AUTISTIC SPECTRUM DISORDERS

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AUTISTIC SPECTRUM DISORDERS

• Kate Morton

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• Usually people look at you when theyre
  talking to you. I know that theyre working out
  what Im thinking, but I cant tell what theyre
  thinking. It is like being in a room with a
  one-way mirror in a spy film.

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AUTISTIC SPECTRUM DISORDERS

• ASD range of conditions including autism and
  Aspergers syndrome
• Describes a lifelong developmental disorder
• Impairments in 3 main areas
• Social interaction
• Language and communication
• Thought and behaviour
• Spectrum ranging from subtle problems with
  understanding and social function to severe
  disabilities

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EPIDEMIOLOGY

• Each GP likely to have up to 20 people with ASD
  on their list (typical list size 2000)
• Boys gt girls (41) (Aspergers 91)
• Genetic aetiology can be associated with
  Fragile X, PKU and tuberous sclerosis
• No association with social class or ethnicity

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DIAGNOSIS

• Autism difficulties in all 3 main areas, must
  start before the age of 3
• Atypical autism occurs when onset of symptoms
  is after the age of 3
• Most parents aware something wrong when child
  around 18 months
• BUT diagnosis often takes a long time
• Aspergers difficulties with social interaction
  and restricted behaviour and social interaction
  but no significant general delay in language or
  cognition

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POSSIBLE SIGNS

• 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

• Social interaction
• Not smiling socially
• Very independent
• Preferring to play alone
• Communication
• Not responding to name
• Delayed language
• Behavioural
• Oversensitivity to sounds and textures eg
  clothing
• Unusual attachments to toys
• Hyperactivity
• Stereotyped repetitive behaviours

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THE CHAT

• CHecklist for Autism in Toddlers
• For use by GPs or health visitors at 18m check
• Series of questions and observations
• Available via the National Autistic Society
  website
• Note this does not meet the criteria for a
  population screening test but can provide a
  useful structure for assessing relevant clinical
  features
• If suspect, should be referred for diagnostic
  assessment

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ROLE OF THE GP

• If suspect ASD, refer for diagnostic assessment
• Liaise with paediatricians, psychiatry and
  specialist therapists
• Clinical psychologists
• Occupational therapists
• ASD trained teachers
• Management of intercurrent illnesses and
  associated conditions
• Epilepsy
• Hearing and visual impairment
• Mental illness depression, anxiety, ADHD
• Provide information and support to parents and
  carers

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CONSULTATIONS

• Ideally see pt in first or last appt
• Ensure the consulting room is a suitable
  environment - keep sharps out of the way, have
  toys to play with
• Use clear simple language short sentences
  avoid irony, metaphors etc
• Ask questions directly, increased use of closed
  questions
• Explain exactly what you will do in the
  examination before doing it, use pictures or toys
  to help explain
• Check pts understanding

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A WORD ABOUT DIAGNOSTIC OVERSHADOWING

• Specifically mentioned in the curriculum!
• Refers to when a pts presenting symptoms are put
  down to their learning disability, rather than
  the doctor seeking another, potentially treatable
  cause
• Eg pt presents with a new behaviour consider
• Physical cause pain, deterioration in vision or
  hearing
• Psychiatric cause depression, psychosis,
  dementia
• Social cause change in carer, bereavement, abuse

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RESOURCES

• InnovAiT Volume 2, Issue 11 (November 2009)
• National Autistic Society website
  www.autism.org.uk
• The curious incident of the dog in the night time
  (2003) by Mark Haddon