CKS Autism in children

Definition

Autism spectrum disorder (ASD) is a persistent complex developmental disorder, present from early childhood, impairments in reciprocal and social communication which:

1. Limits or impairs activities of daily living.

2. Developmental impairments in social interaction and social communication
   Sharing interests or emotions and engaging in normal conversation.
   Using non-verbal communication in social interactions: lack of eye contact or a total lack of facial expression when interacting with others.
   Developing, maintaining, and understanding relationships.

3. Restricted, repetitive patterns of behaviours, interests, or activities
   Stereotyped or repetitive motor movements, use of objects or speech, and idiosyncratic phrases.
   Inflexible adherence to daily routines or ritualized patterns of behaviour, such as rituals used to greet other people.
   Highly restricted, fixed interests that are abnormal in intensity or focus, such as strong attachment to, or preoccupation with, unusual objects.
   Fascination with sensory aspects of the environment or over/under reactivity to sensations, for example, an adverse response to certain sounds or textures, or an apparent indifference to temperature or pain.

Asperger syndrome is a different form of ASD. People with Asperger syndrome are of average or above average intelligence and do not have the learning disabilities that many people with autism have (although they may have specific learning difficulties). They usually have fewer problems with speech but may still have difficulties with understanding and processing language 

Prevalence

The estimated prevalence in children is at least 1%.
There are about 3–4 times more boys affected by ASD than girls.

Aetiology

The precise cause of ASD is unknown.
However, a number of different genetic and environmental factors are thought to play a role in the development.

Risk factors/associated conditions

1. Anxiety

2. Attention deficit hyperactivity disorder

3. Oppositional defiant disorder

4. Behaviour that challenges

5. Learning (intellectual) disability

6. Epilepsy

Functional problems
sleep problems
eating problems
gastrointestinal disturbances (such as diarrhoea, abdominal pain, and constipation)
sensory issues.

The severity and impact varies greatly depending on age, development, and presence or absence of associated conditions.

Consequences

During childhood:

• The impaired ability to learn in social situations

• Behaviour that challenges

• An increased vulnerability to mental health problems, such as anxiety and depression.

During adulthood:

• Unemployment

• Poor general health

• An increased vulnerability to mental health problems, such as anxiety and depression.

• Social isolation.

Prognosis

ASD is a life-long disorder.

The prognosis of ASD can be improved by early diagnosis and assessment as this facilitates prompt access to support and services in education, health services, and social care.

Diagnosis

The diagnosis of ASD is established by a specialist following referral.
Ideally this is carried out by an autism team if available (or if not, by a paediatrician or a child and adolescent psychiatrist [dependant on local referral policy]).

Features exhibited across a variety of different settings:

• Language delay or regression
  Unusual characteristics of spoken language such as frequent repetition of set words or phrases ('echolalia')
  Reduced and/or infrequent use of language for communication, for example, the use of single words when they are able to speak in sentences.

• A reduced or negative response to others

• Reduced or absent interaction with others

• Reduced or absent eye contact, pointing, and other gestures when interacting with others

• Unusual or restricted interests and/or rigid and repetitive behaviours e.g. repetitive 'stereotypical' movements, such as hand flapping, body rocking while standing, spinning, and finger flicking.Repetitive or stereotyped play, for example, opening and closing doors.

• Overly-focused or unusual interests.

For adults with possible autism who do not have a moderate or severe learning disability, consider using the Autism-Spectrum Quotient – 10 items (AQ-10)

Be aware that making a diagnosis of ASD may be particularly difficult in:

• Children with a learning disability — the intellectual age, not the biological age, of the child needs to be considered when making the diagnosis.

• Children from very deprived backgrounds and in those with a history of maltreatment — care needs be taken to distinguish the features of ASD from behaviours caused by maltreatment or deprivation.

Arrange immediate referral to a paediatrician or paediatric neurologist:

• For children or young people suspected of having ASD or another neurodevelopmental condition due to the following features:

  • Over 3 years of age — regression in language developmental milestones.

  • Of any age — regression in motor developmental milestones.

Primary care management

• Ensuring those with ASD and an associated mental health or behavioural disorder are reviewed by a specialist.

• Ensuring that parents and/or carers are well informed about ASD and the support available.

• Initial management of sleep problems and behaviour that challenges.

• Ensuring that young people with ASD are reassessed in secondary care to establish the need for continuing treatment into adulthood.

Secondary care management

• Developing a care plan and identifying a key worker or case manager.

• Offering specialist interventions to support the development of social and communication skills.

• Review of children and young people with an associated mental health or developmental disorder.

• Offering specialist interventions to support the development of social and communication skills.

• Considering pharmacological interventions to help manage behaviour that challenges.

• Supporting access and maintaining contact with educational, housing, and employment services.

• Providing information to parents and/or carers.

• Planning the transition of a young person's care into adult services.