AUTISM IN THE GP’S WORLD

Objectives

1. Be aware of how autism presents in both young people and adults

2. Recognise the potential difficulties faced by patients, parents or carers in normal daily activities, including GPs surgeries

3. Learn how diagnosis is made and where to find support

Curriculum Statements

Curriculum Statement: Care of People with Learning DisabilityPromoting Equality & Valuing DiversityEthics and Values Based Medicine

Competency:Community orientationData Gathering and Interpretation

Autism- Your checklist

What do I know ?

Why do I need to know ?

Where can I get more information ?

Where is the restroom ?

CASE 1

Autism Spectrum Disorder

A spectrum of psychological characterized by widespread abnormalities of social interactions and communication, as well as restricted interests and repetitive behaviour

Autism Spectrum Disorder

Males > females A life long disability Usually evident during the first three

years of life. A condition that can co-occur with

other conditions, for example Attention Deficit Hyperactivity Disorder, Obsessive-Compulsive Disorder, Learning Disability, Down Syndrome, Hyperlexia, etc.

Autism Spectrum Disorder

Knows no racial or socioeconomic differences

A developmental disability that can be improved and intervened upon, but currently there is no cure.

Triad of Autistic Impairment

Impairment of social interaction

Impairment of language and communication

Impairment of flexibility of thought and behaviour

CHAT

Check list for Autism in Toddlers Series of questions filled in by

parents and primary health workers at 18 month development check.

2 sections: one for the parents and the second are observations by the primary health care worker

If child fails, gets rescreened one month later

CHAT

Currently, autism is rarely detected before the age of three and for the other social-communication disorders, age of detection can be even later. The CHAT, however, is administered when the child is 18 months old. The earlier a diagnosis can be made, the earlier intervention methods can be implemented and family stress reduced.

CASE 2

Autism: Clinical Indicators to Refer

Absolute indications

No babbling by 12 months No gesturing (pointing, waving, bye-bye, etc) by 12

months No single words by 16 months No two-word spontaneous (not just echolalic)

phrases by 24 months ANY loss of ANY language or social skills at ANY age.

Other Clinical Indicators

Communication Concerns

Does not respond to his/her name

Cannot tell me what s/he wants Language is delayed Doesn't follow directions Appears deaf at times Seems to hear sometimes but

not at others Doesn't point or wave goodbye Used to say a few words, but

now doesn't

Behavioural Concerns

Tantrums Is

hyperactive/unco-operative/oppositional

Doesn't know how to play with toys

Gets stuck on things regularly Toe walks Has unusual attachments to toys Lines things up Is oversensitive to certain

textures or sounds Has odd movement patterns

Other Clinical Indicators

Social Concerns

Doesn't smile socially Seems to prefer to play

alone Gets things for him/herself Is very independent Does things 'early' Has poor eye contact Is in his/her own world Tunes out Is not interested in other

children.

Autistic Spectrum Disorders Diagnostic Pathways

Children (<18 years old) : Child Development Centre Community Paediatrician Shropshire/Telford & Wrekin CAMHS or

CAMHS-LD

Adults : Psychiatry Service- **Under

development**

Concluding Thoughts

Historical perspective Bleuler Leo Kanner Hans Asperger

‘Refridgerator mothers’

Patient & Family Perspective Diagnosis

Isolation and Guilt

Educational and Social Support

Empathy

Local & National Perspectives DOH strategy for adults with autism

in England 2010

Autism Act 2009

Facts & figures : Estimated 1 in 100 adults (England) and

1 in 150 children in USA 49% of adults with ASD live at home

with parents

GPs role in ASD

Recognising ASD & referring for further assessment

Providing a safe environment for patients with ASD and communication skills

Continuing health care

Directing patient & family to support networks

References

DOH publications : www.dh.gov.uk/Publicationsandstatistics /Publications

National Autistic Society www.autism.org.uk/gp

National Collaborating Centre for Mental Health (NCCMH) www.nccmh.org.uk/guidelines

Film clip: ‘Rain Man’

QUESTIONS

Quiz : True or False ?

Question 1

Children who have stopped speaking after learning words should be referred for assessment

Quiz : True or False ?

Question 2

Teenagers who have difficult or disruptive behaviours and learning difficulties need to be placed into special needs schools

Quiz : True or False ?

Question 3

Young adults with autism are entitled to housing benefit and financial support, eg DLA

Quiz : True or False ?

Question 4

An adult with Asperger’s Syndrome has more health care needs than adults with no ASD

Quiz : True or False ?

Question 5

When communicating with ASD patients, it is important to avoid metaphors and give clear instructions rather than requests

Answers

Question 1 : T

Question 2 : F

Question 3 : T

Question 4 : F

Question 5 : T

THANK YOU AND GOOD NIGHT