Autism in the GP’s world

1. Autism in the GP’s world

2. Objectives • Be aware of how autism presents in both young people and adults • Recognise the potential difficulties faced by patients, parents or carers in normal daily activities, including GPs surgeries • Learn how diagnosis is made and where to find support

3. Curriculum Statements • Curriculum Statement: Care of People with Learning Disability Promoting Equality & Valuing Diversity Ethics and Values Based Medicine • Competency: Community orientation Data Gathering and Interpretation

4. Autism- Your checklist • What do I know ? • Why do I need to know ? • Where can I get more information ? • Where is the restroom ?

5. Case 1

6. Autism Spectrum Disorder A spectrum of psychological characterized by widespread abnormalities of social interactions and communication, as well as restricted interests and repetitive behaviour

7. 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.

8. 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.

9. Triad of Autistic Impairment Impairment of language and communication Impairment of social interaction Impairment of flexibility of thought and behaviour

10. 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

11. 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.

12. Case 2

13. 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.

14. 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

15. 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.

16. 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**

17. Concluding Thoughts • Historical perspective • Bleuler • Leo Kanner • Hans Asperger • ‘Refridgerator mothers’

18. Patient & Family Perspective • Diagnosis • Isolation and Guilt • Educational and Social Support • Empathy

19. 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

20. 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

21. 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’

22. Questions

23. Quiz : True or False ? • Question 1 Children who have stopped speaking after learning words should be referred for assessment

24. Quiz : True or False ? • Question 2 Teenagers who have difficult or disruptive behaviours and learning difficulties need to be placed into special needs schools

25. Quiz : True or False ? • Question 3 Young adults with autism are entitled to housing benefit and financial support, eg DLA

26. Quiz : True or False ? • Question 4 An adult with Asperger’s Syndrome has more health care needs than adults with no ASD

27. Quiz : True or False ? • Question 5 When communicating with ASD patients, it is important to avoid metaphors and give clear instructions rather than requests

28. Answers • Question 1 : T • Question 2 : F • Question 3 : T • Question 4 : F • Question 5 : T

29. Thank you and good night