AUTISM power point presentation paediatric

Autism an opposite of ADHD(attention deficit hyperactivity disorder)

1. AUTISM

2. INTRODUCTION Autism is a form of Pervasive Developmental Disorders. ( PDD) The pervasive developmental disorders ( PDD) can be understood as disturbances of brain development. Children with these disorders all share the inability to attain expected social, communication, emotional, cognitive, and adaptive abilities. In these children, there is: - delayed and disordered communication. - Atypical social interaction. - Restricted range of interests. - Onset before 3  year of age.

3. AETIOLOGY Multiple genetic regions (chromosomes 16p11.2, 15q24, 11p12-p13) and gene variants (copy number variation, deletions, microdeletions , duplications, inversions, translocations) potentially contribute to abnormal neuronal and axonal growth, synapse formation and myelination . It can result from gene-gene and gene-environment interactions over the course of prenatal and postnatal development. A 4 : 1 male : female AD prevalence ratio suggests a sex-linked inheritance. In utero toxic insults has the potential to produce disruptions in CNS development that can manifest as mental retardation and autistic symptoms.

4. EPIDEMIOLOGY The incidence of AD has increased steadily over the past 15 yr. Current estimates of the prevalence rate of all PDD (63.7/10,000) are approximately 1 in 150-160. Disorder-specific prevalence rate estimate for AD (20.6/10,000),

5. PATHOLOGY Analysis of head circumference, in conjunction with MRI studies, has shown differences in the brain structure of children with AD. The head circumference in AD is normal or slightly smaller than normal at birth until 2  months of age . Afterward children with AD show an abnormally rapid increase in head circumference from 6-14  month of age, increased brain volume in 2-4  year olds, increased volume of the cerebellum, cerebrum and amygdala . There is marked abnormal growth in the frontal, temporal, cerebellar , and limbic regions of the brain. Early , accelerated brain growth during the 1st several years of life is followed by abnormally slow or arrested growth, resulting in areas of underdeveloped and abnormal circuitry in parts of the brain. Areas of the brain responsible for higher-order cognitive, language, emotional, and social functions are most affected.

6. CLINICAL MANIFESTATIONS The core features of autistic disorder (AD) include impairments in 3 symptom domains: - social interaction ; - communication; and - developmentally appropriate behaviour , interests or activities. Stereotypical body movements, a marked need for sameness, and a very narrow range of interests are also common. Approximately 20% of children with AD have macrocephaly but enlarged head size might not be apparent until after the 2nd yr of life.

7. CONT’D Abnormal development of social skills and impaired ability to engage in reciprocal social interactions are hallmark symptoms of Autistic Disorders. They can have early social skill deficits such as abnormal eye contact, failure to orient to name, failure to use gestures to point or show, lack of interactive play, failure to smile, lack of sharing and lack of interest in other children . Some children with Autistic Disorder make no eye contact, whereas others show intermittent engagement with their environment and can make inconsistent eye contact, smile or hug. Most children have some impairment in joint attention, which is the ability to use eye contact and pointing for the purposes of sharing experiences with others. These children show deficits in empathy for what another person might be feeling.

8. CONT’D These children can range from being nonverbal to having some speech (e.g., capable of imitating songs, rhymes, or television commercials). Speech might have an odd intonation and may be characterized by echolalia (imitative repetition of words), pronoun reversal and nonsense rhyming. Early abnormal language concerns include absent babbling or gestures by 12 mo, absent single words by 16 mo, absent 2-word purposeful phrases by 24 mo, and any loss of language or social skills at any time .

9. CONT’D Play skills in AD are typically aberrant, characterized by little symbolic play, ritualistic rigidity, and preoccupation with parts of objects. The child with AD is often withdrawn and spends hours in solitary play, often with restrictive or repetitive interests and behaviors. Tantrum-like rages can accompany disruptions of routine. Intellectual functioning can vary from mental retardation to superior intellectual functioning in select areas (splinter skills, savant behavior). Some children show typical development in certain skills and can even show areas of strength in specific areas, such as puzzles, art or music.

10. DIAGNOSIS DSM-IV-TR DIAGNOSTIC CRITERIA FOR AUTISTIC DISORDER: A     A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3 ):    1     Qualitative impairment in social interaction, as manifested by at least two of the following:    a   Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction    b   Failure to develop peer relationships appropriate to developmental level    c A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)    d Lack of social or emotional reciprocity

11. CONT’D 2     Qualitative impairments in communication as manifested by at least one of the following:    a    Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)    b     In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others    c    Stereotyped and repetitive use of language or idiosyncratic language    d    Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level 3     Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:     a Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus    b    Apparently inflexible adherence to specific, nonfunctional routines or rituals    c   Stereotyped and repetitive motor manners (e.g., hand or finger flapping or twisting, or complex whole-body movements)    d    Persistent preoccupation with parts of objects

12. CONT’D B  Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years : - social interaction - language as used in social communication or - symbolic or imaginative play . C   The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.

13. CONT’D AD is diagnosed by the clinical examination. The gold standard diagnostic tools are the Autism Diagnostic Interview—Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS), which require referral to a trained professional for administration. Critical elements of the evaluation should include a detailed developmental history with a review of communicative and motor milestones, a medical history including discussion of possible seizures, sensory deficits such as hearing or visual impairment.

14. DIFFERENTIAL DIAGNOSIS Mental retardation not associated with PDD. Specific developmental disorders (of language). Early onset psychosis (e.g., schizophrenia ). Selective mutism . Social anxiety. Obsessive-compulsive disorder. Stereotypic movement disorder Inhibited-type reactive attachment disorder. Rarely , childhood-onset dementia.

15. TREATMENT The primary goals of treatment are to: - maximize the child's ultimate functional independence and quality of life by minimizing the core features of the disorder. - facilitating development and learning. - promoting socialization. - reducing maladaptive behaviours . - educating and supporting families.

16. CONT’D The cornerstones of treatment for the PDDs is e ducational interventions which include behavioural and habilitative (speech, occupational, and physical) therapies. These interventions address: - communication. - social skills. - daily-living skills. - play and leisure skills. - academic achievement. - maladaptive behaviours .

17. Cont’d The educational programs for children with PDD can be categorized as: - behavior analytic, - developmental , or - structured teaching on the basis of the underlying theoretical orientation . These intervention should begin as early as possible. - provide intensive intervention educational activities (at least 25  hours/week , 12   month/year). - providing a low student-to-teacher ratio; - including parent training; - promoting opportunities for interaction with typically developing peers - using curricula that address functional spontaneous communication, social skills, functional adaptive skills, reduction of maladaptive behaviours , cognitive skills, and traditional academic skills.

18. CONT’D Parent training and family involvement includes: - educating parents about PDDs. - providing access to needed ongoing supports and services. - training and involving them as co-therapists. - assisting them in advocating for their child's needs. - providing emotional support.

19. CONT’D Pharmacotherapy can increase the ability of persons with AD to benefit from educational and other interventions and to remain in less-restrictive environments. Selective serotonin reuptake inhibitor (SSRIs): fluoxetine , fluvoxamine , citalopram , escitalopram , paroxetine , sertraline Early identification and intervention of PDD are associated with better outcomes.