autism

Autism : 

Autism Prof. Saad S Al-Ani Senior Pediatric Consultant Head of Pediatric Department Khorfakkan hospital Sharjah , UAE

Autism : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 2 Autism It is characterized by a qualitative impairment in: * Verbal and nonverbal communication * Imaginative activity * Reciprocal social interactions

Epidemiology : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 3 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).

Epidemiology (Cont.) : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 4 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

Etiology : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 5 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.

Etiology (cont.) : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 6 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.

Clinical Manifestations : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 7 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.

Clinical Manifestations (Cont.) : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 8 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 The autistic child is often withdrawn and spends hours in solitary play Ritualistic behavior prevails

Clinical Manifestations (Cont.) : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 9 Clinical Manifestations (Cont.) 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

Clinical Manifestations (Cont.) : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 10 Clinical Manifestations (Cont.) 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.

Early diagnosis : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 11 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.

Early diagnosis (cont.) : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 12 Early diagnosis (cont.) These children do not share affect with caregivers by: * Pointing * Communicating interest * Sharing in joint attention

Treatment. : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 13 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

Treatment (cont.) : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 14 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.

Treatment (cont.) : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 15 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.

Treatment principles : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 16 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

Treatment principles (cont.) : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 17 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.

Treatment for older children and adolescents : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 18 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

Treatment for older children and adolescents (cont.) : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 19 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).

Treatment for older children and adolescents (cont.) : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 20 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.

Pharmacotherapy : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 21 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

Pharmacotherapy (cont.) : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 22 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

Pharmacotherapy (cont.) : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 23 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

Prognosis. : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 24 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.

Prognosis (cont.) : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 25 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

Prognosis (cont.) : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 26 Prognosis (cont.) A better prognosis is associated with: 1. Higher intelligence 2. Functional speech 3. Less bizarre symptoms and behavior

Summary : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 27 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

Summary (cont.) : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 28 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

Summary (cont.) : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 29 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

References : 

8/30/2010 Autism / Prof. saad s al ani Khorfakkn hospital 30 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