PRESENTED BY:A.PRIYADHARSHINI M.Sc(N)LECTURER,JAI INSTITUTE OF NURSING AND RESEARCH,GWALIOR.
How do they present?Parents worried about: ◦ Speech and language delay ◦ Abnormal behaviour ◦ Lack of understanding
DEFINITIONA disorder of neural development characterized by impaired social interaction impaired communication skills impaired imagination with restricted interests and repetitive stereotypical behavior
Contd..Itis a complex developmental disability that typically appears during the first three years of life.Autism is also called as kanner syndrome.
AETIOLOGYUNKNOWN AETIOLOGY (problems in neural maturation)STRONG GENETIC BASISONSET BEFORE 36 MONTHS OF AGEAutism is 4 times more prevalent in boys and girls.Classic autism occurs in 10-30 per 10,000
CLINICAL PRESENTATIONThe symptoms occur first during the infancy period.The symptoms of autism vary greatly but follow a general pattern.Not all symptoms are present in all autistic children.
Contd… VARIED SPECTRUMNO EYE CONTACT<------------->INTERMITTENT EYE CONTACT, SMILE AND HUGMENTAL RETARD.<------------->SUPERIOR IQ IN SELECT AREASNO SPEECH<--------------------->ADVANCED SPEECHIMITATE SONGS;
Impaired social interactionAvoid eye contactAvoids cuddling by parents (resists or becomes stiff)Reduced recognition of others happiness, distress or anger (respond same to anger and love)Lack of interest in other childrenPrefers solitary play
NORMAL RESPONSE –ATTEMPT TO LIFT RESPONSE TO CUDDLING
Contd...Unable to join in with others (GROUP PLAY)Resists invasion of personal space or being hurriedLack of awareness of classroom norms e.g. criticises teacher, unwilling to cooperate, doesn’t fit in.May not smile in recognition of their parents faces.
Contd..Speech and facial expressions deveop peculiarly.Resistance to change. E.g. moving the chair.
Impaired communication skillsDelayed language development especially understanding.Poor response to name (apparently deaf).Lack of pointing or pointing only for what they need; and not to share interestLack of empathy; Failure to respond to others’ smiles/ anger
Contd..Echolaliabeyond expected ageReversing pronouns using ‘he’ for self beyond 3yrsUnusual or advanced vocabularyUnusual use of language or tendency to talk only on specific (often factual) topics.
ECHOLALIA REPEATING WORDS OR PHRASES LIKE A PARROT (beyond 3 years)
Impaired imagination• Limited variety of imaginative play• Repetitive play e.g. lining up toys, spinning, flicking, switching on and off• Liking for sameness and/or resists change more than expected for age• More interested in how things work than playing with them.
UNUSUAL TENDENCY TO LINE UPTOYS
OTHER BEHAVIOURS• UNDER OR OVERSENSITIVITY TO SOUND, TOUCH, PAIN OR OTHER SENSES• UNUSUAL PROFILE OF SKILLS WITH SOCIAL AND MOTOR SKILLS BELOW EXPECTED• GENERAL KNOWLEDGE, READING OR VOCABULARY IS ABOVE EXPECTED(THOUGH MAY NOT UNDERSTAND WHAT IS READ)• UNUSUAL MOVEMENTS (CLAPPING, HEAD BANGING, ROCKING MOVEMENTS, EXCESSIVE MOUTHING..)
NOT RESPONDING APPROPRIATELYTO PAIN
Possible Indicators of AutismSpectrum Disorders• Poor eye contact• Doesnt smile• Does not respond to name• Does not babble, point, or make meaningful gestures by 1 year of age• Does not speak one word by 16 months• Does not combine two words by 2 years• Loses language or social skills• Doesnt seem to know how to play with toys• Is attached to one particular toy or object
Diagnosis• Based on history, assessment and investigation.• Audiometry.• Rating scales and formal interviews may help in certain cases (CHAT, M-CHAT)• Assessment must be multiprofessional and in more than one setting. (SCHOOL, HOME, PEERS)
PHARMACOLOGICAL THERAPY:Medications for seizures, hyperactivity, extreme mood changes.FENFLURAMINE- it is a drug that decreases blood serotonin concentrations. Some autistics have abnormally high blood serotonin concentrations.PIRACETAM- it helps autistic child to become more talkative, sociable, less aggressive and increases the attention span.
SUPPORTIVE TREATMENT:Earlyintervention is essential.Encourage and support the parents.Special education class.Clear instructions to the child prompting to perform specific behaviours.Immediate praise the child and rewards for performing those behaviors.Behavior therapySpeech therapy
Contd..Music therapyPlay therapySensory integration therapyAuditory integration training- for different sound frequencies.Eliminating dietary gluten and milk and dairy products.
PROGNOSIS:The outlook for each child depends on the intelligence and language ability.Some people with autism become independent adults.