AUTISM SPEKTRUM DISORDERS (GANGGUAN SPEKTRUM AUTISME)
INTRODUCTION
- Autism is a behaviour disorder.
- It is a Central Nervous System disease with the
unknown etiology(ies)
- There is growing clinical as well as genetics evidence that
the pathway in CNS
- are aberrant.
- The incidence is increasing logarithmically
- At present a worldwide epidemic of autism exists
- are aberrant.
ASD :
1. Asperger's syndrome
2. Atypical autism
3. Pervasive Development Disorder
Unspecified (ICD-10)(PDD-NOS DSM-IV)
ETILOGY
1. Genetic
2. Pre, peri and post natal
3. Neuro-anatomic model
4. Neuro-chemicals
5. Immunologic
6. Viral infections
EARLY DIAGNOSIS
- Under the age of two years
- Means early intervention
- Best results if given before 5-years of age
- The earlier the better
DIAGNOSIS
Shared the following characters:
1. Qualitative impairment in social interaction
à as shown by :
- the use of non verbal behaviors such as eye gaze
and body posture to regulate social interaction,
- a failure to develop peer relationships
- a lack of spontaneous showing and sharing interests
- a lack of social emotional reciprocity
2. Qualitative impairments in social communication
à as shown by:
- a delay in language development without nonverbal compensation
- problems in initiating and sustaining conversations;
- stereotyped use of language
- lack of varied and imaginative of imitative play
3. Restrictited repertoire of interests,behaviours and activities
à as shown by:
- an abnormal over-focus on particular topics
- an adherence to non-functional routines or rituals,
- repetitive
- stereotyped motor mannerisms
- preoccupation with part of objects rather than the whole.
PARENTAL CONCERNS RELEVANT TO AUTISM
A. Communication concerns
. Does not respond to name
. Cannot telll me what she/he want
. Language is delayed
. Does niot follow directions
. Appear deaf at times
. Seems to hear sometimes but not others
. Does not point or wave bye-bye
. Used to say a few words but now does not
B. Behavioural concerns
. Tantrum
. Is hypereactive/uncooperative or oppositional
. Does not know how to play with toys
. Gets stuck on things over and over
. Toe-walks
. Has unusual attachments to toys (holding certain object)
. Lines things up
. Is over sensitive to certain sounds or textures
. Has odd movement patterns
4. Absolute indications for immediate further evaluation
. No babbling by 12 months
. No gesturing (pointing, waving bye-bye, etc) by 12 months
. No single word by 16 months
. No two-word spontaneous (and not just echolalic) by 24 months
. ANY lost of ANY language or social skills at ANY age
A multidisipinary approach to diagnostic assessment is required. The teams varies across centres, but commonly includes:
- Neuro-paediatrician
- Child-psychiatrist
- Clinical psychologist
- Speech and Language therapist
- Occupational therapist
- Physiotherapist
The informations necessary for a diagnosis includes:
- detailed development history
- parents' descriptions of the everyday behaviour and activities of the child
- direct assessment of the child's social interaction style and communicative and intellectual function.
RECOMMENDATIONS FOR INVESTIGATIONS
1. Routine Investigations for all cases
- Speech and language assessment
- Cognitive / developmental assessment
- Basic neurological examination
- Fragile-X and basic chromosome screen (low IQ and dysmorphic cases)
- Wood light
- Hearing test (BERA)
- EEG
2. Additional test (to be conducted only when indicated)
- Sleep EEG
- Full neurological examination
- Brain imaging (Ct-scan,MRI)
- Metabolic / immunological tests
- Fulll chromosome screen
- Lead screening
MANAGEMENT
- Maximize the child's social , communicative and intellectual
functioning.
- Whatever the underlying approach, structure and an
emphasis on developing communication skills are
important aspects of the preschool and school curriculum
for children with ASD
- Behavioural interventions are needed to reduced
repetitive, stereotyped, self injurious and chalanging
behaviours.
Medication :
Current pharmacological treatment does not treat the cores features of ASD
. Neuroleptics (fluoroperazine and haloperidol)
stereotyped and hyperactivity
SE : dystonic reaction and drowsiness
. SSRIs
Adolescents and adult with Aspergers' syndrome
. Clomipramine, 5-HT uptake inhibitor
obsessional and compulsive behavours
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