MCHAT and Autism Management.pptx

Mchat and autism management

1. Dr Nur Syaheeda Date ： 19th May 2023 MCHAT & Autism Management

2. 01/ MCHAT 02/ Referral and Diagnosis 03/ Behavioural Treatments 05/ Complementary & Alternative Treatments Contents 04/ Medical Management

3. MCHAT (Modified Checklist for Autism in Toddlers) This template can change color, shape, content, etc. It is commercially available and pleasant to cooperate with ally available and pleasant Develop as a screening tool for autism to be given to all children at 18 to 30 months of age. It is most widely used screening tool. However if use alone, it has poor predictive value and a high false-positive rate. So the author have since published the Modified Checklist for Autism in Toddlers -Revised with Follow up (MCHAT-R/F)

4. NO for item other than 2,5 and 12 indicate ASD risk. YES for item 2,5 and 12 indicate ASD risk.

5. MCHAT (Malay)

6. Referral and Diagnosis Evaluation for ASD should include a comprehensive assessment preferably by an interdisciplinary team. The evaluation aim to definitively diagnose ASD exclude condition and determine the child’s level of functioning. In the absence of a team, an individual clinician with expertise in evaluating ASD is appropriate.

7. Behavioural Treatments Early extensive behavioural intervention is an immersive behavioural therapy for at least 25 hours per week that is recommended for preschool to early school aged children with ASD. It seeks to teach new skills by reinforcing desirable behaviours encouraging generalization of these skills and decreasing undesiarable behaviours. Behaviour analysis-based early intensive behavioural intervention delivered over an extended time frame leads to improvement in cognitive ability, language and adaptive skills.

8. Cognitive behaviour therapy substantially reduces anxiety symptoms in older children with ASD who have average to above average IQ. Targeted play has led to improvements in early social communication skills. Social skills training has demonstrated short-term improvement in social skills and emotional recognition in school-aged children without intellectual dysfunction. Parent training and education programs improve language skills and decrease disruptive behaviour in children.

9. Medical Management There is no medication available to treat the composite symptoms of ASD, medical management can be a beneficial adjunct. It targets specific maladaptive behaviours for which intensive behavioural therapy has not been effective. It may also target comorbid diagnoses such as anxiety disorders, attention deficit/hyperactive disorders (ADHD) and sleep disorders. Aripiprazole and Risperidone are the only medications approve for the treatment of ASD in USA. These atypical antipsychotics are approved for ASD-associated irritability and in some trials have proven beneficial for treating aggression, explosive outbursts and self-injury.

10. Aripiprazole is approved for children age 6 to 17 years of age. Risperidone is approved for children age 5 to 16 years of age. Although the medication may provide some benefits, they must be weighed against serious potential adverse effects including sedation, weight gain, tremor and extrapyrimidal symptoms. Subspecialty referral should be strongly considered for these treatment. Stimulant such as Methylphenidate (Ritalin) may prove benefit in children with comorbid ADHD but treatment effects are less significant than in children without ASD and adverse effects are more common. Non-stimulant-based treatments may have a larger role in children wth comorbid ADHD and have shown fewer adverse effects.

11. Complementary & Alternative Treatments There is a strong evidence that melatonin helps manage sleep disorders, improve daytime behaviour and has minimal adverse effects. Massage therapy has been studied in several single-blinded randomized controlled trials that demonstrated benefits on ASD symptoms, sleep, language, repetitive behaviours and anxiety. Massage can be performed by parents and has no evidence of harm. Vitamin B 6 and magnesium in larger doses have been studied for use in children with ASD to improve behaviours, speech and language. Results equivocal and at suprtherapeutic doses, there is risk of neuropathy from vitamin B 6 and diarrhoea from magnesium toxicity.

12. Additional treatments that are not recommended because they have not show benefit across several randomized clinical trials include auditory interation training, facilitated communication, gluten- or casein-free diets, hyperbaric oxygen and secretin.

13. THANK YOU

14. Click here to add content of the text，and briefly explain your point of view. Autism was first described by psychiatrist Leo Kranner in 1943 as a disorder in children who has problem relating to others and aa high sensitivity to changes in their environment. DSM-5 created an umbrella diagnosis of ASD consolidating 4 previously separated disorders:- Austistic disorder, Asperger Syndrome, Childhood disintegrative disorder and Pervasive developmental disorder It constitutes a diverse group of condition related to development of the brain. Characteristics may be detected in early childhood, but autism is often not diagnosed until much later. The abilities and needs of autistic people vary and can evolve over time. While some people with autism can live independently, others have severe disabilities and require life-long care and support. Autism Spectrum Disorder (ASD)