AUTISTIC SPECTRUM DISORDERS Kate Morton

“Usually people look at you when they’re talking to you. I know that they’re working out what I’m thinking, but I can’t tell what they’re thinking. It is like being in a room with a one-way mirror in a spy film.” “Usually people look at you when they’re talking to you. I know that they’re working out what I’m thinking, but I can’t tell what they’re thinking. It is like being in a room with a one-way mirror in a spy film.”

AUTISTIC SPECTRUM DISORDERS ASD – range of conditions including autism and Asperger’s syndrome ASD – range of conditions including autism and Asperger’s syndrome Describes a lifelong developmental disorder Describes a lifelong developmental disorder Impairments in 3 main areas: Impairments in 3 main areas:  Social interaction  Language and communication  Thought and behaviour Spectrum – ranging from subtle problems with understanding and social function to severe disabilities Spectrum – ranging from subtle problems with understanding and social function to severe disabilities

EPIDEMIOLOGY Each GP likely to have up to 20 people with ASD on their list (typical list size 2000) Each GP likely to have up to 20 people with ASD on their list (typical list size 2000) Boys > girls (4:1) (Asperger’s 9:1) Boys > girls (4:1) (Asperger’s 9:1) Genetic aetiology – can be associated with Fragile X, PKU and tuberous sclerosis Genetic aetiology – can be associated with Fragile X, PKU and tuberous sclerosis No association with social class or ethnicity No association with social class or ethnicity

DIAGNOSIS Autism – difficulties in all 3 main areas, must start before the age of 3 Autism – difficulties in all 3 main areas, must start before the age of 3 ‘Atypical autism’ occurs when onset of symptoms is after the age of 3 ‘Atypical autism’ occurs when onset of symptoms is after the age of 3 Most parents aware something wrong when child around 18 months Most parents aware something wrong when child around 18 months  BUT diagnosis often takes a long time Asperger’s – difficulties with social interaction and restricted behaviour and social interaction but no significant general delay in language or cognition Asperger’s – difficulties with social interaction and restricted behaviour and social interaction but no significant general delay in language or cognition

POSSIBLE SIGNS Social interaction Social interaction  Not smiling socially  Very independent  Preferring to play alone Communication Communication  Not responding to name  Delayed language Behavioural Behavioural  Oversensitivity to sounds and textures eg clothing  Unusual attachments to toys  Hyperactivity  Stereotyped repetitive behaviours Red flags for autism No babbling by 12m No gesturing by 12m No single words by 16m No 2-word spontaneous phrases by 24m Any loss of any language or social skills at any age

THE ‘CHAT’ = CHecklist for Autism in Toddlers For use by GPs or health visitors at 18m check For use by GPs or health visitors at 18m check Series of questions and observations Series of questions and observations Available via the National Autistic Society website Available via the National Autistic Society website Note this does not meet the criteria for a population screening test but can provide a useful structure for assessing relevant clinical features Note this does not meet the criteria for a population screening test but can provide a useful structure for assessing relevant clinical features If suspect, should be referred for diagnostic assessment If suspect, should be referred for diagnostic assessment

ROLE OF THE GP If suspect ASD, refer for diagnostic assessment If suspect ASD, refer for diagnostic assessment Liaise with paediatricians, psychiatry and specialist therapists Liaise with paediatricians, psychiatry and specialist therapists  Clinical psychologists  Occupational therapists  ASD trained teachers Management of intercurrent illnesses and associated conditions Management of intercurrent illnesses and associated conditions  Epilepsy  Hearing and visual impairment  Mental illness – depression, anxiety, ADHD Provide information and support to parents and carers Provide information and support to parents and carers

CONSULTATIONS Ideally see pt in first or last appt Ideally see pt in first or last appt Ensure the consulting room is a suitable environment - keep sharps out of the way, have toys to play with Ensure the consulting room is a suitable environment - keep sharps out of the way, have toys to play with Use clear simple language – short sentences; avoid irony, metaphors etc Use clear simple language – short sentences; avoid irony, metaphors etc Ask questions directly, increased use of closed questions Ask questions directly, increased use of closed questions Explain exactly what you will do in the examination before doing it, use pictures or toys to help explain Explain exactly what you will do in the examination before doing it, use pictures or toys to help explain Check pt’s understanding Check pt’s understanding

A WORD ABOUT “DIAGNOSTIC OVERSHADOWING”… Specifically mentioned in the curriculum! Specifically mentioned in the curriculum! Refers to when a pt’s presenting symptoms are put down to their learning disability, rather than the doctor seeking another, potentially treatable cause Refers to when a pt’s presenting symptoms are put down to their learning disability, rather than the doctor seeking another, potentially treatable cause Eg – pt presents with a new behaviour – consider: Eg – pt presents with a new behaviour – consider:  Physical cause – pain, deterioration in vision or hearing  Psychiatric cause – depression, psychosis, dementia  Social cause – change in carer, bereavement, abuse

RESOURCES InnovAiT Volume 2, Issue 11 (November 2009) InnovAiT Volume 2, Issue 11 (November 2009) National Autistic Society website National Autistic Society website The curious incident of the dog in the night time (2003) by Mark Haddon The curious incident of the dog in the night time (2003) by Mark Haddon