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Understanding Autism: Key Insights from DSM-5 to Intervention Strategies · Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner

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Music.
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Let's listen in. Goals for today's presentation are to help understand the DSM-5
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diagnostic criteria for ASD or autism spectrum disorder,
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differentiate the autism spectrum disorder from some of the neurodevelopmental
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disorders and the social communication disorders,
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look at some of the common commodities, how there is like an overlap of symptoms,
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and then we'll also briefly review the evidence-based behavioral and pharmacological interventions.
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Right so autism spectrum disorder
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as probably most of your aware is a neurodevelopmental disorder
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that impacts people interact
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with other person social communication
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their learning and their behavior now it is a developmental disc it is described
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as a developmental disorder however it can be diagnosed at any age it is described
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as a developmental disorder because the symptoms generally appear in the first
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few years of life are noted or recognized in there.
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A little bit about the prevalence in epidemiology. As per the 2023 data from
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CDC, 1 in 31 children aged 8 have been diagnosed with autism spectrum disorder.
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Globally, the prevalence in 2021 was around 1%, although it is still increasing
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with better evidence and improving access to cares.
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It is more commonly diagnosed in males compared to females, and it's about like
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four is to one ratio, three to four is to one ratio, depending on which study you look at.
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The average age of diagnosis is about four years, although the symptoms and
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signs are recognized even earlier.
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Now, what causes autism? It appears to be a combination of several genetic and
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environmental factors.
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There definitely appears to be a very strong genetic predisposition.
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The current heritability estimate for autism spectrum disorder is about 0.83,
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which indicates it's a very strong genetic component.
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Some of the environmental factors that's associated with higher risk of autism
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include like prenatal exposures to toxins, drugs, infections,
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and even some prescription medications.
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Increased parental age is another risk factor. There is also some association
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between untreated and undertreated mental illness during pregnancy and autism in the offsprings.
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One thing that needs to be emphasized, because there is a very strong myth out
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there, is that there is no evidence to suggest any association between vaccines and autism.
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Several large studies done in multiple countries have confirmed the same.
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So this is a myth that needs to be broken.
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And talking about myths, there are several common myths about autism.
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We already spoke about the vaccines.
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Now, there's another myth that autism is only a childhood condition.
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Adults do not have autism. That's not true. Once diagnosed with autism,
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they have autism for life.
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It cannot be cured. So far with the current treatments and the interventions,
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we do not have a cure for autism. We can only manage the symptoms with behavioral
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and pharmacological interventions.
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Some people learn coping skills and mask their symptoms, but it cannot be completely cured.
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Not all autistic people have a special talent, or not all autistic people have
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learning disabilities.
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Autistic people are antisocial. This is another common myth.
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The difference between people who have autism and antisocial personality disorder is that in autism,
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they have in the individual has a deficit
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in understanding the social norms of
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the social rules whereas an and whereas an
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antisocial person they understand the rules but they just disregard they don't
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care for the rules only boys are artistic again it is seen across all genders
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it's just that boys or males are more diagnosed with autism and it is not caused by bad parenting,
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Now, the good parental support, kids or individuals can develop better coping
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skills, masking skills, but just autism is not the outcome of bad parenting.
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Now, before we jump into the diagnostic criteria, I would like to emphasize
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that autism is a spectrum disorder.
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If you've met one person with autism, you've only met one person with autism
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because they're like, each individual is like highly unique and they exhibit
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different challenges and abilities.
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This course is to highlight the importance of recognizing the diversity within
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the autism community and avoiding generalizations.
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Now, coming to the DSM-5 diagnostic criteria, which guides us in the diagnosis
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of ASD, the essential features of ASD are broadly organized into two sections.
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Part A, or criteria A, which discusses about the deficits in social communication and interaction.
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And then that criteria B, which discusses about the restricted repetitive patterns
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of behaviors, interests, or activities.
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Now, for someone to be diagnosed with autism,
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They need to demonstrate the deficits or issues in all the three areas that's
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shown here, which is the social-emotional reciprocity, nonverbal communicative
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behaviors, developing, maintaining, and understanding relationships.
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What does that mean? We will look at them individually.
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So social-emotional reciprocity, it can be described as the ability to engage
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with others and share thoughts and feelings.
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Now when someone has deficits in social emotional reciprocity and it it varies
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according to the age in young children it can manifest as like little or no
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showing no initiation of social interactions,
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no sharing of emotions they would probably like have a hard time approaching
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peers on the playground they are interested but they can they do not know how
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to approach they typically wait for others to approach and sometimes it can
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be as severe as even if someone else approaches,
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they just ignore them.
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Now, in older kids and adults without intellectual disability or language deficits,
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it can manifest as difficulties processing and responding to complex social
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cues, like how to join a conversation, when to join, what to say, what not to say.
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Also, some individuals have deficits in understanding jokes or sargasm.
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They have a hard time understanding, and they take the very concrete content
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of what is said instead of applying to the situation.
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They have difficulty with conversing with peers on a general basis.
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And this is not exclusively with peers. It can also be with family members.
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Some individuals who have developed compensation strategies for some of the
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social challenges, they still struggle when they're in a novel or a new or unsupported situation.
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And they can struggle with anxiety when that happens.
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The second part, the nonverbal communicative behaviors, deficits in this can
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manifest as a typical use of eye contact, gestures, body language, speech and intonation.
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An early feature which depicts this of autism, how this manifests is like impaired joint attention.
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They typically do not point to things that they are interested in or they do
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not share their interest.
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They have a hard time following
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someone's pointing or eye gaze they often
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fail to use expressive gestures spontaneously in communication among
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young people and adults with fluid language where there is no deficits the difficulty
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in coordinating non-verbal communication can be seen as like odd or like wooded
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or exaggerated body language not only do they have issues with showing appropriate
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body language, they also can represent,
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misrepresent, or misinterpret other's facial expressions or their body language.
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And the third component of the social communication, developing,
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maintaining, and understanding relationships.
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This can manifest as absent, reduced, or atypical social interest.
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It can manifest as light rejection by others A passivity or inappropriate approaches
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that seem aggressive or disruptive,
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In young children, there is often lack of social play, an imagination Older
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individuals, they must struggle to understand what behavior is considered appropriate
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in one situation but not to the other,
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Frequently, there is a desire to establish friendships Without a complete or
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realistic idea of what friendship entails,
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Again, when considering all these social communication areas,
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we need to consider what is the norm for the age, gender, and the culture.
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Moving on to criteria B, so the criteria A is the social deficits,
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and then the criteria B is the restricted repetitive patterns of behaviors,
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interests, or activities.
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Here, out of the four, you only need to meet the criteria at least for two of them.
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Some of the features are stereotype repetitive movements or speech,
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insistence on sameness, inflexible adherence to routines or rigidity,
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highly restricted fixated interests and then the sensory issues which could
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be like hyper or hyper reactivity to sensory input,
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now what does stereotype repetitive movements or speech look like it can be
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like a simple more water stereotypy like hand flapping finger flicking or like rocking movements,
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and what we usually call stemming repetitive use of objects like spinning coins
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lining up toys by color that can be another one Repetitive speech can present as echolalia,
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parroting of words, stereotype use of certain words or phrases that they see on TV.
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Individuals with limited language
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skills, it can present as high-pitched screeches or animal noises.
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Then the rigidity or the inflexible entrance to routines and insistence on sameness,
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this can manifest as resistance
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to change there is like distress at
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like very small changes also like for
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example eating a different breakfast or like going to
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taking an alternative route to school or work they need
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to adhere to those strict strictly there is
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also rigidity in thinking they might need
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to wear the same clothes every
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day or they might need the same breakfast or same color
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things every day there is ritualized
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patterns of verbal and non-verbal behavior like repetitive questioning or like
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pacing a perimeter that also is kind of like um inflexible at translate routine
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highly restricted and fixated interests here the emphasis is on the abnormal intensity.
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The focus of the interests. And it also can be a typical one,
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what is not normal for their age.
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Now, as we know, in toddler age or sometimes even in school age,
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kids have fixation on certain objects, what we describe as transitional objects.
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The way to kind of differentiate them is that transitional objects offer comfort
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and security while hyperfixations are intense and take a lot of the individual's
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time and get in the way of their social interactions.
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Okay and then the other common presentation is
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sensory issues they can either be hypersensitive to sensory input like very
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sensitive to loud noises certain textures foods or it could be hyper reactivity
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meaning like they have high very high point tolerance so you might see someone who
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comes to the emergency room or to your office with like a big injury to the
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head they don't care about it.
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You might be anxious or scared about it, but they don't really care about it.
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Their pain tolerance can be high.
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Now, not everyone is the same, but they can either be hyper or hyper.
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Again, because of the sensory issues, we have a lot of challenges they can have
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because of, let's say, they're having sensitivity to food textures,
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then it can also lead to feeding disorders.
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So among the criteria B, again, you only need two out of the four to meet the
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criteria for autism spectrum.
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Of the additional requirements the symptoms need to be present in early developmental
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period but they may not become fully manifested until the social demands exceed limited capabilities,
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or may be biased by learned strategies the symptoms should cause clinically
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significant impairment in functioning either in social occupational or other
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areas the disturbances are not better explained by just idd or global developmental
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delay now idd and autism they can frequently co-occur,
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but to make a comorbid diagnosis of ASD and IDD,
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the social communication should be way below that expected for the general developmental level.
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And then, according to the DSFI, one of the specifiers is the level of support.
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So if you see level one, level two, level three, that basically indicates the
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level of support that they need.
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Previously, it used to be called high functioning
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autism or low functioning autism but those
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are outdated and they're somewhat like dangerous
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because it doesn't truly depict the
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strengths and the challenges of an individual so
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instead of that the better way to kind of describe it is the level of support
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that they would need level one being like the minimal support that they would
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need and level three being the highest level of support they would need for
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example in level one they might just need some therapy individual therapy or
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life skills coaching because they don't,
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their deficits are very subtle or the stress is like not as intense,
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when they're during transitions level two they require substantial support let's
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say because of their atypical social behaviors or like excessive interest in
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the specific topics or the distress is like much more noticeable when faced with the change,
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This level would be like the accommodations that we talk in school,
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like help with their reading, their social skills support. They might need social skills training.
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Level three, requiring very substantial support.
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That means these individuals have severe problems with communication or severe stemming behaviors.
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The distress is too extreme when asked to switch tasks or with transitioning.
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These individuals with level three they might need one-on-one
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aids and for communications
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they might need aac tools like augmentative
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and alternative tools picture symbols or like electronic devices to communicate
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so now we looked at the diagnostic criteria based on dsm-5 now let's say when
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should we screen and how do we diagnose autism so the screening tools more than me.
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Pediatricians in the group can definitely are more familiar with that.
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I'm familiar with the MCHAT and the ASQs, but not with the other screening tools.
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The American Academy of Pediatrics suggests that autism screening should be
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a part of standard 18 and 24-month well visits.
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And the National Center on Birth Defects and Developmental Disabilities recommends
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that all children should be screened at ages 9, 18, 24, and 30.
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The MCHAT, which is the one that's
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frequently used is basically a modified checklist for autism in toddlers.
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It's a specific screening tool for autism recommended by the AAB that should
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be administered around 18 and 24 months.
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It consists about 20 questions about the child behavior, and then the results
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will let one know if they need a further evaluation for autism.
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The ASQs, on the other hand, they're not specifically designed for like autism
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screening but they can be used to identify children who may require further
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evaluation by especially if their communication domain score is like below the cutoff.
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Once the screening is done, then you can either administer the diagnostic tools
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or refer them to a psychologist or people who are trained to administer the diagnostic tools.
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The CARS and the GARS, those are the Childhood Autism Rating Scale and the Gilliam Autism Rating Scale.
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They don't need very specific training to administer them.
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It usually takes input from the teachers or for the parents in the first and
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then some of the other caregivers or teachers.
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And they can kind of indicate the possibility of autism spectrum.
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It was the autism diagnostic observation schedule that is kind of the gold standard
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for collecting objective information about social communication.
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And however, one of the major limitations is that it is more time consuming
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and it requires specialized training to administer the test.
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However, it has strong psychometric support and is widely used in clinical settings.
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Often times insurance companies want the diagnosis to be made using an ADOS
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so that they can approve those services like the AV therapy.
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It's important to diagnose or catch the diagnosis of autism at an early age
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because there are several benefits.
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At an individual level, because of the brain plasticity in early childhood,
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if there is early intervention, there is enhanced better outcomes with cognitive,
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language, and social-emotional functioning.
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This can reduce the child's frustration and also enhance the quality of life.
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It reduces the risk for developing psychiatric comorbidities like anxiety and
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depression later on in life.
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At a family level, it provides them with the support, with the knowledge at
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an early time, which can kind of help them facilitate better coping mechanisms with the kids.
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And it also reduces parental stress, has improved better family outcomes.
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And from a society or the community point of view,
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it definitely has some significant long-term cost savings because there is reduced
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need for intensive interventions like crisis interventions in patient psychiatric hospitalizations.
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There is also better social outcomes when we intervene early and because of
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that, they are easily integrated into the society and have greater independence in adulthood.
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All right. Now, while there are benefits, there are also some dangers of early diagnosis.
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However, I believe the benefits definitely outweigh the risks.
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Some of the potential risks are like there is a danger for being labeled and
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stigmatization, which can again impact the self-esteem of the individual.
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There is a risk for over diagnosis or misdiagnosis although it can provoke anxiety
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and high stress level in parents again the risks of that are like the benefits
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of that outweigh the risks because,
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with early intervention later on the stress levels and anxiety can be better.
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What are some of the challenges with making the diagnosis? We have the definitive diagnostic criteria.
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We have several diagnostic tables. What are the challenges or barriers for making a diagnosis?
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One, as you already probably understand, we have to rely on the parent report a lot.
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And if the parents have their own biases or if they are not cognizant or not
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too aware of recognizing some of the subtle symptoms, it can be challenging.
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They may not bring the it for like evaluations or even when they bring in for
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the evaluations their report could be biased or not sufficient now the individuals
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themselves or the patients they themselves can have like,
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not much insight into the symptoms so
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they might not be able to convey the information appropriately now
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with our reducing times appointment times we are only seeing like a snapshot
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of the system or like of the individual so that we don't know what are some
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of the struggles they're experiencing in school or in like other areas unless it's like severe.
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Presence of like other neurodevelopmental disorders like
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adhd language delays speech delays
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or idd they can kind of impact
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our ability to diagnose accurately and
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sometimes during the short visits that they are brought in
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the individuals can like mask the symptoms for
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a while some of the differential diagnosis again
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idd it can exist it
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can be diagnosed along with autism spectrum disorder speech delays language
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disorders that's another area social pragmatic communication disorder or spcd
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this is something that has been introduced in the dsm-5 in a minute we'll look
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at how to differentiate between ASD and social pragmatic communication disorder,
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social anxiety, and ADHD.
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Now, ADHD is highly comorbid with autism spectrum disorder, almost like one in two kids.
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So one in two or three kids. So it's about like 30 to 50% overlap in the symptoms.
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There's a lot of overlap of the symptoms between ADHD and autism spectrum.
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Let's say there is a kid who has short attention span or they have impulsive
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behaviors or because of their hyperactivity, they are not able to sustain a
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conversation with an individual.
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This can be perceived as poor social communication.
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Also, because of their impulsivity, they might not be disliked and might have
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problems with making relationships or friendships with other individuals.
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And so this can be mistaken for autism spectrum. And there is a high overlap
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between the two, in any ways.
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So one of the things that can be done is probably treat the ADHD first and then
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evaluate if there is a suspicion for both of them.
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What is social pragmatic communication disorder and how is it different from autism spectrum.
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Superficially social pragmatic communication disorder is
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asd minus the restricted and derivative behavior so if they meet the criteria
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remember the criteria a part a criteria for making asd diagnosis if they only
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have that not the criteria b then it's basically social pragmatic communication disorder,
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they would benefit from social skills training.
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Now, autism and social anxiety disorder, sometimes social anxiety disorder can be perceived as autism.
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In autism, there is a difficulty in understanding the social norms regardless
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of the judgment, whereas in social anxiety, there is a fear of social judgment.
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Now, individuals with autism can still develop
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social anxiety when social anxiety when it's social anxiety just by itself there
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is preserved social skills like in asd autism ocd they also have an overlap
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of symptoms so it's important to differentiate when it is ocd and when it is
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the serial stereotypical behaviors from,
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autism in ocd there is like intrusive thoughts and the rituals are like driven
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by anxiety there is a lot of anxiety.
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Whereas in ASD, the stereotypical behaviors or repetitive behaviors are just
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comfort seeking. They're not driven by anxiety.
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Again, this is a picture or table depicting the common comorbidities in ASD.
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As we can see, this is only from one study, so I would take it with a grain of salt.
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If you look at it, there is a very high comorbidity with ADHD, almost like 50% plus.
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Then there is like anxiety spectrum disorders, whether it's generalized anxiety.
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I'm surprised that's only 2.4%, but there's like very high specific phobia and social phobia.
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Then there's mood disorders. I hear only MDD is shown in the picture, which is about 20%.
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And then there is OCD, which is about like 40%, if you consider the subsyndromal symptoms.
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They did not show like, again, schizophrenia. I highly doubt it.
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Still seen in kids or individuals with autism spectrum still have schizophrenia.
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Now, as we discussed earlier, you know, because of the sensory and the texture
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issues, individuals who have autism spectrum are at a very high risk for feeding disorders.
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One in three, or I'm sorry, one in three out of four kids who have autism spectrum
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disorder have problems related to eating, and they can manifest as either pica
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or rumination disorder, ARFID, which is the avoidant and restrictive food intake disorder.
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PICA and ARFID are the ones that are most commonly seen.
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And then rumination disorder and then anorexia, bulimia, they're seen less frequently.
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Another picture basically showing the high comorbidity with intellectual disability,
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ADHD, and some of the associated features.
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Anxiety, problems with mood, sleep issues, that's a big thing.
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Again, GI issues because of sensory issues, that is another big thing.
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Seizures is also very highly, about one-third of the individuals with autism
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spectrum can have seizure disorders.
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Now how do we manage
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autism so this is a very important
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part again it needs a team effort
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pediatricians behavioral therapists
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speech-language pathologists occupational therapists psychiatrists
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child psychiatrists psychologists school counselors
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all everybody plays an important part
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along with parents of course during management of
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autisms oftentimes you need to make several referrals
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including for like if for its diagnostic purposes neuropsychology
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or autism diagnostic evaluations for speech
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delays they need speech therapy for sensory issues occupational therapy or feeding
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therapy behavioral therapy for like aba dir or teach again they need They probably
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need like several accommodations in school and support and advocacy is a very important part.
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I know there were some questions about support and advocacy and I'll answer when we get to the end.
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The different types of behavioral therapy available for autism aba that's kind
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of like the most known and the gold standard it's most approved by insurance companies also,
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it's basically breaking down the skills into manageable parts and it uses positive
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reinforcement to get the desired behaviors it is you need a trained bcba for investing aba,
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or like at least a registered behavioral technician and it's delivered for about
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20 to 40 hours for it to be most of per week for it to be most effective the
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dir or floor time as it's known,
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this basically involves one to get on
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the floor with the child to play and do the activities they like it's meant
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to support emotional and intellectual growth by helping them learn skills
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around communication and emotions another therapy
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is teach which is treatment and education of autistic and related communication
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handicapped children this was developed at unc this treatment uses visual cues
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just picture cards to help your help one's child to learn everyday skills like
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getting dressed information is broken down into small steps so they can learn it more easily,
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then there's another one called the pecs the picture exchange communication
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system this is another visual based one it uses symbols and stop picture cards
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and the child learns to ask questions and communicate through special symbols
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again of all the behavioral therapies aba seems to be the most evidence-based and goal standard.
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Occupational therapy can be helpful for sensory integration,
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improving fine motor skills and daily living skills.
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Social skills training is more useful for older children and adolescents.
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In this, there's role-playing, peer interaction, and it can be both individual as well as group.
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Pharmacotherapy, this is basically where we as child psychiatrists come.
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Of course, we also play a role in care coordination, but most of the times the
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kids are referred to us for medications.
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Now, there is only two FDA-approved medications for management of symptoms in ASD.
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One's risperidone from the ages of 5 plus is for irritability and aggression,
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and eryproprazole Abilify, age 6 plus, again approved for irritability.
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Now because these medications are approved for FDA, these are not the only medications.
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We use several other second generation antipsychotics off-label.
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Most important thing when using these medications is to monitor for the metabolic
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side effects and extrapyramidal side effects.
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Especially with Iroproposol Abilify, you can see like a paradoxical reaction
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like increased aggression and irritability.
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That's probably especially in the individuals who are non-verbal they can experience
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akathisia but they do not know how to express and then that comes out as irritability and aggression.
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So monitoring for like EPS is very important now there are like several medications
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we use off-label if there is autism with like comorbid ADHD we use stimulants
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as still as the first line medication we just need to monitor for like any increased
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aggression alpha-agnes like guanfacine and clonidine are used.
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Whenever we're using medications, we need to make sure that we start at low
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doses and titrate them very gradually.
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And for managing autism and anxiety, we still use SSRIs like fluoxetines or loft.
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Just we need to make sure we're monitoring. We need to monitor for activation side effects.
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Autism and OCD, again, SSRIs. higher doses are not often required but still
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behavioral therapy which is exposure and response prevention adapted for asd
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it's it is the main state of treatment,
31:17
Again, for sleep, melatonin, clonidine, we have several other medications that
31:22
we use, but the most commonly used ones are melatonin, clonidine, and hydroxine.
31:29
Again, each individual is very different, and so we have to adjust the medications accordingly.
31:40
I think we have time to go over a case. Okay, yeah, I think we can go over a
31:46
case. This is a case example.
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This is a 12-year-old boy who presented with temper tantrums.
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He was brought in by his mother for psychiatric evaluation of temper tantrums
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after being referred by the school.
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There was also some declining school performance.
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Shortly after starting middle school, Brandon started complaining of stomachaches
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on a school day morning and was often reluctant to go to school.
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After reading till here, my first thought would be social anxiety,
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which is still the case. I would suspect school refusal with social anxiety
32:17
or some possible bullying.
32:19
Those would be my different shoots.
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Brandon's sixth grade teachers reported that he was academically capable.
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So it's not in learning disability mostly, but he had a hard time making,
32:32
he had little ability to make friends.
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Okay, so there are some social concerns here. He seemed to mistrust the intentions
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of classmates who tried to be nice to him, but attempted to befriend others
32:43
who laughingly feigned interest in toy cars and trucks that he brought to school.
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So the statement indicates two features, which is basically,
32:53
you know, he has a hard time reading others, misinterpreting others' intentions.
33:01
So there is some problems with social
33:04
communication, and he also seemed an interest in toy cars and trucks.
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If it was an elementary school kid, that's a little different for someone to
33:13
be excessively interested in cars and toys in a middle school. It's slightly typical.
33:18
When interviewed alone, Brandon responded with non-spontaneous mumbles.
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When asked questions about school, classmates and his family,
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when the examiner asked if he was interested in toy cars, Brandon lit up.
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He pulled several cars, trucks and airplanes from his backpack and while not
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making good eye contact.
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They've talked at length about vehicles using their apparently accurate names,
33:43
front-head loader, V-52, Jaguar, etc.
33:46
And then asked again about school, Brandon pulled out his cell phone and showed
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a string of text messages like, Dumbo, Mr.
33:52
Stutter, Loser, Freak, Everybody Hates You.
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So now this raises the suspicion of problems with social communication and again,
34:01
the increased interest or fixation on cars and trucks.
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Brandon added that other boys would whisper bad words to him in class and then
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scream in his ears in the hallway.
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And I hate loud noises. So some hypersensitivity to sounds.
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He also told the examiner that he sometimes wished that he had never been born.
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Now, that is a little concerning. We always have to pay attention to those. and evaluate further.
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Developmentally, Brandon spoke his first words at the age of 11 months and began
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to use short sentences by age three.
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So his speech language skills seemed to be appropriate at that age, at least.
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He had always been very focused on trucks, cars, and trains.
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According to his mother, he has always been very shy and never had a best friend.
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So somewhat thriving in isolation as he has gotten older it has become more
34:59
apparent that he struggles with jokes and typical adolescent banter because
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he takes things so literally.
35:07
He has issues with, this would be the part where they not only misinterpret.
35:14
Brandon's mother had also seen this behavior as a little odd,
35:18
but added that it was not much different from that of Brandon's father,
35:22
a successful attorney who had similarly focused interests.
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Both of them were sticklers of routine, who lacked a sense of humor,
35:30
because they probably don't understand humor, then the high rigidity.
35:35
Brandon's mother noted that he had made efforts to conceal his interest in trucks,
35:38
cars, and trains outside of the home But would eagerly speak about them when
35:42
encouraged So there seems to be, he has learned masking behaviors and develops some coping skills,
35:49
Brandon had shared with his mother that he tries to appear normal So he has
35:53
some awareness that he is probably not typical when interacting with peers at
35:58
school, which is exhausting,
36:00
He often feels nervous around peers and generally tries to avoid socializing.
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On examination, Brandon was shy and generally not spontaneous.
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He made below-average eye contact. His speech was coherent and goal-directed.
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At times, Brandon stumbled over his words, paused excessively,
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and sometimes rapidly repeated words or parts of the words.
36:21
So, probably some stuttering. Brandon said he felt okay but added that he was
36:27
scared of school, particularly when around other children.
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He appeared sad, brightening only when discussing his toy cars.
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He denied current suicidal ideations or plans, as well as hovicidality.
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He denied psychotic symptoms. He was cognitively intact.
36:43
Any thoughts? Okay, so basically, he would meet all the three criteria for social
36:53
communication, deficits in social communication.
36:55
He at least has two of the criteria for
36:59
like the repetitive restricted interests and
37:02
patterns of behavior so i think
37:05
he would meet a diagnosis of autism spectrum disorder and
37:08
in addition possibly no intellectual disability
37:11
at least based on the information that we have here i would
37:15
say he would probably be level two and would
37:18
need some at least some accommodations in school at social skills training he
37:24
i would say in addition to autism he probably also has stuttering disorder all
37:32
right okay that's that's my case again,
37:37
thank you everyone for all that you do i know you play a very important role
37:41
in coordinating care for some individuals who have Autism Spectrum Disorder.
37:48
I can take questions now,
37:53
Dr. Badapati for that excellent talk. Looks like we do have a few questions in the chat.
37:58
I can go ahead and read those off to you. Looks like we had one say,
38:03
sometimes as patients grow up, the parents request retesting to see if autism label can be removed.
38:10
Can the label be removed if patient is doing better with time?
38:14
So again, if it is true, if they were rightly diagnosed as autism spectrum disorder,
38:22
then it probably is not going away.
38:25
It is possible that when they were diagnosed earlier, it could be a misdiagnosis.
38:30
That can be a time when it can be helpful.
38:33
And again, I understand the parent's concern that they don't want to label the
38:37
child as autism spectrum.
38:39
Again, if they are not needing any supports or services, then it probably need
38:46
not be included in the chart.
38:48
But at some point or the other, it might probably again come up.
38:52
Thank you. And then another question read, can a patient with autism diagnosis
38:57
also be diagnosed with mental retardation or diagnosis?
39:02
Yes, definitely. So we don't use mental retardation anymore,
39:05
but the intellectual developmental disability in the DSM-5, they can both coexist.
39:12
However, if one has a diagnosis of intellectual disability disorder,
39:16
as we discussed earlier, the social functioning should be lower.
39:21
So, for example, let's say because of IDD, the kid's developmental level is at five.
39:26
They could be 10, but the development level is at a five-year-old.
39:30
The social communication issue should be below that of a five-year-old.
39:35
And that's when we can co-diagnose autism spectrum along with IDD.
39:39
So yes, they can both be diagnosed together, IDD and ASD.
39:48
Another question reads, when a diagnosis is made, does it specifically state
39:52
in the diagnosis which level the patient is experiencing?
39:57
It's a specifier. So the diagnosis of autism can be made and then the level of support that can be.
40:04
Does it specifically state in the diagnosis which level the patient is experiencing?
40:09
So that is something that can probably change over time, you know,
40:13
depending on the support level that they need.
40:16
Okay but just because there is a diagnosis we
40:19
don't they again if it's done by a psychologist then they will probably put
40:24
like the level of support it's a space fire and i think someone said why is
40:30
the case level two and not one i think i'm guessing it's about the case that we discussed,
40:39
So I would say two, because the kid is, the symptoms are pretty overt.
40:45
He's the high fixation of interest. And I think he would need more than just
40:50
individual therapy or like some life skills coaching.
40:53
I think he would benefit from like social skills training.
40:56
So that's probably why. And he probably needs some accommodations in school.
41:02
So unbehavioral therapy, which is why I would probably put it at level two.
41:06
I see another one does ABA include OT or do we have to make a separate referral
41:11
to OT I think that would be a different the occupational therapy referral would
41:14
be different than that of ABA.
41:18
Any autism support groups in san antonio
41:22
for parents yes there are definitely autism speaks is
41:25
a good one and then if you are already
41:28
not familiar with the morgan's mac they have
41:31
the multi-access center where they have
41:34
a it's like a one-stop shop it's
41:37
not only exclusive it's not exclusive for kids who are
41:40
on the autism spectrum any with any developmental disabilities
41:44
or even other disabilities they can actually access the mac and they can they're
41:49
assigned a care navigator who can coordinate the care for like they can support
41:54
the family they can support the patient or individual so that can be a good
41:58
resource as well patient appears would benefit with.
42:03
Noise canceling headphones i'm guessing it's about the care case yes i think
42:07
yeah some individuals we actually recommend like noise-canceling headphones.
42:13
And in the case, yes, it can be one of the accommodations that the person, that the kid could get.
42:21
Any autism support in San Antonio for older kids, teens, who may be never,
42:27
who have never completed ABA a form that most ABA centers are for young kids?
42:33
It is true, yeah, I know a lot of the autisms, the ABA
42:36
providers are kind of have like an age restriction or
42:39
cutoff but it can be even for like older teens and adolescents it's just that
42:43
there is like limited support again one of the best resources I would recommend
42:47
is trying the Morgan's multi-assistance center and I can probably also email
42:55
I have a list of some places that I can probably share Mr.
42:58
Silva if I share with you you can probably send it to the group yeah okay can
43:03
school-age patients with autism who have aggressive and self-injurious behaviors
43:07
benefit from a behavior modification plan.
43:11
Yes the behavioral plans can i
43:14
mean the aggressive behaviors and self-injurious behaviors they have like different
43:18
behavioral modification plans oftentimes they kind of identify what could be
43:22
the triggers to modify the setting sometimes even when there's like no apparent
43:27
triggers they I also give them like helmets or like long sleeves and other issues.
43:33
Do you see patients, young patients? Yes, I see ages four plus.
43:39
I've actually seen kids as young as three in the dual diagnosis.
43:42
Music.
43:48
We hope you've enjoyed this episode of Pediatrics Now.
43:52
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43:58
That address is pediatricsnow at uthscsa.edu.
44:04
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44:07
I'm Holly Wehman. I hope you can join us for our next episode.