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Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
Autism Spectrum Disorders for Primary Care Providers
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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

Published in: Health & Medicine
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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
  • 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]

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