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Autism
Spectrum
Disorder
Dr: Hayfaa Omer
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Definition of ASD according to the DSM-V

History of Autism

Epidemiology and risk factors

Outlines of
the Symptoms and signs

presentation Red Flags

Diagnosis

Potential challenges

Management
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A neurodevelopmental condition.

The core clinical characteristics of ASD

include impairments in two areas of
Definition of functioning:
ASD
1.Social communication and social
interaction,

2. Restricted, repetitive patterns of

behavior, interests or activities.
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Maureen Durkin, University of Wisconsin , International Meeting for Autism Research (IMFAR) 4 May 2013
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History of Autism
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The wild child from
Averyon

Dr Jean Itard Victor

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V

• Leo Kannar published a paper entitled Autistic Disturbances of Affective Contact in 1943,
describing 11 children who were highly intelligent but displayed features of autism

“A powerful desire for aloneness, and an obsessive insistence on persistent

sameness”
• Han Asperger in 1944 he published a paper entitled :Autistic Psychopathy in Childhood, in which he
describes 4 boys with similar features of Kannar autism but with special talents
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The concept of Spectrum

High functioning Autism Sever Autism

Autism Level 2 Level 3
Level 1 Needs substantial support Need very substantia
Need support Patient’s social & support
communic ation skills and Patient’s social &
Patient’s social &
repeatative behavor are
communic ation skills &
still obvious to the c asual communication skills &
repetitive behavior are repeatative behavior
observer, even with
only noticeable without serverly impair daily life
support in plac e
support
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Epidemiology of ASD

Symptoms are typically evident around three years

old.

Male to female ratio 4:1

Third of children with ASD exhibit ID.

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Etiology of ASD

Genetic factors.
interactions between multiple genes or gene combinations are responsible for ASD
Parental age
Advanced parental age (Related to de novo spontaneous mutations and/or alterations in
genetic imprinting)
Environmental & perinatal factors
Exposure to toxins and drugs perinatally
Low birth weight, complicated birth,, preterm
diabetes, obesity, hypertension, preeclampsia during pregnancy
Maternal medications use during pregnancy , substances use during pregnancy.
Lack of association with immunization
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Symptoms & Signs of Autism

 Impairments in social interaction and social communication:-

 Problems in Pointing>>>
• To ask
• To share
• To comment

 Lack of spontaneous sharing interest

 Failure to develop peer relationship

appropriate to his developmental level
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 Inability of imitation
Symptoms & Signs of Autism

 Theory of mind ( having an idea of the mental state

of other& predict their action

 Failure of under standing other

people emotion(empathy)
 Lack of joint attention 15
Symptoms & Signs of Autism

 Do not respond to their

names

 Lack of eye contact

Can not play pretend play 16
(symbolic)
Symptoms & Signs of Autism

Stimulus over selectivity

Problem in social & emotional

reciprocity
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Impairment in using gestures

Delay or lack of spoken language

Marked impairment in the ability to initiate

or sustain conversation
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Sy
 Repetitive restricted stereotyped patterns of behavior
activities and interests :-
 Adherence to routine

 Line up toys

 Repetitive sensory motor behavior like:

• hand flapping
• body rocking
• Toe walking
• Spinning
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Red flags for ADS
https://www.cdc.gov/ncbddd/autism/signs.html

Not respond to their name by 12 months of age

Not point at objects to show interest (point at an airplane flying over) by 14 months
Not play “pretend” games (pretend to “feed” a doll) by 18 months
Avoid eye contact and want to be alone
Have trouble understanding other people’s feelings or talking about their own feelings
Have delayed speech and language skills
Repeat words or phrases over and over (echolalia)
Give unrelated answers to questions
Get upset by minor changes
Have obsessive interests
Flap their hands, rock their body, or spin in circles
Have unusual reactions to the way things sound, smell, taste, look, or feel
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DSM-5 Diagnostic Criteria for ASD

A. Persistent deficits in social B. Restricted, repetitive patterns of

communication and social interaction behavior, interests, or activities as
across multiple contexts, as manifested manifested by at least two of the
by deficit in ALL of the following: following:

1. Social-emotional reciprocity 1. Stereotyped or repetitive motor movements,

use of objects, or speech
2 . Nonverbal communicative behaviors
used for social interaction 2. Insistence on sameness, inflexible adherence
to routines, or ritualized patterns of verbal or
3. Developing, maintaining, and nonverbal behavior
understanding relationships
3. Highly restricted, fixated interests that are
abnormal in intensity or focus
4. Hyper- or hyporeactivity to sensory input or
unusual interest in sensory aspects of the
environment
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What will happen if any child shows features
suggestive of ASD

Assessment

investigations Treatments
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7 Pillars of assessment
 1- History
Developmental history,FH,prental history. Screening (cast),ADI-R
 2- Examination
MSE,physical examination,ADOS-2
 3- Intellectual ability
IQ test and scholastic assessment
 4- Speech/Language/ Occupational Therapy assessment
look for co-occurring language problems, sensory and motor deficits
 5- physical investigation
E.g. Genetic testing ,MRI .EEG
 6- Behavioral and mental
 7- Family
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Then move to more standardized assessment

 Screening tools
• Childhood Autism Spectrum Test (CAST)

 Diagnostic tools
• Autism Diagnostic Interview – Revised (ADI-R)
• CARS
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Comorbidities

• Epilepsy in up to 35%.

• Intellectual difficulties in 70%.

• Higher functioning individual may develop depressive or anxiety

symptom because of insight into their condition.
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What is the main role of the psychartrist in the
management of ASD

• The clinician should help the family obtain appropriate, evidence-based,and

structured education and behavioral interventions for children with ASD.

• The clinician should maintain an active role in long-term treatment planning

and family support and support of the individual.

• The clinician should specifically inquire about the use of

alternative/complementary treatments and be prepared to discuss their risk
and potential benefits.

• To direct the family

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Treatment

• Goal of treatment-reducing disruptive behavior and promote learning in

areas or language acquisition, communication, and self-help skills.

• Make profile of the child and family strengths and weaknesses

• Treatment goals should me updated as per child and progress rate.

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There is currently no medical

or biological treatment of
the core features of ASD
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Medications Use

 Irritability:
 Risperidone and aripipazole (FDA approved)
 ADHD (40 to 60%):
 Methylphenidate, atomoxetine and clonidine (without evidence)
 Anxiety (40 to 60%)
 EB is for CBT
 SSRIs used without evidence
 Depression:
 EB is for CBT
 SSRIs used without evidence
 Sleep:
 Sleep hygiene, decrease media hours
 You can use melatonin
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intervention
Auditory Integration Floortime Augmentative Communication
Sensory Integration Music Therapy Vision Therapy
ABA Incidental Teaching Vitamins
Discrete Trial Training TEACCH Hyperbaric Oxygen
Lovaas/UCLA Intervention PECS Pharmacological treatments
Early Start Denver Model Pivotal Response Training Chelation
Holding Therapy Prompting Diets
Reinforcement
Dolphin Assisted Therapy Drugs
Son-Rise
Facilitated Communication Response Interruption/Redirection Supplements
Computer-Aided Instruction Functional Communication Training Dogs assisted therapy
Differential Reinforcement Naturalistic Intervention
Discrete Trial Training Parent-Implemented Intervention
Extinction Peer-Mediated Instruction and Intervention
Functional Behavior Assessment
Best research
evidence

Interventions with some evidence EBP

Clinical
Interventions with insufficient evidence / not Expertise
Patient
Values
recommended
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Potential Challenges

• Early intervention services/Evidence-base practice

• Patient challenges

• Parents challenges

• Society challenges
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Barriers to early childhood intervension

 Late diagnosis because there is no specialized clinics or

hospitals.
 Majority of children with ASD in low-and middle-income
countries have no access to evidence based interventions.
 Comprehensive treatments are extremely expensive.
 Lack of funding of financial coverage of services.
 Scarcity of highly trained intervention providers in the schools.
 Low level of awareness among general population.
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Families prospect….

 Scarcity of specialized providers

 It is hard for many children to find providers
available immediately after diagnosis.
 Accessing ASD intervention as soon as possible in
life is a critical public health issue.
 Competing demands of other children, work, family
life etc…
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Society prospect…..

 Lifelong disability
 High medical care
 Increased mental health problems in caregivers
 A priority in the ASD field is to evaluate whether
specialized interventions proven efficacious in
University RCTs are effective when implemented in
communities around the world.
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Schools prospect….

 Staff’s competing priorities and responsibilities.

 The lack of administrators and teacher support.
 Difficulty obtaining resources and materials.
 Finding time for the intervention during the school
day.
 Limited training.
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Conclusion

 We went through a long phase in order to understand the disease

and we can claim that we understand it better now. A growing
number of affected individuals and a growing number of people
interested in the disease.
 The initial observations and opinions are not unintelligent ideation
but rather smart as they characterized the disease as functional
brain disorders regardless of the name attached to it.
 We are still trying to find how and why.
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Resources

IACAPAP textbook of child Psychiatry

https://iacapap.org/content/uploads
/C.2-ASD-2014-v1.1.pdf
Goodman textbook of child Psychiatry
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THANK YOU @ZAIN