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• Out of the four studies that were reviewed, three reported an increased risk of autism in children from
... [Show More] mothers with a different ethnic origin, with one study indicating a greater risk for immigrant mothers from East Asia
• Four reviews suggest that both advanced maternal and paternal age are risk factors for autism, with paternal age perhaps playing a more significant role. Fathers over the age of 50 have the greatest risk of having an offspring with autism compared to fathers below 30 years of age
• The most consistent and well-replicated finding has been that 25–50% of children and adolescents with autism have elevated serotonin levels in blood and platelets
• OT and arginine vasopressin (AVP) are important regulators of complex social behaviors. There have been some reports of differences in levels of peripheral OT and AVP in children with autism compared to age-matched controls.
• GABA abnormalities in blood and platelets have been reported in individuals with autism. Postmortem studies have identified widespread decreased number of GABA receptor binding sites
• Observations of immune system abnormalities in ASD have been noted including fetal protein reactive IgG antibodies in plasma from mothers of children with autism, maternal infection, and dysregulated cytokine signaling
• Many different neuropathological changes have been described in postmortem samples including macroencephaly, acceleration and deceleration in brain growth, increased neural packing, decreased cell size in the limbic system and decreased Purkinje cell number in the cerebellum. Abnormalities in organization of the cortical mini-column, representing the fundamental subunit of vertical cortical organization may underlie the pathology of ASD and result in altered thalamocortical organization, cortical disinhibition, and dysfunction of the arousal-modulating system of the brain
• One of the most widely replicated findings in ASD is the increased head size and brain volume (mainly due to increased volumes in frontal lobes and anterior temporal regions) most notably in the preschool period
• In general, studies show that there are abnormalities in measures of white matter, particularly in those pathways integrating higher order cognitive processes or complex social-emotional processing
• Although there are no pathognomonic signs or symptoms of ASD, a number of the national clinical guidelines provide detailed information about the types of signs and symptoms that are commonly observed in preschool, school-aged children and adolescents with a possible ASD. Several authors and guidelines highlight the so-called “Red Flags” for an immediate “fast track” referral of certain “high risk” groups for an ASD specific assessment
• For children with a diagnosis of ASD, review and reassessment, especially at times of transition (such as starting in education, changing school, onset of adolescence or emerging into early adulthood) are likely to be beneficial either in anticipation of possible change in circumstances or if there is evidence of deterioration, onset of a mental health problem, or a new disorder such as epilepsy. Furthermore, some children and youth may not have been identified or assessed during the early years, but additional developmental, social, and academic pressures or the increased expectations of the school years may lead to symptoms and behaviors that require a multidisciplinary ASD diagnostic assessment at a later stage
• The core components of an ASD diagnostic assessment include:
o an ASD specific developmental history using the framework of published internationally agreed diagnostic criteria
o medical history including a prenatal and perinatal history, identification of any relevant past and/or current health conditions and risk factors such as a history of possible epilepsy, and family history to identify genetic disorders, recognized medical and mental health conditions
o physical examination including an assessment for congenital anomalies, any evidence of skin conditions, evaluation of growth, and measurement of head circumference.
o individual ASD specific assessments (through direct interaction and observation usually in more than one setting). Observational assessment may include the use of an ASD-
specific tool such as the Autism Diagnostic Observation Schedule (ADOS) or the Childhood Autism Rating Scale (CARS)
o other individual assessments depending on the clinical presentation
o individual assessments such as vision or hearing, cognitive, sensory, perceptual, motor co-ordination, and psychological investigations to complete a skill- and need-based profile
• The four most commonly used diagnostic instruments for ASD include three semi-structured instruments for obtaining a developmental history (Autism Diagnostic Interview-Revised (ADI-R); Diagnostic Interview for Social and Communication Disorders (DISCO) and Development, Dimensional and Diagnostic Interview (3di) and one observational measure (the ADOS)
• In some parts of the world, comparative genomic hybridization arrays are now recommended within professional clinical best practice guidelines to be used as first line investigations especially in the presence of intellectual disability or dysmorphology
• Assessment of family strengths and needs and the social and cultural context for the child or young person is important as part of a skill- and need-based assessment.
• Over time, intervention plans will change in response to the child’s developmental profile, their circumstances and the onset of any additional physical and mental health disorders. Management and support are likely to include a number of different agencies and professionals working collaboratively
• The goals of interventions include:
o Reduce the core symptoms and behaviors of ASD
o Enable an individual to achieve their own potential
o Treat any co-occurring problems or symptoms that impair developmental progress or cause significant distress for the affected individual and other family members or carers
o Treat any co-occurring problems or symptoms that impair developmental progress or cause significant distress for the affected individual and other family members or carers
• National and professional organizations have published practice guidelines which provide general and specific recommendations usually based on the best clinical practice
• Early intensive behavioral intervention (EIBI) is the most frequently evaluated intervention in preschool children with ASD. These interventions are largely based on the model of Applied Behavioral Analysis (ABA) principles and other comprehensive behaviorally and developmentally based programmes for young children with ASD
• There is evidence that augmentative forms of communication such as the Picture Exchange Communication System (PECS) can improve the communication skills of young children with ASD and should be part of the comprehensive treatment plan
• Interventions such as sensory integration therapy (SIT) and auditory integration training (AIT) have been proposed to alleviate hyper- or hyposensitivity to certain stimuli and to frequencies and sounds
• Visual therapies, music therapy and use of restricted diets and dietary supplementation such as omega-3 fatty acids, have also been used by families to treat both core ASD symptoms and associated problems such as ADHD-like behaviors, gastrointestinal problems, and sensory disturbance. The gluten free, casein free diet (GFCFD) is the most frequently implemented restrictive dietary intervention for individuals with ASD.
• There is some evidence that vocational programs may increase employment success for some individuals with ASD
• Systematic reviews have also demonstrated some evidence that the use of antipsychotic medications (such as risperidone) can reduce repetitive behaviors in children and adolescents. Considering the evidence for statistically significant adverse effects associated with antipsychotics (see NICE CG 170, 2013 for an updated review) the NICE clinical guideline development group did not recommend antipsychotic medications for the treatment of core symptoms of ASD. There is now sufficient evidence to recommend that certain interventions should not be used to treat core features of ASD. These include long-term chelation therapy, hyperbaric oxygen, and secretin
• It is now widely recognized that children and young people with ASD have higher rates of co- occurring mental health disorders than individuals in the general population and children with other disabilities. These include ADHD, Oppositional Defiant Disorder, anxiety, mood disturbance, and obsessive-compulsive disorder
• There is evidence that a group or individual-based intervention adjusted to the needs of children with ASD can be effective
• For the treatment of co-occurring ADHD, a combination of family and school-based behavioral interventions could be instigated and later, if required, supported by a trial of medication. However, the use of stimulants and other recommended second line medications for the treatment of ADHD-like symptoms show that the response rate is lower than for children and adolescents without ASD and with a higher rate of adverse side effects
• Antipsychotic m [Show Less]