Autism Spectrum Disorders

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Autism Spectrum Disorders 2-5-2013

A.M.B.E.R. clinic Albuquerque Multidisciplinary Behavioral Evaluation for Recovery and Resiliency Alya Reeve, MD, MPH University Of New Mexico Health Sciences Center Professor of Psychiatry, Neurology & Pediatrics PI, Continuum of Care

Overview • Discursive journey through symptoms

related to autism

• 1/88 estimated • 4:1 male:female • tends to run in families

• Issues of neuroplasticity

Normal Developmental Steps •Babbling by 12 months •Gesturing (pointing, waving bye-bye) by 12 months •Saying single words by 16 months •Saying two-word spontaneous phrases by 24 months (not just echoing) •Losing any language or social skills at any age

Autism • Difficulties before age 3: • Pretend play • Social interactions • Verbal and nonverbal communication

• May appear normal before 1 - 2 years; suddenly "regress" and lose language or social skills they had previously gained = “regressive” type

Childhood Assessment • • • • • •

CHAT Checklist for Autism in Toddlers ADI-R Autism Diagnostic Interview - Revised ADOS Autism Diagnostic Observation Schedule CARS Childhood Autism Rating Scale PDD Screening Test- stage 3 Gillian Autism Rating Scale

Adulthood - symptoms • • • • •

Social interactions/reciprocity Speech anomalies Reading nonverbal cues Logical, solution-based May have other areas of strength: • marriage • highly valued skill/ability

Visual Learning • Scanning • R/O attention deficit disorder

• Visual or pattern recall • “parents are just there”

• Indirect eye contact

Sensitivity to Environmental Noise • • • • •

Sound Multiple sensory inputs Tactile (Temple Grandin) Difficulty prioritizing concerns Patterns

Genetic Testing • Mitochondrial disorders • Enzymatic deficiency disorders • Neurologic soft signs; minor physical anomalies  Genetic testing consultation • Familial disorders: e.g. HD

Theory of Mind • Being able to imagine another

person’s experience • Story boards • Roles v. Feelings

People with ASD • Low to high IQ

• Asperger Syndrome

• May be complex problem solvers • Notice parts rather than whole • Adhere to routines

ASD Symptoms • Focused interests

• collections • selective interests • idiosyncrasies

• Decreased flexibility

• insistence on following their preferences • adherence to rules

Autism Symptoms – Differential Diagnosis • • • • • • • •

Fragile – X Tuberous Sclerosis Intellectual Disability Schizophrenia Brain Injury Narcissism Severe depression Severe anxiety • OCD with psychosis

Secondary conditions • Obsessions • Compulsions • Sleep d/o • Eating d/o

• limited dietary interests

• Repetitive injury • overuse • self-injury

Treatment issues • Social interaction training • behavioral training

• Decrease anxiety

• behavioral tx; medications

• Support concentration • Decrease OCB • Eliminate relevant allergens

• ?metals; gluten; immune system

Summary Increased rate of detection worldwide or increased incidence (?) • No known etiology • Treat dysfunctional symptoms • Lifespan disorder or permanent remission?... •

Next presentation:

2-12-2013 Nonverbal Mental Status Examination and Clinical Assessment in TBI and I/DD resources and back issues can be found at Continuum of Care website: http://som.unm.edu/coc/Training/powerpointnew.html

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Autism Spectrum Disorders

Autism Spectrum Disorders 2-5-2013 A.M.B.E.R. clinic Albuquerque Multidisciplinary Behavioral Evaluation for Recovery and Resiliency Alya Reeve, MD, ...

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