Autism spectrum disorder (ASD) is defined by difficulties with social interaction and communication, and restricted or repetitive behaviors. It is more common in males than females. The causes are genetic and environmental factors that impact brain development. Symptoms usually appear by age 2. Diagnosis involves screening tools and observing behaviors. Treatment involves early intervention with intensive educational and behavioral therapies for at least 25 hours per week. Medications may help specific symptoms but do not treat the underlying condition. Prognosis is better with early identification and treatment.

1. Prof Dr Hussein Abdeldayem
Prof of Ped Neurology, Alex University
Member of AAN, AAP, ICNA
AUTISMAUTISM

2. Autism Spectrum DisorderAutism Spectrum Disorder
ASDASD
They are defined as a group of biologically based
neurodevelopment disorders that share two
common areas of concern
Qualitative
impairments in
social interactions
Qualitative
impairments in
social interactions
Restricted and
repetitive
interests or
behaviors
Restricted and
repetitive
interests or
behaviors
Qualitative
impairments in
communication
Qualitative
impairments in
communication

3. ASD
male 4/ 1 female

4. ASD

5. DSM-V
No pervasive developmental
disorder term
But
ASDMild Severe

6. 1 child in every 150. - - 88 68
2007 2012 2014

7. please refer
 Failure to Attend to human voices
 Failure to Look at face and eyes of others
 Failure to Orient to name
 Failure to Demonstrate interest in other children
 Failure to imitate
 NO babbling, pointing or gesturing by 12 mo
 NO single words by 16 mo
 NO 2 words spontaneous phrases by 24 mo
 Any loss of language or social skills at any age
Auditory assessment is needed (ABR)
Screening for autism: M-CHAT

8. So…What causes autism?
Genetic Factors
Factors that affect the
capacity for methylation
(including gender)
Factors that affect
metal handling
Environmental Factors
Vaccine AdditivesEnvironmental Exposure
To Heavy Metals
Brain Differences
Effect or cause

9. Is there an increased risk
of having another child
with autism (recurrence)?
 The incidence of
autism in the general
population is 0.2-1%,
but the risk of having
a second (or
additional) autistic
child increases almost
50-fold to
approximately 10 to
20%.

11. Formal diagnosis
+

12. CARS
 To assess severity
 60 questions
 For the mother or
caregiver and
noticed by the
examiner
 <15 normal
 15-30 : risky and
mild
 30-35: moderate
 >35: severe

13. Treatment
AUSTISM IS A TREATBLE DISEASE
SESSIONS ,SESSIONS , SESSIONS ,
SESSIONS
SESSIONS
SESSIONS

14. AUTISM IS A TREATABLE DISEASE

15. Treatment
Recommended Regimens
1. Start as early as possible
2. Individualized programming for each child
3. Have curricular emphasis on attention ,
communication, play and social correlation
4. Highly supportive, predictable and organized
5. At least 25-30 hours/week of educational services
6. In small classes including 1:1 time for most children
7. Teachers with special expertise in working with
children with autism / Provide training of teachers.**
8. Family counseling *** and group therapy
9. Changeable program (cont.)

16. Cont-
9. Regular re-evaluation, progress and adjustment :
every 3 months
10.Use functional analysis of behaviors
11.Provide transitional planning

17. Pharmacological Role
1- Atypical antipsychotic*:
as resperidone and aripiprazole
2- Selective serotonin reuptake
inhibitors **:
as sertraline, fluoxetine
3- Insomnia:
Melatonin
4- Mood stabilizers/ AED:
as valproic acid, Carbamazepine
5- ADHD :
as Methylphenidate, Atomoxetine
6- omega 3/zinc

19. Psychopharmacologic interventions DO NOT treat the underlying
ASD.
They can improve the child's functioning and his ability to participate
in behavioral interventions.
They are usually prescribed for:
Inattention
Hyperactivity, and impulsivity
Aggression, outbursts, and self-injury
Anxiety
Obsessive compulsive behaviors, rigidity, and repetitive behaviors
Depressive symptoms
Sleep dysfunction
Pharmacological interventions

20. SIB REPITATIVE BEHAV

21. Rispadex
(Risperidone*)
Rispadex
(Risperidone*)
 dopamine blocker (antagonist )
 5-HT2A antagonist
*available
as a 1 mg/mL oral solution)

22. Rispadex
(Risperidone*)
 Improve:
 Aggression
 Improve language development
 Improve communication
 Decrease self-injury
 Repetitive behavior
 Hyperkinesia
 Good sleep

23. Rispadex
(Risperidone*)
 Only FDA approved (10/2006 )
 Suggested Dose
 Duration: at least 6 mo

24. ARIPIPRAZOLE (Aripiprex)

25. ARIPIPRAZOLE (Aripiprex)
 FDA APPROVED FOR ASD
 Atypical antipsychotic ( partial
DOPAMINE AGONIST )
 2013-2014*

26. ARIPIPRAZOLE (Aripiprex)
 FDA APPROVED FOR ASD
 6weeks:
1- decrease irritability
2- decrease hyperactivity
3- decrease stereotype

27. ARIPIPRAZOLE (Aripiprex)
 FDA APPROVED FOR ASD
 S/E:
1- weight gain
2- sleepiness
3- drooling
4- tremors
5- tardive dyskinesia
Gradual withdraw
Not with CBZ or fluoxetine

28. SIB
SIB TREATMENT
 1- RESPERIDONE
 2- ARIPIPRAZOLE
 3- HALOPERIDOL

29. Haloperidol
 Haloperidol, marketed under the trade name Haldol,
HALONASE , SAFINASE TABLET (1.5 and 5 mg) , is
a typical antipsychotic medication. Wikipedia
 Formula: C21H23ClFNO2
 Metabolism: Liver-mediated
 Biological half-life: 14–37 hours (oral)
 Excretion : Biliary (hence in feces) and in urine
 Other indications: Tics , schizophrenia

30.  Not used with: citalopram , desipramin,
erythromycin , clarithromycin
 Take care with Atomoxetin, CZP, DIAZEPAM ,
BENZATROPINE, CBZ, FLUOXETINE

31. Complementary and Alternative
Therapies
NON - Inclusive
Because Few studies
 Vitamin B6
 Magnesium
 Dimethyl glycine
 Diet: Gluten / Casein free
 Hyperbaric Oxygen Therapy
 Secretin
Insufficient
No controlled studies
 Antifungals
 IV immunoglobulin
 Chelation therapy
 GABA
 Stem cell therapy
 Coenzyme Q
OTHERS*

32. 9/2015

36. Non Biological based practices
 Acupuncture
 Auditory integration training
 Alpha Stimulant Set (cranial electrostimulation)
 Biofeedback and neurofeedback
 Chiropractic*
 Hypnosis
 Hippotherapy (therapeutic horseback riding
 Sensory integration therapy
 Transcranial magnetic stimulation
 Yoga

37. Alpha waves stimulant

38. Alpha cranial stimulation
session

39. Complementary
approaches
Music
Quoran
Pets

40. Factors with positive outcomes for
TREATMENT
 Age: early identification
 Higher cognitive abilities
 CARS score (mild ASD)
 NO clinical Seizures
 Not Secondary ASD

41. AUTISM IS NOT MENTAL RETARDATION
 AUTISTIC CHILD IS USUALLY TALENT IN
MATH
MUSIC
ART
Einshtein , Newton , Messi