Autistic spectrum disorder

I have absolutely no interest in dealing with behavioural problems in kids, unfortunately, it is part of the job as a GP. There is a strong push from parents and schools to label these children with a diagnosis. Once they have a diagnosis, they can receive extra fundings and extra help at school. Having said that, it is also important to diagnose children with ASD early so that there is a better chance for them to function independently in the future.

What is Autism?

• Lifelong neurodevelopment disability that affects how an individual communicates and interacts with people and their environment. There are difficulties in 2 primary areas. 
• social interaction 
• repetitie behaviours and interests

How common is autism ?

• Australia 1/160 - 1/100
• USA & Europe 6-7/1000

What cause autistic spectrum disorder?

• exact cause is unknown 
• multifactorial is the keyword in exam 
• some genetic factors in play
• monozygotic twins 60%
• dizygotic 3 %
• More common in males than females 4:1
• More common in certain chromosomal disorders e.g. Fragile X syndrome 
• Increased in neurogenetic disorders e.g. tuberous sclerosis 

• NOT CAUSED BY VACCINATION

How do children with Autistic spectrum disorder present?

• Parents usually aware before 18 months 
• Most common parental concerns include delayed speech and behaviour problems

What is the Role of GP?

• Identify problem early and refer 
• Need to conduct a full history and physical exam
• Appropriate referrals e.g. hearing/vision, intervention services+/-therapy, paediatrician
• ongoing multidisciplinary management and review

What are some absolute indications for immediate refer?

• No Babbling, pointing or other gestures by 12 months
• No sharing of interests in objects with another person
• No single words by 16 months
• No 2 word spontaneous phrases by 24 months
• Any loss of language or social skills at any age

Any screening tools available ?

• M-Chat (16-30 months) Free to download online. Just type M-Chat on google.

What are some key elements in intervention?

• The earlier the better, the more the better
• early intervention between 15-25 hours a week
• Multidisciplinary supportive individualized
• In collaboration with family 
• Strategies to be able to generalise skills
• Develop functional, spontaneous communication 
• Reduction of maladaptive behaviours
• Teach functional adaptive skills
• Opportunity for neurotypical peer interaction 
• Clear Goal setting, predictability and routine 
• Continual review 

Does medication help?

• In general, medication does not help. 
• It is mainly used to treat other co-morbidities e.g. ADHD, insomnia, anxiety etc

What is the prognosis?

• 10 % adults with ASD live independently 

References: 

• Austism spectrum disorder by Dr. Gillian Brooks from diploma of child health webcast 2016