Autistic Spectrum Conditions

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Autistic Spectrum Conditions

• Soni Bhate

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Content

• Policies
• Diagnosis
• What next?

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it seems that for success in science and art a
dash of autism is necessary
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Policies

• Autism Act 2009
• Fulfilling and rewarding lives the strategy for
  adults with autism in England (March 2010)
• Towards 'Fulfilling and rewarding lives' The
  first year delivery plan for adults with autism
  in England (April 2010)
• Supporting People with Autism through Adulthood
  (National Audit Office) 2009

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The Governments (at the time) Vision

• All adults with autism are able to live
  fulfilling and rewarding lives within a society
  that accepts and understands them. They can get a
  diagnosis and access support if they need it, and
  they can depend on mainstream public services to
  treat them fairly as individuals, helping them
  make the most of their talents.

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ASC - types

• Autism, also known as autistic disorder,
  childhood autism, early infantile autism,
  Kanners syndrome or infantile psychosis.
• Asperger syndrome.
• Childhood Disintegrative Disorder, also known as
  CDD, dementia infantalis, disintegrative
  psychosis or Hellers syndrome.
• Pervasive Developmental Disorder (Not Otherwise
  Specified), also known atypical autism.

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ASC

• Overall prevalence 1 (1.8 men, 0.2 women)
  (Brugha et al,2009)
• Three times as common in boys
• Half have a LD

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Conditions that may be associated with ASC

• Fragile X
• ADHD
• Dyspraxia/dyslexia
• Downs syn----10 prev
• Neurofibromatosis
• Generalised LD
• Tourettes syn
• Tuberose Sclerosis
• Phenylketonuria

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ASC - genetics

• Twin studies show increased rate in siblings

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The Triad

• Social interaction
• Social communication
• Social imagination

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Social interaction impairment different
manifestations

• Aloof, indifferent, passive
• Active but odd/bizzare
• Over-formal stilted
• Sociable with 1 person difficulties in a group

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Social communication impairmentdifferent
manifestations

• No communication
• Communicates own needs
• Repetitive, one-sided
• Formal, long winded , literal

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Social imagination impairmentdifferent
manifestations

• Handles objects for simple sensations
• Handles objects for practical uses
• Copies pretend play of others
• Limited pretend play repetitive, isolated
• Invents own imaginary world but rigid and
  stereotyped

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Childhood autism-ICD 10

• a pervasive developmental disorder defined by
  the presence of abnormal and/or impaired
  development that is manifest before the age of 3
  years and by the characteristic type of abnormal
  functioning in 3 areas

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Asperger Syndrome

• Asperger Syndrome (or high functioning
  autism) usually describes those people with an
  ASD who have an average or above average IQ and
  relatively good spoken language but who also
  experience significant difficulties with social,
  occupational and other areas of their life
  (Powell 2002).
• Taking Responsibility, good practice guidelines
  for services for people with Asperger Syndrome.
  2002 Andrew Powell. National Autistic Society

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Aspergers----ICD 10

• No significant general delay
• Qualitative abnormalities in reciprocal social
  interaction
• Stereotyped patterns

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Aspergers - the reality

• "Reality to an autistic person is a confusing,
  interacting mass of events, people, places,
• sounds and sights. There seems to be no clear
  boundaries, order or meaning to anything. A large
  part of my life is spent just trying to work out
  the pattern behind everything."

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Aspergers- additional symptoms

• Unusual responses to sensory stimuli. For
  example, some people with Asperger syndrome may
  be hypersensitive to specific sounds, textures or
  colours. Others may be oblivious to discomfort or
  pain.
• Behavioural disturbances. For example, some
  people with Asperger syndrome may be hyperactive.
  Others may be aggressive towards others or may
  harm themselves.
• Cognitive characteristics. People with Asperger
  syndrome are of average or higher than average
  intelligence but struggle to think abstractly or
  symbolically.

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Sensory processing disorders

• Sensory integration is the ability to organise
  sensory information for use
• Dr A Ayres-1971

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Sensory processing disorder

• Ordinary sensory experiences felt in unusual way
• Impacts on arousal level
• Can cause sensory seeking or avoidance behaviour

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Impact of SPD on daily functioning

• Difficulty with social interaction
• Avoidance of situations
• Poor sleep patterns
• Self stimulation and self injurious behaviours
• Etc etc

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Diagnosis of ASC

• Clinical (behaviourally defined) using ICD/DSM
• Various structured interviews

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Some structured tools

• Adult diagnostic observation schedule ADOS (Lord
  et al 2002)
• Diagnostic interview for social and communication
  disorders DISCO (Wing et al 2002)
• Adult diagnostic interview revised ADI-R (Lord et
  al 1994)

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ASC comorbidity

• 40 of people with ASC show signs of psychiatric
  comorbidity (Ghaziuddin 2002)

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Aspergers---comorbidity

• Dyspraxia
• Epilepsy
• Depression
• Anxiety
• ADHD
• OCD

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ASC and offending

• Rate of law-breaking including offending is low
  (woodbury-smith 2006, Langstrom 2009)
• When offences occur likely to be in 3 broad
  categories violent, sexual, criminal
  particularly arson (Mullen 2004, Berney 2004)

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Interventions

• Self awareness
• Self advocacy
• Environment
• Therapy
• Acceptance less self blame

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Psychosocial interventions

• Individual psychotherapy to help the individual
  to process the feelings aroused by being socially
  handicapped
• Parent education and training
• Behavioral modification
• Social skills training
• Educational interventions

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Therapies

• Perception, expression and regulation of emotion
  is recognised as an area of difficulty ( Attwood
  2004) .
• Attwood has developed a tool for helping people
  with ASC to have a greater understanding (
  CAT-KIT)

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Therapies

• CBT helpful (Gauss 2007)
• Social stories to correct dysfunctional beliefs

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Employment

• Only 15 of people with ASC are in employment
  compared with 48 with general disabilities ( NAO
  2009)

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Psychopharmacological interventions

• For hyperactivity, inattention and impulsivity
  Psycho stimulants (methylphenidate), atomoxetine
• For irritability and aggression Mood Stabilizers
  (valproate, carbamazepine), Beta Blockers
  (propranolol), anti-psychotics (risperidone,
  olanzapine, quetiapine)
• For preoccupations, rituals and compulsions
  SSRIs (fluoxetine, paroxetine), Tricyclic
  Antidepressants (clomipramine)
• For anxiety SSRIs (sertraline, fluoxetine)