Autism

Autism

Prof. Saad S Al-AniSenior Pediatric Consultant

Head of Pediatric Department Khorfakkan hospital

Sharjah , UAE

04/12/23 Autism / Prof. saad s al ani Khorfakkn hospital

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Autism

It is characterized by a qualitative impairment in:

* Verbal and nonverbal communication

* Imaginative activity * Reciprocal social interactions


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Epidemiology

Prevalence rates ranging from 10 to 20 per 10,000 children.

The disorder is much more common in males than females (3-4:1).


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Epidemiology (Cont.)

Autism can be associated with other neurologic disorders, particularly

* Seizure disorders, and, * Tuberous sclerosis * Fragile X syndrome. (a lesser

extent) Develops before 36 mo of age and is

typically diagnosable at 18 mo of age


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Etiology

The cause of autism is multifactorial. Genetic factors play a significant role. There is a 60-90% concordance rate for

monozygotic twins and less than 5% concordance rate for dizygotic twins.


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Etiology (cont.)

language and cognitive

abnormalities are more common in relatives of autistic children than in the general population.

Anomalies have been reported most promising may be the findings of deletions and duplications in chromosome 15.


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Clinical Manifestations Early measurable diagnostic symptoms

and signs of autism include : * Poor eye contact * Little symbolic play * Limited joint attention or orienting to one's name * Reliance on nonverbal communication * Delay in use of words.


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Clinical Manifestations (Cont.)

* Stereotypical body movements * Marked need for sameness * Very narrow range of interests are also common. The autistic child is often withdrawn

and spends hours in solitary play Ritualistic behavior prevails


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Tantrum-like rages may accompany disruptions of routine

Eye contact is typically minimal or absent The following may indicate a heightened

awareness and sensitivity to some stimuli :

1. Visual scanning of hand and finger movements 2. Mouthing of objects 3. Rubbing of surfaces


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Diminished responses to pain and lack of startle responses to sudden loud noises

If speech is present; echolalia, pronoun reversal,

nonsense rhyming, and other idiosyncratic language forms may predominate.


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Early diagnosis Of children at risk for autism can be

facilitated by the use of the Checklist for Autism in Toddlers (CHAT), a screening instrument.

Using home movies of 1-yr birthday parties has shown that children at risk for autistic disorder can be reliably identified at this age.


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Early diagnosis (cont.)

These children do not share affect

with caregivers by: * Pointing * Communicating interest * Sharing in joint attention


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Treatment. Considerable advances have been made

in the treatment of autism, especially within the educational, psychosocial, and biologic areas.

There is compelling evidence that intensive behavioral therapy, beginning before 3 yr of age and targeted toward speech and language development, is successful both in improving language capacity and later social functioning


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Treatment (cont.)

Treatment is most successful when geared toward the individual's particular behavior patterns and language function.

Parent education, training, and support

is always indicated Pharmacotherapy for certain target

symptoms may be helpful.


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Treatment (cont.)

Working with families of autistic children is vital to the child's overall care.

Children with autism require alternate educational approaches even when language capacity is near normal.


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Treatment principles The following treatment principles are

emphasized: 1.Use of: * Objective measures such as the Childhood Autism Rating Scale

(CARS) to measure behavior and behavioral change

* Interventions based on cognitive and behavioral theories * Visual structures for optimal education


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Treatment principles (cont.)

2. Enhancement of skills and acceptance

by the environment of autism-related deficits

3. Multidisciplinary training for all professionals working with autistic children.

Educational programming should begin as early as possible, preferably by age 2-4.


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Treatment for older children and adolescents

With relatively higher intelligence but with poor social skills and psychiatric symptoms (e.g., depression, anxiety, obsessive-compulsive symptoms) may require :

* Psychotherapy * Behavioral or cognitive therapy * Pharmacotherapy


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Treatment for older children and adolescents (cont.)

Typically, behavior modification is a major part of the overall treatment for older children with autism.

These procedures include: 1. Enhancement (i.e., rewards emphasizing appropriate

choice) 2. Reduction (extinction, time-out, punishment).


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Treatment for older children and adolescents (cont.)

Ethical concerns about vigorous

aversive therapy approaches have led to specific guidelines.

Social skills training is also currently used as a treatment modality and appears effective, especially in a group format.


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Pharmacotherapy Used to ameliorate target behaviors

that include: 1. Hyperactivity 2. Tantrums 3. Physical aggression 4. Self-injurious behavior 5. Stereotypes 6. Obsessive-compulsive behaviors


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Pharmacotherapy (cont.)

Newer atypical neuroleptics (e.g., risperidone, olanzapine) have shown effectiveness in treating the above behaviors, and in some instances, have also improved social relatedness


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Pharmacotherapy (cont.)

Other medicines used to treat psychiatric symptoms in autistic children include:

* Stimulants * Serotonin reuptake inhibitors (SSRIs) * Clonidine. The SSRIs, in particular, appear to be somewhat effective in diminishing: * Hyperactive * Agitated * Obsessive-compulsive behaviors


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Prognosis.

Some children, especially those with speech, may grow up to live self-sufficient, employed, albeit isolated, lives in the community.

Many others remain dependent on family for their everyday lives or require placement in facilities outside the home.


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Prognosis (cont.)

Because early, intensive therapy may improve language and social function, delayed diagnosis may lead to worse outcome

There is no increased risk for the development of schizophrenia in adulthood but the cost of delayed diagnosis across the life span is high


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Prognosis (cont.)

A better prognosis is associated with:

1. Higher intelligence 2. Functional speech 3. Less bizarre symptoms and

behavior


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Summary Autism is characterized by impairment in: * Verbal and nonverbal communication * Imaginative activity * Reciprocal social interactions Much more common in males than females (3-4:1). The cause of autism is multifactorial. Poor eye contact, little symbolic play, limited joint

attention or orienting to one's name, reliance on nonverbal communication and delay in use of words are early measurable diagnostic symptoms and signs


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Summary (cont.)

The following may indicate a heightened awareness and sensitivity to some stimuli :

1. Visual scanning of hand and finger movements 2. Mouthing of objects 3. Rubbing of surfaces Use of the Checklist for Autism in Toddlers (CHAT), a

screening instrument facilitates the diagnosis Considerable advances have been made in the

treatment of autism, especially within the educational, psychosocial, and biologic areas


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Summary (cont.)

Treatment is most successful when geared toward the individual's particular behavior patterns and language function.

Treatment for older children and adolescents include: Psychotherapy, Behavioral or cognitive therapy and Pharmacotherapy

Newer atypical neuroleptics (e.g., risperidone, olanzapine) have shown effectiveness

A better prognosis is associated with: 1. Higher intelligence 2. Functional speech 3. Less bizarre symptoms and behavior


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References AAP Committee on Children with Disabilities:

Developmental surveillance and screening of infants and young children. Pediatrics 2001;108:192-6.

Glascoe FP: Early detection of developmental and behavioral problems. Pediatr Rev 2000;21:272-9; quiz 280. Medline Similar articles

Jellinek M, Patel B, Froehle M: Bright Futures in Practice: Mental Health-Volume II, Tool Kit. Arlington, VA, National Center for Education in Maternal and Child Health, 2002.

Kelleher KJ, McInerny TK, Gardner WP, et al: Increasing identification of psychosocial problems: 1979-1996. Pediatrics 2000;105:1313-21. Medline Similar articles

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