Autism Spectrum Disorders for Primary Care Providers
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Basics of Autism Spectrum Disorders for Primary Care Providers

Basics of Autism Spectrum Disorders for Primary Care Providers

Sourav Sengupta, MD, MPH

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  • PRIOR TO AGE 3 NOT RETT’s, CHILDHOOD DISINTEGRATIVE DISORDER
  • M-CHAT= modified checklist for autism in toddlers
  • M-CHAT= modified checklist for autism in toddlers
  • M-CHAT= modified checklist for autism in toddlers
  • Tss = Therapeutic Staff Support

Autism Spectrum Disorders for Primary Care Providers Presentation Transcript

  • 1. Autism for PCPs Sourav Sengupta, MD, MPH Child Fellow, Western Psychiatric Institute & Clinic February 14, 2012
  • 2. 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
  • 3. 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
  • 4. On the “spectrum”…
    • Asperger’s Disorder
      • Social Interaction
      • Repetitive Behaviors
      • Not significant language, cognitive delays/deficits
  • 5. On the “spectrum”…
    • 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
  • 6. On the “spectrum”…
    • 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
  • 7. On the “spectrum”…
    • Pervasive Developmental Disorder NOS
      • Impairment in communication, social interaction, and/or repetitive behaviors
      • Specific criteria unmet
      • Subsyndromal?
  • 8. What is NOT autism?
    • Selective mutism (only in SELECT settings)
    • Anxiety/separation anxiety
    • Sensory Processing/Integration Disorder (overlap)
  • 9. 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
  • 10. 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?
  • 11. Surveillance
    • Ask parents about developmental and behavioral concerns
    • Observe for any ASD signs
    • Understand family hx of ASD
  • 12. 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
  • 13. 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!”
  • 14. Quick Clinical Screen - Language
    • Diminished drive to communicate
    • No pointing, gestures, facial expressions
    • Echolalia
    • Cannot understand simple commands
  • 15. Medical Work-up
    • Need for medical genetics eval?
    • Wood’s light  tuberous sclerosis
    • Lead screening
    • Metabolic testing (vomiting, seizures)
    • Hearing evaluation
  • 16. 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
  • 17. Treatment
    • Goals:
      • Improve social and language skills (EARLY)
      • Decrease challenging behaviors
      • Support families
      • Foster INDEPENDENCE
  • 18. Treatment
    • Behavioral
      • Intensive therapy (>25hrs/week)  improved cognitive, language, life skills
      • Applied Behavioral Analysis
      • Play therapy, Floortime
      • Social Skills
  • 19. 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
  • 20. 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
  • 21. 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!
  • 22. 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!
  • 23. Thank you!
    • Questions?
    • [email_address]