Autism Spectrum Disorders for Primary Care Providers

Autism for PCPs Sourav Sengupta, MD, MPH Child Fellow, Western Psychiatric Institute & Clinic February 14, 2012

Overview
What is autism?
Who has autism?
How do we help people with autism?
Social issues surrounding autism
Resources for PCPs, families in Western PA

What is autism? Social Interaction non-verbal shared play peer relationships social/emotional reciprocity Communication spoken language conversation repetition imaginative/imitative play Repetitive Behaviors intense, restricted interests inflexible routines, rituals motor stereotypies interest in parts > whole

On the “spectrum”…
Asperger’s Disorder
Social Interaction
Repetitive Behaviors
Not significant language, cognitive delays/deficits

Rett’s Disorder
Normal prenatal, perinatal development
Normal psychomotor development through 5 months
Normal head circumference
Deceleration of head circumference growth b/t 5-48 mo
Loss of motor skills, replaced by stereotypies
Loss of social interaction
Gait/trunk motor deficits
Severe expressive/receptive language deficits

Childhood Disintegrative Disorder
Normal development until 2 yo
Loss of in 2+ skills < 10 yo:
Language
Social skills
Bowel/Bladder
Play
Motor
Impaired in 2+: language, social, repetitive behaviors

Pervasive Developmental Disorder NOS
Impairment in communication, social interaction, and/or repetitive behaviors
Specific criteria unmet
Subsyndromal?

What is NOT autism?
Selective mutism (only in SELECT settings)
Anxiety/separation anxiety
Sensory Processing/Integration Disorder (overlap)

Biological Underpinnings
10x increase in siblings
Increased concordance in monozygotic twins
Multiple underlying genetic etiologic possibilities
Environment likely affects gene expression
No evidence for MMR relationship
ASD + dysmorphism +/- family hx  think genetic syndrome

ASD prevalence increasing
1 in 110 children in the US, increasing
Why?
Improved awareness, diagnosis?
Changes in diagnostic criteria?
Service delivery for children with ASD?
Pre-term births?
Environmental?

Surveillance
Ask parents about developmental and behavioral concerns
Observe for any ASD signs
Understand family hx of ASD

Screen
Test all children at 18- and 24-month visits
Numerous available – M-CHAT is free for clinical use, well replicated
High sensitivity, low(er) specificity – follow-up interview to identify false positives
http://www.mchatscreen.com

Quick Clinical Screen - Social
Joint attention – enjoying shared experiences
“ Look at that picture/ball/duck/cool thing!”
Brings a toy to parent and smiles
Social orienting
Reponse to name
Pretend play
“ Someone’s calling you on the cellphone!”
“ Pour me a cup of tea!”

Quick Clinical Screen - Language
Diminished drive to communicate
No pointing, gestures, facial expressions
Echolalia
Cannot understand simple commands

Medical Work-up
Need for medical genetics eval?
Wood’s light  tuberous sclerosis
Lead screening
Metabolic testing (vomiting, seizures)
Hearing evaluation

Get help!
Alliance for Infants and Toddlers!
Child Psychiatrist, Developmental Pediatrician, Child Neurologist (get an ADOS!)
Specialized therapist (BS, TSS, OT, cognitive/social skills)
Case Management
School System
Speech pathologist

Treatment
Goals:
Improve social and language skills (EARLY)
Decrease challenging behaviors
Support families
Foster INDEPENDENCE

Treatment
Behavioral
Intensive therapy (>25hrs/week)  improved cognitive, language, life skills
Applied Behavioral Analysis
Play therapy, Floortime
Social Skills

Treatment
Treat co-morbid conditions, medical & psychiatric!
Constipation
Pain (dental, headache, ear)
Medications (see handout)
Please be careful with benzodiazepines!
Melatonin 0.05mg/kg 1-2 hours before bedtime

Treatment
What about Complementary and Alternative Medicine in autism?
Normalize
Ask!
Don’t judge!
Respond based on risk to health of child
Assist in navigating studies, providers, resources

Clinical Environment
Parent/Caretaker must accompany!
Limit other children in office/exam room
Quiet, neutral environment (ask parent)
Developmentally- and ASD-appropriate expectations about level of interaction/participation
Allow self-soothing
Be flexible!

Pearls from Temple
Develop child’s strengths, teach from those!
Turn-taking!
Be flexible around sensory issues
Simple, direct, calm, FREQUENT communication
Be wary of low expectations!

Thank you!
Questions?
[email_address]

Autism Spectrum Disorders for Primary Care Providers

by drsengupta on Mar 01, 2012

Accessibility

Categories

Upload Details

Usage Rights

Statistics

Autism Spectrum Disorders for Primary Care Providers Presentation Transcript