L-27: Developmental Delay - Intellectual Disabilities And Autism

Front 1

Autism

Back 1

Disorder of social communication, social interaction

Behavioral - restrictive, stereotypical behaviors.

Self-contained and not interested in interactions. Less range of behaviors.

Interest in object's feel rather than function.

Front 2

Autism Spectrum Disorder DSM V definition

Back 2

Deficits in social communication/interaction

Restricted, repetitive patterns of behavior

Symptoms present in early development

Symptoms must cause functional impairment

Not due to intellectual disability.

Front 3

Deficits in social communication in autism

Back 3

- Social reciprocity

- Nonverbal communication

- Developing, maintaining, and understanding relationships

Specify severity - based on how much support required.

Front 4

Restrictive/Repetitive Behaviors in autism

Back 4

- Stereotypic or repetitive movements - self-stimulating to child.

- Restricted, fixed interests

- Hyper or hypo-reactivity to sensory input

Specify severity.

Front 5

Specifiers in Diagnosis of Autism

Back 5

- W/ or w/o intellectual impairment

- W/ or w/o language impairment

- Associated with medical/genetic condition or environmental factor

- Associated with another neurodevelopmental disorder

Front 6

Gender Differences in Autism

Back 6

M>F, 4:1

Females have more severe intellectual disability when do have it.

Front 7

Neurobiology considerations in autism

Back 7

- Co-occurring seizure disorders common (up to 25%)

- fMRI: difficulty with tasks involving facial expressions

Don't know what causes autism

Front 8

Risk factors for autism

Back 8

- Advanced maternal or paternal age

- Extreme prematurity (<26 wk)

- Closer spacing of pregnancies

- Family recurrence among siblings (2-10%)

Front 9

Co-occuring intellectual disability and autism

Back 9

20% - normal IQ

25% - mild to moderate impairment

50% - severe or profound impairment

Front 10

Interdisciplinary evaluation of autism

Back 10

Some biological assessments - including genetic testing as standard of care.

Other:

Audiology testing

Speech and language evaluation

Occupational therapy

Psychological testing

Screen for seizures

Front 11

AAP Recommended Screening for Autism

Back 11

Recommend universal screening at 18 and 24 mos.

- MCHAT - yes/no questionnaire

Diagnosed late in childhood often - want to do early intervention.

Front 12

Multi-modal intervention for autism

Back 12

Family support and education

Foster normal development

Neurological/genetic consultation

Behavioral services

Educational support services

Front 13

Psychosocial therapy treatments for autism

Back 13

- Applied Behavioral Analysis - behavioral therapy that does not require child to be verbal. Analyze behavior, change reinforcers to shape behavior.

- Pivotal Response Treatment - Less time intensive, more generalizable gain

- Social Skills Training - Reduce aggression

- Cognitive Behavioral Therapy - To target anxiety

Front 14

Pharmacologic treatment for autism

Back 14

No anti-autism medications

2 antipsychotic medicationsi are FDA approved for irritability due to autism, aripiprazole, risperidone

Treat co-occuring conditions - SSRI for anxiety, treat ADHD.

Oxytocin?

Front 15

Intellecual Disability

Back 15

Deficits in intellectual functions (e.g. problem solving) by clinical evaluation and standardized testing (IQ < 70 or > 2 SD below population mean)

Deficits in adaptive functioning

Onset during development

Front 16

Domains in Intellecual Disability

Back 16

Functional domains:

Conceptual: reading, writing, knowledge, memory

Social: empathy, interpeersonal communication
Practical: personal care, job responsibility, organizing tasks

Front 17

Diagnostic tests for intellectual disability

Back 17

Chromosomal microarrays - identify syndromes for information about treatment, progression/prognosis.

Front 18

Clinical neuroimaging for intellectual disability

Back 18

No consensus. Not established standard of care.

Front 19

Psychiatric comorbidities in intellectual disability

Back 19

High rate of co-occurence

Mental illness thought to have greater impact on functioning than intellectual disability

Major factor, often overlooked.

Front 20

Self-Injurious behavior in Intellectual disability and Autism

Back 20

Common.

Some biologic approaches but require behavioral intervention.