Pervasive developmental disorders. workshop

Transcription

1 Pervasive developmental disorders workshop

2 Historical perspective Leo Kanner 1943:extreme autistic aloneness, preservation of sameness, excellent memory, delayed echolalia, oversensitivity to stimuli, restricted spontaneous activity, highly intelligent families. Hans Asperger 1944 published a dissertation on" autistic psychopathy.

3 Diagnostic criteria ICD 10 Childhood autism F84.0 Qualitative impairments in reciprocal social interaction Qualitative impairments in communication Restricted repetitive and stereotyped patterns of behaviour, interests and activities Manifest before the age of 3 years

4 Autism-associated problems Fears and phobias Sleeping and eating difficulties Temper tantrums and aggression Learning disability or specific learning difficulties Sensory processing issues Syndrome can be diagnosed in all age groups

5 Differential diagnosis Learning disability Language disorder Selective mutism Attachment disorder Obsessive compulsive disorder Rett s Syndrome-mutations gene MECP2 Disintegrative disorder

6 Screening for genetic conditions Tuberous sclerosis- autosomal dominant gene on chromosome 9 1% of individuals with autism have Fragile X Syndrome Phenylketonuria-questionable Congenital rubella Neurofibromatosis

7 Psychological models of autism Theory of mind: Simon Baron- Cohen 1985; Sally-Anne test Executive function hypothesis: planning and organisation Weak central coherence: Happe, Briskman,Frith 2001

8 Epidemiology Initial studies:4-10 autistic children in every live births 1979 Wing and Gould 21 per Fombonne / Baird 2006, Lancet 100/10 000= about 1%

9 Screening for autism Checklist for autism in toddlers at 18m. (Baron-Cohen et al.,1996):eye contact, look there is.. and observing if child follows, pretend play can you make a cup of tea?, Where is the light?, can the child build a tower of bricks

10 Screening for ASD Social Communication Questionnaire SCQ by M. Rutter, T. Bailey and C. Lord. Applicable from age 4 40 questions administered to parents with a cut off point of 15 Cost effective and takes 10 minutes

11 Assessment tools Autism Diagnostic Interview-Revisedlengthy and detailed interview conducted with parents. Autism Diagnostic Observational Scheduleexamination of the child using specific toy materials, 1 hour assessment

12 Assessment process Information on child cognitive development- formal and informal Speech and language assessment Occupational therapy assessment Sometimes school observations

13 Classification-Pervasive Developmental Disorders F84.0 Childhood Autism F84.1 Atypical autism F84.2 Rett s syndrome F84.3 Other childhood disintegrative disorder F84.4 Overactive disorder associated with mental retardation and stereotyped movements

14 Classification continued F84.5 Asperger s Syndrome F84.8 Other pervasive developmental disorders F84.9 Pervasive developmental disorder unspecified

15 Management of ASD Educational interventions Psycho-educational group for parents Reports for the school Liaison with schools SALT,OT, dietician-advisory roles Linking parents with National Autistic Society and it s Croydon branch CAMHS s role

16 Co-morbid conditions Attention Deficit Hyperactivity Disorder Tourette's Syndrome Oppositional Defiant Disorder Obsessive compulsive disorder Fears and phobias; anxiety Sensory issues: over or under sensitivity, tactile defensiveness Sleep disorders

17 Co-morbidities Epilepsy:25% of children with ASD will develop epilepsy- tonic-clonic in 75%of cases,12% absence seizures and 7% complex partial seizures. Challenging behaviours including self injurious behaviour (intellectually most impaired children); severe behavioural distubance

18 Croydon pathways Children up to the 5th Children older than 5 birthday are assessed by a Community Paediatrician supported by SALT and Clinical Psychologist from CAMHS years are assessed in CAMHS using multidisciplinary model. ADOS is used in almost all of the assessments.

19 Collaboration between agencies Community paediatricians attend assessments at one of the clinics in CAMHS Clinical psychologist from CAMHS attends assessments at Croydon Community Health Steering party under the leadership of Commissioner from PCT meeting regularly ASD Strategy being developed Professional meetings include education,

20 Discussion and questions Commonly raised issues: support for children with ASD in schools; statement of special educational needs. Educational provisions. Social services involvement: Children s Disability Team (mainly for children with SLD and diagnosis of Autism). Respite care; direct payments. Residential placements-funding implications.