Autism Case

pathophysiology

neurodevelopmental disorder in which persons present with a range of impairments in social communication skills and restrictions in behaviors and interests.

neuropathy - 3 stages of brain development

1. overgrowth in infancy and early childhood

2. slowing and arrest of growth in late childhood

3. degeneration in preadolescence and adulthood

typically, is head size normal at birth in children with autism

yes! brain overgrowth occurs in the first 2 years of life

brain overgrowth mainly affects what areas

frontal lobe, temporal lobes, amygdala

in autism, there is (OVER/UNDER) connectivity of short range neuronal fibers and (OVER/UNDER) connectivity of long neuronal fibers

over; under

etiology

- result of a variety of biologic/genetic and environmental factors

- specific genetic markers have not yet been identified and it is likely that multiple genes are involved

- small definitive familial link although majority of people with autism do NOT have one

risk factors for development of autism

premature infants, children born to older parents, children exposed to prescription medications such as valproic acid and thalidomide during gestation

true/false: vaccines can cause autism

FALSE

incidence

- more common in males

- most commonly diagnosed pediatric condition in the US

- there has been in increase in autism due to better methods for identification and diagnosis as well as an increased public awareness of the disease

two domains of impairments that children with autism have

1. social communication and interaction

2. restricted, repetitive patterns of behavior, interests, or activities

clinical manifestations

- both nonverbal and verbal communication deficits

- difficulty developing and maintaining relationships with peers and caregivers

- social awkwardness

- motor stereotypies such as finger flicking, arm flapping, and body rocking

- may be fixated on routines and rituals and become very disturbed at even the slightest change

- hyper- or hyporeactivity to sensory inputs or unusual interest in certain sensations (i.e. indifference to pain, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement)

diagnostic tools

- DSM-5

- criteria established by American Psychiatric Association related to impairments of social communication and interaction

- Autism Diagnostic Observation Schedule (ADOS) and the companion parent interview called the Autism Diagnostic Interview-Revised (ADI-R)

what is the ADOS

- 45-60 minute standardized qualitative assessment that evaluates a child's social reciprocity, nonverbal and verbal communication, and stereotypical behaviors and interests using various play based activities with an adult tester

- ages 12 months through adulthood

- 3 domains of interest: social, communication, and repetitive behaviors

- score of 9+ = autism

- score of 7-9 = autism spectrum

prognosis

- prognosis for persons with severe symptoms of ASD is poor, with significant impact on activity limitations which markedly or completely preclude participation in social/occupational roles

- prognosis is proportionately better as the symptoms become less severe having little, if any, impact on activities and participation in social/occupational roles

strategies for structuring physical therapy treatment sessions for children with autism

- structuring the environments (predictable space, remove distractions, limit material, follow predictable schedule)

- use a variety of communication available to the child

- repetition

- active engagement (allow for free movement and improvisational activities)

- use verbal and gestural reinforcement

- incorporate breaks into treatment sessions

- can use a reward system when needed (stickers, small toys)