Do not cure the autism but understand it.

1. Diagnosis &management of
Autistic Spectrum Disorders
Moderator-Dr.Mangilal
sir

3. Prevalence
 The prevalence rate of autism in India
is 1 in 250 (figure may vary as many
cases are not diagnosed)
 currently 10 million people are
suffering in India.
 The government only recognized the
disorder in 2001, till 1980s, there were
reports that Autism didn't exist in India.
IAP-2013

4. Etiology of ASD
 The cause of autism is unknown. brain
abnormalities
 genetic(hereditary)
 environmental (e.g., exposure to toxins)
 metabolic disorders (e.g., serotonin deficiency),
viral infections (e.g., German measles
 complications during pregnancy and delivery
unstable genes
 immunizations like (MMR) vaccine.
 fever/flu during pregnancy .

5. Checklist for sign of autism
Social interactions Communication
 Seen to be in their own
world
 Show little eye contact
 Not use of gestures
 Not share of enjoyment or
interests
 Show little emotion or
empathy
 Not respond to their names
 Show not interest to other
children or peers
 Have little or no babble
 Have little or no spoken
language
 Not engage in pretend play
 Have echolalia which
means they echo or mimic
words or phrase without
meaning or in an usual
tone of voice
 Have difficulty
understanding and
following simple
instructions

8. Autistic disorders is characterized by the inability of the children to
communicate and interact socially.
An autistic is a loner. He expresses
lack of interest in other people.
Extreme autistic aloneness

9. Language abnormalities
Rather than engage in
conversation, the autistic
tends to repeat the words
rather than reply, answer or
engage in conversation

10. Repetitive behaviors
An autistic extends
concentration or something
and preserve the
sameness of the
environment.

11. Echolalia
Is a form of autism where
the autistic repeats what it
said by another rather than
respond to a question.

12. Pronoun reversals
Autistics refer to
themselves by “you” and to
others as “I”.
Even after acquiring
speech, still it is not used
for effective social
communication. They do
not respond to verbal
comments.

14. Changes in DSM 5 from DSM 4
TR
Diagnostic and Statistical
Manual of Mental Disorders
 1994-DSM 4
 May2013-DSM 5

15. DSM 5 criteria
A. PERSISTENT DEFICITS IN SOCIAL COMMUNICATION AND
SOCIAL INTERACTION ACROSS CONTEXTS, NOT ACCOUNTED
FOR BY GENERAL DEVELOPMENTAL DELAYS, AND MANIFEST
BY 3 OF 3 SYMPTOMS:
 A1 reflects problems with social
initiation and response
 A2 reflects problems with nonverbal
communication
 A3 reflects problems with social
awareness and insight, as well as with
the broader concept of social
relationships
IAP

16. B. RESTRICTED, REPETITIVE PATTERNS OF
BEHAVIOR, INTERESTS, OR ACTIVITIES AS
MANIFESTED BY AT LEAST 2 OF 4 SYMPTOMS:
 B1 includes atypical speech, movements,
and play
 B2 includes rituals and resistance to
change
 B3 includes preoccupations with objects or
topics

 B4 includes atypical sensory behaviors

17. C. Symptoms must be present in
early childhood (but may not
become fully manifest until social
demands exceed limited
capacities)
D. Symptoms together limit and
impair everyday functioning

 IAP 2013

18.  Changes include:
 • The diagnosis will be called Autism
Spectrum Disorder (ASD)and there no longer
will be subdiagnoses (Autistic
Disorder,Asperger Syndrome, Pervasive
Developmental Disorder Not Otherwise
Specified, Disintegrative Disorder)
 >Although symptoms must begin in early
childhood, they may not be recognized fully
until social demands exceed capacity
 Rett syndrome is a discrete neurologic
disorder and is not a subdiagnosis under ASD,
although patients with Rett syndrome may
have ASD.
 Asperger syndrome also not a subdiagnosis
under DSM 5.
AAP 2013

19.  In DSM-IV, symptoms were divided into three areas
(social reciprocity,communicative intent, restricted and
repetitive behaviors).
 The new diagnostic criteria have been rearranged into
two areas:
1) social communication/interaction
2) restricted repetitive behaviors. The diagnosis will
be based on symptom currently or by history, in
these two areas
 In summary, pediatricians should counsel parents
whose children had a diagnosis of an autism
spectrum disorder they do not need to be reevaluated
for diagnosis .
 AAP2013

20. SCREENING &DIAGNOSIS
 Diagnosing of ASD can be difficult, since
there is no medical test, Doctors look at
the child’s behavior and development to
make a diagnosis.
 ASD can sometimes be detected at 18
months or younger. By age 2, a
diagnosis by an experienced
professional can be considered very
reliable.[1] However, many children do not
receive a final diagnosis until much older.
 Diagnosing an ASD takes two steps:
 Developmental Screening
 Comprehensive Diagnostic Evaluation
 AAP 2013

21.  Developmental Screening
 Developmental screening is a short test to tell if
children are learning basic skills when they
should, or if they might have delays. During
developmental screening the doctor might ask
the parent some questions or talk and play with
the child during an exam to see how she learns,
speaks, behaves, and moves. A delay in any of
these areas could be a sign of a problem.
 All children should be screened for
developmental delays and disabilities during
regular well-child doctor visits at:
 9 months
 18 months
 24 or 30 months
 Additional screening might be needed if a child
is at high risk for developmental problems due
to preterm birth, low birth weight or other
reasons.

22.  Comprehensive Diagnostic Evaluation
 The second step of diagnosis is a
comprehensive evaluation. This thorough
review may include looking at the child’s
behavior and development and interviewing
the parents. It may also include a hearing
and vision screening, genetic testing,
neurological testing, and other medical
testing.
 In some cases, the primary care doctor
might choose to refer the child and family to
a specialist for further assessment and
diagnosis. Specialists are
 Developmental Pediatricians
 Child Neurologists

23. The Modified – Checklist for
Autism in Toddlers
 age range-16-48 month
 M-CHAT------------M-CHAT follow up interview
 1 min (if fails ) 5 min
 Scoring-pass/fail scores based on falling atleast 2
critical items or 3 or more non critical items
 Accuracy-sensitivity-90%
 Specificity-99%Cost-6.06$
Please fill out the following about how
your child usually is. Please try to
answer every question. If the behavior is
rare (e.g., you've seen it once or twice),
please answer as if the child does not do

24. 1. Does your child enjoy being swung, bounced on your knee, etc.? Yes
No
2. Does your child take an interest in other children? Yes No
3. Does your child like climbing on things, such as up stairs? Yes No
4. Does your child enjoy playing peek-a-boo/hide-and-seek? Yes No
5. Does your child ever pretend, for example, to talk on the phone or
take care of a doll or
pretend other things?
6. Does your child ever use his/her index finger to point, to ask for
something? Yes No
7. Does your child ever use his/her index finger to point, to indicate
interest in something? Yes No
8. Can your child play properly with small toys (e.g. cars or blocks)
without just Yes No
mouthing, fiddling, or dropping them?
9. Does your child ever bring objects over to you (parent) to show you
something? Yes No
10. Does your child look you in the eye for more than a second or two?
Yes No
11. Does your child ever seem oversensitive to noise? (e.g., plugging
ears) Yes N

25. 12. Does your child smile in response to your face or your smile?
Yes No
13. Does your child imitate you? (e.g., you make a face-will your
child imitate it?) Yes No
14. Does your child respond to his/her name when you call? Yes
No
15. If you point at a toy across the room, does your child look at
it? Yes No
16. Does your child walk? Yes No
17. Does your child look at things you are looking at? Yes No
18. Does your child make unusual finger movements near his/her
face? Yes No
19. Does your child try to attract your attention to his/her own
activity? Yes No
20. Have you ever wondered if your child is deaf? Yes No
21. Does your child understand what people say? Yes No
22. Does your child sometimes stare at nothing or wander with no
purpose? Yes No
23. Does your child look at your face to check your reaction when
faced es Nwith

26. Treatments for
Autism
Spectrum
Disorders

27.  There is no cure for autism; however, with appropriate
treatment and education, many children with autism spectrum
disorders can learn and develop. Early intervention often can
reduce challenges associated with autism, lessen disruptive
behavior, and provide some degree of independence.
 Treatment depends on the needs of the individual. In most
cases, a combination of treatment methods is more effective.
Autism spectrum disorders may require lifelong treatment.
 According to the National Institutes of Health (NIH), treatment for
autism can include
 Behavioral management therapy . Speech-language
therapy
 Cognitive behavior therapy
 Social skills training Educational and
school-based
 Joint attention therapy Occupational therapy
 Parent-mediated therapy
 Physical therapy
 Medication treatment
 Nutritional therapy

29. Pharmacological intervention
 Currently, there is no medication that can cure
ASD or all of its symptoms. But in many cases,
medication can help treat some of the
symptoms associated with ASD, especially
certain behaviors.
 Any medications not approved by the FDA for
treating symptoms of autism or other
conditions.
 One person with autism might respond to
medications differently than another person
with autism or than people who don't have

30.  SSRI
◦ SSRIs might reduce the frequency and intensity of repetitive
behaviors; decrease anxiety, irritability, tantrums, and
aggressive behavior; and improve eye contact.
 Tricyclics
◦ These medications are another type of antidepressant used to
treat depression and obsessive-compulsive behaviors.
 Psychoactive or anti-psychotic medications
◦ risperidone is approved for reducing irritability in 5-to-16-year-
olds with autism.
◦ These medications can decrease hyperactivity, reduce
stereotyped behaviors, and minimize withdrawal and
aggression among people with autism.
 Stimulant
 help to increase focus and decrease hyperactivity in people
with autism. They are particularly helpful for those with mild
ASD symptoms.
 Anti-anxiety medications
 Anti-convulsants
◦ Almost one-third of people with autism symptoms have
seizures or seizure disorders.

31.  Behavior Modification
 Behavior modification often involves highly
structured, skill-oriented activities that are based on
the individual's needs and interests. It usually
requires intense, one-on-one training with a
therapist and extensive caregiver involvement.
 Sensory integration therapy is a type of behavior
modification that focuses on helping people with
ASD cope with sensory stimulation. Treatment may
include having the individual handle materials with
different textures or listen to different sounds.
 Play therapy is a type of behavior modification
that is used to improve emotional development,
which in turn, improves social skills and learning.
Play therapy involves adult-child interaction
 Social stories can also be used to improve
undeveloped social skills. Stories are designed to
help people with ASD understand the feelings,
ideas, and points of view of others,

32. Applied Behavioral
Analysis
 This treatment program (ABA) is based on the
principles of positive reinforcement .
 There are several methods of behavior
modification that are used to treat inappropriate,
repetitive, and aggressive behavior and to provide
autistic people with skills necessary to function in
their environment. Most types of behavior
modification are based on the theory that rewarded
behavior is more likely to be repeated than
behavior that is ignored. This theory is
called applied behavior analysis (ABA)

33. ABA Three Step Procedure
 Antecedent: The verbal or physical stimulus such as
a command or request.
 Resulting Behavioral response to stimulus or a lack
of response
 Consequence: the positive reinforcement or no
response for inappropriate behavior

34. Play therapy is a type of behavior modification that is
used to improve emotional development, which in turn,
improves social skills and learning. Play therapy involves
adult-child interaction
 Floor Time is simply the
idea that a child’s
communication skills
can be improved by
building on his/her
strengths while playing
together on the floor.

35. Integrated Play Groups

36. TEACCH
raining and ducation of utistic and
Related ommuni ation for andicapped
Children
 This is a highly structured program based
on the “Culture of Autism”
 Term refers to the “relative strengths and
difficulties shared by people with autism
and that are relevant to how they learn”

37. Intervention
 In this approach, children are
evaluated to determine emergent
skills and intervention is designed to
build on these skills.
 The intervention plan is developed for
each individual child to help plan
activities and experiences.
 The child refers to visual supports
such as picture schedules to help
them predict and cope with daily
activities.

38. SCERTS
 Social Communication, Emotional
Regulation, and Transactional
Support
 Social Communication: spontaneous
functional communication, emotional
expression and secure and trusting
relationships with others
 Emotional Regulation

39. The Hanen Approach
 This approach is based
on the belief that parents
should be the child’s
language teachers,
because they have the
strongest bond and have
many opportunities to
teach language in the
natural contexts of daily
living.
 Parents are trained by
Hanen certified SLPS.

40. In Summary
 There are many, many different
approaches to treating Autism
Spectrum Disorders.
 This list is by no means
comprehensive.
 Parents and therapists should engage
in careful research before committing
to any specific program.

41.  Communication Therapy
 Communication therapy is used to treat
autistic people who are unable to
communicate verbally, or to initiate
language development in young children
with the disorder. Speech therapy may be
used to help people with autism gain the
ability to speak.
 Picture exchange communication
systems (PECS) enable autistic people to
communicate using pictures that represent
ideas, activities, or items. The individual is
able to convey requests, needs, and
desires to others by simply handing them a
picture.

44.  Dietary Modifications
 Autism is not caused by diet and the
use of dietary modifications and
supplements to treat the disorder is
controversial.
 Researchers have found elevated levels
of proteins found in wheat, oats and rye
(gluten) and casein,Eliminating foods
that contain gluten and casein from the
diet may cause side effects and should
not be done without the advice of a
qualified health care provider.
 Studies have shown that vitamin B,
magnesium,cod liver
oilsupplements may improve behavior,
eye contact, attention span, and learning
in autistic people. Vitamin C has been

45. Prognosis or outcome of
autism
 Some children with autism may improve at
4-6 years of age especially those with mild
autism who have been treated at an early
age.
 Current policy of inclusion within the
education system helps to support the
majority of ASD sufferers within
mainstream schools.
 49% of adults with autism still living with
parents
 12% have full time employment.
 10% had a social life and some
employment but required some support
 46% needed specialist residential

46. Poor prognostic factors
co-existing mental retardation.
environmental toxins
advanced parental age
 diseases that co-exist with autism like
Fragile X syndrome, Down’s
syndrome etc. About 10–15% of
autism cases have an identifiable
chromosomal abnormality.

47. Consider the following differential diagnoses for
ASD
 Neurodevelopmental disorders:
 – specific language delay or disorder
 – intellectual disability or global developmental delay
 Mental and behavioural disorders:
 – attention deficit hyperactivity disorder (ADHD)
 – mood disorder
 – anxiety disorder
 – oppositional defiant disorder (ODD)
 – conduct disorder
 – obsessive compulsive disorder (OCD)
 Conditions in which there is developmental
regression:
 – Rett syndrome
 – epileptic encephalopathy.
 Other conditions:
 – severe hearing impairment
 – severe visual impairment

48. Famous personality with ASD

49. THANK YOU