AUTISM

SPECTRUM
DISORDERS

Dr. Maja P.S.,

Sp.S
Neurologi
department
 (AUTISM SPEKTRUM DISORDERS)

GANGGUAN SPEKTRUM AUTISME

INTRODUCTION
- Autism is a behaviour disorder.
- It is a Central Nervous System disease with the
unknown etiology(ies)
- There is growing clinical as well as genetics evidence that
the pathway in CNS
* are aberrant.
* The incidence is increasing logarithmically
*At present a worldwide epidemic of autism exists
 ASD :
1. Aspergers syndrome
2. Atypical autism
3. Pervasive Development Disorder
Unspecified (ICD-10)
(PDD-NOS DSM-IV)
 ETILOGY
1. Genetic
2. Pre, peri and post natal
3. Neuro-anatomic model
4. Neuro-chemicals
5. Immunologic
6. Viral infections

EARLY DIAGNOSIS
Under the age of two years
Means early intervention
Best results if given before 5-years of age
The earlier the better
 DIAGNOSIS
Shared the following characters:
1. Qualitative impairment in social interaction
as shown by :
* the use of non verbal behaviors such as eye gaze
and body posture to regulate social interaction,
* a failure to develop peer relationships
* a lack of spontaneous showing and sharing interests
* a lack of social emotional reciprocity
2. Qualitative impairments in social communication
as shown by:
a delay in language development without nonverbal compensation
problems in initiating and sustaining conversations;
stereotyped use of language
lack of varied and imaginative of imitative play

3. Restrictited repertoire of interests,behaviours and activities

as shown by:
an abnormal over-focus on particular topics
an adherence to non-functional routines or rituals,
repetitive
stereotyped motor mannerisms
preoccupation with part of objects rather than the whole.
 PARENTAL CONCERNS RELEVANT TO AUTISM
1. Communication concerns
. Does not respond to name
. Cannot telll me what she/he want
. Language is delayed
. Does niot follow directions
. Appear deaf at times
. Seems to hear sometimes but not others
. Does not point or wave bye-bye
. Used to say a few words but now does not
2. Social concerns
. Does not smile socially
. Seems to prefer to play alone
. Gets things for her/himself
. Is very independent
. Does thins early
. Has p[oor eye contact
. Is in a world of his/her own
. ignores us
. Is not interested in other children
 Behavioural concerns
. Tantrum
. Is hypereactive/uncooperative or oppositional
. Does not know how to play with toys
. Gets stuck on things over and over
. Toe-walks
. Has unusual attachments to toys (holding certain
object)
. Lines things up
. Is over sensitive to certain sounds or textures
. Has odd movement patterns
 4. Absolute indications for immediate further evaluation
. No babbling by 12 months
. No gesturing (pointing, waving bye-bye, etc) by
12 months
. No single word by 16 months
. No two-word spontaneous (and not just echolalic) by
24 months
. ANY lost of ANY language or social skills at ANY
age
 A multidisipinary approach to diagnostic assessment is required. The
teams varies across centres, but commonly includes:
- Neuro-paediatrician
- Child-psychiatrist
- Clinical psychologist
- Speech and Language therapist
- Occupational therapist
- Physiotherapist
The informations necessary for a diagnosis includes:
detailed development history
parents descriptions of the everyday behaviour and
activities of the child
direct assessment of the childs social interaction style
and communicative and intellectual function.
RECOMMENDATIONS FOR INVESTIGATIONS
1. Routine Investigations for all cases
- Speech and language assessment
- Cognitive / developmental assessment
- Basic neurological examination
- Fragile-X and basic chromosome screen (low IQ and dysmorphic
cases)
- Wood light
- Hearing test (BERA)
- EEG
 2. Additional test (to be conducted only
when indicated)
- Sleep EEG
- Full neurological examination
- Brain imaging (Ct-scan,MRI)
- Metabolic / immunological tests
- Fulll chromosome screen
- Lead screening
 MANAGEMENT
- Maximize the childs social , communicative and intellectual
functioning.
- Whatever the underlying approach, structure and an
emphasis on developing communication skills are
important aspects of the preschool and school curriculum
for children with ASD
- Behavioural interventions are needed to reduced
repetitive, stereotyped, self injurious and chalanging
behaviours.
 Medication :
Current pharmacological treatment does not treat the
cores features of ASD
. Neuroleptics (fluoroperazine and haloperidol)
stereotyped and hyperactivity
SE : dystonic reaction and drowsiness
. SSRIs
Adolescents and adult with Aspergers syndrome
. Clomipramine, 5-HT uptake inhibitor
obsessional and compulsive behavours