Autistic Spectrum Conditions Soni Bhate

Content Policies Diagnosis What next?

Leo kanner also born austria. Lived in usa since early years Leo kanner also born austria. Lived in usa since early years. Published 1943 paper about ‘donald’ and others autism launched on the world. Although he described children with aspergers kanners autism is now used to describe those with low end autism

Austrian psych/paed 1906- 1980 published case study 1944 in german of 4 children. May have had aspergers himself. Called it autistic psychopathy

‘it seems that for success in science and art a dash of autism is necessary’ Kanner described autism this was more widely known than aspergers as was published in english

Policies Autism Act 2009 Fulfilling and rewarding lives: the strategy for adults with autism in England (March 2010) Towards 'Fulfilling and rewarding lives': The first year delivery plan for adults with autism in England (April 2010) Supporting People with Autism through Adulthood (National Audit Office) 2009

The Governments (at the time) Vision ‘All adults with autism are able to live fulfilling and rewarding lives within a society that accepts and understands them. They can get a diagnosis and access support if they need it, and they can depend on mainstream public services to treat them fairly as individuals, helping them make the most of their talents.’

ASC - types Autism, also known as autistic disorder, childhood autism, early infantile autism, Kanner’s syndrome or infantile psychosis. Asperger syndrome. Childhood Disintegrative Disorder, also known as CDD, dementia infantalis, disintegrative psychosis or Heller’s syndrome. Pervasive Developmental Disorder (Not Otherwise Specified), also known atypical autism.

ASC Overall prevalence 1% (1.8% men, 0.2% women) (Brugha et al,2009) Three times as common in boys Half have a LD

Conditions that may be associated with ASC Fragile X ADHD Dyspraxia/dyslexia Downs syn----10% prev Neurofibromatosis Generalised LD Tourettes syn Tuberose Sclerosis Phenylketonuria

ASC - genetics Twin studies show increased rate in siblings

The Triad Social interaction Social communication Social imagination

Social interaction impairment; different manifestations Aloof, indifferent, passive Active but odd/bizzare Over-formal stilted Sociable with 1 person difficulties in a group

Social communication impairment; different manifestations No communication Communicates own needs Repetitive, one-sided Formal, long winded , literal

Social imagination impairment; different manifestations Handles objects for simple sensations Handles objects for practical uses Copies pretend play of others Limited ‘pretend’ play; repetitive, isolated Invents own imaginary world but rigid and stereotyped

Childhood autism-ICD 10 ‘ a pervasive developmental disorder defined by the presence of abnormal and/or impaired development that is manifest before the age of 3 years and by the characteristic type of abnormal functioning in 3 areas’

Asperger Syndrome Asperger Syndrome (or “high functioning autism”) usually describes those people with an ASD who have an average or above average IQ and relatively good spoken language but who also experience significant difficulties with social, occupational and other areas of their life (Powell 2002). Taking Responsibility, good practice guidelines for services for people with Asperger Syndrome. 2002 Andrew Powell. National Autistic Society

Aspergers----ICD 10 No significant general delay Qualitative abnormalities in reciprocal social interaction Stereotyped patterns

Aspergers - the reality "Reality to an autistic person is a confusing, interacting mass of events, people, places, sounds and sights. There seems to be no clear boundaries, order or meaning to anything. A large part of my life is spent just trying to work out the pattern behind everything."

Aspergers- additional symptoms Unusual responses to sensory stimuli. For example, some people with Asperger syndrome may be hypersensitive to specific sounds, textures or colours. Others may be oblivious to discomfort or pain. Behavioural disturbances. For example, some people with Asperger syndrome may be hyperactive. Others may be aggressive towards others or may harm themselves. Cognitive characteristics. People with Asperger syndrome are of average or higher than average intelligence but struggle to think abstractly or symbolically.

Sensory processing disorders ‘Sensory integration is the ability to organise sensory information for use’ Dr A Ayres-1971

Sensory processing disorder Ordinary sensory experiences felt in unusual way Impacts on arousal level Can cause sensory seeking or avoidance behaviour

Impact of SPD on daily functioning Difficulty with social interaction Avoidance of situations Poor sleep patterns Self stimulation and self injurious behaviours Etc etc

Diagnosis of ASC Clinical (behaviourally defined) using ICD/DSM Various structured interviews

Some structured tools Adult diagnostic observation schedule ADOS (Lord et al 2002) Diagnostic interview for social and communication disorders DISCO (Wing et al 2002) Adult diagnostic interview revised ADI-R (Lord et al 1994)

ASC comorbidity 40% of people with ASC show signs of psychiatric comorbidity (Ghaziuddin 2002)

Aspergers---comorbidity Dyspraxia Epilepsy Depression Anxiety ADHD OCD

ASC and offending Rate of law-breaking including offending is low (woodbury-smith 2006, Langstrom 2009) When offences occur likely to be in 3 broad categories; violent, sexual, criminal particularly arson (Mullen 2004, Berney 2004)

Interventions Self awareness Self advocacy Environment Therapy Acceptance – less self blame

Psychosocial interventions Individual psychotherapy to help the individual to process the feelings aroused by being socially handicapped Parent education and training Behavioral modification Social skills training Educational interventions

Therapies Perception, expression and regulation of emotion is recognised as an area of difficulty ( Attwood 2004) . Attwood has developed a tool for helping people with ASC to have a greater understanding ( CAT-KIT)

Therapies CBT helpful (Gauss 2007) Social stories to correct dysfunctional beliefs

Employment Only 15% of people with ASC are in employment compared with 48% with general disabilities ( NAO 2009)

Psychopharmacological interventions For hyperactivity, inattention and impulsivity: Psycho stimulants (methylphenidate), atomoxetine For irritability and aggression: Mood Stabilizers (valproate, carbamazepine), Beta Blockers (propranolol), anti-psychotics (risperidone, olanzapine, quetiapine) For preoccupations, rituals and compulsions: SSRIs (fluoxetine, paroxetine), Tricyclic Antidepressants (clomipramine) For anxiety: SSRIs (sertraline, fluoxetine)