is oversensitive to certain
textures or sounds Has odd movement patterns
Other Clinical Indicators
Social Concerns
Doesn't smile socially Seems to prefer to play
alone Gets things for him/herself Is very independent Does things 'early' Has poor eye contact Is in his/her own world Tunes out Is not interested in other
children.
Autistic Spectrum Disorders Diagnostic Pathways
Children (<18 years old) : Child Development Centre Community Paediatrician Shropshire/Telford & Wrekin CAMHS or
CAMHS-LD
Adults : Psychiatry Service- **Under
development**
Concluding Thoughts
Historical perspective Bleuler Leo Kanner Hans Asperger
‘Refridgerator mothers’
Patient & Family Perspective Diagnosis
Isolation and Guilt
Educational and Social Support
Empathy
Local & National Perspectives DOH strategy for adults with autism
in England 2010
Autism Act 2009
Facts & figures : Estimated 1 in 100 adults (England) and
1 in 150 children in USA 49% of adults with ASD live at home
with parents
GPs role in ASD
Recognising ASD & referring for further assessment
Providing a safe environment for patients with ASD and communication skills
Continuing health care
Directing patient & family to support networks
References
DOH publications : www.dh.gov.uk/Publicationsandstatistics
/Publications
National Autistic Society www.autism.org.uk/gp
National Collaborating Centre for Mental Health (NCCMH) www.nccmh.org.uk/guidelines
Film clip: ‘Rain Man’
QUESTIONS
Quiz : True or False ?
Question 1
Children who have stopped speaking after learning words should be referred for assessment
Quiz : True or False ?
Question 2
Teenagers who have difficult or disruptive behaviours and learning difficulties need to be placed into special needs schools
Quiz : True or False ?
Question 3
Young adults with autism are entitled to housing benefit and financial support, eg DLA
Quiz : True or False ?
Question 4
An adult with Asperger’s Syndrome has more health care needs than adults with no ASD
Quiz : True or False ?
Question 5
When communicating with ASD patients, it is important to avoid metaphors and give clear instructions rather than requests
Answers
Question 1 : T
Question 2 : F
Question 3 : T
Question 4 : F
Question 5 : T
THANK YOU AND GOOD NIGHT