Autism Dr. Anindya Das AIIMS Rishikesh - PowerPoint Presentation

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Autism

Dr. Anindya Das

AIIMS Rishikesh

Learning Objectives

Language development in children

Autistic spectrum disorders

Defining features

Co- occurring conditions

Management & outcome

Language Development

0-12mts

Pre-Linguistic

6

wks

Crying, cooing (vowel sounds)

6 mtsbabbling (appearance of consonants) even in the deaf 8 mtstuneful babble (intonations simulate conversation) 10-11 mtsdistinct units of sound (phonemes, pad & pat, bad & bat)

12-18 mtsSingle word stageconstant utterance to refer to a thingholophrastic use (one word for complex meanings): “papa-hungry-food”By 18 mts≈ 18 words (mainly nouns & some action verbs)

18-30 mtsTwo word stageTelegraphic speech: 2-3 utterances, rigid word order (use request, warn, name, etc.)2yrsExpn of vocabulary

30-48 mtsGrammatical differentiationincreasing length of utterancesinclusion of function words: prepositions (of, to, for, with, on, at) & conjunctions (and, but, if)development of syntactical rules (e.g. adding ‘s’ to pluralize)

From 5yrs

earning of more advanced conversational rules e.g. not interrupting

gradual internalization of speech into verbal thought

Autistic spectrum

disorders: defining features

Marked

impairment in

reciprocal

social

& interpersonal interaction: absent social smile & lack of eye-to-eye-contactlack of awareness of others’ existence or feelingslack of attachment to parents & absence of separation anxietyno/abnormal social play; prefers solitary gamesmarked impairment in making friendslack of imitative behaviourabsence of fear in presence of danger

ASD:

defining features

Marked impairment in language

& non-verbal communication

in

infancy, absence of communicative

sounds (babbling)lack of verbal/facial response to sounds/voices (mistaken as deaf initiallyAbsent/delayed speech (about half of autistic children never develop useful speech)abnormal speech patterns & content (echolalia, perseveration, poor articulation, pronominal reversal (I-You) is common

Abnormal behavioural characteristics

restricted, stereotyped, repetitive repertoire of interests &

activities (knowledge is narrow and limited to 1 or few topics)

mannerisms, stereotyped behaviours such as head-banging, body-spinning, hand-flicking, lining-up objects, rocking, clapping

ritualistic and compulsive behaviour

resistance to even the slightest change in the environment

attachment may develop to inanimate objectshyperkinesis is commonly associatedASD: defining features

ASD: the spectrum

Asperger’s syndrome or high functioning autism

: autism without any significant delay in language or intellectual development, M:F=8:1

Heller’s

syndrome or disintegrative

disorder/psychosis

: age 3-5 yrs, a rapid downhill deterioration in developmental milestones & neurological deficits, organic brain syndromes of varying aetiologies lipoid degeneration of ganglia in CNS), prognosis poorRett’s syndrome: only reported in girls, after a period of normal early development & head circumference between 5-30 mts. there is a deceleration of head growth, loss of purposive hand movements and acquired fine motor skills & subsequent appearance of stereotyped movements of hands (e.g. hand-wringing).

ASD: Co-occurring conditions

Epidemiology:

2–5 children per 10,000 live

births, M:F=5:1

Associated

medical conditions: infantile spasms,

congenital rubella, tuberous sclerosis, cerebral lipidosis, fragile X syndromeAssociated Intellectual disability (ID): 75% of which 50% have moderate to profound IDCo-occuring epilepsy is common (25%)

ASD: Management

Behaviour Therapy

development of a regular routine with as few changes as possible

structured class room training

positive reinforcements to teach self-care skills

speech therapy and/or sign language teaching

behavioural techniques to encourage interpersonal interactions

ASD: Outcome

depends on the severity of the condition

developmental

gains

in at

least some areas (e.g., increased interest in social interaction

) during adolescence (but small fraction deteriorate)minority of ASD live & work independently in adulthood (depends on the degree of language & intellectual abilities)

Thanks

Bibliography:

Shorter Oxford Textbook of Psychiatry

International Classification of Diseases-10

th

ed.

Classification of mental and behavioural disorders Diagnostic and Statistical Manual-5th editionNew Oxford Textbook of Psychiatry