Wednesday, December 14, 2016

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Autism/ Asperger's Syndrome/ ASD

Autism/ Autism Spectrum Disorder
    Autism Spectrum Disorder (ASD), Autism, & Asperger's Disorder/Syndrome belongs to a group of neuro-developmental conditions/pervasive developmental disorders. With the recently published DSM-5, these related conditions are merged into a collective term called Autism Spectrum Disorder.
    About 1 in 88 children has autism spectrum disorder (ASD) according to estimates from CDC (USA) Autism and Developmental Disabilities Monitoring (ADDM) Network. ASD is about 5 times more common in males than in females.
Symptoms of Autism:
- Impairments in social interactions and social communications
- Restricted, repetitive and stereotyped patterns of behaviour
Causes of Autism:
There is generally no single specific cause for ASD. Possible causes include genetics, congenital infection, low birth weight/premature birth and etc.  
Autism Assessments:
    Although there is no medical test, like a blood or radiological test, to diagnose ASD, the skilled doctor makes the diagnosis by taking a detailed developmental history, observing the person’s behaviour and collating information from relevant sources. In some people, they may only be formally diagnosed with having ASD when they become older e.g. adolescent age group, due to non-specific and sub-threshold symptoms when they were younger.
    If needed for some cases, the doctor may utilize the Autism Diagnostic Interview – Revised (ADI-R) and/or Autism Diagnostic Observation Schedule (ADOS) for a comprehensive assessment.
    Cognitive (IQ) test and adaptive functioning assessments are also valuable to assess and help the child/adolescent enrol into the appropriate school or interventional programmes.
    It is quite common for an individual with ASD to have concurrent problems of inattention/hyperactivity, anxiety, depression, anger outbursts, self-injurious behaviour, or even getting into troubles with the law. These warrant early assessment and treatment too.
Treatment/ Management of Autism:
The Child & Adolescent Psychiatrist will recommend the following treatments:
(a) Educational /Vocational Interventions
- Appropriate early intervention programme for infants & children are critical to ensure these children receive the required educational support/interventions. These should be followed by placement into the appropriate schools as they continue to progress in their development.
- Speech language therapy and occupational therapy are often helpful in helping the child/adolescent reach their maximal functional, academic and vocational potential.
(b) Behavioural Interventions
- Strategies using cognitive and/or behavioural therapy (e.g. ABA), together with occupational and speech language therapy are often first-line management approaches in managing any emotional and behavioural disturbances.
- Helping family members/parents understand the condition and how to manage a relative/child with autism are critical in reducing conflicts between parent-child/relatives and in moderating the risks of developing other psychiatric conditions in the relative/child with autism.
(c) Medications
- Although there are no medications that can cure ASD per se, there are various effective medications that can help treat the associated symptoms of inattention/hyperactivity, anxiety, depression, anger outbursts, self-injurious and repetitive behaviour. These medications include dopamine agonists, selective serotonin reuptake inhibitors and etc.
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