The Co-morbidity Burden ofChildren with Autism Spectrum          Disorders         Ahmad Almai, M.D.                Head o...
Increasing Media Attention
.                                     UAE NEWSPAPERS                                                                      ...
What we know…    • ASD Prevalence is increasing (1992: 1 in 1500)CDC - ASD in 8 year olds:   California DDS on Autism:2002...
California DDS Increase in Autism Appears Specific                                     California DDS, 2009
% Visits to Child Psychiatry Clinic, BSP March, 2012
Psychiatric Disorders Child Psychiatry            Service, SKMC
Diagnostic and StatisticalManual of Mental Disorders o Published by the American Psychiatric Association oClassification o...
Pervasive Developmental                        Disorderso Come under section in DSM-IV-TR entitled…    o Disorders Usually...
DSM Category: PDDs                     Pervasive Developmental Disorders                                                  ...
Autism                                                                 Sensory                                            ...
DSM 5 Autism Spectrum Disorder              Must meet criteria A, B, C, and D:A. Persistent deficits in social communicati...
B. Restricted, repetitive patterns of behavior, interests, or activities asmanifested by at least two of the following:1. ...
Planned changes in autism diagnostic criteria•   Revisions to the current DSM-IV are being finalized in 2012, with DSM-V  ...
Planned changes in autism diagnostic criteriaProposed changes:   – Eliminate subcategories including Asperger’s syndrome, ...
Planned changes in autism diagnostic criteria•   Positives: The subtypes that will be eliminated cannot be reliably    dis...
Planned changes in autism diagnostic criteria•   Three published studies suggest that 25-78% of Aspergers or high    funct...
Autism Co-morbidities Studies
Psychiatric disorders in children with autism spectrum disorders: prevalence, co-morbidity, and associated           facto...
Psychiatric disorders in children with autism spectrum disorders: prevalence, co-morbidity, and associated factors in apop...
Fig. 1 Weighted rates of co-morbidity are shown for all of the disorders and for all of the main disorders, in which the l...
Conclusions• Psychiatric disorders are common and  frequently multiple in children with autism  spectrum disorders. They m...
The Co-Morbidity Burden of Children and Young         Adults with Autism Spectrum Disorders• Study Design: A retrospective...
Figure 1. Prevalence of co-morbidities of autism and prevalence of autism in these co-morbidities. Shown here is the preva...
Figure 3. Co-morbidities of ASD in younger (0–17 years) vs. older (18–34 years). All the co-morbidities’ prevalence were s...
Child Psychiatry Service, SKMC Study• Study Design: A retrospective prevalence  study was performed using EHR CERNER.• Ove...
Demographics
Age Groups        16-18         16%      0-5                  33%11-15 24%
Medical / Neurological Co-      Morbidities
Psychiatric Co-morbidities
Conclusions• The co-morbidities of ASD encompass disease  states that are significantly overrepresented in  ASD with respe...
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Panarab autism comorbi dubai

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Panarab autism comorbi dubai

  1. 1. The Co-morbidity Burden ofChildren with Autism Spectrum Disorders Ahmad Almai, M.D. Head of Child and Adolescent Psychiatry SKMC
  2. 2. Increasing Media Attention
  3. 3. . UAE NEWSPAPERS LIFE & STYLE | HEALTH The rise of autism in the UAE With more and more children being diagnosed as autistic in the UAE, parents have to deal with the financial burden of treatment and therapy, as well as the emotional fall-out, discovers Suchitra Bajpai Chaudhary By Suchitra Bajpai Chaudhary, Friday magazine Published: 00:00 May 11, 2012 Credit: Dennis B. Mallari/GNMMany UAE residents are still ‘clueless’ aboutautismThis comes in face of the recent statistic that indicates a childis diagnosed with autism every 20 minutes in the UAEBy Bindu Suresh RaiPublished Sunday, April 08, 2012 The blank stares that reflected in the eyes of many UAE residents when quizzed over their knowledge of autism backed the claim that more needs to be done in raising awareness for this medical condition in the country. The recently concluded World Autism Day on April 2, which was also marked in Dubai, saw awareness for this developmental condition still at its grassroots level with several members of the public; this was supported further via the results of a spot poll conducted by Emirates 24|7 that indicated only six per cent of the 123 people questioned were aware of autism. A child undergoes therapy at the Dubai Autism Centre. According to local experts, a child is diagnosed with autism every 20 minutes in the UAE and one out of every 110 children is autistic.
  4. 4. What we know… • ASD Prevalence is increasing (1992: 1 in 1500)CDC - ASD in 8 year olds: California DDS on Autism:2002: 1 in 150 12 fold inc from 1987 – 20072006: 1 in 110 13% annual growth
  5. 5. California DDS Increase in Autism Appears Specific California DDS, 2009
  6. 6. % Visits to Child Psychiatry Clinic, BSP March, 2012
  7. 7. Psychiatric Disorders Child Psychiatry Service, SKMC
  8. 8. Diagnostic and StatisticalManual of Mental Disorders o Published by the American Psychiatric Association oClassification of mental disorders used in the US oInfantile autism included for first time in DSM-III oChanged to autism in DSM-III-R oDSM – IV published in 1994 o Text Revision in 2000
  9. 9. Pervasive Developmental Disorderso Come under section in DSM-IV-TR entitled… o Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence o Includes o Mental retardation o Learning disorders o Motor skills disorders o Communication disorders o Pervasive developmental disorders o Attention-deficit and disruptive behavior disorders o Feeding and eating disorders of infancy or early childhood o Tic disorders o Elimination disorders o Others: separation anxiety disorder, selective mutism, reactive attachment disorder of infancy or early childhood, stereotypic movement disorder, disorder of infancy, childhood, or adolescence - NOS
  10. 10. DSM Category: PDDs Pervasive Developmental Disorders Childhood Autistic Rett’s Disintegrative Disorder Disorder Disorder PDD- Asperger’s Not Otherwise Disorder Specified• PDDs are characterized by severe and pervasive impairment in 3 main areas • Social interaction • Communication • Repetitive and restricted behaviors
  11. 11. Autism Sensory Sensory sensitivity sensitivity Seizures Communication Repetitive & language & Self-injurious deficit stereotyped behavior behaviors Mentalretardation Social Sleep interaction disturbance deficits GI problems Immune Immune problems problems
  12. 12. DSM 5 Autism Spectrum Disorder Must meet criteria A, B, C, and D:A. Persistent deficits in social communication and social interaction acrosscontexts, not accounted for by general developmental delays, and manifest byall 3 of the following:1. Deficits in social-emotional reciprocity; ranging from abnormal socialapproach and failure of normal back and forth conversation through reducedsharing of interests, emotions, and affect and response to total lack ofinitiation of social interaction,2. Deficits in nonverbal communicative behaviors used for social interaction;ranging from poorly integrated- verbal and nonverbal communication, throughabnormalities in eye contact and body-language, or deficits in understandingand use of nonverbal communication, to total lack of facial expression orgestures.3. Deficits in developing and maintaining relationships, appropriate todevelopmental level (beyond those with caregivers); ranging from difficultiesadjusting behavior to suit different social contexts through difficulties insharing imaginative play and in making friends to an apparent absence ofinterest in people
  13. 13. B. Restricted, repetitive patterns of behavior, interests, or activities asmanifested by at least two of the following:1. Stereotyped or repetitive speech, motor movements, or use of objects;(such as simple motor stereotypies, echolalia, repetitive use of objects, oridiosyncratic phrases).2. Excessive adherence to routines, ritualized patterns of verbal or nonverbalbehavior, or excessive resistance to change; (such as motoric rituals, insistenceon same route or food, repetitive questioning or extreme distress at smallchanges).3. Highly restricted, fixated interests that are abnormal in intensity or focus;(such as strong attachment to or preoccupation with unusual objects,excessively circumscribed or perseverative interests).4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensoryaspects of environment; (such as apparent indifference to pain/heat/cold,adverse response to specific sounds or textures, excessive smelling or touchingof objects, fascination with lights or spinning objects).C. Symptoms must be present in early childhood (but may not become fullymanifest until social demands exceed limited capacities)D. Symptoms together limit and impair everyday functioning
  14. 14. Planned changes in autism diagnostic criteria• Revisions to the current DSM-IV are being finalized in 2012, with DSM-V due for publication in May, 2013.• Reason for proposed changes: attempt to establish more reproducibility and homogeneity in diagnosis.
  15. 15. Planned changes in autism diagnostic criteriaProposed changes: – Eliminate subcategories including Asperger’s syndrome, PDD- NOS, Rett syndrome, and childhood disintegrative disorder. All of these would be subsumed under the umbrella term, autism spectrum disorder (ASD). – Instead of 3 domains of autism symptoms (repetitive behaviors and deficits in social interaction and language), 2 categories would be used: impairment in social communication and interaction, and restricted interests/repetitive behaviors. No mention of verbal language – it will be considered a co-morbidity. – A new symptom would be included in the second category: hyper- or hypo-reactivity to sensory input, or unusual interest in sensory aspects of the environment. – Each person will also be evaluated in terms of known genetic causes, level of language and IQ, and presence of seizures and/or GI problems. – A new category of Social Communication Disorder will be added to the DSM (people without repetitive behaviors).
  16. 16. Planned changes in autism diagnostic criteria• Positives: The subtypes that will be eliminated cannot be reliably distinguished by expert clinicians; more information will be required in the diagnosis (genetics, IQ, GI issues, seizures, regression history, nature of language impairment), so subtyping will be more straightforward.• Negatives: There is some concern that the criteria will exclude some people who currently have the diagnosis, particularly the higher functioning, milder cases, that do not display repetitive behaviors, for instance. This may result in denying medical treatment and social services to some people on the autism spectrum.
  17. 17. Planned changes in autism diagnostic criteria• Three published studies suggest that 25-78% of Aspergers or high functioning autism will be excluded from the autism diagnosis in DSM-V. Two other, small studies did not support these conclusions, however.• The Autism Speaks foundation is currently funding studies to determine how many people might be excluded and what the healthcare consequences might be.• A significant change in diagnostic criteria in 2013 would complicate future longitudinal studies of prevalence.
  18. 18. Autism Co-morbidities Studies
  19. 19. Psychiatric disorders in children with autism spectrum disorders: prevalence, co-morbidity, and associated factors in a population-derived sample.• Simonoff E; Pickles A; Charman T; Chandler S; Loucas T; Baird G• A subgroup of 112 ten- to 14-year old children from a population-derived cohort was assessed for other child psychiatric disorders (3 months_ prevalence) through parent interview using the Child and Adolescent Psychiatric Assessment. DSM-IV diagnoses for childhood anxiety disorders, depressive disorders, oppositional defiant and conduct disorders, attention-deficit/hyperactivity disorder, tic disorders, trichotillomania, enuresis, and encopresis were identified• Journal of the American Academy of Child & Adolescent Psychiatry. 47(8):921-9, 2008 Aug .
  20. 20. Psychiatric disorders in children with autism spectrum disorders: prevalence, co-morbidity, and associated factors in apopulation-derived sample.Simonoff E et al, Journal of the American Academy of Child & Adolescent Psychiatry. 47(8):921-9, 2008 Aug.
  21. 21. Fig. 1 Weighted rates of co-morbidity are shown for all of the disorders and for all of the main disorders, in which the latter includes ADHD,oppositional defiant or conduct disorder, and any emotional disorder (separation anxiety disorder, generalized anxiety disorder, simple phobia,social phobia, agoraphobia, panic disorder, major depressive disorder, and dysthymic disorder).
  22. 22. Conclusions• Psychiatric disorders are common and frequently multiple in children with autism spectrum disorders. They may provide targets for intervention and should be routinely evaluated in the clinical assessment of this group. J. Am. Acad. Child Adolesc. Psychiatry, 2008;47(8):921Y929. Key Words: autism, child• psychiatric disorders, prevalence, Special Needs and Autism Project.
  23. 23. The Co-Morbidity Burden of Children and Young Adults with Autism Spectrum Disorders• Study Design: A retrospective prevalence study was performed using a distributed query system across three general hospitals and one pediatric hospital. Over 14,000 individuals under age 35 with ASD were characterized by their co-morbidities and conversely, the prevalence of ASD within these co-morbidities was measured. The co-morbidity prevalence of the younger (Age,18 years) and older (Age 18–34 years) individuals with ASD was compared.• Isaac S. Kohane1,2,3*, Andrew McMurry1,2, Griffin Weber3,4, Douglas MacFadden1, Leonard Rappaport5, Louis Kunkel6, Jonathan Bickel2,7, Nich Wattanasin8, Sarah Spence9, Shawn Murphy3,8,10, Susanne Churchill3• 1 Center for Biomedical InformaticsPLoS ONE | www.plosone.org 1 April 2012 | Volume 7 | Issue 4 | e33224
  24. 24. Figure 1. Prevalence of co-morbidities of autism and prevalence of autism in these co-morbidities. Shown here is the prevalence of co-morbiditiesfor individuals with autism (denoted as p(Dx}Autism) where Dx is the co-morbidity) and the reciprocal prevalence of autism given the co-morbidity (i.e. p(Autism|Dx)). The prevalence is reported for patients younger than 35 years old. These results are consistent with prior studies andalso reinforce that monogenic disorders associated with autism individually only account for a small fraction of the disorder. It also reinforces that autism is present in over 5% of the individuals evaluated for CNS anomalies, epilepsy, muscular dystrophy, schizophrenia, Fragile X Syndrome and Tuberous Sclerosis. doi:10.1371/journal.pone.0033224.g001
  25. 25. Figure 3. Co-morbidities of ASD in younger (0–17 years) vs. older (18–34 years). All the co-morbidities’ prevalence were significantly different(p,0.0001 by Chi square) except for bowel disorders, epilepsy, autoimmune disorders (excluding IBD and DM1) and sleep disorders.doi:10.1371/journal.pone.0033224.g003
  26. 26. Child Psychiatry Service, SKMC Study• Study Design: A retrospective prevalence study was performed using EHR CERNER.• Over 418 patient records between age 2-18 who attended treatment at the Child Psychiatry Division between January and June of 2012 were reviewed. Fifty five patient’s records with ASD were selected. We identify the rates and type of psychiatric and medical• Co-morbidities associated with ASDs.
  27. 27. Demographics
  28. 28. Age Groups 16-18 16% 0-5 33%11-15 24%
  29. 29. Medical / Neurological Co- Morbidities
  30. 30. Psychiatric Co-morbidities
  31. 31. Conclusions• The co-morbidities of ASD encompass disease states that are significantly overrepresented in ASD with respect to even the patient populations of secondary and tertiary health centers. This burden of co-morbidities goes well beyond those routinely managed in developmental medicine centers and requires broad multidisciplinary management that providers will have to plan for.
  32. 32. THANK YOUQuestions?

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