Autism spectrum disorder DR VOLOVIK GALINA Autism

Autism spectrum disorder DR. VOLOVIK GALINA

Autism spectrum disorder The essential features of autism spectrum disorder are persistent in reciprocal social communication and social interaction (criterion A) and restricted’ repetitive patterns of behavior, interests or activities (criterion B). These symptoms are present from early childhood and limit or impair everyday functioning (criteria C and D).

History 1867 – Henry Maudsley noted a group of very young children with severe mental disorder (marked deviation, delay and distortion in development) 1943 – Leo Kanner “Autistic disturbance of affective contact” coined the term – infantile autism. 1944 – Hans Asperger described a syndrome that he named “Autistic psychopathy” 1980 – children with autistic spectrum disorder were diagnosed with childhood schizophrenia.

Epidemiology Prevalence – 1% of the population

Developmental and course Symptoms are typically recognized during the second year of life but may be seen earlier that 12 month. Some case presenting a lack of interest in social interaction in the first year of life. Some children experience developmental plateaus or regression, with a gradual or rapid deterioration in social behaviors or use of language such losses are rare in other disorders and may be a useful “red flag” for autism spectrum disorder.

Sex distribution Boys : Girls 4 -5 : 1 Girls with autistic disorder are more likely to have more severe mental retardation.

Risk and prognostic factors Presence or absence of intellectual disability. Epilepsy, is associated with greater intellectual disability and lower verbal ability. Language impairment (functional language by age 5 years is a good prognostic sign). Additional mental health problems.

Environmental Low birth weight Fetal exposure to valproate Parents age Nonspecific risk factors

Genetic and physiological factors Heritability – 37%90% Linkage analyses have demonstrated that regions of chromosomes 7, 2, 4, 15, 19 are likely to contribute to the genetic basis of autism. Fragile-X syndrome – associated with autism, 1% of children with autism also have fragile-X syndrome.

Differential diagnosis Rett syndrome Selective mutism (early development is not typically disturbed, social reciprocity is not imaired). Language disorders and social (pragmatic) communication disorder. Intellectual disability without autism spectrum disorder. Stereotypic movement disorder ADHD Schizophrenia

Comorbidity 70% of individuals with autism spectrum disorder may have one comorbid mental disorder. Intellectual impairment Structural language disorder 40% may have two ore more comorbid menatal disorder.

Diagnostic features A – Persistent deficits in social communication and social interaction across multiple contexts as manifested by the following- Deficits in social – emotional reciprocity Deficit in nonverbal communicative behaviors used for social interaction Deficit in developing, maintaining, and understanding relationships

B – Restricted repetitive patterns of behavior, interests or activities: Stereotyped or repetitive motor movements use of objects or spech Inflexible adherence to routines, ritualized patterns of verbal and nonverbal behavior Hyper- or hyporeactivity Restricted, to sensory fixated input or interests that unusual are abnormal interest in in intensity or sensory focus aspects of the environment

C – Symptoms must be present in the early developmental period D – Symptoms cause clinically significant impairment in social occupational or other important areas of current functioning E – These disturbance are not better explained by intellectual disability or global developmental delay

Diagnosis CARS – Child Autistic Rating Scale ADOS-G – Autism Diagnostic Observation Schedule Generic

Treatment Goals: • Improve abilities to integrate into schools • Develop meaningful peer relationships • Increase the likelihood of maintaining independent living as adults • Increase socially acceptable and prosocial behavior • Decrease odd behavioral symptoms • Improve verbal and nonverbal communication • Training programs

Psychopharmacologic trials • No specific medications • Reducing hyperactivity, obsessions and compulsive behaviors, irritability, aggression and self-injurious behaviors

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